Yoko Wakaba1, Megumi Iizawa1, Keiko Gondo2, Sumiko Inouei3, and Hiroshi Fujino4
1The Research Institute for the Education of Exceptional Children,Tokyo Gakugei University, Nukuikita 4-I-I, Koganei, Tol<yo,]84-850], Japan
2Department of Early Childhood Education, St. Margaret's Junior College, Kugayama 4-29-23, Tokyo,168-8626, Japan
3R&D Center, PIGEON Corporation, 6-20-4, Kinunodai, Yawara-rnura, Tsukuba-gun, Ibaraki, 300-2495, Japan
4Department of Education for Children with Disabilities, Faculty of Education, Tokyo Gakugei University, Nukuikita 4-I-1, Koganei, Tokyo, 184-8501, Japan
Temperament is considered to be an important factor influencing the onset and development of stuttering in children. Wakaba estimates that one-third of children who stutter can be characterized as a difificult child, a higher proportion than among normally fluent children. This study examines two groups of subjects, five in an “Easy Child” group and five in a “Difficult Child” group. Four data collection strategies were used to assess the developmental history and behavior characteristics of the children and their relationships with their parents. Temperament was found to be a contributory factor in the development of stuttering symptoms associated with tension in the “Difficult Child” group. More subjects need to be studied before these results can be generalized.
Thomas and Chess (1977) identified three types of children, the “Easy Child,” the “Difficult Child” and the “Slow-to-Warm-Up Child,” from longitudinal observations of children using nine categories of temperament: activity level, rhythm city, approach or withdrawal, adaptability, threshold of responsiveness, intensity of reaction, quality of mood, distractibility, and attention span and persistence. Carey and McDerritt. (1978) developed the ‘Infant Temperament Questionnaire’ (ITQ), which has been adopted in many countries. In Japan, Soeda et al. made a standardized ‘Infant Temperament Questionnaire’ (Japanese version) using data from 737 normal children 3 years of age (Soeda et al. 1967)
An ‘Easy Child’ has a generally good mood, mild reactions to external stimuli and regular physiological rhythms. Such children have the ability to adapt to changes in their environment. A ‘Difficult Child’ has irregular physiological rhythms and difficulty adapting to changes in his or her environment. Recently, children’s temperament has come to be considered an important factor in determining problem behavior (Okubo & Sato, 1984). Wakaba reported that ‘Difficult Child’ accounted for 33.1% of stuttering children in whom onset of stuttering was in their third year, which is a higher percentage than among the general population of children in Japan (Wakaba 1997).
We began systematic research on the onset and development of stuttering in Japan in 2002.
This report is a preliminary analysis of the influence of temperament on onset and development of childhood stuttering.
Two groups of subjects, five ‘Easy Child’ and five ‘Difficult Child’, were selected from 17 stuttering children whose ages ranged from 2 years and 11 months to 6 years and 1 month (mean = 3 years and 8 months), based on the results of the Behavioral Style Questionnaire (Japanese Version): J B SQ. Another seven subjects were assessed as ‘Intermediate-Low Child’. They were compared in several aspects. The onset of stuttering was in the third year in all subjects (see Table 1).
Table 1. Subjects
Data collection strategies
- Information on stuttering symptoms: Status at the time of initial examination. The subjects were observed by 2 trained observers for 30 minutes as they played with their mothers. The observers rated (1) the severity and (2) the type of the stuttering symptoms. ‘The Scale for Rating Severity of Stuttering" (Johnson et. al., 1963) was used to rate the severity of the stuttering. Evaluation of period from onset of stuttering until initial examination. (1) Judgment of tendency to increasing severity: Subjects in whom associated behavior and blocking were seen in the first year after the onset of stuttering were judged to have a tendency for increasing severity. (2) Appearance of physical tension: A judgment was made as to whether the child was tense in part or all of his or her body. (3) A judgment was made as to whether any associated behavior had appeared. (4)A judgment was made as to Whether any emotional response had appeared.
- Data related to personality or behavior characteristics: At the initial examination, the mother completed (1) the ‘TS Personality Test for Preschooler and School Age Children’, and (2) a questionnaire on emotional problems (developed by Wakaba, this questionnaire covers 6 types of behaviors: eating behaviors, behaviors of digestion and excretion, sleeping behaviors, sensitiveness, neurotic habits, other specific behaviors.)
- Data related to history of growth and development: At the initial examination, the mother completed questionnaires on the child’s history of stuttering and history of growth and development. The mother was also interviewed with regard to these histories.
- Information on parent-child relationship: At the initial examination, the mother or father completed the ‘Japanese Standardized Parent/Child Relations Test’. Each of 10 items was scored, with 1 point for “stable,” 3 points for “borderline,” and 5 points for “risk.” A total score was then calculated.
To compare the 2 groups, a Mann-Whitney test was conducted for the results of the age at onset of stuttering and the results of the ‘Japanese Standardized Parent/Child Relations Test’.
In the ‘Difficult Child’ group, the mean age at onset of stuttering was 2 years and 6 months (range: 2;3 - 2,7), and the mean age at initial examination was 3 years and 4 months range: 3;2 - 3;10). Four of these children (80%) showed a tendency for increasing severity of stuttering. The severity of stuttering at the initial examination ranged from 2 to 5, with a mean of 3,4. The type of stuttering symptoms were diverse, with 3-12 types exhibited. Associated behavior had appeared in all 5 children in this group (in 2 of whom it had disappeared at the time of initial examination). Physical tension was seen in all 5 children. Two of the children became frustrated when they could not say something, and exhibited an emotional response, such as saying “I can’t say itl”. All five children experienced fluctuations in worsening and abating symptoms. Emotional problem behaviors included a tendency to sensitivity, such as being uneasy with new people or places, perspiration, coughing, colds, and eczema. From the personality test the 5 children were judged to have a tendency to maladjustment (nervousness, emotional instability, low level of sociality, familial maladjustment, regression, low self-control). A problem in the parent-child relationship was seen in 3 of the children.
Figure 1. Score of JBSQ/Difficult Child group
Figure 2. Score of JBSQ/Easy Child group
Table 2. Comparing the two groups
In the ‘Easy Child’ group, the mean age at onset of stuttering was 2 years and 7 months (range: 2;2 - 3;7), and the mean age at initial examination was 3 years and 4 months (range: 3;1- 3;10). A change toward increasing severity was seen in two of the children (40%). The severity of stuttering at the time of initial examination ranged from 2 to 5, with a mean of 3.2. Two to five types of stuttering symptom were observed, which was less than in the Difficult Child group. Associated behavior was seen in three children, but not in the other two. Physical tension was seen in 1 child. No emotional responses were observed. Two children experienced fluctuations in the severity of stuttering symptoms. Emotional problem behaviors included a variety of nervous habits, such as finger sucking, sucking on clothes, nail biting, masturbation, drooling, and hair loss. In the personality test, two children showed a tendency to maladjustment (aggressiveness, impulsiveness, instability, and sulking when admonished), whereas three showed adaptive tendencies. Problems in the parent-child relationship were found in three cases.
There were no statistically significant differences in the age at onset of stuttering or parent-child relationship test results between two groups.
The two groups were compared with regard to the development of stuttering, using the four indicators of time from onset of stuttering until initial examination, changes in severity physical tension when stuttering, appearance of associated symptoms, and appearance of emotional responses. These four kinds of indicators were more prevalent in the ‘Difficult Child’ group than in the ‘Easy Child’ group. In the ‘Difficult Child’ group, stuttering became more severe in the year following onset, and physical tension appeared frequently. Associated symptoms are thought to be physical movements performed to release physical tension when a child is about to make an utterance in situations that produced physical tension in the child. As seen in the results of the questionnaire on temperament, children in the ‘Difficult Child’ group tended to respond sensitively to stimuli from their surroundings, and it is supposed that tendencies for such behavioral patterns would make a child susceptible to physical tension.
No difference was seen between the groups in the assessed severity of stuttering at the time of the initial examination. The ‘Difficult Child’ group was observed to have a clearly greater number of types of stuttering symptoms than the ‘Easy Child’ group. In the therapeutic process, observations of fluctuations in stuttering symptoms revealed a decrease in the number of types of stuttering symptoms as the severity of the stuttering abated. It is thought that in young children the number of types of symptoms as well as the frequency of symptoms reflect the severity of stuttering.
In the area of emotional problem behaviors of these children since birth, behaviors showing sensitivity were found to be more common in the ‘Difficult Child’ than in the ‘Easy Child’ group, whereas nervous habits were more common in the ‘Easy Child’ group. The differences between the two groups cannot be understood descriptively with the present data, so further investigations with a greater number of subjects are needed. The. results of the personality test showed a greater tendency for maladjustment in the ‘Difficult Child’ group. This agrees with a finding in an earlier study on temperament (Thomas et al., 1980), in which it was pointed out that ‘Difficult Child’ do not have good compatibility with their environment. Maladjustment to the environment is thought to produce tension in children while at the same time strongly affecting psychological stability, and may thus be considered a factor in increasing severity of stuttering.
Temperament characteristics seemed to contribute to the formation of stuttering symptoms associated with tension in difficult children. In the future a greater number of subjects should be examined to generalize these results.
This research was supported by Japanese government: Grant-in-Aid for Scientific Research, Category B (1) No 14390015 ( Title: Study on onset, development, spontaneous recovery, and fundamental therapeutic information of stuttering by interdisciplinary research method).
Andrews, G.(l985) Epidemiology of stuttering. In R. F. Curlee & W. Perkins. (Eds.) The nature and treatment of stuttering. (pp. 1-12). London: Taylor & Francis.
Carrey, W. B. & McDeritt, S. C. (1978). Revision of the infant temperament questionnaire. Pediatrics, 61, 735-759.
Johnson, W., Darley, F. C., & Spriestersbach, D.C. (1963) Diagnostic methods in speech pathology. New York: Harper Row Publishers.
Okubo, K. & Sato, T. (1984) Kishitu to hattatu no tuisekiteki kenkyu (1): 6 Kishitu to jyotyotekj monndaikodo tono kanren. Tohoku Shinrigaku Dai38kai Taikai Syoroku, 72-73.
Soeda, A., Sano, M., Syoji, J., & Maekawa, K. (1967) Sansaiji no kishitu ni kansuru kenkyu. Dai38kai Nihon Syonihokengakkai Koensyu, F-15.
Thomas, A., & Chess, S. (1977 ) Temperament and development. New York : Brunner Mazel.
Thomas, A., & Chess, S. (1980). The dynamics of psychological development. New York : Brunner hdazel
Wakaba, Y. (1997). Research on temperament of stuttering children with early onset. Journal of Fluency Disorders, 22, 2, 97.