سطوح اضطراب در نوجوانان که لکنت زبان دارند

High levels of anxiety can negatively affect the lives of children and adolescents. Thirty-six adolescents who stutter and 36 adolescents who do not stutter were administered standardized scales for anxiety and self-esteem. Significant differences were found for the total T-scores for Revised Children's Manifest Anxiety Scale for the two groups, although both groups mean T-scores were within normal range. Eighty-three percent of adolescents who stutter and 95% of adolescents who do not stutter earned scores in the normal range. No significant differences were found on the self-esteem scale, with 86% of adolescents who stutter and 97% of adolescents who do not stutter earning scores in the normal/positive range. Adolescents who stutter with co-occurring disorders displayed significantly higher levels of anxiety than adolescents who stutter with no co-occurring disorders. No significant differences were found between groups on ethnicity, socioeconomic class, gender and anxiety levels. A positive, significant correlation between anxiety scores and self-esteem scores was found for both groups. Learning outcomes: Readers will learn about and understand (a) the role of anxiety and self-esteem in stuttering; (b) the methods used to evaluate anxiety and self-esteem in adolescents; and (c) the similarities between adolescents who stutter and adolescents who do not stutter on anxiety and self-esteem scales.

Living with a chronic disability can negatively influence an individual's emotional and psychosocial adjustment. Stuttering is an unpredictable disorder (Bloodstein, 1995, Guitar, 2005, Manning, 2001 and Shapiro, 1999) with conflicting and variable responses from fluent communication partners and reported negative communication experiences (Bebout & Bradford, 1992; Ham, 1990; Ruscello, Lass, Schmitt, & Pannbacker, 1994; Turnbaugh, Guitar, & Hoffman, 1979; Woods & Williams, 1971). Data from qualitative studies suggest suffering, helplessness, shame, and stigma may be core experiences for some adults who stutter (Corcoran & Stewart, 1998; Crichton-Smith, 2002; Klompas & Ross, 2004). These experiences may make persons who stutter more susceptible to negative emotional responses, poorer self-esteem, and higher anxiety levels (Guitar, 2005, Manning, 2001, Shapiro, 1999, Silverman, 2004 and Van Riper, 1982). 1.1. Anxiety and adults who stutter Physiological and emotional anxiety has been reported in persons who stutter (Blomgren, Roy, Callister, & Merrill, 2005; Blood, Blood, Bennett, Simpson, & Susman, 1994; Blood, Wertz, Blood, Bennett, & Simpson, 1997; Caruso, Chodzko-Zajko, Bidinger, & Sommers, 1994; Craig, 1990; Craig, Hancock, Tran, & Craig, 2003; DeCarle & Pato, 1996; Dietrich & Roaan, 2001; Ezrati-Vinacour & Levin, 2004; Fitzgerald, Djurdjic, & Maguin, 1992; Gabel, Colcord, & Petrosino, 2002; Kraaimaat, Jansseen, & Brutten, 1988; Kraaimaat, Vanryckeghem, & Van Dam-Baggen, 2002; Mahr & Torosian, 1999; Menzies, Onslow, & Packman, 1999; Messenger, Onslow, Packman, & Menzies, 2004; Miller & Watson, 1992; Schneier, Wexler, & Liebewitz, 1997; Weber & Smith, 1990). Numerous standardized scales, equipment measuring emotional arousal, heart rate, blood pressure, and skin conductance, personality inventories, subjective ratings, sensitivity, avoidance, stress, and distress scales are used to evaluate both state and trait anxiety in persons who stutter. It has been reported that as high as 44% of clients seeking treatment for stuttering could be assigned a co-occurring social phobia or social anxiety diagnosis (Stein, Baird, & Walker, 1996). In both state and trait anxiety, Craig (1990) and Ezrati-Vinacour and Levin (2004) showed that clinical samples of people who stutter (PWS) scored higher than control participants. Researchers question the results of anxiety studies with PWS due to methodical issues (Craig, 1994 and Menzies et al., 1999). A report by Menzies et al. (1999) suggests that the (a) construct of anxiety, (b) number of participants, (c) speaking tasks, (d) trait anxiety measures, and (e) treatment status of the participants could bias finding a relationship between anxiety and stuttering. As early as 1994, Craig suggested that treatment for stuttering could have moderating effects on anxiety levels, measurements, and results. In an attempt to control for this bias Craig et al. (2003) examined trait anxiety in a randomized population sample using a standardized anxiety measure. From a random selection and telephone interview of 4689 households, 87 individuals were identified as PWS. Of this group, 63 completed a trait anxiety measure over the telephone. Results revealed that PWS were shown to have higher chronic anxiety levels than the individuals who did not stutter. Craig et al. also reported that “most of the difference is due to those participants whose stuttering was more severe and who seek therapy” (p. 1203). In other words, those seeking treatment had higher severity ratings and tended to have higher levels of anxiety. The authors conclude that fluency disorders, if chronic, are associated with higher levels of trait anxiety. 1.2. Anxiety in children and adolescents High levels of anxiety can negatively affect the lives of children and adolescents. Researchers suggest that the prevalence of anxiety disorders in children and adolescents may be as high as 20% (Costello & Angold, 1995; Manassis, Avery, Butalia, & Mendlowitz, 2004; Velting, Setzer, & Albano, 2004). Studies suggest that children and youth with anxiety disorders may be at higher risk for educational underachievement, depression, poorer social support networks and increased family conflicts (Ameringen, Mancini, & Farvolden, 2003; Pine, Cohen, Gurley, Brook, & Ma, 1998; Velting et al., 2004). Recent reviews on the effectiveness of cognitive-behavioral treatments for anxiety, specific phobias, and school refusal offer empirical data on positive treatment outcomes (Balon, 2004; King, Heyne, & Ollendick, 2005). Studies have also reported that adolescents with disabilities may be at higher risk for anxiety and anxiety related disorders (Hommel et al., 2003; Jackson, Ciechomski, King, Tonge, & Heyne, 2002; King et al., 2005; King, Ollendick, Gullone, Cummins, & Josephs, 1990; Williams et al., 2003). Anxiety disorders have also been reported as more common in children with communication disorders (Beitchman et al., 2001; Cantwell and Baker, 1987 and Cantwell and Baker, 1988). A few studies have reported anxiety in children and youth who stutter. These studies have used anxiety measures as predictors of treatment outcomes or relapse in youth and adolescents who stutter (Blood, 1995; Hancock & Craig, 1998; Kraaimaat et al., 1988). For example, Hancock and Craig (1998) reported that only pre-treatment %SS and immediate post-treatment anxiety were significant factors in predicting stuttering frequency 1 year after treatment in 77 children aged 9–14 years. In another study examining treatment outcomes in children and adolescents, Hancock et al. (1998) included a measure of trait anxiety. The authors reported no significant differences between groups on state anxiety scores at the 12-month and 2–6-year follow-ups. They did report a trend for participants to become less anxious after 2–6 years of treatment. Studies have also addressed the specific role and identification of anxiety in youth and adolescents who stutter. Craig and Hancock (1996) in a study examining anxiety in children between 8 and 14 years reported that children who stutter were no more anxious than children who do not stutter of the same age. They concluded that anxiety was not higher in children with more severe stuttering. Beitchman et al. (2001) reported on children with speech and language disorders, including stuttering in children. They employed a longitudinal design in which participants, identified with speech and language disorders at 5 years, were administered psychiatric interviews 14 years later (age 19) to determine the relationship between speech, language impairments and anxiety in young adulthood. Results showed that children with language impairments were significantly more likely to develop anxiety disorders. As mentioned above, the study also examined children with speech disorders including voice, stuttering and dysarthria. The inclusion criterion was very broad. For example, evidence of stuttering was assessed by a master's level speech-language pathologist (SLP) based on “the analysis of spontaneous speech, and number, letter and word repetition” (p. 78). The authors of this study did not provide any other information about stuttering behaviors, severity, duration, physical concomitants, standardized/commercially available measures, or attitude assessments, even though the initial assessments were conducted on 5-year-old children. The study included 38 participants grouped as speech impaired category including stuttering, voice and dysarthria for the analyses. Beitchman et al. concluded the speech impaired group did not have significantly different rates of psychiatric outcomes/disorders (including anxiety) from the control group. The results did not provide the number of participants with voice, stuttering or dysarthria disorders, an analysis by speech disorder, or a follow-up determination of the existence of the stuttering, voice or dysarthria speech problems at age 19. The results need to be replicated. In a follow-up to this study, Voci, Beitchman, Brownlie, and Wilson (2006) used the same methodology to examine social anxiety and the fear of social communication. They posited that early childhood language impairment was a precursor for late adolescent social phobia. Their results showed that individuals with “a history of early language impairment had 2.7 times the odds of having a social phobia by age 19” (p. 1). They also suggested that although the rate of social phobia at age 19 for the 38 participants with early speech impairment (including PWS) was not statistically different from the controls, future research should address the possibility of increased risk in speech impaired participants. The authors do add the disclaimer and limitation that they were “unable to conduct analyses to determine whether language impairment continued to predict social phobia after controlling for other early childhood risk factors” (p. 13). Blood, Blood, Tellis, and Gabel (2003) summarized studies suggesting that adolescents with physical or psychosocial problems or disabilities are confronted by or experience negative stereotypes from their peers and other individuals which may increase anxiety levels and/or disorders. Although they reported that stuttering did not present a stigmatizing condition for 65% of adolescents who stutter, 60% of the participants responded that they “never or rarely” talked about their stuttering. This lack of communication and/or the potential for misinformation about a chronic disability like stuttering could contribute to negative emotional responses and heightened levels of anxiety. 1.3. Current study We decided to study systematically anxiety in adolescents who stutter to increase our understanding of the role of anxiety in stuttering across the lifespan. These findings may assist clinicians and researchers in identifying heightened levels of anxiety as a co-occurring condition in some adolescents who stutter and help in treatment planning and techniques in schools and clinics. This study may also provide additional support for conflicting research reporting anxiety and negative emotional responses across the lifespan of PWS. Menzies et al. (1999) suggested that some of the conflicts reported in the literature about stuttering and anxiety may be related to the measures employed, definitions used, and participants involved in the research. Examining adolescents who stutter may provide information about the development or progression of anxiety in PWS. Few studies have examined anxiety in adolescents. Specifically, we wanted to (a) determine overall anxiety indices in adolescents who stutter using a standardized measure; (b) determine overall self-esteem in adolescents who stutter using a standardized measure; (c) examine the relationship between self-esteem and anxiety in adolescents who stutter; and (d) examine the relationship among anxiety and gender, ethnicity, stuttering severity, socioeconomic class, and co-occurring disorders in adolescents who stutter.