Rhyme Production Strategies Distinguish Stuttering Recovery and Persistence

Abstract

Purpose The primary aim of the current study was to examine the developing phonological awareness of 4- to 5-year-old children who stutter (CWS) in relation to eventual recovery (CWS-eRec) or persistance (CWS-ePer) in stuttering, accounting for the presence of typical speech (TS) production or speech sound disorder (SSD). Method In the 1st year of a 5-year longitudinal study, 37 children who do not stutter (CWNS) and 48 CWS completed a rhyme discrimination and a rhyme production task from the Phonological Awareness Test-Second Edition (Robertson & Salter, 2007). Using data from their last year of participation, CWS were classified into CWS-ePer and CWS-eRec. Each CWS group was further divided into TS and SSD groups based on speech production abilities at the time of the rhyme tasks. Accuracy on the rhyme tasks was compared. Groups were also compared on strategies used to generate correct and incorrect responses for the rhyme production task (e.g., real-word correct, nonword correct, semantic association, repeated cues). Results All groups performed similarly on the rhyme discrimination task. On the rhyme production task, CWS-ePer-SSD and CWS-eRec-SSD performed with less accuracy than CWNS, but CWS-ePer-TS, CWS-eRec-TS, and CWNS achieved similar task accuracy. On correct rhyme production trials, CWS-ePer-TS created more nonword rhymes than real-word rhymes. CWS-ePer-TS used the nonword strategy at 1.88 times the CWNS rate. CWS-eRec-TS fell between CWS-ePer-TS and CWNS in use of the nonword strategy. Conclusions Reliance on a nonword strategy for rhyme production in CWS-ePer-TS may reflect differences in underlying phonological representations and ease of phonological access to the lexicon compared to CWNS.

Figure 1.

Scatter plot and regressions from studies of phonological awareness representing children's percent accuracy on rhyme tasks across ages (Carroll et al., 2003; Corriveau et al., 2010; Lonigan et al., 1998; Maclean et al., 1987). Studies included rhyme-matching tasks, in which participants choose a word from two options that rhymes with a stimulus (Carroll et al., 2003; Maclean et al., 1987), and rhyme oddity tasks, in which participants choose a word from three to four options that does not rhyme with the others (Corriveau et al., 2010; Lonigan et al., 1998; Maclean et al., 1987). The overall regression line considers data points from each study and is included to approximate rhyme development from 40 to 78 months.

Figure 2.

Scatter plot displaying development of phonological production over time in relation to stuttering onset (data from Rvachew & Brosseau-Lapré, 2018, pp. 164–169; for reviews, see Bunta et al., 2009; Ingram, 2002; MacLeod et al., 2011; Schmitt et al., 1983). The gray rectangle represents the onset of stuttering, which usually occurs between 24 and 48 months of age (Yairi & Ambrose, 2013). Phonological production accuracy increases steeply from approximately 30% at 25 months of age to approximately 80% at 48 months of age.

Figure 3.

Differences between groups on the rhyme discrimination and rhyme production tasks. Our six post hoc pairwise comparisons with conservative Bonferroni-corrected p value (p = .008) revealed that groups performed similarly on the rhyme discrimination task. On the rhyme production task, groups with typical speech (TS) performed with similar accuracy; however, the groups of CWS (children who stutter) with speech sound disorder (SSD) performed significantly lower than children who do not stutter (CWNS). CWS-eRec = children who stutter and eventually recovered; CWS-ePer = children who stutter and eventually persisted.

Figure 4.

Percentage of responses from each group that used the following rhyme production strategies: real-word correct, nonword correct, semantic association, and repeated cues. The upper graph shows groups with typical speech (TS), and the lower graph shows groups with speech sound disorder (SSD). Although the CWNS (children who do not stutter) and CWS-ePer-TS (children who stutter and eventually persisted with typical speech) performed similarly on the rhyme production task, a greater proportion of correct responses from CWS-ePer-TS were achieved through nonword correct trials than real-word correct trials. CWS-eRec-TS = children who stutter and eventually recovered with typical speech; CWS-eRec-SSD = children who stutter and eventually recovered with speech sound disorder; CWS-ePer-SSD = children who stutter and eventually persisted with speech sound disorder.

Figure 5.

Participant patterns of rhyme production strategy use on correct trials. The upper plot shows groups with typical speech, and the lower plot shows groups with speech sound disorder (SSD). Although the groups with typical speech demonstrated similar performance on the rhyme production task, individual CWNS (children who do not stutter) and CWS-eRec-TS (children who stutter and eventually recovered with typical speech) demonstrated mixed patterns of strategy use compared to individual CWS-ePer-TS (children who stutter and eventually persisted with typical speech). None of the individual CWS-ePer-TS or CWS-ePer-SSD (children who stutter and eventually persisted with speech sound disorder) used the real-word correct strategy more than the nonword correct strategy. CWS-eRec-SSD = children who stutter and eventually recovered with speech sound disorder.