Paediatrics (RCH) - Theses

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    Anxiety and stuttering: closing the research gaps
    Smith, Kylie ( 2017)
    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 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. 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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    Early stuttering, temperament and anxiety
    Many stuttering adults and adolescents experience speech-related anxiety. This relationship has not been examined in the preschool population. Given this, it is unknown whether stuttering preschool children also exhibit anxiety traits. Particular temperament traits have been identified as precursors of anxiety. Temperament refers to the way an individual reacts to or interacts with their environment. While the expression of temperament traits is largely genetically determined, it is also influenced by environmental factors. Variations in the expression of temperament traits between individuals are observed as personality traits. Two hypotheses regarding the relationship between temperament and early stuttering have been discussed in the literature. The first is that temperament is associated with the development of stuttering. Certain temperament traits are theorised to influence the onset, development and maintenance of the disorder. The second hypothesis is that temperament differences arise as an effect of stuttering. Stuttering preschool children can experience negative communication interactions. It is therefore possible that those negative interactions may influence the expression of temperament traits, particularly the precursors of anxiety. Further exploration of the relationship between temperament and early stuttering is crucial in order to ascertain which of the above hypotheses is true. Knowledge about the expression of temperament traits is required in order to determine whether stuttering children express temperament traits differently from non-stuttering children as well as to determine whether they have a heightened risk of developing anxiety. This doctoral study was embedded within the Early Language in Victoria Study (ELVS). ELVS has a prospective, longitudinal design. The overall aim of ELVS was to examine the epidemiology and evolution of communication impairments, including stuttering, from infancy through to 7 years. The aim of the present study was to investigate the expression of temperament traits, including the precursors of anxiety, among stuttering children in ELVS. Data were collected with a prospective, longitudinal cohort design. In total, 1444 children were recruited into this study. By 4 years, 173 children had been confirmed as stuttering and 1271 children were assigned to the non-stuttering group. Temperament data were collected using a parent-report scale which was included in annual parent completed questionnaires from 2-4 years. During this time, parents of stuttering participants also completed a stuttering questionnaire at 12 consecutive, monthly home visits, immediately post stuttering onset. At 6 and 7 years, temperament and stuttering behaviour data were collected from stuttering participants in annual parent completed questionnaires. The results from this study revealed little evidence of differences between stuttering and non-stuttering preschool children’s expression of temperament traits, including the precursors of anxiety, up to 4 years. There was little evidence of associations between various stuttering behaviours and the expression of temperament traits amongst stuttering participants. These findings suggest that within this study’s cohort, stuttering children were not at greater risk of developing anxiety compared to non-stuttering children and the range of stuttering characteristics exhibited by stuttering children did not influence the expression of their temperament traits, including the precursors of anxiety.