Assessment of Executive Functioning in School-Age Children With And Without Stuttering: A case-control study

Abstract

Background: Stuttering is defined as a neurodevelopmental disorder, with disruptions in the normal fluency and time patterning of speech that are inappropriate for the individual's age and language skills. Executive functions (EF) include various cognitive skills, such as directing the attention required for planning and maintaining thoughts and behaviors, suppressing inappropriate stimuli, keeping the processed information active, and providing the transition between the information. This study was aimed at investigating whether there is a difference between school-age children with and without stuttering about executive functions (EF) skills and attention. Method: Twenty-six children with stuttering (14 boys; mean age=10.1±2.88) and twenty-five children without stuttering (14 boys; mean age=10.2±2.77) aged between 7 and 12 were admitted to the study. The participants were administered the Visual Aural Digit Span Test-B Form (VADS-B), which evaluates working memory and audiovisual attention, and the Cancellation Tests (CT), which evaluates sustained attention. The Parents of the participants were applied the Behavior Rating Inventory of Executive Function (BRIEF), which was developed to evaluate executive functions, problem-solving skills and adaptive behaviors. Differences in mean subscores of VADS-B, CT, and BRIEF were analyzed using univariate analysis of covariance (ANCOVA) with participant group as the factor and VADS-B, CT, and BRIEF subscores as the dependent variable; Chronological age (years) was designated as a covariate. Results: This study was conducted between two groups that were equal in terms of age, gender, developmental steps (walking, talking, toilet training), family structure, and socioeconomic status (p>0.05). All subscales of VADS-B (aural-verbal, aural-written, visual-verbal, visual-written) were found to be significantly lower in children with stuttering (p<0.05). In cancellation test results, there was a significant difference between the groups in terms of hit scores and total number of errors in organized letter and random letter forms (p<0.05). No difference was found between the two groups in the BRIEF scale completed by the parents (p>0.05). Conclusion: This study demonstrated that school-aged children with stuttering had weaker working memory and sustained attention performance in performance-based tests. Thus, we believe that in the evaluation and treatment of stuttering, comprehensive approaches should be adopted to evaluate attention and executive functions and to improve these functions. In this area, studies with larger samples are needed in which stuttering, attention, and executive functions are evaluated more comprehensively with different tasks (computer-based performance tests, parent-teacher scales, etc.) and neuroimaging (magnetic resonance imaging [MRI]). Lastly, the tasks used in our study (VADS-B, CT, and BRIEF) were applied to Turkish-speaking school-age children with stuttering for the first time. In this regard, we think that our study will contribute to the literature.