Clinical Characteristics Associated With Stuttering Persistence: A Meta-Analysis

Abstract

Purpose The purpose of this meta-analytic study was to identify clinical characteristics, defined as child factors that can be assessed by a speech-language pathologist as part of a routine speech-language evaluation that may differentiate children who persist in stuttering from children who eventually recover from stuttering. Clinical characteristics explored included sex, age at onset, family history of stuttering, stuttering frequency and severity, speech-language skills, and temperament. Method Studies were identified through electronic databases, journals, and reference lists of relevant reports (e.g., research articles). Eligible studies followed young children who stutter (i.e., under 6 years old) for at least 24 months, assessed a potential clinical marker at study entry, and determined talker group classification (i.e., persistent or recovered) at study completion. Sex and family history differences were estimated using risk ratios; all other differences were estimated using Hedges's g. Heterogeneity and methodological differences among studies were evaluated. Results Eleven studies (41 reports) met eligibility criteria. Persistent children were older at stuttering onset and exhibited higher frequencies of stuttering-like disfluencies, lower speech sound accuracy, and lower expressive and receptive language skills than recovered children. Males and children with a family history of stuttering were also more likely to persist. Conclusions Clinical characteristics were identified that are associated with increased risk for stuttering persistence. Future studies have the potential to translate these clinical characteristics into prognostic markers for stuttering persistence risk.

Figure 1.

Flow chart depicting selection of studies.

Figure 2.

Risk of bias summary figure. The study confounding source of bias category was only assessed for studies that explored speech-language skills and temperament.

Figure 3.

Forest plot comparing risk for stuttering persistence between males and females. As indicated by the diamond falling to the right of the line of no effect, males are at increased risk for persistence compared to females. CI = confidence interval; F = female; M = male; RE = random effects.

Figure 4.

Contour funnel plot of studies reporting risk related to sex. Asymmetry related to the distribution of the data points may be due to publication bias, differences in study methods, and the direction of the relation.

Figure 5.

Forest plot comparing mean age at stuttering onset for persistent and recovered children. As indicated by the diamond falling to the right of the line of no effect, persistent children were older at stuttering onset than recovered children. CI = confidence interval; RE = random effects.

Figure 6.

Forest plot comparing risk for stuttering persistence between children with and without family histories of stuttering. As indicated by the diamond falling to the right of the line of no effect, children with a family history of stuttering are at increased risk for stuttering persistence compared to children without a family history of stuttering. No risk differences were found based on family history of persistent and recovered stuttering. CI = confidence interval; RE = random effects.

Figure 7.

Forest plot comparing mean stuttering behaviors for persistent and recovered children. As evidenced by the positioning of the diamond relative to the line of no effect, persistent children exhibited a higher frequency of stuttering-like disfluencies than recovered children. All other differences were nonsignificant. CI = confidence interval; RE = random effects; SLD = stuttering-like disfluencies; SSI = Stuttering Severity Instrument.

Figure 8.

Forest plot comparing mean speech-language skills for persistent and recovered children. As indicated by the positioning of the diamonds relative to the line of no effect, persistent children exhibit lower speech sound accuracy, receptive language, and expressive language than recovered children. All other differences were nonsignificant. APP-R = Assessment of Phonological Processes–Revised (Hodson, 1986); BBTOP-CI = Bankson–Bernthal Test of Phonology—Consonant Inventory (Bankson & Bernthal, 1990); CDI = MacArthur–Bates Communicative Development Inventories (Fenson et al., 1993); CI = confidence interval; DSS = Developmental Sentence Scoring (Lee & Canter, 1971); EVT = Expressive Vocabulary Test (Williams, 1997); GFTA = Goldman-Fristoe Test of Articulation (Goldman & Fristoe, 2000); IPSYN = Index of Productive Syntax (Scarborough, 1990); MLU = mean length of utterance; PLS = Preschool Language Scales (Zimmerman et al., 1979); PPVT = Peabody Picture Vocabulary Test (Dunn & Dunn, 1997); Reynell = Reynell Language Development Scale (Reynell, 1983); SPELT = Structured Photographic Expressive Language Test (Dawson et al., 2003); TACL = Test for Auditory Comprehension of Language (Carrow-Woolfolk, 1999); TELD = Test of Early Language Development (Hresko et al., 1999).

Figure 9.

Forest plot comparing temperament for persistent and recovered children. As indicated by all diamonds crossing the line of no effect, differences are nonsignificant. CI = confidence interval; RE = random effects.