ادراکات پدر و مادر از تاثیر لکنت زبان بر روی کودکان پیش دبستانی آنها و خودشان

Speech-language pathologists (SLPs) are advised to consider the distress of preschoolers and parents along with the social consequences of the child's stuttering when deciding whether to begin or delay treatment. Seventy-seven parents completed a survey that yielded quantitative and qualitative data that reflected their perceptions of the impact of stuttering on their children and themselves. Sixty-nine (89.6%) parents reported between 1 and 13 types of negative impact (modal = 2). The most frequently reported reactions of children were frustration associated with their stuttering, withdrawal, reduced or changed verbal output, making comments about their inability to talk, and avoidances. The most frequently reported peer reaction was teasing (27.3%). Seventy parents (90.9%) reported that they were affected by their child's stuttering. Their most frequently reported reactions were worry/anxiety/concern, uncertainty about what to do, frustration, upset (parent term), self-blame (fear that they had caused the stuttering), taking time to listen, waiting for the child to finish talking, modifying their own speech, and asking the child to modify speech. Findings support calls for SLPs to consider the distress of preschool children and their parents and the social consequences of the children's stuttering when making the decision to begin or delay treatment. Learning outcomes: Readers will be able to describe parents’ perceptions of the impact of stuttering on their children and themselves. In particular, readers will learn about (1) parents’ perceptions of young children's awareness and reactions to their stuttering, (2) parents’ perceptions of the social consequences of stuttering for young children; and (2) the emotional effect of stuttering on parents.

Stuttering starts in the early years of life, typically between ages 2 and 4 years (Yairi & Ambrose, 2005). Because many children will recover from stuttering without treatment, waiting periods are now commonly recommended to allow natural recovery to occur (e.g., see Yairi & Ambrose, 2005). In a review of the literature, Langevin, Packman, and Onslow (2009) noted that recommendations for wait times ranged from 6 months to 1–2 years, and even as long as 3 years. For example, a watchful waiting period of 1 year is typically recommended before implementing the Lidcombe Program (Onslow, Packman, & Harrison, 2003), as research has shown that waiting for 1 year does not jeopardise responsiveness (Packman, Onslow, & Attanasio, 2003). However, although responsiveness to Lidcombe program was not jeopardised in the studies referred to in Packman et al. (2003), this does not mean that the children in those studies were not experiencing negative impacts of stuttering while they were awaiting treatment. If a child is suffering distress, it would not be ethical to defer treatment for 1 year, simply on the grounds that there is no evidence that the child will suffer ill-effects while awaiting treatment. As Packman et al. (2003) state “it is not known whether children who are frustrated by their stuttering, or teased because of it, will suffer any long-term psychological problems if treatment is delayed for some period within the preschool years” (p. 49). Indeed, little is known about the consequences of stuttering for young children who are awaiting treatment with Lidcombe Program or any other treatment approach. When deciding whether to begin or delay treatment, speech-language pathologists (SLPs) have been advised to consider persistence risk factors, such as gender, age at onset of stuttering, time since onset of stuttering, and family history of stuttering (e.g., Yairi & Ambrose, 2005). They have also been advised to consider the child's reactions to stuttering, parent distress, and the social consequences of stuttering (Curlee and Yairi, 1997, Ingham and Cordes, 1998, Packman et al., 2003, PCAFWLC, 2008 and Yairi and Ambrose, 2005). While there is convincing evidence that many preschoolers become aware of their stuttering and react negatively to it, little is known about the social consequences of early stuttering. This is in stark contrast to the larger body of knowledge that shows that school-age children (who in the reviewed studies ranged from 8 to 18 years of age) are perceived negatively (Langevin, 2009, Langevin and Hagler, 2004 and Langevin et al., 2009a), teased (Blood and Blood, 2004, Blood and Blood, 2007, Hugh-Jones and Smith, 1999 and Langevin et al., 1998), less accepted socially, less likely to be perceived as leaders, and more likely to be categorized as “bully-victims” than are non-stuttering children (Davis, Howell, & Cooke, 2002). In addition, very little is known about the impact of early stuttering on parents. 1.1. Awareness of and reactions to stuttering in young children Existing research suggests that many young children become aware of their stuttering and react negatively to it. Research using parent report has consistently shown that many young children indicate either directly (e.g., saying “I can’t talk”) or indirectly (e.g., crying when they are not able to talk) that they are aware of their stuttering and that it is affecting them negatively. In a 1960 review of clinical records, Bloodstein (Bloodstein & Bernstein Ratner, 2008) found that at age 3 years about half of the children were reported to exhibit behaviours such as “hitting themselves on the mouth, crying, laughing, looking down and blushing, placing their hands in front of their face, hitting the wall with their hands, or saying ‘I can’t talk,’ ‘Why can’t I talk?’ ‘Help me talk.”’ (Bloodstein & Bernstein Ratner, p. 34). In a survey of 121 parents of preschool children who stutter, Onslow, Harrison, and Jones (1993; reported in Packman et al., 2003) found that 30% of parents indicated that their children were aware of their stuttering and were reacting negatively to it, in some cases immediately after onset. Indeed, Yairi (1983) reported that 18% of parents perceived that their 2- and 3-year-old children became aware of their stuttering close to the time of onset. Recently Boey et al. (2009) used parents’ reports of remarks made by the child (e.g., “I can’t talk”) or “unambiguous non-verbal reactions” (p. 338) (e.g., sighing) to investigate awareness of and reaction to stuttering in children age 2–7 years. Using an interview protocol, data were gathered from parents of 1122 children. Parents first were asked how their child reacted to speech difficulties, whether they thought their child was aware of the problem (response options were yes/no/doubt/or unknown), and how they knew that the child was aware. Then parents were asked about specific reactions (e.g., whether the child stopped talking during a moment of stuttering, or if the child asked for help). Boey et al. found that 75.1% of the children were reported to exhibit stuttering-associated reactions, with 42% of children exhibiting two types of reactions, and 36.5% exhibiting 3 types of reactions. Awareness increased with age from 56.7% in 2-year-olds to 89.7% in 7-year-olds. Parents most frequently reported that children made remarks about their speech, asked for help, and showed awareness through their attitude or posture, became cross or sad, cried about their speech, ceased to talk, or left the situation. Experimental studies of awareness of stuttering in young children conducted by Ambrose and Yairi (1994) (with children aged 2–6 years) and Yairi and Ambrose (2005) (with children aged 23–56 months at the initial visit) used a paradigm in which children were asked to point to the puppet who talked like they talked. Awareness of stuttering was inferred if the child pointed to the puppet who stuttered; conversely awareness of fluency was inferred if the child pointed to the fluent puppet. Yairi and Ambrose (2005) indicated that 15% of the children who stuttered in the 1994 study indicated possible awareness of stuttering, whereas approximately 10% of the children in the follow-up study gave indications of awareness in the initial visit that occurred within 12 months of the onset of stuttering. However, Yairi and Ambrose (2005) found that when children were tested at 5 additional visits over a 3-year period, there appeared to be a growing awareness of stuttering between 4 and 5 years of age. Using an earlier version of the KiddyCat (Vanryckeghem & Brutten, 2007), a self-report measure of communication attitudes, Vanryckeghem, Brutten, and Hernandez (2005) investigated speech-associated attitudes of children (aged 3 years 2 months to 6 years 3 months) who do and do not stutter. As would be expected, scores of children who stutter were significantly higher than those of the non-stuttering children, meaning that the attitudes of the children who stutter were more negative than their non-stuttering peers. Finally, in a qualitative study of the communicative conceptions of a group of boys who do and do not stutter (aged 5 years 10 months to 8 years 10 months), Bajaj, Hodson, and Westby (2005) found that children who stuttered described themselves as “good talkers” less frequently than their fluent peers. 1.2. Social consequences of and peer reactions to stuttering in the early years There is indirect evidence that young children are aware that stuttered speech is different from fluent speech and that they evaluate stuttered speech negatively. In an experimental study using a puppet paradigm similar to that used in Ambrose and Yairi (1994) and Yairi and Ambrose (2005), Ezrati-Vinacour, Platzky, and Yairi (2001) investigated awareness of stuttering in normally fluent children (aged 3.0–7.11 years). Children were asked to indicate if the puppet who “stuttered” and the fluent puppet talked in the same way and if the stuttered speech was good or not good talking. Children also were asked to indicate with which puppet they would like to play. Results showed that normally fluent children as young as 3 years recognized stuttered speech and that recognition increased with age. Similarly, children as young as age 3 evaluated stuttered speech negatively and negative evaluation increased sharply at age 4. Almost half (46.7%) of the 3-year-old children chose the fluent puppet for a friend. This rose to 68.8% at 4 years and 87.5% at 5 years old. Limited existing research suggests that preschoolers experience social consequences of stuttering. Parents have reported that peers mimic the stuttering and tease and pick on their children (Onslow, Attanasio, & Harrison, 2003). In an early observational study of interactions between preschoolers who stutter (aged 2 years 3 months to 6 years 4 months) and their parents and peers (aged 3 years 8 months to 7 years 6 months) in the laboratory, Meyers (1990) found that peers used more negative than positive statements in conversation with the preschoolers who stuttered than did parents. More recently, in direct observations of four preschoolers who stutter (aged 3 years 2 months to 4 years 2 months) in free play on the preschool playground, Langevin, Packman, et al. (2009) found that three of the four children experienced negative peer reactions to their stuttering. Peers were judged to react to stuttered utterances with confusion, or they ignored, walked away from, or mocked the child who stuttered. Stuttering also was noted to interfere with the ability to lead peers in play, participate in sociodramatic play (pretend play with peers), and resolve conflicts. Further, for one child, direct observations of peer responses to the child's stuttering were consistent with the parent's report of peer responses. However, not all parents were aware of the difficulties that their children were experiencing in play. 1.3. Impact of stuttering on parents Knowledge about the impact of stuttering on parents and families has been limited by the lack of empirical investigation. In particular, very little is known about how parents feel about their child's stuttering, or its impact on the parent-child relationship. As Yairi and Ambrose (2005) stated, “…the continuous influence of stuttering… on the child's family has largely been overlooked by investigators. Perhaps for this reason, the counselling has typically centred on what parents can do to help their child, not on the crisis created for the family by the presence of a child who stutters.” (p. 398). 1.4. The current study Existing research elucidates many ways in which young children react emotionally to their stuttering; however, less is known about how stuttering affects their play and the ways in which peers respond to stuttering. Much less is known about the ways in which stuttering affects parents. The purpose of this study, then, was to investigate the extent and nature of impact of stuttering on preschoolers (aged 3–6 years in this study) and their parents. A survey, TheImpact of Stuttering on Preschool Children and Parents (ISPP), was developed specifically for this study. It contains closed and open-ended questions that afforded collection of quantitative data (i.e., frequency of different types of impacts of stuttering on children and parents) and qualitative data (i.e., in-depth information about the ways in which stuttering impacts children and parents).