Investigating Stuttering Awareness in Children Who Stutter: A Cross-sectional Study Using Direct Questions
Main Article Content
Abstract
Background: Stuttering is a fluency disorder that begins in childhood. Parents and physicians may sometimes underestimate the condition if the child is unaware of their own stuttering, leading to a "wait-and-see" approach without early intervention or prevention.
Aim: This study aimed to assess the awareness of stuttering among children who stutter.
Methods: We enrolled 106 children aged 5–12 years with stuttering. The average frequency of stuttering was 6.6% among participants. The following four questions were asked regarding their perceptions of stuttering and experiences of teasing/bullying: “Do you sometimes repeat words or get stuck while speaking?” and “Has anyone asked you why you speak that way?” “Has anyone imitated the way you speak?” and “Has anyone laughed at your speech?” The percentage of children who answered ‘yes’ to each question was calculated.
Results: Of the 106 participants, 60.3% reported experiencing teasing or bullying, 84.9% perceived their own stuttering, and 89.6% answered "Yes" to at least one of the four questions. Significant differences in the perception and experience of teasing and bullying were observed among children aged 8–10 years old.
Conclusion: Including questions about perception in addition to teasing/ bullying helped identify children’s awareness of their stuttering. These questions may be useful for promoting early intervention and preventing disadvantages associated with stuttering.
Keywords:
Awareness, Bullying, Childhood-onset fluency disorder, Stuttering, Teasing.
Article Details
How to Cite
KIKUCHI, Yoshikazu et al.
Investigating Stuttering Awareness in Children Who Stutter: A Cross-sectional Study Using Direct Questions.
Medical Research Archives, [S.l.], v. 13, n. 5, may 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6468>. Date accessed: 21 june 2025.
doi: https://doi.org/10.18103/mra.v13i5.6468.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Battle DE. Diagnostic and statistical manual of mental disorders (DSM). CoDAS. 2013;25:191-192.
2. Mansson H. Childhood stuttering. J Fluency Disord. 2000;25:47-57.
3. Reilly S, Onslow M, Packman A, et al. Predicting stuttering onset by the age of 3 years: A prospective, community cohort study. Pediatrics. 2009; 123:270-277.
4. Reilly S, Onslow M, Packman A, et al. Natural history of stuttering to 4 years of age: A prospective community-based study. Pediatrics. 2013;132:460-467.
5. Yairi E, Ambrose NG. Early childhood stuttering I: persistency and recovery rates. J Speech Lang Hear Res. 1999;42:1097-1112.
6. Yairi E, Ambrose N. Early childhood stuttering. Austin: Pro-Ed, Inc.; 2005.
7. Yairi E, Ambrose N. Epidemiology of stuttering: 21st century advances. J Fluency Disord. 2013;38:66-87.
8. Murphy WP, Yaruss JS, Quesal RW. Enhancing treatment for school-age children who stutter II. Reducing bullying through role-playing and self-disclosure. J Fluency Disord. 2007;32:139-162.
9. Blood GW, Boyle MP, Blood IM, Nalesnik GR. Bullying in children who stutter: Speech-language pathologists’ perceptions and intervention strategies. J Fluency Disord. 2010;35:92-109.
10. Kikuchi Y, Umezaki T, Sawatsubashi M, et al. Experiences of teasing and bullying in children who stutter. Int Arch Commun Disord. 2019;2:013.
11. Blumgart E, Tran Y, Craig A. Social anxiety disorder in adults who stutter. Depress Anxiety. 2010;27:687-692.
12. Menzies RG, O’Brian S, Onslow M, Packman A, St Clare T, Block S. An experimental clinical trial of a cognitive-behavior therapy package for chronic stuttering. J Speech Lang Hear Res. 2008;51:1451-1464.
13. Iverach L, Jones M, McLellan LF, et al. Prevalence of anxiety disorders among children who stutter. J Fluency Disord. 2016;49:13-28.
14. Gunn A, Menzies RG, Onslow M, et al. Phase I trial of a standalone internet social anxiety treatment for adolescents who stutter: iBroadway. Int J Lang Commun Disord. 2019;54:927-939.
15. Kikuchi Y, Kenjo M, Yoshida E, et al. Social anxiety disorder in adolescents who stutter: A risk for school refusal. Pediatr Int. 2023;65:e15622.
16. Craig A, Blumgart E, Tran Y. The impact of stuttering on the quality of life in adults who stutter. J Fluency Disord. 2009;34:61-71.
17. Koedoot C, Bouwmans C, Franken MC, Stolk E. Quality of life in adults who stutter. J Commun Disord. 2011;44:429-443.
18. McAllister J, Collier J, Shepstone L. The impact of adolescent stuttering on educational and employment outcomes: Evidence from a birth cohort study. J Fluency Disord. 2012;37:106-121.
19. Gerlach H, Totty E, Subramanian A, Zebrowski P. Stuttering and labor market outcomes in the United States. J Speech Lang Hear Res. 2018; 61:1649-1663.
20. Langevin M, Packman A, Onslow M. Parent perceptions of the impact of stuttering on their preschoolers and themselves. J Commun Disord. 2010; 43:407-423.
21. Johnson W. The onset of stuttering. Minneapolis: University of Minnesota Press; 1959.
22. Ambrose NG, Yairi E. The Tudor Study: Data and ethics. Am J Speech Lang Pathol. 2002;11:190-203.
23. Frigerio-Domingues C, Drayna D. Genetic contributions to stuttering: The current evidence. Mol Genet Genomic Med. 2017;5:95-102.
24. Kang C, Riazuddin S, Mundorff J, et al. Mutations in the lysosomal enzyme-targeting pathway and persistent stuttering. N Engl J Med. 2010;362:677-685.
25. Raza MH, Mattera R, Morell R, et al. Association between rare variants in AP4E1, a component of intracellular trafficking, and persistent stuttering. Am J Hum Genet. 2015;97:715-725.
26. Raza MH, Domingues CEF, Webster R, et al. Mucolipidosis types II and III and non-syndromic stuttering are associated with different variants in the same genes. Eur J Hum Genet. 2016;24:529-534.
27. Jones M, Onslow M, Packman A, et al. Randomised controlled trial of the Lidcombe programme of early stuttering intervention. BMJ. 2005;331:659.
28. Trajkovski N, O’Brian S, Onslow M, et al. A three-arm randomized controlled trial of Lidcombe Program and Westmead Program early stuttering interventions. J Fluency Disord. 2019;61:105708.
29. de Sonneville-Koedoot C, Stolk E, Rietveld T, Franken MC. Direct versus Indirect Treatment for Preschool Children who Stutter: The RESTART Randomized Trial. PLOS ONE. 2015;10:e0133758.
30. Waelkens V, Mini KIDS. Direct therapy for young children who stutter (2-6 years). Tiegem (BE) Veerle Waelkens. 2018.
31. Millard SK, Zebrowski P, Kelman E. Palin parent-child interaction therapy: The bigger picture. Am J Speech Lang Pathol. 2018;27:1211-1223.
32. Woods S, Shearsby J, Onslow M, Burnham D. Psychological impact of the Lidcombe Program of early stuttering intervention. Int J Lang Commun Disord. 2002;37:31-40.
33. Yaruss JS, Reeves N, Herring C. How speech-language pathologists can minimize bullying of children who stutter. Semin Speech Lang. 2018;39: 342-355.
34. Johnson G, Onslow M, Horton S, Kefalianos E. Reduced stuttering for school-age children: A systematic review. J Fluency Disord. 2023;78:106015.
35. Johnson G, Onslow M, Horton S, Kefalianos E. Psychosocial features of stuttering for school-age children: A systematic review. Int J Lang Commun Disord. 2023;58:1829-1845.
36. Ezrati-Vinacour R, Platzky R, Yairi E. The young child’s awareness of stuttering-like disfluency. J Speech Lang Hear Res. 2001;44:368-380.
37. Ambrose NG, Yairi E. The development of awareness of stuttering in preschool children. J Fluency Disord. 1994;19:229-245.
38. Boey RA, Van de Heyning PH, Wuyts FL, Heylen L, Stoop R, De Bodt MS. Awareness and reactions of young stuttering children aged 2-7 years old towards their speech disfluency. J Commun Disord. 2009;42:334-346.
39. Kikuchi Y, Umezaki T, Adachi K, et al. Awareness of stuttering in Japanese children aged 3-7 years. Pediatr Int. 2021;63:150-153.
40. Vanryckeghem M, Brutten GJ, Hernandez LM. A comparative investigation of the speech-associated attitude of preschool and kindergarten children who do and do not stutter. J Fluency Disord. 2005;30:307-318.
41. Winters KL, Byrd CT. Pediatrician referral practices for children who stutter. Am J Speech Lang Pathol. 2020;29:1404-1422.
42. Riley GD, Riley J. Physician’s screening procedure for children who may stutter. J Fluency Disord. 1989;14:57-66.
43. Yairi E, Carrico DM. Early childhood stuttering: Pediatricians’ attitudes and practices. Am J Speech Lang Pathol. 1992;1:54-62.
44. LaSalle LR, Huffman GD. Speech sample measures in Japanese children and adults who stutter. Speech, Language and Hearing/ 2014;18: 64-73.
45. Coloroso B, The bully, the bullied, and the bystander. New York, NY: HarperCollins Publisher, Inc, 2003.
46. Langevin M, Bortnick K, Hammer T, Wiebe E. Teasing/bullying experienced by children who stutter: Toward development of a questionnaire. Contemp Issues Commun Sci Disord. 1998;25:8-20.
47. Bloodstein O. The Development of Stuttering Ⅱ. Developmental Phases. J speech hear disord. 1960;25:366-376.
48. Constantino CD, Leslie P, Quesal RW, Yaruss JS. A preliminary investigation of daily variability of stuttering in adults. J Commun Disord. 2016;60:39-50.
49. Davidow JH, Ye J, Edge RL. The reliability of simultaneous versus individual data collection during stuttering assessment. Int J Lang Commun Disord. 2023;58:1251-1267.
50. Sønsterud H, Howells K, Ward D. Covert and overt stuttering: Concepts and comparative findings. J Commun Disord. 2022;99:106246.
51. Brutten GJ, Dunham SL. The Communication Attitude Test. J Fluency Disord. 1989;14:371-377.
2. Mansson H. Childhood stuttering. J Fluency Disord. 2000;25:47-57.
3. Reilly S, Onslow M, Packman A, et al. Predicting stuttering onset by the age of 3 years: A prospective, community cohort study. Pediatrics. 2009; 123:270-277.
4. Reilly S, Onslow M, Packman A, et al. Natural history of stuttering to 4 years of age: A prospective community-based study. Pediatrics. 2013;132:460-467.
5. Yairi E, Ambrose NG. Early childhood stuttering I: persistency and recovery rates. J Speech Lang Hear Res. 1999;42:1097-1112.
6. Yairi E, Ambrose N. Early childhood stuttering. Austin: Pro-Ed, Inc.; 2005.
7. Yairi E, Ambrose N. Epidemiology of stuttering: 21st century advances. J Fluency Disord. 2013;38:66-87.
8. Murphy WP, Yaruss JS, Quesal RW. Enhancing treatment for school-age children who stutter II. Reducing bullying through role-playing and self-disclosure. J Fluency Disord. 2007;32:139-162.
9. Blood GW, Boyle MP, Blood IM, Nalesnik GR. Bullying in children who stutter: Speech-language pathologists’ perceptions and intervention strategies. J Fluency Disord. 2010;35:92-109.
10. Kikuchi Y, Umezaki T, Sawatsubashi M, et al. Experiences of teasing and bullying in children who stutter. Int Arch Commun Disord. 2019;2:013.
11. Blumgart E, Tran Y, Craig A. Social anxiety disorder in adults who stutter. Depress Anxiety. 2010;27:687-692.
12. Menzies RG, O’Brian S, Onslow M, Packman A, St Clare T, Block S. An experimental clinical trial of a cognitive-behavior therapy package for chronic stuttering. J Speech Lang Hear Res. 2008;51:1451-1464.
13. Iverach L, Jones M, McLellan LF, et al. Prevalence of anxiety disorders among children who stutter. J Fluency Disord. 2016;49:13-28.
14. Gunn A, Menzies RG, Onslow M, et al. Phase I trial of a standalone internet social anxiety treatment for adolescents who stutter: iBroadway. Int J Lang Commun Disord. 2019;54:927-939.
15. Kikuchi Y, Kenjo M, Yoshida E, et al. Social anxiety disorder in adolescents who stutter: A risk for school refusal. Pediatr Int. 2023;65:e15622.
16. Craig A, Blumgart E, Tran Y. The impact of stuttering on the quality of life in adults who stutter. J Fluency Disord. 2009;34:61-71.
17. Koedoot C, Bouwmans C, Franken MC, Stolk E. Quality of life in adults who stutter. J Commun Disord. 2011;44:429-443.
18. McAllister J, Collier J, Shepstone L. The impact of adolescent stuttering on educational and employment outcomes: Evidence from a birth cohort study. J Fluency Disord. 2012;37:106-121.
19. Gerlach H, Totty E, Subramanian A, Zebrowski P. Stuttering and labor market outcomes in the United States. J Speech Lang Hear Res. 2018; 61:1649-1663.
20. Langevin M, Packman A, Onslow M. Parent perceptions of the impact of stuttering on their preschoolers and themselves. J Commun Disord. 2010; 43:407-423.
21. Johnson W. The onset of stuttering. Minneapolis: University of Minnesota Press; 1959.
22. Ambrose NG, Yairi E. The Tudor Study: Data and ethics. Am J Speech Lang Pathol. 2002;11:190-203.
23. Frigerio-Domingues C, Drayna D. Genetic contributions to stuttering: The current evidence. Mol Genet Genomic Med. 2017;5:95-102.
24. Kang C, Riazuddin S, Mundorff J, et al. Mutations in the lysosomal enzyme-targeting pathway and persistent stuttering. N Engl J Med. 2010;362:677-685.
25. Raza MH, Mattera R, Morell R, et al. Association between rare variants in AP4E1, a component of intracellular trafficking, and persistent stuttering. Am J Hum Genet. 2015;97:715-725.
26. Raza MH, Domingues CEF, Webster R, et al. Mucolipidosis types II and III and non-syndromic stuttering are associated with different variants in the same genes. Eur J Hum Genet. 2016;24:529-534.
27. Jones M, Onslow M, Packman A, et al. Randomised controlled trial of the Lidcombe programme of early stuttering intervention. BMJ. 2005;331:659.
28. Trajkovski N, O’Brian S, Onslow M, et al. A three-arm randomized controlled trial of Lidcombe Program and Westmead Program early stuttering interventions. J Fluency Disord. 2019;61:105708.
29. de Sonneville-Koedoot C, Stolk E, Rietveld T, Franken MC. Direct versus Indirect Treatment for Preschool Children who Stutter: The RESTART Randomized Trial. PLOS ONE. 2015;10:e0133758.
30. Waelkens V, Mini KIDS. Direct therapy for young children who stutter (2-6 years). Tiegem (BE) Veerle Waelkens. 2018.
31. Millard SK, Zebrowski P, Kelman E. Palin parent-child interaction therapy: The bigger picture. Am J Speech Lang Pathol. 2018;27:1211-1223.
32. Woods S, Shearsby J, Onslow M, Burnham D. Psychological impact of the Lidcombe Program of early stuttering intervention. Int J Lang Commun Disord. 2002;37:31-40.
33. Yaruss JS, Reeves N, Herring C. How speech-language pathologists can minimize bullying of children who stutter. Semin Speech Lang. 2018;39: 342-355.
34. Johnson G, Onslow M, Horton S, Kefalianos E. Reduced stuttering for school-age children: A systematic review. J Fluency Disord. 2023;78:106015.
35. Johnson G, Onslow M, Horton S, Kefalianos E. Psychosocial features of stuttering for school-age children: A systematic review. Int J Lang Commun Disord. 2023;58:1829-1845.
36. Ezrati-Vinacour R, Platzky R, Yairi E. The young child’s awareness of stuttering-like disfluency. J Speech Lang Hear Res. 2001;44:368-380.
37. Ambrose NG, Yairi E. The development of awareness of stuttering in preschool children. J Fluency Disord. 1994;19:229-245.
38. Boey RA, Van de Heyning PH, Wuyts FL, Heylen L, Stoop R, De Bodt MS. Awareness and reactions of young stuttering children aged 2-7 years old towards their speech disfluency. J Commun Disord. 2009;42:334-346.
39. Kikuchi Y, Umezaki T, Adachi K, et al. Awareness of stuttering in Japanese children aged 3-7 years. Pediatr Int. 2021;63:150-153.
40. Vanryckeghem M, Brutten GJ, Hernandez LM. A comparative investigation of the speech-associated attitude of preschool and kindergarten children who do and do not stutter. J Fluency Disord. 2005;30:307-318.
41. Winters KL, Byrd CT. Pediatrician referral practices for children who stutter. Am J Speech Lang Pathol. 2020;29:1404-1422.
42. Riley GD, Riley J. Physician’s screening procedure for children who may stutter. J Fluency Disord. 1989;14:57-66.
43. Yairi E, Carrico DM. Early childhood stuttering: Pediatricians’ attitudes and practices. Am J Speech Lang Pathol. 1992;1:54-62.
44. LaSalle LR, Huffman GD. Speech sample measures in Japanese children and adults who stutter. Speech, Language and Hearing/ 2014;18: 64-73.
45. Coloroso B, The bully, the bullied, and the bystander. New York, NY: HarperCollins Publisher, Inc, 2003.
46. Langevin M, Bortnick K, Hammer T, Wiebe E. Teasing/bullying experienced by children who stutter: Toward development of a questionnaire. Contemp Issues Commun Sci Disord. 1998;25:8-20.
47. Bloodstein O. The Development of Stuttering Ⅱ. Developmental Phases. J speech hear disord. 1960;25:366-376.
48. Constantino CD, Leslie P, Quesal RW, Yaruss JS. A preliminary investigation of daily variability of stuttering in adults. J Commun Disord. 2016;60:39-50.
49. Davidow JH, Ye J, Edge RL. The reliability of simultaneous versus individual data collection during stuttering assessment. Int J Lang Commun Disord. 2023;58:1251-1267.
50. Sønsterud H, Howells K, Ward D. Covert and overt stuttering: Concepts and comparative findings. J Commun Disord. 2022;99:106246.
51. Brutten GJ, Dunham SL. The Communication Attitude Test. J Fluency Disord. 1989;14:371-377.