“Stuttering is more than disfluent speech. There’s so much more that children who stutter go through.”
Assistant Professor of Communicative Sciences and Disorders Bridget Walsh, Ph.D., CCC-SLP, will study the risk factors in children that lead to chronic stuttering in adulthood, in a research project funded by a $3.1 million grant from the National Institutes of Health. Her research focuses on a narrow window of early childhood, when stuttering emerges.
"Stuttering is probably the most prominent example of speech disfluency," said MSU Chair of the Department of Communicative Sciences and Disorders Dimitar Deliyski, Ph.D. He said the department takes a variety of approaches to the research, from studying the neurological changes that occur in the brain to the physiological changes that occur during stuttering. "If you look at the field of stuttering research, we have the best people in each of these areas approaching the problem."
One of these experienced scientists, Walsh is working to uncover the clues that could point to a chronic stuttering condition early in a person's life.
“To better understand the genesis of stuttering, we focus on the time when it emerges—in the preschool years—most often between ages 2-5 years,” said Walsh. “Most often, kids begin to stutter around age three a time when they start putting multiple words together to make longer utterances. That’s when parents start to notice that their child may be stuttering.”
Stuttering is fairly common in young children. Approximately 5-8% of preschoolers go through a period of stuttering. The good news is that most, 75-80%, of these children will recover from stuttering. On the other hand, children who continue are at risk for developing chronic stuttering that may lead to the development of adverse impact.
“Children who continue to stutter are at risk for developing negative feelings toward their speech, reduced self-esteem and often endure bullying in school,” Walsh said.
Correcting Speech Patterns in Early Childhood
“Because so many kids go through a period of stuttering yet go on to develop typical speech, pediatricians may counsel parents to delay therapy to allow time for natural recovery,” said Walsh. “Delaying therapy for preschoolers at risk for persistent stuttering permits atypical speech patterns to form that may be difficult to treat as kids get older.”
Speech patterns become more ingrained over time. Beyond the age of 7, the chance for spontaneous recovery decreases, and researchers find that stuttering is more likely to persist. Older children can make progress toward speaking more fluently, but the rate of relapse is high along with the chance of being adversely impacted by their speech difficulties.
“With preschool children, the focus of treatment is on reducing or even eliminating the stuttering. Once the child is older, treatment shifts to helping the child manage their stuttering and the tougher issues that accompany it: bullying, teasing, and poor self-esteem. Effective therapy focuses on helping a child become a successful communicator regardless of whether they are fluent,” said Walsh.
Walsh pointed out that many people who stutter who seem to speak fluently actually engage in what is called ‘covert stuttering.’
“These individuals often go to great lengths to avoid moments of stuttering and conceal their disfluencies, sometimes at the expense of saying precisely what they mean or asking for exactly what they want.” Walsh referred to the example of U.S. President Joe Biden, who sometimes changes direction when he gives a public speech.
“It’s incredibly inspiring that we have a president who is a person who stutters,” said Walsh. “I wish though that he would be a bit more open about his stuttering. There have been a number of articles describing how President Biden ‘overcame’ his stuttering. Yet if you watch and listen to him during debates and interviews, he appears to be using different strategies to avoid openly stuttering—such as slurring a word or possibly substituting words when he senses he is about to stutter on one.
“This was detrimental to his campaign when the opposition described instances of unclear speech as signs of dementia exploiting his stuttering to suggest he was not mentally fit to become president. As difficult as it may be, we encourage people who stutter to disclose their stuttering—to get it out in the open so they don’t have to work so hard to hide it. A straightforward, ‘Sometimes I stutter, so bear with me’ can be an extremely effective strategy that notifies the listener while making it less stressful for the person who stutters.”
Identifying Children Who Are Most at Risk
Diagnosing stuttering in young children is fairly straightforward and my lab and others have made good progress unearthing risk factors associated with stuttering persistence.
“We do not yet know, however, how a child’s unique developmental pathway leads them to recover or persist in stuttering. That is, in essence, what this grant is about,” said Walsh.
In her research, Walsh and Co-Investigator Scott Yaruss, Ph.D., a professor of communicative sciences and disorders, are working to identify the risk factors that point to stuttering persistence in individual kids who stutter. By pinpointing which children may be at heightened risk of chronic stuttering, we can devote resources to the children who need it most.
“This is a longitudinal study. We will follow preschoolers who are stuttering across the developmental window of early childhood because we want a dynamic account of how critical factors implicated in stuttering unfold over time and contribute to different outcomes,” said Walsh. “Dr. Yaruss and I aim to unravel the mechanisms that underly these two different trajectories, persistence or recovery, to identify targets for intervention or therapy. It’s fruitful research.”
In her research, Walsh uses a newer neuroimaging technique, functional near-infrared spectroscopy (fNIRS) that offers an unprecedented means to study brain activity during natural speech production. fNIRS is a noninvasive optical imaging technique that measures the relative changes in oxygenated and deoxygenated hemoglobin in the outer layers of the brain called the cortex. Similar to fMRI, it infers activity based on blood flow, however, it is less sensitive to motion artifact. Walsh explained that fNIRS is safe and offers the significant advantage of recording brain activity while a person is sitting up and speaking.
“We will assess whether differences in patterns of brain activity during speech identified in our prior research with older children who stutter can help distinguish preschool children at risk for persistence, thus helping establish a neural basis for stuttering persistence and recovery,” she said.
Another aim of the project is to study the development of adverse impact in children who stutter.
“We know that stuttering leaves a lasting imprint on children who persist. Ample evidence shows that older children and adults may be negatively affected by their stuttering. However, we do not understand how and when adverse impact related to stuttering develops in children,” said Walsh. “With the pandemic, we have moved this research to an online survey format and are studying stuttering’s adverse impact in children aged 3-18 years. Our preliminary findings reveal factors that may place children at greater risk for developing adverse impact while other protective factors appear to mitigate this risk.“
With the National Institutes of Health supporting the research, Walsh hopes to reach more reach parents, pediatricians and other care providers who know a child who stutters and can recommend the child for the study.
“This research will bring new insights into why stuttering persists in some children and in parallel, could change how we assess and treat these children in the future,” said Walsh.
Families of children who stutter aged 3-18 years who are interested in participating in online/survey research can visit: https://msu.co1.qualtrics.com/jfe/form/SV_5aSm2go9aezloR8
By Melissa Priebe