Research Notes

Kurt Eggers, Ghent U, Thomas More, & Turku U,  and Robin Jones, Vanderbilt University Medical Center

Rothbart defines temperament as constitutionally based individual differences in reactivity and self-regulation (Rothbart, 2011). In this definition, ‘reactivity’ refers to the arousability of physiological and sensory response systems, and ‘self-regulation’ are those processes that can modulate (facilitate or inhibit) one’s reactivity. When a child is confronted with a stimulus, it may lead to positive (e.g., smiling) or negative (e.g., fear, anger) reactivity within the child. This is overtly and/or covertly expressed and can be measured through somatic (e.g., facial expressions), autonomic (e.g., heart rate increase), cognitive (e.g., alerting), and neuroendocrine (e.g., cortisol release) responses. As the child grows older, s/he will be able to modulate this reactivity by using self-regulation processes (e.g., shifting one’s attention away or towards the stimulus) to increase positive reactivity and/or decrease negative reactivity. Thus, over time temperament structure changes from a predominantly reactivity-driven concept in infants to a structure with more emphasis on self-regulatory processes in older children.

The constitutional component to temperament should be viewed as its biological basis (i.e., it is something you are born with), but it is important to note that it is influenced over time by maturation and experience (e.g., Saudino, 2005).
Temperament plays an important role in the experience and expression of emotions and also exerts an important influence on the child’s social-emotional development, personality development, and family system as well as a profound effect on the way in which children interact with their environments (Rothbart et al., 2000).

Over the last two decades, several studies have been conducted focusing on the relation between temperament and stuttering. For a comprehensive overview, see review articles (Jones, et al., 2014; Kefalianos et al., 2012) as well as our recent book chapter (Jones et al., in press) on the topic. The main findings from these studies have indicated that children who stutter, compared to children who do not stutter, may: 1) be more emotionally reactive and exhibit more negative emotions (e.g., Eggers et al., 2010; Karrass et al., 2006), and 2) have lower self-regulation (e.g., Eggers et al, 2010; Jones et al., 2014) or difficulties in processes supporting self-regulation, such as attentional focusing/shifting and inhibitory control (e.g., Eggers et al., 2012, 2013). Findings from studies in adults who stutter have been less unequivocal (e.g., Lucey et al., 2019).
In addition to studying between group-differences, several studies have shown that increased positive or negative reactivity is associated with increased stuttering frequency and/or stuttered utterances (e.g., Choi et al., 2016; Jones et al., 2014). Similarly, studies on self-regulation have found decreased regulation to be associated with increased stuttering frequency and/or severity (e.g., Jones et al., 2017; Kraft et al., 2019). A recent series of studies also explored associations between temperament, anxiety and the impact of stuttering. Children with higher positive reactivity (i.e., more extraverted and less fearful/shy), experienced a lower overall impact of their stuttering while children with higher negative reactivity (i.e., more irritable and easily frustrated), experienced a higher overall impact (Eggers et al., 2021). Further, higher negative reactivity and lower positive reactivity and self-regulation were associated with elevated levels of anxiety and depression in CWS (Eggers et al., in press).
Based on a growing body of research, evidence seems to suggest that temperament may play a salient role in the onset, development, and possibly the chronicity (e.g., Koenraads et al., 2021) of stuttering for at least some people who stutter. From a clinical point of view, assessing temperament (e.g., through parent- or child questionnaires, interviews, observations) in a child who stutters, may increase the understanding of how a child reacts in certain situations and regulates his/her emotions. Therapeutically, we suggest to proceed with caution until the underlying mechanisms between temperament and stuttering have been unraveled. However, clinicians may be able to suggest strategies to optimize parent-child alliance as well as ideal problem solving/coping strategies to apply, as already described in recent evidence-based treatment approaches (e.g., Kelman et al., 2020).


References
Choi, D., Conture, E. G., Walden, T. A., Jones, R. M., & Kim, H. (2016). Emotional diathesis, emotional stress, and childhood stuttering. Journal of Speech, Language, and Hearing Research, 59(4), 616-630. https://doi.org/10.1044/2015_JSLHR-S-14-0357
Eggers, K., De Nil, L. F., & Van den Bergh, B. R. (2010). Temperament dimensions in stuttering and typically developing children. Journal of Fluency Disorders, 35, 355-372. https://doi.org/10.1016/j.jfludis.2010.10.004
Eggers, K., De Nil, L., & Van den Bergh, B. (2012). The efficiency of attentional networks in children who stutter. Journal of Speech, Language, and Hearing Research, 55, 946-959. https://doi.org/10.1044/1092-4388(2011/10-0208)
Eggers, K., De Nil, L., & Van den Bergh, B. (2013). Inhibitory control in childhood stuttering. Journal of Fluency Disorders, 38, 1-13. https://doi.org/10.1016/j.jfludis.2012.10.001
Eggers, K., Millard, S., & Kelman, E. (2021). Temperament and the impact of stuttering in adolescents. Journal of Speech, Language, and Hearing Research, 64, 417–432. https://doi.org/10.1044/2020_JSLHR-20-00095
Eggers, K., Millard, S., & Kelman, E. (In press). Temperament, anxiety, and depression in school-age children who stutter.
Jones, R. M., Buhr, A. P., Conture, E. G., Tumanova, V., Walden, T. A., & Porges, S. W. (2014). Autonomic nervous system activity of preschool-age children who stutter. Journal of Fluency Disorders, 41, 12–31. https://doi.org/10.1016/j.jfludis.2014.06.002
Jones, R. M., Choi, D., Conture, E., & Walden, T. (2014). Temperament, Emotion, and Childhood Stuttering. Seminars in Speech and Language, 35(2), 114–131. https://doi.org/10.1055/s-0034-1371755
Jones, R. M., Conture, E. G., & Walden, T. A. (2014). Emotional reactivity and regulation associated with fluent and stuttered utterances of preschool-age children who stutter. Journal of Communication Disorders, 48, 38-51. https://doi.org/10.1016/j.jcomdis.2014.02.001
Jones, R., Eggers, K., & Zengin-Bolatkale, H. (In press). Temperamental and emotional processes. In P. Zebrowski, J. Anderson, and E. Conture (Eds.) Stuttering: Characteristics, assessment, and treatment (4th Ed.). Thieme Medical Publishers.
Jones, R. M., Walden, T. A., Conture, E. G., Erdemir, A., Lambert, W. E., & Porges, S. W. (2017). Executive Functions Impact the Relation Between Respiratory Sinus Arrhythmia and Frequency of Stuttering in Young Children Who Do and Do Not Stutter. Journal of Speech, Language, and Hearing Research, 60(8), 2133–2150. https://doi.org/10.1044/2017_JSLHR-S-16-0113
Karrass, J., Walden, T. A., Conture, E. G., et al. (2006). Relation of emotional reactivity and regulation to childhood stuttering. Journal of Communication Disorders, 39, 402-423. https://doi.org/10.1016/j.jcomdis.2005.12.004
Kefalianos, E., Onslow, M., Block, S., Menzies, R., & Reilly, S. (2012). Early stuttering, temperament and anxiety: two hypotheses. Journal of Fluency Disorders, 37(3), 151-163. https://doi.org/10.1016/j.jfludis.2012.03.002
Kefalianos, E., Onslow, M., Ukoumunne, O., Block, S., & Reilly, S. (2014). Stuttering, Temperament, and Anxiety: Data from a community cohort ages 2–4 years. Journal of Speech, Language, and Hearing Research, 57(4), 1314-1322. https://doi.org/10.1044/2014_JSLHR-S-13-0069
Kelman, E., & Nicholas, A. (2020) Palin Parent-Child Interaction Therapy for Early Childhood Stammering. Routledge
Koenraads, S. P. C., Jansen, P. W., Baatenburg de Jong, R. J., van der Schroeff, M. P., & Franken, M. C. (2021). Bidirectional associations of childhood stuttering with behavior and temperament. Journal of Speech, Language, and Hearing Research, 64(12), 4563-4579. https://doi.org/10.1044/2021_JSLHR-20-00252
Kraft, S. J., Lowther, E., & Beilby, J. (2019). The role of effortful control in stuttering severity in children: replication study. American Journal of Speech, Language Pathology, 28, 14–28. https://doi.org/10.1044/2018_AJSLP-17-0097
Lucey, J., Evans, D., & Maxfield, N. D. (2019). Temperament in adults who stutter and its association with stuttering frequency and quality-of-life impacts. Journal of Speech, Language, and Hearing Research, 62(8), 2691-2702. https://doi.org/10.1044/2019_JSLHR-S-18-0225
Rothbart, M. K. (2011). Becoming who we are: Temperament and personality in development. Guilford Press.
Rothbart, M. K., Derryberry, D., & Hershey, K. (2000). Stability of temperament in childhood: Laboratory infant assessment to parent report at seven years. In V. J. Molfese and D. L. Molfese (Eds.) Temperament and personality: Development across the Life Span. Mahwah, NJ: Lawrence Erlbaum Associates, Publishers.
Saudino, K. J. (2005). Behavioral Genetics and Child Temperament. Developmental and Behavioral Pediatrics, 26, 214-223. https://doi.org/10.1097/00004703-200506000-00010