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ARTICLES: Sheena Reilly, Mark Onslow, Ann Packman, Melissa Wake, Edith L. Bavin, Margot Prior, Patricia Eadie, Eileen Cini, Catherine Bolzonello, and Obioha C. Ukoumunne Predicting Stuttering Onset by the Age of 3 Years: A Prospective, Community Cohort Study Pediatrics 2009; 123: 270-277 [Abstract] [Full text] [PDF]

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Predicting stuttering onset

Peter Howell   (17 January 2009)

Response to Howell - Onset of stuttering unpredictable

Sheena Reilly, Ann Packman, Mark Onslow, Melissa Wake, Edith Bavin, Margot Prior, Patricia Eadie, Eileen Cini, Catherine Bolzonello, Obioha Ukoumunne   (26 January 2009)

Predicting stuttering onset 17 January 2009
Peter Howell, Professor of Psychology University Colleague London Send letter to journal: Re: Predicting stuttering onset p.howell{at}ucl.ac.uk Peter Howell	Predicting stuttering onset Stuttering starts in childhood, usually shortly after language onset. However, there is little published information about a child’s speech between when language starts and when stuttering starts. Reilly et al.’s1 study provides much-needed information. I have two comments. Speech characteristics were not examined as prospective factors for risk of stuttering (Reilly et al. made no recordings before stuttering onset). Information about stuttering onset was provided by parental report: 71% of parents reported that onset of stuttering was abrupt and 97.1% reported that stuttering started when the child began to produce utterances of more than one word. Although parents were instructed on what features to look out for, the criteria supplied by the authors on onset of stuttering are not unanimously agreed. The list included whole-word repetitions. However Conture2 considers these symptoms ambiguous, and Wingate3 rejects them, as diagnostic features of stuttering. It would be valuable to analyze all symptoms on the recorded session made shortly after stuttering onset for the children reported to be stuttering in order to verify the parental reports. The reported association between stuttering onset and growth in language development also has the limitation that it is based on parental-report. It would be useful to analyse the recordings from the session after stuttering onset, as verification of the parents’ reports. 1619 participants were included in the study, from a cohort of 1911 who were sent the original questionnaires. Data (but no analyses) are presented that can be used to see if there was selective attrition between the cohort and test samples (e.g., whether children with certain risk factor were more likely to have been excluded from the study than others). As the authors note, more mothers had degrees in the participant, than the non-participant, group. Using the data in Table 1, there is a significant association between mother’s education level and whether the sample was from the participant or non-participant group ( 2=8.51,df=2 ). This qualifies Reilly et al.’s finding that high maternal education was a risk factor for stuttering onset. Peter Howell, PhD University College London ACKNOWLEDGEMENT This work was supported by Wellcome Trust grant 072639. REFERENCES 1 Reilly S et al. Predicting stuttering onset by the age of 3 years. Pediatrics, 2009;123(1). 2 Conture EG Stuttering. 2nd ed. Englewood-Cliffs: Prentice Hall; 1990. 3 Wingate ME Foundations of stuttering. San Diego: Academic; 2002. Conflict of Interest: None declared
Response to Howell - Onset of stuttering unpredictable 26 January 2009
Sheena Reilly, Professor of Paediatric Speech Pathology Murdoch Childrens Research Institute, University of Melbourne, Ann Packman, Mark Onslow, Melissa Wake, Edith Bavin, Margot Prior, Patricia Eadie, Eileen Cini, Catherine Bolzonello, Obioha Ukoumunne Send letter to journal: Re: Response to Howell - Onset of stuttering unpredictable sheena.reilly{at}mcri.edu.au Sheena Reilly, et al.	Professor Howell says that the single-syllable word repetitions that we instructed parents to look out for are not regarded universally as stuttering. Of course such repetitions are not always stuttering, but they certainly can be. However, when formulating instructions to parents about what to look out for, we were guided by the work of the most widely published group currently working in early stuttering. Yairi and colleagues, from the University of Illinois Stuttering Research Program, include repetitions of monosyllabic words in their standard description of what could be possible stutters1. The actual identification of the presence of stuttering in our study was made by a speech pathologist after seeing the child in person, not according to the descriptions of possible stuttering given to the parents. A rigorous consensus procedure was used when it was unclear whether a child's disfluencies were stuttered or normal. We agree with Professor Howell that objective assessments of language, speech and voice prior to stuttering onset (i.e. at age 2) would be valuable and we encourage this in future large-scale studies. However, there are logistic and cost barriers to doing so and we believe the characteristics reported by parents are likely to be a good proxy. It is also worth emphasizing that almost 20% of the children in our sample had delayed expressive language2 and were not combining words at 2 years of age. Professor Howell also says that it would be useful to analyze the recordings made shortly after stuttering onset in order to verify both parental reports of the nature of stuttering at onset and the stage of language development at onset. We agree but both of these can change soon after a child starts to stutter. It is known, for example, that as a result of stuttering some children shorten and/or simplify their utterances and may at times even avoid speaking altogether. We maintain that parent reports of the nature of stuttering at onset, which were made soon after onset, and the language measures made prior to onset are valid. Indeed, for the reasons given above we regard these as among the strengths of the study. Professor Howell goes on to say that the finding of an association between maternal education and stuttering onset might be artefactual. This finding was unexpected however, we disagree that the minor differential dropout well before stuttering onset is likely to have produced this bias. Regardless, we think that Howell misses the crucial point of our report that the onset of stuttering was essentially unpredictable in any functional way; all predictors in the study combined only accounted for 3.7% of stuttering onset. Whether the minute portion of stuttering explained by maternal education is artefactual is hence a minor issue. 1. Yairi, E. & Ambrose, N. (2005). Early Childhood Stuttering. Austin: Pro Ed. 2. Reilly S, Wake M, Bavin EL, et al. Predicting language at 2 years of age: A prospective community study. Pediatrics. 2007;120(6). Available at: www.pediatrics.org/cgi/content/full/120/6/e1441 Conflict of Interest: None declared