اختلالات رخ داده مشترک در کودکانی که لکنت زبان دارند

This study used a mail survey to determine the (a) percentage of children who stutter with co-occurring non-speech disorders, speech disorders, and language disorders, and (b) frequency, length of sessions, and type of treatment services provided for children who stutter with co-occurring disorders. Respondents from a nationwide sample included 1184 speech–language pathologists (SLPs). Of the 2628 children who stuttered, 62.8% had other co-occurring speech disorders, language disorders, or non-speech–language disorders. Articulation disorders (33.5%) and phonology disorders (12.7%) were the most frequently reported co-occurring speech disorders. Only 34.3% of the children who stuttered had co-occurring non-speech–language disorders. Of those children with co-occurring non-speech–language disorders, learning disabilities (15.2%), literacy disorders (8.2%), and attention deficit disorders (ADD) (5.9%) were the most frequently reported. Chi-square analyses revealed that males were more likely to exhibit co-occurring speech disorders than females, especially articulation and phonology. Co-occurring non-speech–language disorders were also significantly higher in males than females. Treatment decisions by SLPs are also discussed.

Clinicians and researchers working with individuals who stutter are all too aware of the fact that co-occurring speech and language disorders often complicate problem conceptualization, participant selection, methodological concerns, and therapy planning (Blood & Seider, 1981, Bloodstein, 1995 and Conture, 2001; Conture, Louko, & Edwards, 1993; Nippold, 1990 and Shapiro, 1999; St. Louis, Ruscello, & Lundeen, 1992). Studies examining co-occurring stuttering and other speech, language, and non-speech and language disorders have attempted to clarify the nature of stuttering in children and adults, the type and frequency of co-occurring speech, language and non-speech–language disorders, and provide support for reported subgroups in the heterogeneous population of individuals who stutter (Conture, 2001, Nippold, 1990, Schwartz & Conture, 1988, Watkins & Yairi, 1997, Yairi, 1990, Yairi & Ambrose, 1992 and Yairi & Ambrose, 1999). Recently, Arndt and Healey (2001) conducted a study to determine the number of children who stuttered with co-occurring language disorders and phonological disorders. They concluded, based on the survey data from 241 speech–language pathologists (SLPs) from 10 states in the United States, that 56% of the 467 children who stuttered had verified fluency disorders only, while 44% (205) had verified fluency and concomitant phonological and/or language disorders. They also obtained information about treatment decisions for children who stutter with co-occurring language and phonological disorders. According to the authors, the majority of SLPs reported using a “blended treatment” approach for these co-occurring disorders, which was defined as treating both disorders simultaneously within the therapy program. Their results provide important additional information about the relationships among fluency, language, and phonology disorders and SLPs’ treatment choices. The presence of co-occurring non-speech disorders such as those affecting learning, attention, reading and auditory processing may also influence decisions about treatment hierarchies for children who stutter (Conture, 2001 and Manning, 2002). A number of older studies have reported on the frequency of these co-occurring non-speech–language disorders, but few studies have conducted systematic investigations in school-age children who stutter. For example, Heltman and Peacher (1943) reported that of the 102 children with spastic paralysis that they examined, 3.9% exhibited stuttering disorders. Similarly, Anderson, Hood, and Sellers (1988) reported the presence of subtle central auditory processing disorders (CAPD) in children who stutter. Nippold and Schwarz (1990) reported conflicting findings in a review of the literature on the frequency of co-occurring reading disorders in children who stutter. However, the frequency of occurrence, the number and type of disorders, and the treatment choices for children with co-occurring non-speech–language disorders has not been studied in a nationwide sample. Determining the frequency of occurrence of disorders in children who stutter could enhance our information about subgroups in children who stutter. The recent Arndt and Healey (2001) study was an important first step in examining in a systematic manner co-occurring disorders of school-age children who stutter. Their data provide meaningful information for clinicians because children with fluency disorders and co-occurring phonology and/or language disorders may require different assessment and/or treatment programs than children with only a fluency disorder. The purpose of this study was to expand on earlier investigations about co-occurring disorders in children who stutter and specifically elaborate on the important contributions of the Arndt and Healey (2001) study. This type of research is important for enhancing our understanding about subgroups of children who stutter and the need to acknowledge/appreciate individual differences in children who stutter (Nippold, 1990, Schwartz & Conture, 1988, Watkins & Yairi, 1997 and Yairi, 1990). Controversy still exists about the conclusions drawn from data about co-occurring disorders in children who stutter. For example, Conture (2001) concluded that in the last few decades we have learned that the “prevalence of phonological concerns in the population of children who stutter is greater than in the population of children who don’t stutter” (p. 156). However, Nippold (2002) in her review of 15 studies examining the relationship between phonology and stuttering in children cautioned that “empirical evidence of an interaction (between stuttering and phonology) remains elusive” (p. 106). Such contrasting interpretations of the research demonstrate the need for studies to clarify the relationship between co-occurring disorders and stuttering. First, we decided to use a nationwide sampling procedure to ensure large geographic representation. The Arndt and Healey (2001) study was restricted to 10 states which shared similar definitions of “verifiable fluency disorders.” Second, we requested data only on speech, language, and non-speech–language disorders that could be documented through the students’ case histories, school files, information shared by parents, teachers, members of collaborative teams, or current diagnostic terms used to describe the child. The Arndt and Healey (2001) study supplied respondents with state verification/eligibility criteria. In the discussion section of the Arndt and Healey study they stated that it “is difficult to know whether respondents accurately interpreted and followed the verification criteria provided” (p. 77). Their study addressed co-occurring non-speech–language disorders in children who stutter in an interesting manner. They asked respondents to “provide information … of students who were verified as having a fluency disorder and were suspected of having a concomitant disorder, but did not meet their state’s verification criteria …. A suspected concomitant disorder was defined as one that was thought to exist but did not meet state verification standards” (p. 72). They reported that SLPs identified 109 children with “suspected concomitant disorders” including phonology, language, and non-speech–language disorders (voice, learning disorders, reading disorders, emotional disturbances, and attention deficit with hyperactivity disorders). Although these instructions provided some guidance, they could have resulted in an overestimate of the frequency of co-occurring disorders or may have been confusing for SLPs who tried to interpret what disorders should be included in a category of “suspected concomitant disorders.” In contrast, the SLPs surveyed in the present study were requested to provide information only on co-occurring disorders if they knew they could provide evidence (if requested). We explained that the rationale for this procedure was that we did not want to over-represent the students’ disorders by speculation, “clinical hunches,” or even the best intuitive guesses ( Appendix B). Third, we provided a detailed and more complete list of potential co-occurring speech disorders, language disorders, and non-speech–language disorders based on practicing SLPs’ feedback. We randomly sampled 35 SLPs prior to the survey about the types of co-occurring disorders of children on their caseloads who stutter. As a result, we included 18 categories including specific syndromes (e.g., Tourette’s) and specific disorders (e.g., sensory integration). We also subdivided language disorders into receptive and expressive problem categories, and further subdivided these categories into syntactic, semantic, and pragmatic disorders. We also provided a specific language impairment category. Similarly, instead of examining primarily phonology disorders, we included categories for other speech disorders including: articulation, voice, cluttering, dysphagia, and English as a second language. Finally, one of the unquestionable facts about stuttering is the higher prevalence among males than females. The generally accepted ratio is 3 males:1 female (Bloodstein, 1995 and Van Riper, 1982). Few studies have examined the gender factor when reporting on co-occurring disorders. It is possible that males may demonstrate different types and frequencies of co-occurring disorders than females. The Arndt and Healey (2001) study did not comment on the gender of the children in their methodology or results. Therefore, we specifically wanted to determine (a) the percentage and frequencies of male and female children who stutter with co-occurring speech disorders, language disorders and non-speech–language disorders, and (b) the frequency (number of therapy sessions), length of sessions (in minutes), and type (group vs. individual) of treatment services provided to children with co-occurring disorders.