anxiety and stuttering

223 Pages·2017·8.76 MB·English

by  Kylie Smith

ANXIETY AND STUTTERING:
CLOSING THE RESEARCH GAPS
Kylie Anne Smith
Orchid ID: 0000-0001-6957-5361
Submitted in total fulfilment of the requirements of the degree of
Doctor of Philosophy
Murdoch Childrens Research Institute
Department of Paediatrics
The University of Melbourne
February 2017
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Abstract
Background: Adults who seek treatment for stuttering are significantly more likely to
be diagnosed with social anxiety disorder than non-stuttering controls. However, it is
unclear when the onset of anxiety in stuttering typically occurs, and whether there are
differences between children who stutter in the general community and those who seek
treatment.
Aims: The aims of this thesis were to:
1. Review the research pertaining to anxiety and stuttering in children and adolescents,
to identify trends and determine the timing of anxiety onset in stuttering;
2. Compare anxiety symptoms, emotional and behavioural functioning, and
temperament traits in children from a community sample who (i) stutter, (ii) have
recovered from stuttering, and (iii) have never stuttered;
3. Compare anxiety symptoms, and emotional and behavioural functioning, for
children who stutter from: (i) a community cohort study (community stuttering
cases) and; (ii) a clinical case-control study (clinical stuttering cases), and children
who have never stuttered and;
4. Compare family and environmental characteristics, and social and emotional
functioning, for control groups recruited to a community cohort study and clinical
case-control study.
Methods: For Aim 1, peer-reviewed publications investigating anxiety in preschoolers,
children, and adolescents who stutter were identified using specific search terms in
Medline, CINAHL and psycINFO databases. Known risk factors for anxiety in
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stuttering children and adolescents were identified, and the research evidence related to
anxiety in this population was appraised. For Aim 2, measures of child anxiety,
temperament, and emotional and behavioural functioning were completed by children
and parents from a community cohort study, including (i) children who stuttered, (ii)
children who had recovered from stuttering, and (iii) non-stuttering controls. Linear
regression modelling compared outcomes between the three groups, controlling for a
range of child, family and environmental variables. For Aims 3-4, outcomes were then
compared to those from children who stutter and non-stuttering controls from a clinical
case-control study.
Results: Regarding Aim 1, based on a review of the literature, the age of anxiety onset
in stuttering could not be reliably determined. Regarding Aims 2 - 4, all groups in the
community cohort study had scores within the normal range on measures of anxiety,
and emotional and behavioural functioning, with no significant differences between
groups. Similarly, scores on all measures fell within the normal range for the children in
the clinical case-control study. However, children who stutter from both the clinical and
community studies reported higher social anxiety and internalizing symptoms compared
with non-stuttering controls. As a group, the clinical stuttering cases reported higher
generalised anxiety symptoms than the community stuttering cases. The controls
participating in the case-control study came from a higher socioeconomic background
than the other three groups. They also had lower anxiety scores than the community
controls.

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Conclusion: While in the normal range, higher social anxiety symptoms among school-
age children who stutter from clinical and community samples may mark the start of the
development of social anxiety disorder in stuttering. Higher general anxiety symptoms
among clinical stuttering cases compared with community stuttering cases may be a
driver for seeking treatment for stuttering. Differences in socioeconomic status and
anxiety among participants recruited to clinical and community stuttering studies
highlights the need for understanding the nature of control groups when interpreting
research findings. Further research with community samples of children who stutter is
needed to further clarify risk factors for the development of social anxiety in stuttering.

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Declaration
This is to certify that the thesis comprises only my original work towards the
PhD except where indicated in the Preface. Due acknowledgement has been made in the
text to all other material used. The thesis is fewer than 100 000 words in length,
exclusive of tables, maps, bibliographies and appendices.

Kylie Anne Smith, February 2017

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Preface
Publications included in this thesis:
Smith, K. A., Iverach, L., O'Brian, S., Kefalianos, E., & Reilly, S. (2014). Anxiety of
children and adolescents who stutter: a review. Journal of Fluency Disorders, 40, 22-
34.
Smith, K. A., Iverach, L., O'Brian, S., Mensah, F., Kefalianos, E., Hearne, A., & Reilly,
S. (2017). Anxiety in 11-year-old children who stutter: Findings from a prospective
longitudinal community sample. Journal of Speech, Language, and Hearing Research,
60, 1211-1222.
Presentations arising from this thesis:
Smith, K.A., Iverach, L., O'Brian, S., Onslow, M., Mensah, F., Hearne, A., Reilly,
S. (2016, May). Anxiety and children who stutter: Closing the gap in the research.
Speech Pathology Australia National Conference, Making Waves, Perth, Australia.
Smith, K. A., Iverach, L., Kefalianos, E., Morgan, A., Reilly, S. (abstract accepted).
Anxiety and childhood stuttering: Examining the problem from a community
perspective. Oxford Dysfluency Conference, Oxford, UK.

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Scholarships and grants:
• Australian Postgraduate Award; 2012-2017 ($27,000 pro rata)
• Melbourne Childrens Postgraduate Health Research Scholarship; 2012-2017
($5,000 pro rata)
• Murdoch Childrens Research Institute Student Conference Support Scheme;
2016 ($2,500)
• University of Melbourne, Departmental of Paediatrics Travelling Scholarship;
2016 ($500)
Relevant employment:
• June 2009 - Present: Brenda Carey’s Stuttering Treatment Centre, a specialist
private clinic for the treatment of stuttering.
• January 2010 – Present: Presenter of the Lidcombe Program, and Management
of School-Age Stuttering workshops on behalf of Continuing Professional
Education in Stuttering, Australian Stuttering Research Centre, University of
Sydney
• May 2016 and 2017: Guest lecture at University of Melbourne, second year
Masters of Speech Pathology, Treatment of Adult and Adolescent Stuttering.
• April 5th 2016: Student clinical supervision, University of Melbourne.

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Community and Media Engagement:
• January 2015 – Present: Convener of Stuttering Special Interest Group,
Victorian Branch.
• August 2016: Invited interview on 774 ABC radio on childhood stuttering
• June 2015: Interview on RRR Einstein A GoGo on research for present thesis.
• June 2015: Interview on Kinderling Kids Radio on stuttering and anxiety in
preschoolers.
• August 24th 2015: Murdoch Childrens Research Institute blog post. Stuttering
and anxiety; the chicken and the egg; https://www.mcri.edu.au/users/murdoch-
childrens-media/blog/stuttering-and-anxiety-chicken-and-egg.
• August 8th 2016: Murdoch Childrens Research Institute blog post. Exploring the
impact of childhood stuttering; https://www.mcri.edu.au/users/murdoch-
childrens-media/blog/exploring-impact-childhood-stuttering.
Publications prior to PhD candidature enrolment:
Smith, K. (2010). Webcam Lidcombe Program Treatment. ACQuiring Knowledge in
Speech, Language and Hearing, 12(3), 129-130.
O'Brian, S., Smith, K., & Onslow, M. (2014). Webcam delivery of the Lidcombe
program for early stuttering: a phase I clinical trial. Journal of Speech Language
Hearing Research, 57, 825-830.
Reilly, S., Kefalianos, E., & Smith, K. (2013). The natural history of stuttering onset
and recovery: data from a longitudinal study. Enfance, 275-285.
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A signed copy of the Co-Author Authorisation and the Declaration for Thesis
with Publication have been submitted with this thesis for the publications listed above.
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