Anxiety in 11-Year-Old Children Who Stutter: Findings From a Prospective Longitudinal Community Sample Purpose To examine if a community sample of 11-year-old children with persistent stuttering have higher anxiety than children who have recovered from stuttering and nonstuttering controls. Method Participants in a community cohort study were categorized into 3 groups: (a) those with persistent stuttering, (b) those with recovered stuttering, ... Research Article
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Research Article  |   April 16, 2017
Anxiety in 11-Year-Old Children Who Stutter: Findings From a Prospective Longitudinal Community Sample
 
Author Affiliations & Notes
  • Kylie A. Smith
    Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
    Department of Paediatrics, University of Melbourne, Victoria, Australia
  • Lisa Iverach
    Australian Stuttering Research Centre, The University of Sydney, Lidcombe NSW, Australia
    Department of Psychology, Macquarie University, North Ryde NSW, Australia
  • Susan O'Brian
    Australian Stuttering Research Centre, The University of Sydney, Lidcombe NSW, Australia
  • Fiona Mensah
    Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
    Department of Paediatrics, University of Melbourne, Victoria, Australia
  • Elaina Kefalianos
    Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
    Department of Audiology and Speech Pathology, University of Melbourne, Victoria, Australia
  • Anna Hearne
    Speech Language Therapy, Institute of Education, Massey University, Albany, New Zealand
  • Sheena Reilly
    Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
    Department of Paediatrics, University of Melbourne, Victoria, Australia
    Menzies Health Institute Queensland, Griffith University, Southport, Australia
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Kylie A. Smith: kylie.smith@mcri.edu.au
  • Editor: Julie Liss
    Editor: Julie Liss×
  • Associate Editor: Hans-Georg Bosshardt
    Associate Editor: Hans-Georg Bosshardt×
Article Information
Speech, Voice & Prosodic Disorders / Fluency Disorders / Newly Published / Research Article
Research Article   |   April 16, 2017
Anxiety in 11-Year-Old Children Who Stutter: Findings From a Prospective Longitudinal Community Sample
Journal of Speech, Language, and Hearing Research, Newly Published. doi:10.1044/2016_JSLHR-S-16-0035
History: Received January 27, 2016 , Revised July 17, 2016 , Accepted October 27, 2016
 
Journal of Speech, Language, and Hearing Research, Newly Published. doi:10.1044/2016_JSLHR-S-16-0035
History: Received January 27, 2016; Revised July 17, 2016; Accepted October 27, 2016

Purpose To examine if a community sample of 11-year-old children with persistent stuttering have higher anxiety than children who have recovered from stuttering and nonstuttering controls.

Method Participants in a community cohort study were categorized into 3 groups: (a) those with persistent stuttering, (b) those with recovered stuttering, and (c) nonstuttering controls. Linear regression modeling compared outcomes on measures of child anxiety and emotional and behavioral functioning for the 3 groups.

Results Without adjustment for covariates (unadjusted analyses), the group with persistent stuttering showed significantly increased anxiety compared with the recovered stuttering group and nonstuttering controls. The group with persistent stuttering had a higher number of children with autism spectrum disorder and/or learning difficulties. Once these variables were included as covariates in subsequent analysis, there was no difference in anxiety, emotional and behavioral functioning, or temperament among groups.

Conclusion Although recognized to be associated with stuttering in clinical samples, anxiety was not higher in school-age children who stutter in a community cohort. It may be that anxiety develops later or is less marked in community cohorts compared with clinical samples. We did, however, observe higher anxiety scores in those children who stuttered and had autism spectrum disorder or learning difficulties. Implications and recommendations for research are discussed.

Adults who stutter and seek stuttering treatment have an increased risk of social anxiety disorder compared with nonstuttering controls (Blumgart, Tran, & Craig, 2010; Iverach et al., 2009). Social anxiety disorder (also known as social phobia) involves a pervasive and debilitating fear of social humiliation and negative evaluation by others (American Psychiatric Association, 2013; Clark & Wells, 1995; Rapee & Heimberg, 1997). There are multiple risk factors for the development of anxiety disorders, including genetics, temperament, and environmental and cognitive factors (Ollendick & Hirshfeld-Becker, 2002; Rapee & Spence, 2004). Although there is no evidence that preschoolers who stutter are genetically predisposed to anxiety (Andrews & Harris, 1964; Reilly, Onslow, et al., 2009) or have a more anxious temperament than those who do not stutter (Alm, 2014; Kefalianos et al., 2014), there are compelling reasons to believe social anxiety may exist among school-age children who stutter and seek treatment (Davis, Shisca, & Howell, 2007; Iverach et al., 2016). It is unknown, however, if this is also the case for school-age children who stutter in the general community (Smith, Iverach, O'Brian, Kefalianos, & Reilly, 2014).
To date, research on the association between stuttering and anxiety in school-age children has been almost exclusively with participants who (a) were seeking or receiving stuttering treatment and (b) had self-nominated (or been nominated by their parents) to participate. These are known as clinical samples. The proportion of school-age children who stutter and who access stuttering therapy is unknown, but research with young children with communication difficulties in general shows that it may be as low as 10% (Skeat, Eadie, Ukoumunne, & Reilly, 2010). It is also unclear as to what differentiates those who do and do not seek treatment for stuttering. As such, generalizing findings from clinical studies on the association between social anxiety disorder and stuttering to the general community is premature. To better understand the association between anxiety and stuttering at the population level, community cohort studies that include those who have and have not sought stuttering treatment (i.e., community samples) are required. Further, as community cohorts include a diverse sample of school-age children who stutter, they may be more representative of the range of children who stutter rather than the often highly selected participants in clinical studies.
Determining if community samples of school-age children who stutter are socially anxious contributes to our overall understanding of the epidemiology of anxiety in stuttering. If social anxiety or anxiety more broadly is evident in this population, findings can inform the development of prevention and early intervention programs that target all children who stutter and not just those seeking stuttering treatment. It will ensure health professionals are better equipped to provide informational counseling regarding risks and priorities for treatment. If anxiety is not apparent, this may suggest the findings from clinical studies may not be generalizable to the wider stuttering community.
The primary aim of this study was to compare anxiety and emotional and behavioral functioning in a community cohort of 11-year-old children with persistent stuttering compared with those who had recovered from stuttering and nonstuttering controls. At 11 years of age, children are on the cusp of adolescence, a time when the onset of social anxiety disorder typically occurs in the general population (Iverach & Rapee, 2013). As such, it was considered an ideal time to collect information about social and emotional well-being. We also examined if children with persistent stuttering have a temperament that places them at risk of developing anxiety in the future compared with children who recovered from stuttering. We sought to compare outcomes among groups with and without stuttering, including predictors and confounders of anxiety (i.e., unadjusted and adjusted analyses). We did this in order to gain a broad understanding of study participants, followed by an examination of if specific factors could explain any differences between groups.
Method
Participants
Participants were 843 11-year-old children from the Early Language in Victoria Study (ELVS; Reilly, Bavin, et al., 2009). ELVS is a prospective community cohort study in Melbourne, Victoria, designed to allow investigation into the epidemiology of language impairment. One thousand, nine hundred eleven participants were recruited at 8 months of age from six socioeconomically diverse local government areas. Recruitment occurred via maternal and child health nurses at routine 8-month visits (attended by > 80% of families), hearing screenings, and advertisements in local newspapers. Children with developmental delay, hearing loss, Down syndrome, cerebral palsy, or other serious intellectual or physical disability were excluded as were children whose parents could not speak or understand English. Parents completed questionnaires and well-validated measures on communication and general development at baseline (8 months) and then annually from when children were 12 months to 11 years old. Children also completed questionnaires at 11 years of age. Face-to-face assessments occurred approximately biennially. The data generated from ELVS has been used in numerous studies regarding communication with publications in a range of peer-reviewed journals (e.g., Bretherton et al., 2014; Eadie et al., 2015; McKean et al., 2015; Serry et al., 2015; Watts, Eadie, Block, Mensah, & Reilly, 2015).
The present study is the most recent in a series of studies regarding stuttering in the ELVS cohort (Kefalianos et al., 2014; Reilly, Onslow, et al., 2013, 2009). All families in ELVS were initially invited to participate in the ELVS stuttering study in 2005 when the children were 2 years of age. Parents were provided with information regarding stuttering behaviors and asked to contact the ELVS research team as soon as possible if their child exhibited the described behaviors anytime between the ages of 2 and 4 years. Stuttering was subsequently confirmed by a speech-language pathologist (SLP). As shown in Figure 1, the present study included all children confirmed as stuttering in the initial stuttering study (by 4 years of age) as well as children identified as stuttering after 4 years of age via parent report or by an SLP during one of the face-to-face assessments (n = 141). This group was collectively called the stuttering cohort.
Figure 1.

Flow of Early Language in Victoria Study (ELVS) participants into present study.

 Flow of Early Language in Victoria Study (ELVS) participants into present study.
Figure 1.

Flow of Early Language in Victoria Study (ELVS) participants into present study.

×
When ELVS participants were 11 years of age, an SLP or trained research assistant phoned all participants in the stuttering cohort. During this call, parents were asked if their child had stuttered in the last 12 months. The SLP or research assistant then engaged the child in a 10-min recorded conversation in order to confirm the presence or absence of stuttering. On the basis of our own pilot study and previous research experience with school-age children, it was deemed that any longer than 10 min was an unreasonable amount of time to expect an 11-year-old to talk on the phone with a stranger. Considering this and to ensure uniformity, 10 min was the standard duration of all calls. The child was told he or she could talk about anything he or she wanted to or could opt for the SLP to introduce a topic. Topics typically included a discussion of hobbies, extracurricular activities, movies, or recent holidays.
Persistent stuttering status was assigned if parents confirmed their child had unambiguous stuttering (i.e., repeated movements and/or fixed postures with or without audible behaviors; Teesson, Packman, & Onslow, 2003) within the last 12 months or if the SLP heard stuttering during the 10-min phone conversation with the child (n = 20). Further information regarding stuttering was collected from parents and children in the persistent stuttering group, including a severity rating of the child's average stuttering over the past week on a scale of 1 (no stuttering) to 10 (very severe stuttering). Recovered stuttering status was assigned if parents reported the absence of stuttering (as previously described) over the last 12 months and if no stuttering was heard during the 10-min conversation with the child (n = 121). If a child presented with ambiguous stuttering—that is, dysfluency that could not definitively be classified as stuttering by an SLP on the basis of a speech sample with the child and a case history—the child was excluded from subsequent analysis (n = 8). The remaining participants in ELVS who had never experienced stuttering onset made up the nonstuttering controls (n = 701). ELVS methodology and the methodology of the ELVS stuttering studies have been described in detail in a number of publications (Kefalianos et al., 2014; Reilly, Kefalianos, & Smith, 2013; Reilly, Onslow, et al., 2009).
Measures
ELVS Questionnaires, Parent and Child Versions
Participants and their parents were given the option of completing an online or paper-based questionnaire. Those opting for the online version received an email containing a URL link to consent forms and parent and child questionnaires. Those opting for a hard copy were mailed consent forms and parent and child questionnaires with a reply-paid envelope included. Questionnaires asked about participant, mother, and family variables (see Table 1). Regarding the diagnoses of autism spectrum disorder (ASD) and learning difficulties (LD), the parent questionnaire asked, “Has a doctor or health professional told you that your child currently has an Autism Spectrum Disorder?” and “Has a doctor or health professional told you that your child currently has Learning Difficulties?” In the case of ASD, if parents responded “yes” to this question, they were then contacted by a senior psychologist who interviewed them regarding the process of diagnosis and the number and description of health professionals involved in the diagnosis. Questionnaires also included the measures described below. Cross-sectional data from the child and parent questionnaires and longitudinal data from earlier parent questionnaires were utilized to establish the characteristics of the cohort and predictors of anxiety.
Table 1. Variable and variable types.
Variable and variable types.×
Variable Details Completed by Variable type a
Presence of anxiety 1. Spence Children's Anxiety Scale 1. Stuttering cohort: parents and children 1. Continuous
2. Strengths and Difficulties Questionnaire 2. ELVS cohort: parents and children 2. Continuous
Presence of specific temperament dimensions The School-Age Temperament Inventory Stuttering cohort: parents Continuous
Exposure to teasing and bullying Child yes/no response to experience of teasing and/or bulling ELVS cohort: children via ELVS Child Questionnaire Categorical, coded as yes/no
Stuttering treatment status Parent yes/no response to question asking if their child had received stuttering therapy in the last 12 months Stuttering cohort: parents via ELVS Parent Questionnaire Categorical, coded as yes/no
Diagnosis of ASD Parent yes/no response to question asking if their child had received a diagnosis of ASD ELVS cohort: parents via ELVS Parent Questionnaire Categorical, coded as yes/no
Diagnosis of LD Parent yes/no response to question asking if their child had received a diagnosis of LD ELVS cohort: parents via ELVS Parent Questionnaire Categorical, coded as yes/no
Gender Gender of participant ELVS cohort: parents via ELVS Parent Questionnaire Categorical, coded as male/female
Maternal mental health Measured with Kessler-6 ELVS cohort: parents; longitudinal data from annual ELVS Parent Questionnaires Continuous
Socioeconomic status Measured with the Socio-Economic Index for Areas, Index of Relative Disadvantage ELVS cohort: parents via ELVS Parent Questionnaire Continuous
Stuttering severity rating 10-point rating scale, 1 = no stuttering and 10 = very severe stuttering Stuttering cohort: parents and children in the persistent stuttering group only: via ELVS Parent Questionnaire and the Stuttering Outcome Call Continuous
Age of onset Whether stuttering onset occurred pre– or post–4 years of age ELVS cohort: via ELVS Parent Questionnaire and longitudinal data from previous ELVS stuttering studies Categorical, coded as pre–/post–4 years
Note. ELVS = Early Language in Victoria Study; ASD = autism spectrum disorder; LD = learning difficulties.
Note. ELVS = Early Language in Victoria Study; ASD = autism spectrum disorder; LD = learning difficulties.×
a Represents how variables were included in the regression models for the majority of the analyses. Linearity was assessed statistically via likelihood ratio test. In a small number of analyses, the likelihood ratio test returned p < .05, indicating there was significant evidence that the relationship between variables was not linear. In such cases, variables were included as categorical variables.
Represents how variables were included in the regression models for the majority of the analyses. Linearity was assessed statistically via likelihood ratio test. In a small number of analyses, the likelihood ratio test returned p < .05, indicating there was significant evidence that the relationship between variables was not linear. In such cases, variables were included as categorical variables.×
Table 1. Variable and variable types.
Variable and variable types.×
Variable Details Completed by Variable type a
Presence of anxiety 1. Spence Children's Anxiety Scale 1. Stuttering cohort: parents and children 1. Continuous
2. Strengths and Difficulties Questionnaire 2. ELVS cohort: parents and children 2. Continuous
Presence of specific temperament dimensions The School-Age Temperament Inventory Stuttering cohort: parents Continuous
Exposure to teasing and bullying Child yes/no response to experience of teasing and/or bulling ELVS cohort: children via ELVS Child Questionnaire Categorical, coded as yes/no
Stuttering treatment status Parent yes/no response to question asking if their child had received stuttering therapy in the last 12 months Stuttering cohort: parents via ELVS Parent Questionnaire Categorical, coded as yes/no
Diagnosis of ASD Parent yes/no response to question asking if their child had received a diagnosis of ASD ELVS cohort: parents via ELVS Parent Questionnaire Categorical, coded as yes/no
Diagnosis of LD Parent yes/no response to question asking if their child had received a diagnosis of LD ELVS cohort: parents via ELVS Parent Questionnaire Categorical, coded as yes/no
Gender Gender of participant ELVS cohort: parents via ELVS Parent Questionnaire Categorical, coded as male/female
Maternal mental health Measured with Kessler-6 ELVS cohort: parents; longitudinal data from annual ELVS Parent Questionnaires Continuous
Socioeconomic status Measured with the Socio-Economic Index for Areas, Index of Relative Disadvantage ELVS cohort: parents via ELVS Parent Questionnaire Continuous
Stuttering severity rating 10-point rating scale, 1 = no stuttering and 10 = very severe stuttering Stuttering cohort: parents and children in the persistent stuttering group only: via ELVS Parent Questionnaire and the Stuttering Outcome Call Continuous
Age of onset Whether stuttering onset occurred pre– or post–4 years of age ELVS cohort: via ELVS Parent Questionnaire and longitudinal data from previous ELVS stuttering studies Categorical, coded as pre–/post–4 years
Note. ELVS = Early Language in Victoria Study; ASD = autism spectrum disorder; LD = learning difficulties.
Note. ELVS = Early Language in Victoria Study; ASD = autism spectrum disorder; LD = learning difficulties.×
a Represents how variables were included in the regression models for the majority of the analyses. Linearity was assessed statistically via likelihood ratio test. In a small number of analyses, the likelihood ratio test returned p < .05, indicating there was significant evidence that the relationship between variables was not linear. In such cases, variables were included as categorical variables.
Represents how variables were included in the regression models for the majority of the analyses. Linearity was assessed statistically via likelihood ratio test. In a small number of analyses, the likelihood ratio test returned p < .05, indicating there was significant evidence that the relationship between variables was not linear. In such cases, variables were included as categorical variables.×
×
Spence Children's Anxiety Scale, Child and Parent Report
The Spence Children's Anxiety Scale (SCAS; Nauta et al., 2004; Spence, 1998) is a multi-informant behavior rating scale. It is designed to measure symptoms broadly corresponding to anxiety disorders identified in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 2000). The scale consists of 38 anxiety symptom items (e.g., “I worry about things” and “I feel afraid that I will make a fool out of myself in front of other people”) and six positively worded filler items. For each item, respondents complete a 4-point Likert scale ranging from 0 (never) to 3 (always), depicting the frequency of each symptom. Responses are used to generate six subscale scores, including panic attack and agoraphobia, separation anxiety disorder, social phobia, physical injury fears, obsessive-compulsive disorder, and generalized anxiety disorder. The total score is the sum of all anxiety symptom items with higher scores indicating increased frequency and severity of symptoms. The reliability and validity of the SCAS Child Report (SCAS-C) and SCAS Parent Report (SCAS-P) have been examined in a range of settings and cultures. Internal consistency of the subscales and total score ranges from satisfactory to excellent for both the SCAS-C and SCAS-P (Whiteside & Brown, 2008). Strong convergent, divergent, and discriminant validity have also been demonstrated (Essau, Anastassiou-Hadjicharalambous, & Muñoz, 2011; Nauta et al., 2004; Spence, Barrett, & Turner, 2003). The stuttering cohort—that is, the persistent and recovered stuttering groups—completed the SCAS-C and SCAS-P. The nonstuttering controls did not complete these measures. This was in order to avoid overburdening participants with multiple assessments that did not pertain to the specific aims of the wider ELVS study—that is, the epidemiology of language impairment.
The Strengths and Difficulties Questionnaire, Parent and Self-Report
The Strengths and Difficulties Questionnaire (SDQ) is a brief screening questionnaire evaluating emotional and behavioral problems and attributes relating to DSM-IV classifications of child mental health (Goodman, 2001). The SDQ is comprised of 25 items that are rated on a 3-point Likert scale, ranging from 0 (not true) to 2 (certainly true). Items load onto five scales: conduct problems, hyperactivity/inattention, emotional symptoms, peer problems, and prosocial behavior. The total score is a sum of the subscale scores with the exception of the prosocial behavior subscale. The prosocial behavior subscale is comprised of questions on positive attributes (e.g., considerate of other people's feelings, helpful if someone else is feeling ill or upset) and therefore does not contribute to the total difficulties score. Broader internalizing and externalizing scores are recommended for use with “low-risk” community samples to most accurately discriminate clinical disorders. The internalizing score is calculated by summing the emotional symptoms and peer problems subscales, and the externalizing subscale is the sum of conduct problems and hyperactivity subscales. Outcomes on three anxiety-specific questions within the emotional symptoms subscale, including “many worries, often seems worried,” “nervous or clingy in new situations, easily loses confidence,” and “many fears, easily scared,” can also be used to investigate anxiety symptoms. There is a large body of research demonstrating the strong psychometric properties of the SDQ (Hawes & Dadds, 2004; McAllister, Collier, & Shepstone, 2012; Stone et al., 2010). Of particular note, with a large community sample of Australian children, Hawes and Dadds (2004)  found a moderate-to-strong internal reliability (coefficient α ranging from .59 to .80) across all SDQ subscales; adequate validity of the subscales; and sound external validity between the SDQ subscales, teacher ratings, and diagnostic interviews. Further, several studies have demonstrated the capacity of the SDQ to effectively predict DSM-IV diagnoses, including internalizing disorders, such as anxiety (Becker, Rothenberger, & Sohn, 2015; Hawes & Dadds, 2004). The ELVS cohort, including the stuttering cohort and nonstuttering controls, completed the SDQ.
School-Aged Temperament Inventory
The School-Aged Temperament Inventory (SATI) is a parent-report measure of temperament in children ages 8–11 years (McClowry, 1995). The scale is comprised of 38 statements, evaluating the temperament dimensions of negative reactivity (intensity and frequency with which negative affect is expressed), task persistence (self-direction in fulfilling tasks and responsibilities), approach/withdrawal (the child's initial response to new people and situations), and activity (energy levels and motor activity). Parents use a 5-point Likert scale, ranging from 1 (never) to 5 (always), to indicate how frequently they observe their child exhibiting the behavior described in each statement. A mean score is calculated for each dimension with higher scores indicating more pronounced expressions of the specific trait. For the purposes of the present study, outcomes for the approach/withdrawal dimension were of particular interest given that high scores on this dimension may be indicative of an anxious temperament (Prior, Smart, Sanson, & Oberklaid, 2000). The SATI has good reliability and validity. For example, internal consistency estimates using Cronbach α ranged from .80 to .92 for the four dimensions (McClowry, Halverson, & Sanson, 2003). Convergent validity has been demonstrated with the SATI showing strong correlation with another measure conceptually similar to the SATI (McClowry, 1995). Only the stuttering cohort completed the SATI and not the nonstuttering controls. As with the SCAS, the rationale for this was to avoid overburdening participants with measures that did not pertain to the specific aims of the wider ELVS study.
Data Analysis
The primary explanatory variable was stuttering status (i.e., persistent stuttering, recovered stuttering, or nonstuttering control at 11 years of age). Primary outcomes were continuous mean scores on the SCAS-C, SCAS-P, SDQ parent and child report, and SATI. Covariates that may be associated with anxiety identified a priori were included in statistical analyses (see Table 1). These included the following:
  • gender;

  • mean continuous socioeconomic status at birth indicated by the Socio-Economic Index for Areas, Index of Relative Disadvantage. Socio-Economic Index for Areas scores are standardized for the Australian population with a mean of 1,000 and SD of 100. Lower scores indicate greater disadvantage (Australian Bureau of Statistics, 2001);

  • mean continuous maternal mental health as measured by the Kessler-6 (Andrews & Slade, 2001). Maternal mental health was measured annually from when children were 12 months of age, and mean maternal mental health was determined when children were 11 years old. Higher scores indicate greater psychological distress;

  • timing of stuttering onset (categorical variable coded as pre– or post–4 years of age);

  • mean continuous stuttering severity at 11 years of age for those with persistent stuttering on the basis of the severity rating scale administered in the stuttering outcome call. Children in the recovered stuttering group and nonstuttering group were assigned a severity rating of one to indicate no stuttering; and

  • exposure to teasing and bullying via child-report in the ELVS questionnaire (categorical variable coded as yes/no).

In addition to these variables, a diagnosis of ASD and/or LD (categorical variables coded as yes/no) were also included as covariates in statistical analyses. This was because the prevalence of these disorders was significantly higher in the group with persistent stuttering compared with the recovered stuttering group and nonstuttering controls and presented potential confounding.
Outcomes on the SCAS, SDQ, and SATI were examined in individual histograms. The distributions showed an expected spread of values—that is, data skewed to the right—with the majority of values in the low range with a decreasing number showing higher scores within the ranges of the measures. As such, linear regression modeling was determined to be the most appropriate statistical test to compare mean differences between groups and control for potential confounding.
In order to investigate if any data points were exerting undue influence on the coefficients, the following scatter plots were generated: (a) participant total scores on the SCAS, SCAS-P against participant group—that is, recovered stuttering and persistent stuttering; (b) participant total scores on the SDQ parent- and self-report against participant groups—that is, nonstuttering controls, recovered stuttering, and persistent stuttering; and (c) participant scores on the four dimensions of the SATI against participant group—that is, recovered stuttering and persistent stuttering. No extreme data points warranting further investigation were observed.
A collinearity diagnosis was completed for all covariates using the “vif” command in Stata 14.1. This function displays a variance inflation factor (vif) for each covariate in each regression model. A vif value that is greater than 10 indicates potential collinearity among covariates. Vif factors ranged from 1.03 to 6.97, showing no evidence of collinearity among covariates in the present study.
The assumption of linearity between continuous covariates and primary outcomes was assessed statistically via the likelihood ratio test. The likelihood ratio test compares a model in which the covariate is included as a continuous term with a model in which it is included as a categorical term. Continuous covariates were redefined into categories that reflected the spread of the data; Socio-Economic Index for Areas and mean maternal mental health were divided into tertiles, and mean stuttering severity was categorized into three groups: severity rating 1, greater than severity rating 1 but less than or equal to 4, and greater than severity rating 4. When the assumption was not met (i.e., the likelihood ratio test returned p < .05), indicating the association was nonlinear, the covariates were modeled as categorical in the analyses.
Univariable and multivariable linear regression modeling compared mean differences in outcomes among the participant groups on the following measures: (a) SCAS-C and SCAS-P subscales and total scores for persistent and recovered stuttering groups—multivariable linear regression models also compared effect sizes for all subscales of the SCAS; (b) SDQ scales and total scores, internalizing score, and three anxiety-specific SDQ questions for the persistent stuttering group, recovered stuttering group, and nonstuttering controls; and (c) SATI dimensions (i.e., negative reactivity, task persistence, approach/withdrawal, and activity) for children with persistent and recovered stuttering. For analysis involving the SCAS and the SATI, the recovered stuttering group was included as the reference group. This was because it was hypothesized that this group was more likely to approximate “average” mean scores compared with the group with persistent stuttering and therefore was more appropriate to use as the baseline group. Also, data were not collected from the nonstuttering controls on these measures. For analyses involving the SDQ, the nonstuttering controls were included as the reference group as their outcomes acted as the norms by which outcomes from the recovered and persistent stuttering groups could be compared. Regression modeling for all outcome variables was completed with and without covariates included (adjusted and unadjusted analysis).
Although it is acknowledged that multiple comparisons can result in false positives, formal adjustment for multiple testing can be too conservative and, in most instances, is not recommended (Perneger, 1998). As such, in the present study, findings were interpreted cautiously, consistencies and themes across findings were identified, and we were cognizant of the potential for spurious findings. All analyses were performed using Stata version 14.1.
Results
Participants
There were 843 11-year-old children in the present study, consisting of 20 (2.4%) with persistent stuttering, 121(14.4%) with recovered stuttering, and 702 (83.3%) nonstuttering controls. Table 2 summarizes the distribution of child, family, and environmental characteristics of the sample and also stuttering-specific characteristics for those with persistent stuttering.
Table 2. Distribution of child and family characteristics of 702 nonstuttering controls, 121 recovered stuttering cases, and 20 persistent stuttering cases.
Distribution of child and family characteristics of 702 nonstuttering controls, 121 recovered stuttering cases, and 20 persistent stuttering cases.×
Characteristic Nonstuttering controls Recovered stuttering Persistent stuttering
n (%) 702 (83.3) 121 (14.4) 20 (2.4)
Gender, n (%)
 Female 404 (57.6) 46 (38.0) 7 (35.0)
 Male 298 (42.5) 75 (62.0) 13 (65.0)
Socio-Economic Index for Areas, Index of Relative Disadvantage disadvantage score, M (SD) 1,044.8 (53.2) 1,045.7 (51.4) 1,037 (49.7)
Maternal mental health score, M (SD) 3.2 (2.3) 3.2 (2.0) 3.6 (2.0)
Diagnosis other than stuttering, n (%)
 Learning difficulties 46 (6.7) 7 (6.1) 4 (20.0)
 Autism spectrum disorder 41 (5.9) 5 (4.3) 4 (20.0)
Stuttering cohort only
Age of stuttering onset, n (%)
 Pre–4 years of age 94 (77.7) 11 (55)
 Post–4 years of age 27 (22.3) 9 (45)
Ever sought treatment for stuttering, n (%) 12 (9.9) 5 (25)
Mean stuttering severity (range) 3.9 (2, 6.7)
Table 2. Distribution of child and family characteristics of 702 nonstuttering controls, 121 recovered stuttering cases, and 20 persistent stuttering cases.
Distribution of child and family characteristics of 702 nonstuttering controls, 121 recovered stuttering cases, and 20 persistent stuttering cases.×
Characteristic Nonstuttering controls Recovered stuttering Persistent stuttering
n (%) 702 (83.3) 121 (14.4) 20 (2.4)
Gender, n (%)
 Female 404 (57.6) 46 (38.0) 7 (35.0)
 Male 298 (42.5) 75 (62.0) 13 (65.0)
Socio-Economic Index for Areas, Index of Relative Disadvantage disadvantage score, M (SD) 1,044.8 (53.2) 1,045.7 (51.4) 1,037 (49.7)
Maternal mental health score, M (SD) 3.2 (2.3) 3.2 (2.0) 3.6 (2.0)
Diagnosis other than stuttering, n (%)
 Learning difficulties 46 (6.7) 7 (6.1) 4 (20.0)
 Autism spectrum disorder 41 (5.9) 5 (4.3) 4 (20.0)
Stuttering cohort only
Age of stuttering onset, n (%)
 Pre–4 years of age 94 (77.7) 11 (55)
 Post–4 years of age 27 (22.3) 9 (45)
Ever sought treatment for stuttering, n (%) 12 (9.9) 5 (25)
Mean stuttering severity (range) 3.9 (2, 6.7)
×
Comorbid Developmental Difficulties
According to parent report, a higher percentage of children in the group with persistent stuttering had a diagnosis of ASD compared with children with recovered stuttering and the nonstuttering controls. Differences were found to be statistically significant; the persistent stuttering group had fourfold increased odds of a diagnosis of ASD compared with the nonstuttering controls and 5.6-fold increased odds of ASD compared with the recovered stuttering group. In a similar manner, there was a higher percentage of children with parent report of a diagnosis of LD in the group with persistent stuttering compared with the recovered stuttering group and nonstuttering controls. These differences were also found to be statistically significant; the persistent stuttering group had 3.5-fold increased odds of a diagnosis of LD compared with the nonstuttering control group and 3.9-fold increased odds of a diagnosis of LD compared with the recovered stuttering controls. Considering that children with ASD can have different temperament profiles to typically developing children, ASD and LD were controlled for in subsequent analyses (Konstantareas & Stewart, 2006).
Analysis of Anxiety and Temperament
Table 3 shows linear regression models of continuous mean scores on the SCAS-C and SCAS-P for the group with persistent stuttering compared with those from the recovered stuttering group (reference group). Unadjusted modeling showed that the group with persistent stuttering had significantly higher mean scores (indicating higher anxiety) compared with the recovered stuttering group on the following subscales: separation anxiety (parent and child report), physical injury fears (child report), and obsessive-compulsive disorder (parent and child report). However, confidence intervals on the whole were imprecise, and the lower limit was either close to or equal to zero on the majority of subscales. This indicates that in the general population there may in fact be no difference in mean scores between the persistent and recovered stuttering groups. In a similar manner, although effect sizes ranged from 0.2 to 1 SD, they also had wide confidence intervals with the lower limits close to or equal to zero. All differences attenuated in the adjusted models after controlling for ASD and LD, many effect sizes became negative, and confidence intervals remained imprecise. This suggests that the effects observed in the unadjusted models were a product of the unusually high number of participants in the group with persistent stuttering with a diagnosis of ASD and/or LD. In summary, unadjusted analysis of the SCAS-C and SCAS-P showed significant differences between persistent or recovered stuttering groups, but confounders, particularly ASD and LD, included in subsequent models accounted for these differences.
Table 3. Mean differences in the Spence Children's Anxiety Scale Child Report (SCAS-C) and Parent Report (SCAS-P) subscale scores and total scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).
Mean differences in the Spence Children's Anxiety Scale Child Report (SCAS-C) and Parent Report (SCAS-P) subscale scores and total scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).×
SCAS subscale and total score Parent (n = 110), child (n = 98) report Unadjusted
Adjusted
Mean difference [95% CI] Effect size p Mean difference [95% CI] Effect size p
Panic attack and agoraphobia Parent 0.8 [0.0, 1.6] 0.5 [0.0, 1.0] .058** −0.1 [−1.9, 1.6] 0.0 [−1.2, 1.0] .885
Child 0.5 [−0.8, 1.9] 0.2 [−0.3, 0.6] .439 −0.4 [−4.5, 3.6] −0.1 [−1.3, 1.1] .821
Separation anxiety Parent 1.7 [0.5, 3.0] 0.6 [0.2, 1.1] .008* −1.0 [−4.2, 2.2] −0.4 [−0.6, 0.8] .537
Child 1.6 [0.1, 3.1] 0.5 [0.0, 1.0] .040* −0.6 [−4.5, 3.3] −0.2 [−1.5, 1.1] .751
Physical injury fears Parent 1.0 [0.0, 1.9] 0.5 [0.0, 1.0] .053** −0.5 [−2.8, 1.8] −0.2 [−1.4, 0.9] .685
Child 1.5 [0.4, 2.7] 0.6 [0.1, 1.1] .011* −0.8 [−4.1, 2.5] −0.3 [−1.6, 1.0] .635
Social phobia Parent 1.4 [−0.1, 2.9] 0.5 [0.0, 1.0] .063** −0.2 [−3.6, 4.1] 0.1 [−1.2, 1.4] .914
Child 0.6 [−1.1, 2.3] 0.2 [−0.3, 0.7] .471 1.1 [−3.4, 5.5] 0.3 [−1.0, 1.6] .639
Obsessive-compulsive disorder Parent 1.5 [0.8, 2.2] 1.0 [0.5, 1.5] < .001* −0.6 [−1.7, 0.4] −0.4 [−1.2, 0.3] .238
Child 1.4 [0.0, 2.8] 0.5 [0.0, 1.0] .044* −0.5 [−4.1, 3.0] −0.2 [−1.4, 1.1] .759
Generalized anxiety disorder Parent 0.8 [−0.3, 2.0] 0.4 [−0.1, 0.8] .154 −0.4 [−3.1, 2.4] −0.2 [−1.3, 1.0] .797
Child 0.7 [−1.0, 2.3] 0.2 [−0.3, 0.7] .393 2.7 [−1.6, 7.0] 0.8 [−0.5, 2.1] .219
Total score Parent 7.3 [2.5, 12.1] 0.7 [0.3, 1.2] .003* −2.5 [−9.9, 4.9] −0.3 [−1.0, 0.5] .497
Child 7.7 [0.2, 15.3] 0.5 [0.0, 1.0] .046** 0.7 [−19.8, 21.2] 0.0 [−1.3, 1.4] .945
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.×
* p ≤ .05.
p ≤ .05.×
** p ≤ .10.
p ≤ .10.×
Table 3. Mean differences in the Spence Children's Anxiety Scale Child Report (SCAS-C) and Parent Report (SCAS-P) subscale scores and total scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).
Mean differences in the Spence Children's Anxiety Scale Child Report (SCAS-C) and Parent Report (SCAS-P) subscale scores and total scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).×
SCAS subscale and total score Parent (n = 110), child (n = 98) report Unadjusted
Adjusted
Mean difference [95% CI] Effect size p Mean difference [95% CI] Effect size p
Panic attack and agoraphobia Parent 0.8 [0.0, 1.6] 0.5 [0.0, 1.0] .058** −0.1 [−1.9, 1.6] 0.0 [−1.2, 1.0] .885
Child 0.5 [−0.8, 1.9] 0.2 [−0.3, 0.6] .439 −0.4 [−4.5, 3.6] −0.1 [−1.3, 1.1] .821
Separation anxiety Parent 1.7 [0.5, 3.0] 0.6 [0.2, 1.1] .008* −1.0 [−4.2, 2.2] −0.4 [−0.6, 0.8] .537
Child 1.6 [0.1, 3.1] 0.5 [0.0, 1.0] .040* −0.6 [−4.5, 3.3] −0.2 [−1.5, 1.1] .751
Physical injury fears Parent 1.0 [0.0, 1.9] 0.5 [0.0, 1.0] .053** −0.5 [−2.8, 1.8] −0.2 [−1.4, 0.9] .685
Child 1.5 [0.4, 2.7] 0.6 [0.1, 1.1] .011* −0.8 [−4.1, 2.5] −0.3 [−1.6, 1.0] .635
Social phobia Parent 1.4 [−0.1, 2.9] 0.5 [0.0, 1.0] .063** −0.2 [−3.6, 4.1] 0.1 [−1.2, 1.4] .914
Child 0.6 [−1.1, 2.3] 0.2 [−0.3, 0.7] .471 1.1 [−3.4, 5.5] 0.3 [−1.0, 1.6] .639
Obsessive-compulsive disorder Parent 1.5 [0.8, 2.2] 1.0 [0.5, 1.5] < .001* −0.6 [−1.7, 0.4] −0.4 [−1.2, 0.3] .238
Child 1.4 [0.0, 2.8] 0.5 [0.0, 1.0] .044* −0.5 [−4.1, 3.0] −0.2 [−1.4, 1.1] .759
Generalized anxiety disorder Parent 0.8 [−0.3, 2.0] 0.4 [−0.1, 0.8] .154 −0.4 [−3.1, 2.4] −0.2 [−1.3, 1.0] .797
Child 0.7 [−1.0, 2.3] 0.2 [−0.3, 0.7] .393 2.7 [−1.6, 7.0] 0.8 [−0.5, 2.1] .219
Total score Parent 7.3 [2.5, 12.1] 0.7 [0.3, 1.2] .003* −2.5 [−9.9, 4.9] −0.3 [−1.0, 0.5] .497
Child 7.7 [0.2, 15.3] 0.5 [0.0, 1.0] .046** 0.7 [−19.8, 21.2] 0.0 [−1.3, 1.4] .945
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.×
* p ≤ .05.
p ≤ .05.×
** p ≤ .10.
p ≤ .10.×
×
Table 4 shows unadjusted and adjusted linear regression modeling of the individual subscales of the SDQ, the SDQ internalizing score, and the three anxiety-specific questions, comparing the persistent and recovered stuttering groups with the nonstuttering controls (reference group). Unadjusted modeling showed no significant differences between the recovered stuttering group and the nonstuttering controls. The group with persistent stuttering, however, had significantly higher mean scores (indicating increased symptoms) compared with nonstuttering controls on the following subscales: emotional symptoms (parent report), hyperactivity (parent report), and peer problems (parent and child report). As with the SCAS, multivariable regression models accounted for differences in unadjusted analysis, and there were no statistically significant differences in outcomes on the SDQ between the persistent and recovered stuttering groups and nonstuttering controls in the adjusted models (i.e., emotional symptoms subscale, parent report; hyperactivity subscale, parent report; and peer problems, parent and child report). The exception to this was the prosocial behaviors subscale. In adjusted analysis, the group with persistent stuttering had significantly higher mean scores on the prosocial behavior scale score compared with the nonstuttering controls.
Table 4. Mean differences in Strengths and Difficulties Questionnaire [SDQ; child and parent report] subscale scores, total scores, internalizing difficulties, and anxiety-specific questions when comparing the group with persistent stuttering and recovered stuttering group with the nonstuttering controls [reference group].
Mean differences in Strengths and Difficulties Questionnaire [SDQ; child and parent report] subscale scores, total scores, internalizing difficulties, and anxiety-specific questions when comparing the group with persistent stuttering and recovered stuttering group with the nonstuttering controls [reference group].×
SDQ subscale and total score Parent/child report Unadjusted
Adjusted
Recovered stuttering, M [95% CI] p Persistent stuttering, M [95% CI] p Recovered stuttering, M [95% CI] p Persistent stuttering, M [95% CI] p
Emotional symptoms Parent −0.2 [−0.6, 0.2] .346 1.3 [0.3, 2.2] .008* −1.0 [−2.9, 0.9] .288 −0.9 [−4.1, 2.3] .288
Child −0.1 [−0.5, 0.4] .816 0.1 [−0.9, 1.0] .883 −1.2 [−3.1, 0.8] .235 −0.3 [−3.6, 3.0] .861
Conduct problems Parent 0.0 [−0.3, 0.3] .969 0.0 [−0.6, 0.7] .957 0.2 [−0.9, 1.2] .747 −1.1 [−3.0, 0.8] .209
Child 0.1 [−0.3, 0.4] .711 0.3 [−0.4, 1.0] .397 −0.2 [−1.5, 1.2] .820 −1.9 [−4.1, 0.4] .098**
Hyperactivity/inattention Parent −0.1 [−0.5, 0.4] .811 1.8 [0.7, 2.9] .001* −1.4 [−3.7, 1.0] .253 −0.7 [−4.6, 3.3] .738
Child 0.2 [−0.3, 0.7] .430 0.6 [−0.4, 1.6] .260 −0.2 [−2.5, 2.2] .878 −1.2 [−5.0, 2.9] .599
Peer problems Parent −0.1 [−0.4, 0.2] .560 1.0 [0.3, 1.7] .007* −0.1 [−1.4, 1.1] .831 −0.8 [−2.9, 1.4] .472
Child 0.1 [−0.3, 0.4] .684 0.8 [0.1, 1.6] .024* −0.2 [−1.6, 1.2] .800 0.2 [−2.1, 2.5] .869
Prosocial Parent −0.1 [−0.4, 0.3] .725 −0.5 [−1.2, 0.3] .228 1.4 [−0.3, 3.0] .097** 3.3 [0.6, 6.1] .018*
Child −0.1 [−0.4, 0.2] .487 −0.5 [−1.2, 0.1] .124** −0.0 [−1.5, 1.5] .966 0.0 [−2.6, 2.5] .979
Total difficulties Parent −0.3 [−1.4, 0.8] .546 4.1 [1.5, 6.6] .002* −2.4 [−7.0, 2.1] .294 −3.6 [−11.3, 4.1] .360
Child 0.3 [−0.9, 1.5] .651 1.8 [−0.7, 4.4] .164 −1.7 [−6.7, 3.3] .570 −3.0 [−11.4, 5.5] .490
Internalizing difficulties Parent −0.3 [−0.9, 0.3] .352 2.3 [0.8, 3.6] .002* −1.2 [−3.5, 1.1] .313 −1.7 [−5.6, 2.2] .395
Child 0.0 [−0.7, 0.7] .955 0.9 [−0.5, 2.4] .213 −1.4 [−4.1, 1.4] .333 0.0 [−4.8, 6.6] .966
Anxiety-specific questions Parent −0.2 [−0.5, 0.1] .290 1.1 [0.5, 1.8] .001* −1.4 [−2.7, 0.1] .048* −0.5 [−3.3, 2.5] .767
Child 0.0 [−0.4, 0.3] .829 0.0 [−0.7, 0.7] .919 −1.4 [−2.9, 0.0] .046* −0.7 [−3.1, 1.7] .552
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.×
* p ≤ .05.
p ≤ .05.×
** p ≤ .10.
p ≤ .10.×
Table 4. Mean differences in Strengths and Difficulties Questionnaire [SDQ; child and parent report] subscale scores, total scores, internalizing difficulties, and anxiety-specific questions when comparing the group with persistent stuttering and recovered stuttering group with the nonstuttering controls [reference group].
Mean differences in Strengths and Difficulties Questionnaire [SDQ; child and parent report] subscale scores, total scores, internalizing difficulties, and anxiety-specific questions when comparing the group with persistent stuttering and recovered stuttering group with the nonstuttering controls [reference group].×
SDQ subscale and total score Parent/child report Unadjusted
Adjusted
Recovered stuttering, M [95% CI] p Persistent stuttering, M [95% CI] p Recovered stuttering, M [95% CI] p Persistent stuttering, M [95% CI] p
Emotional symptoms Parent −0.2 [−0.6, 0.2] .346 1.3 [0.3, 2.2] .008* −1.0 [−2.9, 0.9] .288 −0.9 [−4.1, 2.3] .288
Child −0.1 [−0.5, 0.4] .816 0.1 [−0.9, 1.0] .883 −1.2 [−3.1, 0.8] .235 −0.3 [−3.6, 3.0] .861
Conduct problems Parent 0.0 [−0.3, 0.3] .969 0.0 [−0.6, 0.7] .957 0.2 [−0.9, 1.2] .747 −1.1 [−3.0, 0.8] .209
Child 0.1 [−0.3, 0.4] .711 0.3 [−0.4, 1.0] .397 −0.2 [−1.5, 1.2] .820 −1.9 [−4.1, 0.4] .098**
Hyperactivity/inattention Parent −0.1 [−0.5, 0.4] .811 1.8 [0.7, 2.9] .001* −1.4 [−3.7, 1.0] .253 −0.7 [−4.6, 3.3] .738
Child 0.2 [−0.3, 0.7] .430 0.6 [−0.4, 1.6] .260 −0.2 [−2.5, 2.2] .878 −1.2 [−5.0, 2.9] .599
Peer problems Parent −0.1 [−0.4, 0.2] .560 1.0 [0.3, 1.7] .007* −0.1 [−1.4, 1.1] .831 −0.8 [−2.9, 1.4] .472
Child 0.1 [−0.3, 0.4] .684 0.8 [0.1, 1.6] .024* −0.2 [−1.6, 1.2] .800 0.2 [−2.1, 2.5] .869
Prosocial Parent −0.1 [−0.4, 0.3] .725 −0.5 [−1.2, 0.3] .228 1.4 [−0.3, 3.0] .097** 3.3 [0.6, 6.1] .018*
Child −0.1 [−0.4, 0.2] .487 −0.5 [−1.2, 0.1] .124** −0.0 [−1.5, 1.5] .966 0.0 [−2.6, 2.5] .979
Total difficulties Parent −0.3 [−1.4, 0.8] .546 4.1 [1.5, 6.6] .002* −2.4 [−7.0, 2.1] .294 −3.6 [−11.3, 4.1] .360
Child 0.3 [−0.9, 1.5] .651 1.8 [−0.7, 4.4] .164 −1.7 [−6.7, 3.3] .570 −3.0 [−11.4, 5.5] .490
Internalizing difficulties Parent −0.3 [−0.9, 0.3] .352 2.3 [0.8, 3.6] .002* −1.2 [−3.5, 1.1] .313 −1.7 [−5.6, 2.2] .395
Child 0.0 [−0.7, 0.7] .955 0.9 [−0.5, 2.4] .213 −1.4 [−4.1, 1.4] .333 0.0 [−4.8, 6.6] .966
Anxiety-specific questions Parent −0.2 [−0.5, 0.1] .290 1.1 [0.5, 1.8] .001* −1.4 [−2.7, 0.1] .048* −0.5 [−3.3, 2.5] .767
Child 0.0 [−0.4, 0.3] .829 0.0 [−0.7, 0.7] .919 −1.4 [−2.9, 0.0] .046* −0.7 [−3.1, 1.7] .552
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.×
* p ≤ .05.
p ≤ .05.×
** p ≤ .10.
p ≤ .10.×
×
Table 5 shows linear regression models of the dimensions of the SATI comparing the group with persistent stuttering with the recovered stuttering group (reference group). The unadjusted models showed that the group with persistent stuttering had significantly higher mean scores (suggesting more pronounced temperamental traits) on the approach/withdrawal temperament dimension compared with the recovered stuttering group. The effect sizes ranged from 0.1 of a SD to 1.1. All differences were accounted for in the adjusted models, which found no difference between children with persistent and recovered stuttering in regards to temperament.
Table 5. Mean differences in School-Age Temperament Inventory (SATI) scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).
Mean differences in School-Age Temperament Inventory (SATI) scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).×
SATI dimension Unadjusted
Adjusted
Mean difference [95% CI] Effect size p Mean difference [95% CI] Effect size p
Negative reactivity 0.3 [−0.1, 0.6] 0.3 [−0.2, 0.8] .175 0.2 [−0.7, 1.0] 0.2 [−1.0, 1.3] .715
Task persistence −0.3 [−0.6, 0.0] −0.4 [−0.9, 0.1] .089** 0.4 [−0.4, 1.2] 0.7 [−0.6, 1.9] .285
Approach/withdrawal 0.4 [0.1, 0.6] 0.6 [0.1, 1.1] .020* −0.2 [−0.7, 0.3] −0.4 [−1.1, 0.4] .333
Activity 0.3 [−0.1, 0.6] 0.3 [−0.1, 0.8] .166 0.1 [−0.9, 1.0] 0.1 [−1.2, 1.4] .881
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.×
* p ≤ .05.
p ≤ .05.×
** p ≤ .10.
p ≤ .10.×
Table 5. Mean differences in School-Age Temperament Inventory (SATI) scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).
Mean differences in School-Age Temperament Inventory (SATI) scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).×
SATI dimension Unadjusted
Adjusted
Mean difference [95% CI] Effect size p Mean difference [95% CI] Effect size p
Negative reactivity 0.3 [−0.1, 0.6] 0.3 [−0.2, 0.8] .175 0.2 [−0.7, 1.0] 0.2 [−1.0, 1.3] .715
Task persistence −0.3 [−0.6, 0.0] −0.4 [−0.9, 0.1] .089** 0.4 [−0.4, 1.2] 0.7 [−0.6, 1.9] .285
Approach/withdrawal 0.4 [0.1, 0.6] 0.6 [0.1, 1.1] .020* −0.2 [−0.7, 0.3] −0.4 [−1.1, 0.4] .333
Activity 0.3 [−0.1, 0.6] 0.3 [−0.1, 0.8] .166 0.1 [−0.9, 1.0] 0.1 [−1.2, 1.4] .881
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.×
* p ≤ .05.
p ≤ .05.×
** p ≤ .10.
p ≤ .10.×
×
Discussion
Using data from a community cohort study, we found no evidence that 11-year-old children with persistent stuttering were more anxious than those who had recovered from stuttering. Children with persistent stuttering performed no differently on a measure of emotional and behavioral functioning than those with recovered stuttering and nonstuttering controls. Further, we found no evidence that children with persistent stuttering had a more anxious temperament than those who had recovered from stuttering. Findings suggest that while social anxiety is reported to be associated with stuttering in clinical samples, this was not the case in a community sample of school-age children who stuttered. As an alternative, it may be that anxiety develops later in the school years, possibly further into adolescence.
Our null findings on the anxiety–stuttering association in school-age children are consistent with the only other community-based study also to investigate this (Andrews & Harris, 1964). As discussed, they also provide further evidence of disparities in outcomes between clinical and community samples with clinical samples of school-age children who stutter being more likely to have higher anxiety or anxious temperament. Stuttering severity and maternal mental health may be potential factors that differentiate the clinical and community cohorts. For example, the group with persistent stuttering presented with mild-to-moderate stuttering, and more severe stuttering may be a driver of help-seeking compared with milder stuttering. It is also plausible that those with more severe stuttering are more anxious. In short, clinical samples may be comprised of of children who have more severe stuttering and are subsequently more anxious than those in community samples where a broader range of severity ratings are seen, and the same might be said of anxiety. Regarding maternal mental health, there were no significant differences in average maternal mental health scores between the group with persistent stuttering, the recovered stuttering group, and nonstuttering controls. As the participants were at an age at which a parent would likely be involved in accessing speech therapy, a mother anxious about her child's stuttering may be more likely to seek help. Further, a mother with anxiety is more likely to have a child who also has anxiety (Beesdo-Baum & Knappe, 2012). So, if maternal or child anxiety is the driving force behind seeking speech therapy, it is possible that clinical cohorts represent the more anxious individuals of the stuttering population. In lieu of research investigating differences in characteristics between child and family predictors of anxiety in community and clinical samples, we can only speculate at this stage.
An unexpected finding was the high proportions of children with ASD and/or LD in the group with persistent stuttering compared with the recovered stuttering group and the nonstuttering controls. A number of explanations for this are possible. ASD and LD are associated with communication and developmental issues, and stuttering therapy may have been prioritized lower in light of other perceived priorities (Scaler Scott, Tetnowski, Flaitz, & Yaruss, 2014). For those who did seek treatment, outcomes may have been compromised by common features of ASD or LD, such as poor self-monitoring, joint attention, and turn-taking. Therefore, school-age children with stuttering and ASD and/or LD may be more likely to have persistent stuttering due to a lack of or unsuccessful stuttering therapy. Another possibility was that the high number of children with ASD and/or LD in the present sample was reflective of a population sample that does not exclude subgroups with additional needs. This, however, would not account for the high proportion of children with ASD and/or LD in the group with persistent stuttering only. Last, it must be noted that although the diagnosis of ASD was verified by a senior psychologist, the diagnosis of LD was not. On balance, we cannot be sure if the high proportion of participants from the group with persistent stuttering with ASD and/or LD is a spurious finding, a result of subjective reporting of LD, or a true representation of a community sample of school-age children with stuttering. It is unknown if other studies with school-age children who stutter identified similar rates of ASD and/or LD during their recruitment process. Irrespective of this, together unadjusted and adjusted analyses suggest that in school-age children an association between anxiety and stuttering may be more evident in children who stutter and have ASD and/or LD.
Limitations
Both study strengths and limitations arose from being nested within a large longitudinal community cohort study. Recruitment prior to stuttering onset and verification of stuttering at multiple time points by SLPs allowed for the identification of mild and short-lived stuttering, which may have otherwise been missed in cross-sectional study designs or those utilizing clinical samples (Reilly, Kefalianos, et al., 2013). However, as with all longitudinal studies with both clinical and community cohorts, attrition over time is an issue. Ignoring participant dropout in longitudinal studies has the potential to bias estimates “toward showing better health over time than is true” (Jones, Mishra, & Dobson, 2015, p. 1165). In the present study, as stuttering onset and recovery occurred at different ages for individual participants, accurate analysis of dropouts was not possible. For example, verification of stuttering occurred at 2–4, 6–7, and 11 years. For participants who dropped out between these points, it is unknown if stuttering persisted or recovered. It is plausible that children with stuttering and anxiety were more likely to drop out of ELVS in order to avoid talking with researchers and, in doing so, biased the results in favor of children without anxiety who stutter.
Maximizing retention by avoiding overburdening participants with lengthy questionnaires is an important consideration in all longitudinal studies. The SCAS and SDQ are quick and easy to complete and widely used in psychological research. However, a more rigorous and sensitive diagnostic assessment administered by a clinician may have had a greater ability to detect subtle differences in anxiety between groups. Also to minimize overburdening participants, the SCAS and SATI were only completed by ELVS participants with a history of stuttering onset. It is acknowledged that using children who have recovered from stuttering as the control group with which to compare outcomes for children who stutter limits the conclusions that can be drawn. However, the SDQ was completed by all ELVS participants and was included to provide additional information on anxiety symptoms in school-age children who stutter compared with nonstuttering controls.
Regarding measurement of stuttering, only parents completed severity ratings of their child's stuttering and only audible stuttering behaviors were assessed by the SLP. Having an SLP see the child in order to identify any inaudible stuttering behaviors and assign a severity rating may have served to provide more objective and comprehensive information on the child's stuttering severity.
Last, although the ELVS cohort was a large sample in its entirety, the number with persistent stuttering consisted of 20 participants. Smaller sample sizes may have reduced statistical power to estimate differences with precision and detect the differences identified in larger samples. The null finding in the present study may have been in part the result of insufficient statistical power (Jones, Gebski, Onslow, & Packman, 2002).
Recommendations
The study did not find evidence that, as a group, children who stutter experience higher anxiety than those who have recovered from stuttering or who have never stuttered. However, considering the increased risk of social anxiety disorder in adults who stutter, SLPs should be vigilant in monitoring and screening for anxiety in school-age clients if there is concern or if there is a diagnosis of ASD or LD. Further, research on the clinical and personal significance of psychological programs that protect against anxiety will establish if such programs will be of benefit to this population (Bothe & Richardson, 2011). It is recommended that future research focus on identifying a larger group with persistent stuttering within a community sample. Ideally, this could be done in a birth cohort for which families are recruited prior to the identification of any developmental disabilities in the participating children. This would provide access to a cohort in which the full range of child ability and disability is represented. This will permit researchers to examine the relationships between stuttering and other childhood comorbidities. Comparing and contrasting clinical and community data from school-age children who stutter allows researchers and clinicians to determine whether they differ and, if so, which factors differentiate the groups. Ultimately, these data will permit more accurate judgments about the extent to which findings from clinical samples, which are much easier to recruit for research than community samples, can be generalized to the whole stuttering population.
Conclusion
We found no evidence that a community sample of 11-year-old children who stutter were more anxious than those who had recovered from stuttering and nonstuttering controls. Anxiety was more likely to be associated with stuttering in school-age children if there was also a diagnosis of ASD and/or LD. Although findings contribute to our understanding of anxiety in stuttering across the lifespan, they must be interpreted in the context of the limitations mentioned above and replicated before firm conclusions can be drawn. Continued investigation is crucial as only when the anxiety–stuttering association in school-age children is clear will we be able to understand the holistic experience of stuttering and ensure school-age children who stutter receive the best possible care.
Acknowledgments
We would like to thank all the parents and children who participated in this study and Dr. Angela Morgan for her supervision and support.
References
Alm, P. A. (2014). Stuttering in relation to anxiety, temperament, and personality: Review and analysis with focus on causality. Journal of Fluency Disorders, 40, 5–21. [Article] [PubMed]
Alm, P. A. (2014). Stuttering in relation to anxiety, temperament, and personality: Review and analysis with focus on causality. Journal of Fluency Disorders, 40, 5–21. [Article] [PubMed]×
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.×
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.×
Andrews, G., & Harris, M. (1964). The syndrome of stuttering. London, England: The Spastics Society Medical Education and Information Unit in association with William Heinemann Medical Books.
Andrews, G., & Harris, M. (1964). The syndrome of stuttering. London, England: The Spastics Society Medical Education and Information Unit in association with William Heinemann Medical Books.×
Andrews, G., & Slade, T. (2001). Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health, 25, 494–497. https://doi.org/10.1111/j.1467-842X.2001.tb00310.x [Article] [PubMed]
Andrews, G., & Slade, T. (2001). Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health, 25, 494–497. https://doi.org/10.1111/j.1467-842X.2001.tb00310.x [Article] [PubMed]×
Australian Bureau of Statistics. (2001). Socio-Economic Indexes for Areas. Canberra, Australia: Author.
Australian Bureau of Statistics. (2001). Socio-Economic Indexes for Areas. Canberra, Australia: Author.×
Becker, A., Rothenberger, A., & Sohn, A. (2015). Six years ahead: A longitudinal analysis regarding course and predictive value of the Strengths and Difficulties Questionnaire (SDQ) in children and adolescents. European Child & Adolescent Psychiatry, 24, 715–725. https://doi.org/10.1007/s00787-014-0640-x [Article] [PubMed]
Becker, A., Rothenberger, A., & Sohn, A. (2015). Six years ahead: A longitudinal analysis regarding course and predictive value of the Strengths and Difficulties Questionnaire (SDQ) in children and adolescents. European Child & Adolescent Psychiatry, 24, 715–725. https://doi.org/10.1007/s00787-014-0640-x [Article] [PubMed]×
Beesdo-Baum, K., & Knappe, S. (2012). Developmental epidemiology of anxiety disorders. Child and Adolescent Psychiatric Clinics of North America, 21, 457–478. [Article] [PubMed]
Beesdo-Baum, K., & Knappe, S. (2012). Developmental epidemiology of anxiety disorders. Child and Adolescent Psychiatric Clinics of North America, 21, 457–478. [Article] [PubMed]×
Blumgart, E., Tran, Y., & Craig, A. (2010). Social anxiety disorder in adults who stutter. Depression and Anxiety, 27, 687–692. [Article] [PubMed]
Blumgart, E., Tran, Y., & Craig, A. (2010). Social anxiety disorder in adults who stutter. Depression and Anxiety, 27, 687–692. [Article] [PubMed]×
Bothe, A. K., & Richardson, J. D. (2011). Statistical, practical, clinical, and personal significance: Definitions and applications in speech-language pathology. American Journal of Speech-Language Pathology, 20, 233–242. [Article] [PubMed]
Bothe, A. K., & Richardson, J. D. (2011). Statistical, practical, clinical, and personal significance: Definitions and applications in speech-language pathology. American Journal of Speech-Language Pathology, 20, 233–242. [Article] [PubMed]×
Bretherton, L., Prior, M., Bavin, E., Cini, E., Eadie, P., & Reilly, S. (2014). Developing relationships between language and behaviour in preschool children from the Early Language in Victoria Study: Implications for intervention. Emotional and Behavioural Difficulties, 19, 7–27. [Article]
Bretherton, L., Prior, M., Bavin, E., Cini, E., Eadie, P., & Reilly, S. (2014). Developing relationships between language and behaviour in preschool children from the Early Language in Victoria Study: Implications for intervention. Emotional and Behavioural Difficulties, 19, 7–27. [Article] ×
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R. G., Liebowitz, M. R., Hope, D. A., & Schneier, F. R. (eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). New York, NY: Guilford Press.
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R. G., Liebowitz, M. R., Hope, D. A., & Schneier, F. R. (eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). New York, NY: Guilford Press.×
Davis, S., Shisca, D., & Howell, P. (2007). Anxiety in speakers who persist and recover from stuttering. Journal of Communication Disorders, 40, 398–417. [Article] [PubMed]
Davis, S., Shisca, D., & Howell, P. (2007). Anxiety in speakers who persist and recover from stuttering. Journal of Communication Disorders, 40, 398–417. [Article] [PubMed]×
Eadie, P., Morgan, A., Ukoumunne, O. C., Ttofari Eecen, K., Wake, M., & Reilly, S. (2015). Speech sound disorder at 4 years: Prevalence, comorbidities, and predictors in a community cohort of children. Developmental Medicine & Child Neurology, 57, 578–584. [Article]
Eadie, P., Morgan, A., Ukoumunne, O. C., Ttofari Eecen, K., Wake, M., & Reilly, S. (2015). Speech sound disorder at 4 years: Prevalence, comorbidities, and predictors in a community cohort of children. Developmental Medicine & Child Neurology, 57, 578–584. [Article] ×
Essau, C. A., Anastassiou-Hadjicharalambous, X., & Muñoz, L. C. (2011). Psychometric properties of the Spence Children's Anxiety Scale (SCAS) in Cypriot children and adolescents. Child Psychiatry & Human Development, 42, 557–568. [Article]
Essau, C. A., Anastassiou-Hadjicharalambous, X., & Muñoz, L. C. (2011). Psychometric properties of the Spence Children's Anxiety Scale (SCAS) in Cypriot children and adolescents. Child Psychiatry & Human Development, 42, 557–568. [Article] ×
Goodman, R. (2001). Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1337–1345. https://doi.org/10.1097/00004583-200111000-00015 [Article]
Goodman, R. (2001). Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1337–1345. https://doi.org/10.1097/00004583-200111000-00015 [Article] ×
Hawes, D. J., & Dadds, M. R. (2004). Australian data and psychometric properties of the Strengths and Difficulties Questionnaire. Australian and New Zealand Journal of Psychiatry, 38, 644–651. [Article] [PubMed]
Hawes, D. J., & Dadds, M. R. (2004). Australian data and psychometric properties of the Strengths and Difficulties Questionnaire. Australian and New Zealand Journal of Psychiatry, 38, 644–651. [Article] [PubMed]×
Iverach, L., Jones, M., McLellan, L. F., Lyneham, H. J., Onslow, M., Menzies, R. G., & Rapee, R. M. (2016). Prevalence of anxiety disorders among children who stutter. Journal of Fluency Disorders, 49, 13–28. [Article] [PubMed]
Iverach, L., Jones, M., McLellan, L. F., Lyneham, H. J., Onslow, M., Menzies, R. G., & Rapee, R. M. (2016). Prevalence of anxiety disorders among children who stutter. Journal of Fluency Disorders, 49, 13–28. [Article] [PubMed]×
Iverach, L., O'Brian, S., Jones, M., Block, S., Lincoln, M., Harrison, E., … Onslow, M. (2009). Prevalence of anxiety disorders among adults seeking speech therapy for stuttering. Journal of Anxiety Disorders, 23, 928–934. [Article] [PubMed]
Iverach, L., O'Brian, S., Jones, M., Block, S., Lincoln, M., Harrison, E., … Onslow, M. (2009). Prevalence of anxiety disorders among adults seeking speech therapy for stuttering. Journal of Anxiety Disorders, 23, 928–934. [Article] [PubMed]×
Iverach, L., & Rapee, R. (2013). Social anxiety disorder and stuttering: Current status and future directions. Journal of Fluency Disorders, 40, 69–82. https://doi.org/10.1016/j.jfludis.2013.08.003 [Article] [PubMed]
Iverach, L., & Rapee, R. (2013). Social anxiety disorder and stuttering: Current status and future directions. Journal of Fluency Disorders, 40, 69–82. https://doi.org/10.1016/j.jfludis.2013.08.003 [Article] [PubMed]×
Jones, M., Gebski, V., Onslow, M., & Packman, A. (2002). Statistical power in stuttering research: A tutorial. Journal of Speech, Language, and Hearing Research, 45, 243–255. [Article]
Jones, M., Gebski, V., Onslow, M., & Packman, A. (2002). Statistical power in stuttering research: A tutorial. Journal of Speech, Language, and Hearing Research, 45, 243–255. [Article] ×
Jones, M., Mishra, G. D., & Dobson, A. (2015). Analytical results in longitudinal studies depended on target of inference and assumed mechanism of attrition. Journal of Clinical Epidemiology, 68, 1165–1175. https://doi.org/10.1016/j.jclinepi.2015.03.011 [Article] [PubMed]
Jones, M., Mishra, G. D., & Dobson, A. (2015). Analytical results in longitudinal studies depended on target of inference and assumed mechanism of attrition. Journal of Clinical Epidemiology, 68, 1165–1175. https://doi.org/10.1016/j.jclinepi.2015.03.011 [Article] [PubMed]×
Kefalianos, E., Onslow, M., Ukoumunne, O., Block, S., Prior, M., & Reilly, S. (2014). Stuttering, temperament and anxiety: Data from a community cohort aged 2–4 years. Journal of Speech, Language, and Hearing Research, 57, 1314–1322. [Article]
Kefalianos, E., Onslow, M., Ukoumunne, O., Block, S., Prior, M., & Reilly, S. (2014). Stuttering, temperament and anxiety: Data from a community cohort aged 2–4 years. Journal of Speech, Language, and Hearing Research, 57, 1314–1322. [Article] ×
Konstantareas, M. M., & Stewart, K. (2006). Affect regulation and temperament in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 36, 143–154. [Article] [PubMed]
Konstantareas, M. M., & Stewart, K. (2006). Affect regulation and temperament in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 36, 143–154. [Article] [PubMed]×
McAllister, J., Collier, J., & Shepstone, L. (2012). The impact of adolescent stuttering on educational and employment outcomes: Evidence from a birth cohort study. Journal of Fluency Disorders, 37, 106–121. https://doi.org/10.1016/j.jfludis.2012.01.002 [Article] [PubMed]
McAllister, J., Collier, J., & Shepstone, L. (2012). The impact of adolescent stuttering on educational and employment outcomes: Evidence from a birth cohort study. Journal of Fluency Disorders, 37, 106–121. https://doi.org/10.1016/j.jfludis.2012.01.002 [Article] [PubMed]×
McClowry, S. G. (1995). The development of the School-Age Temperament Inventory. Merrill-Palmer Quarterly, 41, 271–285. Retrieved from http://www.jstor.org/stable/23087890
McClowry, S. G. (1995). The development of the School-Age Temperament Inventory. Merrill-Palmer Quarterly, 41, 271–285. Retrieved from http://www.jstor.org/stable/23087890 ×
McClowry, S. G., Halverson, C. F., & Sanson, A. (2003). A re-examination of the validity and reliability of the School-Age Temperament Inventory. Nursing Research, 52, 176–182. [Article] [PubMed]
McClowry, S. G., Halverson, C. F., & Sanson, A. (2003). A re-examination of the validity and reliability of the School-Age Temperament Inventory. Nursing Research, 52, 176–182. [Article] [PubMed]×
McKean, C., Mensah, F. K., Eadie, P., Bavin, E. L., Bretherton, L., Cini, E., & Reilly, S. (2015). Levers for language growth: Characteristics and predictors of language trajectories between 4 and 7 years. PloS One, 10(8), e0134251. [Article] [PubMed]
McKean, C., Mensah, F. K., Eadie, P., Bavin, E. L., Bretherton, L., Cini, E., & Reilly, S. (2015). Levers for language growth: Characteristics and predictors of language trajectories between 4 and 7 years. PloS One, 10(8), e0134251. [Article] [PubMed]×
Nauta, M. H., Scholing, A., Rapee, R. M., Abbott, M., Spence, S. H., & Waters, A. (2004). A parent-report measure of children's anxiety: Psychometric properties and comparison with child-report in a clinic and normal sample. Behaviour Research and Therapy, 42, 813–839. [Article] [PubMed]
Nauta, M. H., Scholing, A., Rapee, R. M., Abbott, M., Spence, S. H., & Waters, A. (2004). A parent-report measure of children's anxiety: Psychometric properties and comparison with child-report in a clinic and normal sample. Behaviour Research and Therapy, 42, 813–839. [Article] [PubMed]×
Ollendick, T. H., & Hirshfeld-Becker, D. R. (2002). The developmental psychopathology of social anxiety disorder. Biological Psychiatry, 51, 44–58. https://doi.org/10.1016/S0006-3223(01)01305-1 [Article] [PubMed]
Ollendick, T. H., & Hirshfeld-Becker, D. R. (2002). The developmental psychopathology of social anxiety disorder. Biological Psychiatry, 51, 44–58. https://doi.org/10.1016/S0006-3223(01)01305-1 [Article] [PubMed]×
Perneger, T. V. (1998). What's wrong with Bonferroni adjustments. BMJ, 316, 1236–1238. [Article] [PubMed]
Perneger, T. V. (1998). What's wrong with Bonferroni adjustments. BMJ, 316, 1236–1238. [Article] [PubMed]×
Prior, M., Smart, D., Sanson, A., & Oberklaid, F. (2000). Does shy-inhibited temperament in childhood lead to anxiety problems in adolescence? Journal of the American Academy of Child and Adolescent Psychiatry, 39, 461–468. [Article] [PubMed]
Prior, M., Smart, D., Sanson, A., & Oberklaid, F. (2000). Does shy-inhibited temperament in childhood lead to anxiety problems in adolescence? Journal of the American Academy of Child and Adolescent Psychiatry, 39, 461–468. [Article] [PubMed]×
Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741–756. [Article] [PubMed]
Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741–756. [Article] [PubMed]×
Rapee, R. M., & Spence, S. H. (2004). The etiology of social phobia: Empirical evidence and an initial model. Clinical Psychology Review, 24, 737–767. [Article] [PubMed]
Rapee, R. M., & Spence, S. H. (2004). The etiology of social phobia: Empirical evidence and an initial model. Clinical Psychology Review, 24, 737–767. [Article] [PubMed]×
Reilly, S., Bavin, E. L., Bretherton, L., Conway, L., Eadie, P., Cini, E., … Wake, M. (2009). The Early Language in Victoria Study (ELVS): A prospective, longitudinal study of communication skills and expressive vocabulary development at 8, 12 and 24 months. International Journal of Speech-Language Pathology, 11, 344–357. [Article]
Reilly, S., Bavin, E. L., Bretherton, L., Conway, L., Eadie, P., Cini, E., … Wake, M. (2009). The Early Language in Victoria Study (ELVS): A prospective, longitudinal study of communication skills and expressive vocabulary development at 8, 12 and 24 months. International Journal of Speech-Language Pathology, 11, 344–357. [Article] ×
Reilly, S., Kefalianos, E., & Smith, K. (2013). The natural history of stuttering onset and recovery: Data from a longitudinal study. Enfance, 3, 275–285. [Article]
Reilly, S., Kefalianos, E., & Smith, K. (2013). The natural history of stuttering onset and recovery: Data from a longitudinal study. Enfance, 3, 275–285. [Article] ×
Reilly, S., Onslow, M., Packman, A., Cini, E., Conway, L., Ukoumunne, O. C., … Wake, M. (2013). Natural history of stuttering to 4 years of age: A prospective community-based study. Pediatrics, 132, 460–467. [Article] [PubMed]
Reilly, S., Onslow, M., Packman, A., Cini, E., Conway, L., Ukoumunne, O. C., … Wake, M. (2013). Natural history of stuttering to 4 years of age: A prospective community-based study. Pediatrics, 132, 460–467. [Article] [PubMed]×
Reilly, S., Onslow, M., Packman, A., Wake, M., Bavin, E. L., Prior, M., … Ukoumunne, O. C. (2009). Predicting stuttering onset by the age of 3 years: A prospective, community cohort study. Pediatrics, 123, 270–277. [Article] [PubMed]
Reilly, S., Onslow, M., Packman, A., Wake, M., Bavin, E. L., Prior, M., … Ukoumunne, O. C. (2009). Predicting stuttering onset by the age of 3 years: A prospective, community cohort study. Pediatrics, 123, 270–277. [Article] [PubMed]×
Scaler Scott, K., Tetnowski, J. A., Flaitz, J. R., & Yaruss, J. S. (2014). Preliminary study of disfluency in school-aged children with autism. International Journal of Language & Communication Disorders, 49, 75–89. https://doi.org/10.1111/1460-6984.12048 [Article] [PubMed]
Scaler Scott, K., Tetnowski, J. A., Flaitz, J. R., & Yaruss, J. S. (2014). Preliminary study of disfluency in school-aged children with autism. International Journal of Language & Communication Disorders, 49, 75–89. https://doi.org/10.1111/1460-6984.12048 [Article] [PubMed]×
Serry, T. A., Castles, A., Mensah, F. K., Bavin, E. L., Eadie, P., Pezic, A., … Reilly, S. (2015). Developing a comprehensive model of risk and protective factors that can predict spelling at age seven: Findings from a community sample of Victorian children. Australian Journal of Learning Difficulties, 20, 83–102. [Article]
Serry, T. A., Castles, A., Mensah, F. K., Bavin, E. L., Eadie, P., Pezic, A., … Reilly, S. (2015). Developing a comprehensive model of risk and protective factors that can predict spelling at age seven: Findings from a community sample of Victorian children. Australian Journal of Learning Difficulties, 20, 83–102. [Article] ×
Skeat, J., Eadie, P., Ukoumunne, O., & Reilly, S. (2010). Predictors of parents seeking help or advice about children's communication development in the early years. Child: Care, Health & Development, 36, 878–887. https://doi.org/10.1111/j.1365-2214.2010.01093.x [Article]
Skeat, J., Eadie, P., Ukoumunne, O., & Reilly, S. (2010). Predictors of parents seeking help or advice about children's communication development in the early years. Child: Care, Health & Development, 36, 878–887. https://doi.org/10.1111/j.1365-2214.2010.01093.x [Article] ×
Smith, K. A., Iverach, L., O'Brian, S., Kefalianos, E., & Reilly, S. (2014). Anxiety of children and adolescents who stutter: A review. Journal of Fluency Disorders, 40, 22–34. https://doi.org/10.1016/j.jfludis.2014.01.003 [Article] [PubMed]
Smith, K. A., Iverach, L., O'Brian, S., Kefalianos, E., & Reilly, S. (2014). Anxiety of children and adolescents who stutter: A review. Journal of Fluency Disorders, 40, 22–34. https://doi.org/10.1016/j.jfludis.2014.01.003 [Article] [PubMed]×
Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36, 545–566. [Article] [PubMed]
Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36, 545–566. [Article] [PubMed]×
Spence, S. H., Barrett, P. M., & Turner, C. M. (2003). Psychometric properties of the Spence Children's Anxiety Scale with young adolescents. Journal of Anxiety Disorders, 17, 605–625. [Article] [PubMed]
Spence, S. H., Barrett, P. M., & Turner, C. M. (2003). Psychometric properties of the Spence Children's Anxiety Scale with young adolescents. Journal of Anxiety Disorders, 17, 605–625. [Article] [PubMed]×
Stone, L., Otten, R., Engels, R., Janssens, J., Vermulst, A., & Van Der Maten, M. (2010). Psychometric properties of the parent and teacher versions of the Strengths and Difficulties Questionnaire for 4 to 12 year olds: A review. Clinical Child and Family Psychological Review, 13, 253–274. https://doi.org/10.1007/s10567-010-0071-2 [Article]
Stone, L., Otten, R., Engels, R., Janssens, J., Vermulst, A., & Van Der Maten, M. (2010). Psychometric properties of the parent and teacher versions of the Strengths and Difficulties Questionnaire for 4 to 12 year olds: A review. Clinical Child and Family Psychological Review, 13, 253–274. https://doi.org/10.1007/s10567-010-0071-2 [Article] ×
Teesson, K., Packman, A., & Onslow, M. (2003). The Lidcombe Behavioral Data Language of stuttering. Journal of Speech, Language, and Hearing Research, 46, 1009–1015. https://doi.org/10.1044/1092-4388(2003/078) [Article]
Teesson, K., Packman, A., & Onslow, M. (2003). The Lidcombe Behavioral Data Language of stuttering. Journal of Speech, Language, and Hearing Research, 46, 1009–1015. https://doi.org/10.1044/1092-4388(2003/078) [Article] ×
Watts, A., Eadie, P., Block, S., Mensah, F., & Reilly, S. (2015). Language ability of children with and without a history of stuttering: A longitudinal cohort study. International Journal of Speech-Language Pathology, 17, 86–95. [Article] [PubMed]
Watts, A., Eadie, P., Block, S., Mensah, F., & Reilly, S. (2015). Language ability of children with and without a history of stuttering: A longitudinal cohort study. International Journal of Speech-Language Pathology, 17, 86–95. [Article] [PubMed]×
Whiteside, S. P., & Brown, A. M. (2008). Exploring the utility of the Spence Children's Anxiety Scales parent- and child-report forms in a North American sample. Journal of Anxiety Disorders, 22, 1440–1446. https://doi.org/10.1016/j.janxdis.2008.02.006 [Article] [PubMed]
Whiteside, S. P., & Brown, A. M. (2008). Exploring the utility of the Spence Children's Anxiety Scales parent- and child-report forms in a North American sample. Journal of Anxiety Disorders, 22, 1440–1446. https://doi.org/10.1016/j.janxdis.2008.02.006 [Article] [PubMed]×
Figure 1.

Flow of Early Language in Victoria Study (ELVS) participants into present study.

 Flow of Early Language in Victoria Study (ELVS) participants into present study.
Figure 1.

Flow of Early Language in Victoria Study (ELVS) participants into present study.

×
Table 1. Variable and variable types.
Variable and variable types.×
Variable Details Completed by Variable type a
Presence of anxiety 1. Spence Children's Anxiety Scale 1. Stuttering cohort: parents and children 1. Continuous
2. Strengths and Difficulties Questionnaire 2. ELVS cohort: parents and children 2. Continuous
Presence of specific temperament dimensions The School-Age Temperament Inventory Stuttering cohort: parents Continuous
Exposure to teasing and bullying Child yes/no response to experience of teasing and/or bulling ELVS cohort: children via ELVS Child Questionnaire Categorical, coded as yes/no
Stuttering treatment status Parent yes/no response to question asking if their child had received stuttering therapy in the last 12 months Stuttering cohort: parents via ELVS Parent Questionnaire Categorical, coded as yes/no
Diagnosis of ASD Parent yes/no response to question asking if their child had received a diagnosis of ASD ELVS cohort: parents via ELVS Parent Questionnaire Categorical, coded as yes/no
Diagnosis of LD Parent yes/no response to question asking if their child had received a diagnosis of LD ELVS cohort: parents via ELVS Parent Questionnaire Categorical, coded as yes/no
Gender Gender of participant ELVS cohort: parents via ELVS Parent Questionnaire Categorical, coded as male/female
Maternal mental health Measured with Kessler-6 ELVS cohort: parents; longitudinal data from annual ELVS Parent Questionnaires Continuous
Socioeconomic status Measured with the Socio-Economic Index for Areas, Index of Relative Disadvantage ELVS cohort: parents via ELVS Parent Questionnaire Continuous
Stuttering severity rating 10-point rating scale, 1 = no stuttering and 10 = very severe stuttering Stuttering cohort: parents and children in the persistent stuttering group only: via ELVS Parent Questionnaire and the Stuttering Outcome Call Continuous
Age of onset Whether stuttering onset occurred pre– or post–4 years of age ELVS cohort: via ELVS Parent Questionnaire and longitudinal data from previous ELVS stuttering studies Categorical, coded as pre–/post–4 years
Note. ELVS = Early Language in Victoria Study; ASD = autism spectrum disorder; LD = learning difficulties.
Note. ELVS = Early Language in Victoria Study; ASD = autism spectrum disorder; LD = learning difficulties.×
a Represents how variables were included in the regression models for the majority of the analyses. Linearity was assessed statistically via likelihood ratio test. In a small number of analyses, the likelihood ratio test returned p < .05, indicating there was significant evidence that the relationship between variables was not linear. In such cases, variables were included as categorical variables.
Represents how variables were included in the regression models for the majority of the analyses. Linearity was assessed statistically via likelihood ratio test. In a small number of analyses, the likelihood ratio test returned p < .05, indicating there was significant evidence that the relationship between variables was not linear. In such cases, variables were included as categorical variables.×
Table 1. Variable and variable types.
Variable and variable types.×
Variable Details Completed by Variable type a
Presence of anxiety 1. Spence Children's Anxiety Scale 1. Stuttering cohort: parents and children 1. Continuous
2. Strengths and Difficulties Questionnaire 2. ELVS cohort: parents and children 2. Continuous
Presence of specific temperament dimensions The School-Age Temperament Inventory Stuttering cohort: parents Continuous
Exposure to teasing and bullying Child yes/no response to experience of teasing and/or bulling ELVS cohort: children via ELVS Child Questionnaire Categorical, coded as yes/no
Stuttering treatment status Parent yes/no response to question asking if their child had received stuttering therapy in the last 12 months Stuttering cohort: parents via ELVS Parent Questionnaire Categorical, coded as yes/no
Diagnosis of ASD Parent yes/no response to question asking if their child had received a diagnosis of ASD ELVS cohort: parents via ELVS Parent Questionnaire Categorical, coded as yes/no
Diagnosis of LD Parent yes/no response to question asking if their child had received a diagnosis of LD ELVS cohort: parents via ELVS Parent Questionnaire Categorical, coded as yes/no
Gender Gender of participant ELVS cohort: parents via ELVS Parent Questionnaire Categorical, coded as male/female
Maternal mental health Measured with Kessler-6 ELVS cohort: parents; longitudinal data from annual ELVS Parent Questionnaires Continuous
Socioeconomic status Measured with the Socio-Economic Index for Areas, Index of Relative Disadvantage ELVS cohort: parents via ELVS Parent Questionnaire Continuous
Stuttering severity rating 10-point rating scale, 1 = no stuttering and 10 = very severe stuttering Stuttering cohort: parents and children in the persistent stuttering group only: via ELVS Parent Questionnaire and the Stuttering Outcome Call Continuous
Age of onset Whether stuttering onset occurred pre– or post–4 years of age ELVS cohort: via ELVS Parent Questionnaire and longitudinal data from previous ELVS stuttering studies Categorical, coded as pre–/post–4 years
Note. ELVS = Early Language in Victoria Study; ASD = autism spectrum disorder; LD = learning difficulties.
Note. ELVS = Early Language in Victoria Study; ASD = autism spectrum disorder; LD = learning difficulties.×
a Represents how variables were included in the regression models for the majority of the analyses. Linearity was assessed statistically via likelihood ratio test. In a small number of analyses, the likelihood ratio test returned p < .05, indicating there was significant evidence that the relationship between variables was not linear. In such cases, variables were included as categorical variables.
Represents how variables were included in the regression models for the majority of the analyses. Linearity was assessed statistically via likelihood ratio test. In a small number of analyses, the likelihood ratio test returned p < .05, indicating there was significant evidence that the relationship between variables was not linear. In such cases, variables were included as categorical variables.×
×
Table 2. Distribution of child and family characteristics of 702 nonstuttering controls, 121 recovered stuttering cases, and 20 persistent stuttering cases.
Distribution of child and family characteristics of 702 nonstuttering controls, 121 recovered stuttering cases, and 20 persistent stuttering cases.×
Characteristic Nonstuttering controls Recovered stuttering Persistent stuttering
n (%) 702 (83.3) 121 (14.4) 20 (2.4)
Gender, n (%)
 Female 404 (57.6) 46 (38.0) 7 (35.0)
 Male 298 (42.5) 75 (62.0) 13 (65.0)
Socio-Economic Index for Areas, Index of Relative Disadvantage disadvantage score, M (SD) 1,044.8 (53.2) 1,045.7 (51.4) 1,037 (49.7)
Maternal mental health score, M (SD) 3.2 (2.3) 3.2 (2.0) 3.6 (2.0)
Diagnosis other than stuttering, n (%)
 Learning difficulties 46 (6.7) 7 (6.1) 4 (20.0)
 Autism spectrum disorder 41 (5.9) 5 (4.3) 4 (20.0)
Stuttering cohort only
Age of stuttering onset, n (%)
 Pre–4 years of age 94 (77.7) 11 (55)
 Post–4 years of age 27 (22.3) 9 (45)
Ever sought treatment for stuttering, n (%) 12 (9.9) 5 (25)
Mean stuttering severity (range) 3.9 (2, 6.7)
Table 2. Distribution of child and family characteristics of 702 nonstuttering controls, 121 recovered stuttering cases, and 20 persistent stuttering cases.
Distribution of child and family characteristics of 702 nonstuttering controls, 121 recovered stuttering cases, and 20 persistent stuttering cases.×
Characteristic Nonstuttering controls Recovered stuttering Persistent stuttering
n (%) 702 (83.3) 121 (14.4) 20 (2.4)
Gender, n (%)
 Female 404 (57.6) 46 (38.0) 7 (35.0)
 Male 298 (42.5) 75 (62.0) 13 (65.0)
Socio-Economic Index for Areas, Index of Relative Disadvantage disadvantage score, M (SD) 1,044.8 (53.2) 1,045.7 (51.4) 1,037 (49.7)
Maternal mental health score, M (SD) 3.2 (2.3) 3.2 (2.0) 3.6 (2.0)
Diagnosis other than stuttering, n (%)
 Learning difficulties 46 (6.7) 7 (6.1) 4 (20.0)
 Autism spectrum disorder 41 (5.9) 5 (4.3) 4 (20.0)
Stuttering cohort only
Age of stuttering onset, n (%)
 Pre–4 years of age 94 (77.7) 11 (55)
 Post–4 years of age 27 (22.3) 9 (45)
Ever sought treatment for stuttering, n (%) 12 (9.9) 5 (25)
Mean stuttering severity (range) 3.9 (2, 6.7)
×
Table 3. Mean differences in the Spence Children's Anxiety Scale Child Report (SCAS-C) and Parent Report (SCAS-P) subscale scores and total scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).
Mean differences in the Spence Children's Anxiety Scale Child Report (SCAS-C) and Parent Report (SCAS-P) subscale scores and total scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).×
SCAS subscale and total score Parent (n = 110), child (n = 98) report Unadjusted
Adjusted
Mean difference [95% CI] Effect size p Mean difference [95% CI] Effect size p
Panic attack and agoraphobia Parent 0.8 [0.0, 1.6] 0.5 [0.0, 1.0] .058** −0.1 [−1.9, 1.6] 0.0 [−1.2, 1.0] .885
Child 0.5 [−0.8, 1.9] 0.2 [−0.3, 0.6] .439 −0.4 [−4.5, 3.6] −0.1 [−1.3, 1.1] .821
Separation anxiety Parent 1.7 [0.5, 3.0] 0.6 [0.2, 1.1] .008* −1.0 [−4.2, 2.2] −0.4 [−0.6, 0.8] .537
Child 1.6 [0.1, 3.1] 0.5 [0.0, 1.0] .040* −0.6 [−4.5, 3.3] −0.2 [−1.5, 1.1] .751
Physical injury fears Parent 1.0 [0.0, 1.9] 0.5 [0.0, 1.0] .053** −0.5 [−2.8, 1.8] −0.2 [−1.4, 0.9] .685
Child 1.5 [0.4, 2.7] 0.6 [0.1, 1.1] .011* −0.8 [−4.1, 2.5] −0.3 [−1.6, 1.0] .635
Social phobia Parent 1.4 [−0.1, 2.9] 0.5 [0.0, 1.0] .063** −0.2 [−3.6, 4.1] 0.1 [−1.2, 1.4] .914
Child 0.6 [−1.1, 2.3] 0.2 [−0.3, 0.7] .471 1.1 [−3.4, 5.5] 0.3 [−1.0, 1.6] .639
Obsessive-compulsive disorder Parent 1.5 [0.8, 2.2] 1.0 [0.5, 1.5] < .001* −0.6 [−1.7, 0.4] −0.4 [−1.2, 0.3] .238
Child 1.4 [0.0, 2.8] 0.5 [0.0, 1.0] .044* −0.5 [−4.1, 3.0] −0.2 [−1.4, 1.1] .759
Generalized anxiety disorder Parent 0.8 [−0.3, 2.0] 0.4 [−0.1, 0.8] .154 −0.4 [−3.1, 2.4] −0.2 [−1.3, 1.0] .797
Child 0.7 [−1.0, 2.3] 0.2 [−0.3, 0.7] .393 2.7 [−1.6, 7.0] 0.8 [−0.5, 2.1] .219
Total score Parent 7.3 [2.5, 12.1] 0.7 [0.3, 1.2] .003* −2.5 [−9.9, 4.9] −0.3 [−1.0, 0.5] .497
Child 7.7 [0.2, 15.3] 0.5 [0.0, 1.0] .046** 0.7 [−19.8, 21.2] 0.0 [−1.3, 1.4] .945
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.×
* p ≤ .05.
p ≤ .05.×
** p ≤ .10.
p ≤ .10.×
Table 3. Mean differences in the Spence Children's Anxiety Scale Child Report (SCAS-C) and Parent Report (SCAS-P) subscale scores and total scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).
Mean differences in the Spence Children's Anxiety Scale Child Report (SCAS-C) and Parent Report (SCAS-P) subscale scores and total scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).×
SCAS subscale and total score Parent (n = 110), child (n = 98) report Unadjusted
Adjusted
Mean difference [95% CI] Effect size p Mean difference [95% CI] Effect size p
Panic attack and agoraphobia Parent 0.8 [0.0, 1.6] 0.5 [0.0, 1.0] .058** −0.1 [−1.9, 1.6] 0.0 [−1.2, 1.0] .885
Child 0.5 [−0.8, 1.9] 0.2 [−0.3, 0.6] .439 −0.4 [−4.5, 3.6] −0.1 [−1.3, 1.1] .821
Separation anxiety Parent 1.7 [0.5, 3.0] 0.6 [0.2, 1.1] .008* −1.0 [−4.2, 2.2] −0.4 [−0.6, 0.8] .537
Child 1.6 [0.1, 3.1] 0.5 [0.0, 1.0] .040* −0.6 [−4.5, 3.3] −0.2 [−1.5, 1.1] .751
Physical injury fears Parent 1.0 [0.0, 1.9] 0.5 [0.0, 1.0] .053** −0.5 [−2.8, 1.8] −0.2 [−1.4, 0.9] .685
Child 1.5 [0.4, 2.7] 0.6 [0.1, 1.1] .011* −0.8 [−4.1, 2.5] −0.3 [−1.6, 1.0] .635
Social phobia Parent 1.4 [−0.1, 2.9] 0.5 [0.0, 1.0] .063** −0.2 [−3.6, 4.1] 0.1 [−1.2, 1.4] .914
Child 0.6 [−1.1, 2.3] 0.2 [−0.3, 0.7] .471 1.1 [−3.4, 5.5] 0.3 [−1.0, 1.6] .639
Obsessive-compulsive disorder Parent 1.5 [0.8, 2.2] 1.0 [0.5, 1.5] < .001* −0.6 [−1.7, 0.4] −0.4 [−1.2, 0.3] .238
Child 1.4 [0.0, 2.8] 0.5 [0.0, 1.0] .044* −0.5 [−4.1, 3.0] −0.2 [−1.4, 1.1] .759
Generalized anxiety disorder Parent 0.8 [−0.3, 2.0] 0.4 [−0.1, 0.8] .154 −0.4 [−3.1, 2.4] −0.2 [−1.3, 1.0] .797
Child 0.7 [−1.0, 2.3] 0.2 [−0.3, 0.7] .393 2.7 [−1.6, 7.0] 0.8 [−0.5, 2.1] .219
Total score Parent 7.3 [2.5, 12.1] 0.7 [0.3, 1.2] .003* −2.5 [−9.9, 4.9] −0.3 [−1.0, 0.5] .497
Child 7.7 [0.2, 15.3] 0.5 [0.0, 1.0] .046** 0.7 [−19.8, 21.2] 0.0 [−1.3, 1.4] .945
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.×
* p ≤ .05.
p ≤ .05.×
** p ≤ .10.
p ≤ .10.×
×
Table 4. Mean differences in Strengths and Difficulties Questionnaire [SDQ; child and parent report] subscale scores, total scores, internalizing difficulties, and anxiety-specific questions when comparing the group with persistent stuttering and recovered stuttering group with the nonstuttering controls [reference group].
Mean differences in Strengths and Difficulties Questionnaire [SDQ; child and parent report] subscale scores, total scores, internalizing difficulties, and anxiety-specific questions when comparing the group with persistent stuttering and recovered stuttering group with the nonstuttering controls [reference group].×
SDQ subscale and total score Parent/child report Unadjusted
Adjusted
Recovered stuttering, M [95% CI] p Persistent stuttering, M [95% CI] p Recovered stuttering, M [95% CI] p Persistent stuttering, M [95% CI] p
Emotional symptoms Parent −0.2 [−0.6, 0.2] .346 1.3 [0.3, 2.2] .008* −1.0 [−2.9, 0.9] .288 −0.9 [−4.1, 2.3] .288
Child −0.1 [−0.5, 0.4] .816 0.1 [−0.9, 1.0] .883 −1.2 [−3.1, 0.8] .235 −0.3 [−3.6, 3.0] .861
Conduct problems Parent 0.0 [−0.3, 0.3] .969 0.0 [−0.6, 0.7] .957 0.2 [−0.9, 1.2] .747 −1.1 [−3.0, 0.8] .209
Child 0.1 [−0.3, 0.4] .711 0.3 [−0.4, 1.0] .397 −0.2 [−1.5, 1.2] .820 −1.9 [−4.1, 0.4] .098**
Hyperactivity/inattention Parent −0.1 [−0.5, 0.4] .811 1.8 [0.7, 2.9] .001* −1.4 [−3.7, 1.0] .253 −0.7 [−4.6, 3.3] .738
Child 0.2 [−0.3, 0.7] .430 0.6 [−0.4, 1.6] .260 −0.2 [−2.5, 2.2] .878 −1.2 [−5.0, 2.9] .599
Peer problems Parent −0.1 [−0.4, 0.2] .560 1.0 [0.3, 1.7] .007* −0.1 [−1.4, 1.1] .831 −0.8 [−2.9, 1.4] .472
Child 0.1 [−0.3, 0.4] .684 0.8 [0.1, 1.6] .024* −0.2 [−1.6, 1.2] .800 0.2 [−2.1, 2.5] .869
Prosocial Parent −0.1 [−0.4, 0.3] .725 −0.5 [−1.2, 0.3] .228 1.4 [−0.3, 3.0] .097** 3.3 [0.6, 6.1] .018*
Child −0.1 [−0.4, 0.2] .487 −0.5 [−1.2, 0.1] .124** −0.0 [−1.5, 1.5] .966 0.0 [−2.6, 2.5] .979
Total difficulties Parent −0.3 [−1.4, 0.8] .546 4.1 [1.5, 6.6] .002* −2.4 [−7.0, 2.1] .294 −3.6 [−11.3, 4.1] .360
Child 0.3 [−0.9, 1.5] .651 1.8 [−0.7, 4.4] .164 −1.7 [−6.7, 3.3] .570 −3.0 [−11.4, 5.5] .490
Internalizing difficulties Parent −0.3 [−0.9, 0.3] .352 2.3 [0.8, 3.6] .002* −1.2 [−3.5, 1.1] .313 −1.7 [−5.6, 2.2] .395
Child 0.0 [−0.7, 0.7] .955 0.9 [−0.5, 2.4] .213 −1.4 [−4.1, 1.4] .333 0.0 [−4.8, 6.6] .966
Anxiety-specific questions Parent −0.2 [−0.5, 0.1] .290 1.1 [0.5, 1.8] .001* −1.4 [−2.7, 0.1] .048* −0.5 [−3.3, 2.5] .767
Child 0.0 [−0.4, 0.3] .829 0.0 [−0.7, 0.7] .919 −1.4 [−2.9, 0.0] .046* −0.7 [−3.1, 1.7] .552
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.×
* p ≤ .05.
p ≤ .05.×
** p ≤ .10.
p ≤ .10.×
Table 4. Mean differences in Strengths and Difficulties Questionnaire [SDQ; child and parent report] subscale scores, total scores, internalizing difficulties, and anxiety-specific questions when comparing the group with persistent stuttering and recovered stuttering group with the nonstuttering controls [reference group].
Mean differences in Strengths and Difficulties Questionnaire [SDQ; child and parent report] subscale scores, total scores, internalizing difficulties, and anxiety-specific questions when comparing the group with persistent stuttering and recovered stuttering group with the nonstuttering controls [reference group].×
SDQ subscale and total score Parent/child report Unadjusted
Adjusted
Recovered stuttering, M [95% CI] p Persistent stuttering, M [95% CI] p Recovered stuttering, M [95% CI] p Persistent stuttering, M [95% CI] p
Emotional symptoms Parent −0.2 [−0.6, 0.2] .346 1.3 [0.3, 2.2] .008* −1.0 [−2.9, 0.9] .288 −0.9 [−4.1, 2.3] .288
Child −0.1 [−0.5, 0.4] .816 0.1 [−0.9, 1.0] .883 −1.2 [−3.1, 0.8] .235 −0.3 [−3.6, 3.0] .861
Conduct problems Parent 0.0 [−0.3, 0.3] .969 0.0 [−0.6, 0.7] .957 0.2 [−0.9, 1.2] .747 −1.1 [−3.0, 0.8] .209
Child 0.1 [−0.3, 0.4] .711 0.3 [−0.4, 1.0] .397 −0.2 [−1.5, 1.2] .820 −1.9 [−4.1, 0.4] .098**
Hyperactivity/inattention Parent −0.1 [−0.5, 0.4] .811 1.8 [0.7, 2.9] .001* −1.4 [−3.7, 1.0] .253 −0.7 [−4.6, 3.3] .738
Child 0.2 [−0.3, 0.7] .430 0.6 [−0.4, 1.6] .260 −0.2 [−2.5, 2.2] .878 −1.2 [−5.0, 2.9] .599
Peer problems Parent −0.1 [−0.4, 0.2] .560 1.0 [0.3, 1.7] .007* −0.1 [−1.4, 1.1] .831 −0.8 [−2.9, 1.4] .472
Child 0.1 [−0.3, 0.4] .684 0.8 [0.1, 1.6] .024* −0.2 [−1.6, 1.2] .800 0.2 [−2.1, 2.5] .869
Prosocial Parent −0.1 [−0.4, 0.3] .725 −0.5 [−1.2, 0.3] .228 1.4 [−0.3, 3.0] .097** 3.3 [0.6, 6.1] .018*
Child −0.1 [−0.4, 0.2] .487 −0.5 [−1.2, 0.1] .124** −0.0 [−1.5, 1.5] .966 0.0 [−2.6, 2.5] .979
Total difficulties Parent −0.3 [−1.4, 0.8] .546 4.1 [1.5, 6.6] .002* −2.4 [−7.0, 2.1] .294 −3.6 [−11.3, 4.1] .360
Child 0.3 [−0.9, 1.5] .651 1.8 [−0.7, 4.4] .164 −1.7 [−6.7, 3.3] .570 −3.0 [−11.4, 5.5] .490
Internalizing difficulties Parent −0.3 [−0.9, 0.3] .352 2.3 [0.8, 3.6] .002* −1.2 [−3.5, 1.1] .313 −1.7 [−5.6, 2.2] .395
Child 0.0 [−0.7, 0.7] .955 0.9 [−0.5, 2.4] .213 −1.4 [−4.1, 1.4] .333 0.0 [−4.8, 6.6] .966
Anxiety-specific questions Parent −0.2 [−0.5, 0.1] .290 1.1 [0.5, 1.8] .001* −1.4 [−2.7, 0.1] .048* −0.5 [−3.3, 2.5] .767
Child 0.0 [−0.4, 0.3] .829 0.0 [−0.7, 0.7] .919 −1.4 [−2.9, 0.0] .046* −0.7 [−3.1, 1.7] .552
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.×
* p ≤ .05.
p ≤ .05.×
** p ≤ .10.
p ≤ .10.×
×
Table 5. Mean differences in School-Age Temperament Inventory (SATI) scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).
Mean differences in School-Age Temperament Inventory (SATI) scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).×
SATI dimension Unadjusted
Adjusted
Mean difference [95% CI] Effect size p Mean difference [95% CI] Effect size p
Negative reactivity 0.3 [−0.1, 0.6] 0.3 [−0.2, 0.8] .175 0.2 [−0.7, 1.0] 0.2 [−1.0, 1.3] .715
Task persistence −0.3 [−0.6, 0.0] −0.4 [−0.9, 0.1] .089** 0.4 [−0.4, 1.2] 0.7 [−0.6, 1.9] .285
Approach/withdrawal 0.4 [0.1, 0.6] 0.6 [0.1, 1.1] .020* −0.2 [−0.7, 0.3] −0.4 [−1.1, 0.4] .333
Activity 0.3 [−0.1, 0.6] 0.3 [−0.1, 0.8] .166 0.1 [−0.9, 1.0] 0.1 [−1.2, 1.4] .881
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.×
* p ≤ .05.
p ≤ .05.×
** p ≤ .10.
p ≤ .10.×
Table 5. Mean differences in School-Age Temperament Inventory (SATI) scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).
Mean differences in School-Age Temperament Inventory (SATI) scores when comparing the group with persistent stuttering with the recovered stuttering group (reference group).×
SATI dimension Unadjusted
Adjusted
Mean difference [95% CI] Effect size p Mean difference [95% CI] Effect size p
Negative reactivity 0.3 [−0.1, 0.6] 0.3 [−0.2, 0.8] .175 0.2 [−0.7, 1.0] 0.2 [−1.0, 1.3] .715
Task persistence −0.3 [−0.6, 0.0] −0.4 [−0.9, 0.1] .089** 0.4 [−0.4, 1.2] 0.7 [−0.6, 1.9] .285
Approach/withdrawal 0.4 [0.1, 0.6] 0.6 [0.1, 1.1] .020* −0.2 [−0.7, 0.3] −0.4 [−1.1, 0.4] .333
Activity 0.3 [−0.1, 0.6] 0.3 [−0.1, 0.8] .166 0.1 [−0.9, 1.0] 0.1 [−1.2, 1.4] .881
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.
Note. Adjusted models controlled for gender, Socio-Economic Index for Areas, Index of Relative Disadvantage, mean maternal mental health, exposure to teasing/bullying, stuttering severity, age of onset, and diagnosis of autism spectrum disorder and learning difficulties.×
* p ≤ .05.
p ≤ .05.×
** p ≤ .10.
p ≤ .10.×
×