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Stuttering has social consequences, even for 3 and 4 year olds

Title of article reviewed: “Peer Responses to Stuttering in the Preschool Setting”
Authors: Marilyn Langevin, Ann Packman, and Mark Onslow, Australian Stuttering Research Centre, University of Sydney, New South Wales, Australia

marilyn Marilyn Langevin

Sean is a 4-year-old preschooler who stutters. He enjoys playing with his friends, but at times the words get in the way. In the same city live three other preschoolers who stutter – Aaron, Sarah, and David.  Stuttering affects each of them at preschool, especially when they’re playing with their friends.

What these preschoolers have in common, aside from being children who stutter, is the fact that they were subjects of a research project that Marilyn Langevin, of the University of Alberta, completed for her PhD dissertation at the University of Sydney, New South Wales, Australia. Their names are pseudonyms.

Research based on observations of the four children by Marilyn Langevin, Ann Packman, and Mark Onslow, yields new information about how stuttering affects social interactions among preschool children.

The American Journal of Speech-Language Pathology has chosen “Peer Responses to Stuttering in the Preschool Setting,” the journal article based on this research, as the recipient of an ASHA (American Speech-Language Hearing Association) Editor’s Award for 2009. An article selected for an Editor’s Award is the one that the editor and associate editor of a given journal feel meets the highest quality standards in research design, presentation, and impact for a given year. It is a major honour and a significant achievement to receive this Award.

One in 20 people stutter during childhood when learning to speak. Many outgrow it, meaning that the incidence of stuttering among adults is one in 100 people. In deciding when to start treatment, clinicians have focused on what is known about the natural recovery from childhood stuttering, and the responsiveness of a given child to treatments such as the Lidcombe Program.

Now a third factor – the social penalties that stuttering preschoolers may encounter – has been added to the mix. “If stuttering is negatively affecting the social experiences of children in play,” say the authors, “then treatment may need to be started earlier rather than later.”

Even infrequent negative peer responses to stuttering have social consequences

Most responses to stuttered utterances observed in this study were neutral/positive. When a child stuttered while trying to say something, most of the time the child’s peers carried on as would be normal and appropriate when children are engaged in play. Negative responses were infrequent. Yet stuttering did have social consequences. Even a once-a-week negative peer response to stuttering can affect a child’s emotional and social well-being.

For some children, stuttering decreases the effectiveness of communication during play. In other cases there is minimal effect. Stuttering that is less complex in nature may protect against negative peer reactions to stuttering.

In negative responses observed in the study, peers reacted with confusion, or they interrupted, mocked, walked away from, or ignored what the stuttering preschooler had said. The stuttered utterances that met with negative responses typically lacked meaning, contained stutters that were behaviourally complex, and/or were long in duration.

There were also other instances of social interactions not working out so well for the preschoolers who stuttered such as difficulty in leading peers in group play, engaging in pretend play; and in resolving conflicts.

The report is based on observation of four children at play.

The researchers analyzed the outdoor play experiences of four preschoolers who stutter, three boys and one girl, who were on treatment waiting lists in clinics in Sydney, Australia. Their pseudonyms were Aaron, 4; Sean, 4; Sarah, 3; and David, 3. Parent reports of the impact of stuttering were obtained using a questionnaire. The brief initial descriptions of the children, based on parent reports, are evocative and compelling. For example, David was reported by a parent to have become sad when he was unable to “get words out.”

The researchers’ general observations, regarding the impact of stuttering on social interactions, were equally evocative. Aaron, for example, found it hard to lead peers in play and had difficulty participating in play involving rubber ducks. The outcome was that “Aaron finally moved to another part of the sandpit and played alone.”

In Sean’s case, sometimes peers ignored him when he stuttered. In one instance when he tried to become involved in play he was told to “go away.” Sarah had an easy, fluid style of syllable repetition of short durations; her stuttered utterances were always judged to be meaningful. Thus her stuttering did not impede her ability to complete an utterance or communicate her message. She also avoided stutters by changing words.

David’s stuttering was characterized by fixed postures, of short duration, of the speech production mechanism. He found it hard to contribute to group problem-solving discussions or explain events to his teacher, but achieved success in taking on a leadership role in play.

Sociodramatic play

Observational studies described in this report have not been done before. The children were video-recorded using a handheld camcorder and wireless lavaliere microphones (attached to small backpacks) during outdoor play sessions at their preschools. Outdoor play has many elements of free-play, including running, jumping, games of chase, and pretend play.

After recording, the sound tracks were transcribed, and the transcripts were broken down into utterances fitting into one of three categories of communication: (a) a complete thought, (b) an abandoned thought, or (c) an interrupted thought.
Utterances coded as having communicative intent were those in which the child spoke (a) to a peer or (b) to a teacher. Utterances defined as not having communicative intent were ones in which a child spoke to herself during solitary play or parallel play. A feature of group play is that talking will have communicative intent; the conversation that emerges involves the group activity in which the children are engaged.

The study used a coding system based on codes of play behaviour developed to measure social interactions at play. The codes involve three categories of social participation: (a) solitary play, (b) parallel play, and (c) group play – as well as nonplay behaviours such as being unoccupied, being an onlooker, conversing with a peer, and interactions with teachers or adults.
In observation and analysis of play activities, the study distinguished between dramatic play, or solitary pretend play, and sociodramatic play, which features the cooperation of two or more children in pretend play. Both types of play involve imitation and make-believe in which children act out roles using verbal and performed acts. Sociodramatic play involves creativity and intellectual growth and promotes the formation of friendships. Adequate communication is important, given that this form of play proceeds when a child builds on a partner’s comments.

In such play, children negotiate and collaborate in building a script that is followed as the play proceeds. They also make verbal contributions on which they can build the script and in that way keep the play going. As play becomes more sophisticated, children tell each other what to say as well as telling each other what to do.

The study found that stuttering has the potential to limit the verbal participation of stuttering children in sociodramatic play in preschool settings. The researchers had not previously found mention – in parent reports, previous studies, or clinical experience – of such effects of stuttering on sociodramatic play.

Future research

The findings of this study are yet to be replicated. Given the small number of participants and design of the study, the results are not generalizable, but findings for the individual subjects may be relevant in individual clinical cases. Future research, with a larger and more representative group of preschoolers, is warranted regarding the impact of stuttering on the quality of preschoolers’ play, and their ability to lead peers in play, engage in sociodramatic play, and resolve conflicts during play.

Investigation of the usefulness of a “meaningfulness index” as an indication of communicative competence may also be warranted, according to the authors. Findings of the study will be used in future development of educational and assessment materials to help clinicians, preschool teachers, and care givers identify preschoolers at risk of experiencing social penalty for their stuttering.

Research from many disciplines indicates that what happens in the first six years of life has a powerful impact on everything else that follows in a person’s life. Good resources for further reading about this topic include papers by J. Fraser Mustard and Margaret Norrie McCain. Point your browser to these names to yield some great research reports. An underlying theme is that at any stage of life, healthy peer relationships are essential for a person’s happiness and well-being.

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