Emotional and Linguistic Contributions to Developmental Stuttering

描述（由申请人提供）：口吃的终生发生率（即成年人口吃的百分比）接近5%，并且显著影响口吃者的学术、情感、社会和职业成就、发展和潜力（见Bloodstein & Bernstein Ratner， 2008）。然而，80%的受影响者（例如，Yairi & Ambrose, 1999）在没有显著的正式治疗（即“无辅助”康复）的情况下停止了治疗。对于剩下的儿童（即大约1%的6岁以后仍然口吃的儿童），口吃对他们的生活和日常活动的负面影响可能是显著的。因此，迫切需要确定可能引发/导致、加剧或延续口吃的变量，以开发更高效、更有效的基于经验的诊断和治疗方法。此外，正如Yairi（1993）所指出的，“因为晚期口吃与早期形式明显不同……试图推断其[口吃]的病因和性质，或根据成人口吃的模型为口吃儿童开出治疗处方是站不起来的”（Conture, 1991; Yairi, 1990; p.198）。因此，有必要检查口吃通常开始的时期的变量。为了解决这一问题，我们建议对学龄前口吃儿童进行纵向研究，重点研究情感和语言过程如何导致发展性口吃。基于Monroe和Simons（1991）的素质-压力相互作用的病因学概念，申请人的概念模型提出，双重素质（即情感和/或言语语言脆弱性）被环境压力源（例如，变化、差异、结构上的新颖性和/或自发产生言语语言所需的变化）激活，从而导致口吃。这个模型假设，在有口吃和没有口吃的儿童之间，以及在恢复口吃和持续口吃的儿童之间，情感和/或语言变量的有限数量的组合造成了有意义的差异。该项目以我们的初步发现和理论模型为基础，纵向地将情感和言语语言与发展性口吃联系起来，使用多种方法（即观察、标准化测试、家长报告和心理生理学）来评估我们的情感和言语语言的主要结构。这项跨学科的调查——包括发展心理学和语言病理学之间的合作——应该有助于确定口吃的孩子在情绪和语言变量上是否与正常流利的同龄人不同，以及这些差异是否随着时间的推移，可以预测哪些孩子会康复，哪些不会。这项纵向调查的结果将有助于在情感和语言发展的更广泛背景下对口吃进行研究，并有助于将未来的研究重点放在儿童口吃的诊断和治疗方案上。

DESCRIPTION (provided by applicant): Stuttering has a lifetime incidence (i.e., percentage of adults who ever stuttered) of nearly 5% and significantly impacts the academic, emotional, social, and vocational achievements, development and potential of individuals who stutter (see Bloodstein & Bernstein Ratner, 2008). However, seventy-eighty percent of those affected discontinue (e.g., Yairi & Ambrose, 1999) without significant formal treatment (i.e., "unassisted" recovery). For the remaining children (i.e., approximately 1% of children who continue to stutter after 6 years of age), the negative impact of stuttering on their lives and daily activities can be significant. There is a strong need, therefore, to determine variables that may initiate/cause, exacerbate or perpetuate stuttering to develop more efficient, effective empirically-based approaches to diagnosis and treatment. Further, as Yairi (1993) noted, "Because advanced stuttering is markedly different from the incipient form...attempts to infer its [stuttering's] etiology and nature or to prescribe treatment for children who stutter based on models derived from adult stutterers are indefensible" (Conture, 1991; Yairi, 1990; p.198). Thus, it is imperative to examine variables in the period during which stuttering typically begins. To address this imperative, we propose a longitudinal study of preschool-age children who stutter, with emphasis on how emotion and speech-language processes contribute to developmental stuttering. Building on Monroe and Simons' (1991) etiological notion of diathesis-stress interactions, the applicants' conceptual model proposes that dual diatheses (i.e., emotional and/or speech-language vulnerabilities) are activated by environmental stressors (e.g., changes, differences, novelty in structure and/or changes in need to spontaneously generate speech-language) to cause stuttering. This model assumes that a finite number of combinations of emotional and/or speech-language variables contribute to meaningful differences between children who do and do not stutter, as well as between children who recover and those who persist. The proposed project builds on our preliminary findings and theoretical model, longitudinally, to relate emotional and speech-language to developmental stuttering, using multiple methods (i.e., observational, standardized testing, parent-report, and psychophysiology) that assess our major constructs of emotion and speech-language. This interdisciplinary investigation - involving collaboration between developmental psychology and speech-language pathology - should help determine whether children at the onset of stuttering differ from their normally fluent peers on emotion and speech-language variables and whether these differences, over time, predict which children will and will not recover. Findings from this longitudinal investigation will help ground the study of stuttering within the broader context of emotional and speech- language development and help focus future research on issues that inform diagnostic and treatment protocols for childhood stuttering. PUBLIC HEALTH RELEVANCE: Stuttering has a lifetime incidence (i.e., percentage of adults who stuttered at some point) of nearly 5% and significantly impacts the academic, emotional, social, and vocational achievements, development and potential of individuals who stutter (see Bloodstein and Bernstein Ratner, 2008; Conture, 1996; Yairi, 1997). For the remaining children (i.e., the approximately 1% of children who continue to stutter after 6 years of age), the negative impact of stuttering on their lives and daily activities can be significant. Thus, there is a strong need to determine those variables that may initiate/cause, exacerbate or perpetuate stuttering - as this project will attempt to do - in order to eventually develop more efficient, effective empirically-based approaches to the diagnosis and treatment of stuttering.