STUTTERING AND SOCIAL ANXIETY DISORDER 102 A Review on Stuttering and Social Anxiety Disorder in Children: Possible Causes and Therapies/Treatments Nadia Nathania [email protected] University of Nottingham Ningbo China Ningbo, China Abstract In the past two decades, stuttering and its relation to social anxiety disorder have been researched using different approaches in study fields such as neurolinguistics and neuropsychology. This paper presents a review of research publications about social anxiety disorder in children who stutter. It takes into account studies of stuttering, social anxiety disorders, the possible causes as well as atti- tudes and beliefs towards stuttering. Also, therapies or treatments that have been conducted on both English-speaking children who stutter in the Western context and Mandarin-speaking children stut- terers in Asia, Taiwan in particular; will be looked at. Keywords: stuttering, stammering, social anxiety disorder, children, therapies, treatments, English speakers, Mandarin speakers. Introduction Stuttering or stammering is a language childhood and continues in adulthood, relat- disorder in which there is disturbance in the ed to many different brain structures. The speech flow, preventing an individual from second is neurogenic stuttering, acquired in communicating effectively (World Health adulthood due to a neurological event as a Organization 2010; Iverach and Rapee, result of stroke, brain injury or trauma. The 2014). It is most commonly associated with third is psychogenic stuttering, which is a involuntary repetition of sounds, syllables, rare form that arises after severe emotional phrases and words (Carlson, 2013). A stut- trauma. The impact of stuttering on the terer usually becomes unable to produce emotional state of an individual can be se- sounds, which includes pauses or blocks vere, which may lead to fear of stuttering in before speech, and prolongs vowels or sem- social situations, anxiety, stress, and being a ivowels in an attempt to produce fluent target of bullying especially in children. speech (Carlson, 2013). This article focuses on childhood Stuttering can be categorized into three stuttering and aims at giving a deeper in- subtypes (New Scientist 2016). The first is a sight into how both English and Manda- developmental disorder that appears in early rin-speaking children stutterers develop Beyond Words Vol.4, No. 2, November 2016 STUTTERING AND SOCIAL ANXIETY DISORDER 103 social anxiety disorder, the possible caus- children stutterers both in Western and es of stuttering in children, as well thera- Asian contexts. Next, it will describe and pies or treatments available. Firstly, it will explain the benefits of different therapies introduce stuttering as a childhood lan- on stuttering. Finally, it will conclude cur- guage disorder and also look at the auto- rent status and future directions of social nomic nervous system in children stutter- anxiety disorder in children who stutter, ers. Then, it will look at perceptions of and offer some suggestions for future re- stuttering and social anxiety disorder in search in the field. Research in the Past Two Decades Stuttering typically begins to occur the preschool years due to significant neu- when children are developing language ronal plasticity (Iverach and Rapee, and speech skills, particularly between the 2014). The disorder becomes far less age of two and five years old (Yairi, Am- treatable after the preschool years, and by brose, and Cox, 1996). Stuttering, howev- adulthood it often turns out to be a long- er, is most responsive to treatment during term problem. There are two types of stuttering: ter without tension. This type of stutterers more typical disfluencies and less typical shows characteristics of hesitat-ing, using disfluencies (Gregory et al., 1996). Stut- interjections and unfinished words, revis- terers with more typical disfluencies stut- ing sentences, repeating phrases as well as 104 STUTTERING AND SOCIAL ANXIETY DISORDER words. On the contrary, less typical stuttering and anxiety showed ambiguity disfluencies stutterers exper-ience tension and inconsistency, and were difficult to in their stuttering. These could be identi- interpret (Menzies, Onslow, and Pack- fied by their repetitions of words, interjec- man, 1999; Ingham, 1984). The findings tions, sounds, and syllables for three times also included methodological flaws and or more. This type of stutterers also tend weaknesses such as small scope of sam- to prolong the duration of a phoneme, ex- pling, insufficiency to differentiate perience blocks in their speech, and com- groups, and sample selection bias such bine a set of less or more typical that stutterers seeking treatment for their disfluencies characteristics consecutively disorder were recruited as participants in their speech. Several examples of the instead of those who stutter from the gen- stutterer language are shown in the table eral community (Menzies, Onslow, and above. Packman, 1999; Ingham, 1984). The ap- Stuttering has been reported to have plication of physiological and one- effects on the school life as well as emo- dimensional anxiety measurements in- tional functioning of children (Hayhow, stead of measures designed to evaluate Cray, and Enderby, 2002). This is because social anxiety specifically were also defi- it is often associated with negative stereo- ciencies in the methodology (Menzies, types (Blumgart, Tran and Craig, 2010; Onslow, and Packman, 1999; Ingham, Klein and Hood, 2004), affecting quality 1984). of life by putting an individual in threat- Regardless of the uncertainties in the ening states, for example neurotrauma findings, publications of studies in the last (Craig, Blumgart, and Train, 2009). Nega- twenty years have shown evidence of the tive perceptions towards children stutter- relationship between stuttering and social ers are shown Ey empirical ”evidence of anxiety disorder to be more convincing. preschool children who stutter experienc- Menzies, Onslow, and Packman (1999) ing bullying, teasing, exclusion, and nega- reported that many studies have particu- tive peer reactions‘ (Iverach and Rapee, larly established the existence of intensi- 2014). These negative results that are fied anxiety in stutterers, with developing connected with stuttering are believed to evidence showing that anxiety only oc- be the origin of anxiety (Blood and Blood, curs in performance or social-based situa- 2007). tions. These findings are led by more Before the year of 2000, however, studies that have been centered on social findings about the correlation between anxiety, fear of negative evaluation, and STUTTERING AND SOCIAL ANXIETY DISORDER 105 expectancies of social harm (Iverach et Level (SCL) to index the activity of both al., 2011; Craig and Tran, 2006; Menzies, parasympathetic nerves that arises from Onslow, and Packman, 1999). the brain and the lower end of the spinal Autonomic Nervous System Activity cord, and sympathetic nerves, which are In relation to stuttering and social located in the ganglia, near the middle anxiety disorder, the association between part of the spinal cord supplying the in- developmental stuttering and emotional ternal organs, blood vessels, and glands processes has been researched using psy- (Oxford Dictionary 2016). The study dis- chophysiological methods to assess the covered that preschool stutterers dis- autonomic nervous system in preschool- played a greater emotional vulnerability age children who stutter to increase un- and mobilization of emotional reactivity derstanding of this connection (Jones et rather than preschool children who do not al., 2014). The autonomic nervous system stutter, showing a link between stuttering is the function of internal organs influ- and the development of anxiety in a child enced by a division of the peripheral stutterer (Jones et al., 2014). nervous system, which is responsible for Attitudes of Children in the West controlling unconscious bodily functions In the United States, Weidner et al. such as breathing, the heartbeat and diges- (2015) has conducted a study on non- tive processes (Schmidt and Thews, stuttering preschool and kindergarten 1989). It is reported that pre-school aged children and their attitudes towards children stutterers show less adaptability, schoolmates who stutter. The purpose of poor attention span and more negative the study is to understand better the ori- mood compared to children who do not gins of attitudes towards stuttering. The stutter (Jones et al., 2014). study examined attitudes toward stuttering Jones and colleagues (2014) investi- using the Public Opinion Survey on Hum- gated the potential differences in the au- an Attributes-Stuttering/Child (POSHA-S/ tonomic nervous system activity to emo- Child) that was suitable to be used with tional stimuli between preschool stutterers young children. The participants were 27 and non-stutterers. The study included 15 preschool and 24 kindergarten non- male and 5 female preschool-age stutter- stuttering children. The findings showed ers as well as 11 male and 9 female pre- that preschool students had more negative school-age non-stutterers as participants. attitudes towards stuttering compared to The experiment used Respiratory Sinus kindergarten students. Although stuttering Arrhythmia (RSA) and Skin Conductance was viewed negatively, children actually 106 STUTTERING AND SOCIAL ANXIETY DISORDER viewed their stuttering peers positively. Following the results, the teachers However, their knowledge and experience