Parent Report Research Articles

Children and adolescents' quality of life in repeated cross-sectional studies during the COVID-19.

During the COVID-19 pandemic, internalizing and externalizing symptoms have impacted the quality of life of children and adolescents. This cross-sectional study evaluated children's quality of life using parental reports, observing associations with mental health problems and sociodemographic variables. Some behavioral measures were linked to lower quality of life, particularly depression symptoms, relationship problems, and inattention. Multiple regression models indicated that reduced children's quality of life (R2 = 36%) was associated with higher levels of internalizing (r = -0.46) and externalizing (r = -0.23) behavioral problems and younger parents (r = -0.08). Children with previous mental disorder diagnoses had lower quality of life than those without (p < 0.001). In summary, children's quality of life during the COVID-19 pandemic was linked to current mental health, parental age, and previous history of mental disorders.

Impact of COVID‐19 lockdown in England on challenging behaviour and adaptive skills for children in a special school: A longitudinal study

AbstractLongitudinal research is crucial to fully assess the putative impact of the COVID‐19 pandemic on children with an intellectual disability in special school settings—ideally drawing on data pre‐pandemic to be able to evaluate later impact. Data on challenging behaviour and adaptive skills were collected annually for 348 students in one special school across four time points pre‐pandemic and one time point post‐pandemic. Data were analysed using multilevel models with repeated observations over the five time points. There was a decrease in aggressive and destructive behaviours and a decrease in adaptive skills at the post‐pandemic time point, after accounting for other important covariates. There was no evidence of a change in stereotyped or self‐injurious challenging behaviours. Other research using longitudinal methods is rare, but the current findings are consistent with previous research reporting on the impact of COVID‐19 on children and young people, particularly from parent reports. Future considerations for schools include adopting appropriate strategies to support learners to reintegrate back into education. Further research is needed to look at the longer‐term impact of the pandemic on challenging behaviour in children with an intellectual disability.

What I see, what you say: How cross-method variation sharpens characterization of irritability in early childhood.

Identification of clinically significant irritability in preschool age is important to implement effective interventions. However, varying informant and measurement methods display distinct patterns. These patterns are associated with concurrent and future mental health concerns. Patterns across multi-informant methods in early-childhood irritability may have clinical utility, identifying risk for impaired psychosocial functioning. Using data from the Multidimensional Assessment of Preschoolers Study (N=425), latent profile analysis identified irritability patterns through the parent-reported Multidimensional Assessment Profile Scales-Temper Loss (MAPS-TL), parent-reported interviewer-rated Preschool Age Psychiatric Assessment (PAPA), and observer-rated Disruptive Behavior Diagnostic Observation Schedule (DB-DOS). These profiles were characterized on protective factors, global functioning, and mental health syndromes, concurrently and at early school age and preadolescent follow-up. Fit indices favored a five-class model: Low All, High Observation with Examiner (high DB-DOS Examiner Context), High All, High Parent Report (high MAPS-TL/PAPA), and Very High Parent Report (very high MAPS-TL/PAPA). Whereas Low All and High Observation with Examiner exhibited strong psychosocial functioning, remaining profiles showed impaired psychosocial functioning, with the Very High Parent Report group showing higher impairment at follow-ups, ds=0.37-1.25. Multi-informant measurements of irritability may have utility for clinical prediction, and future studies should test utility for diagnostic precision.

Mental Health, Parenting Stress, and Parenting Practices of Parents of Deaf or Hard of Hearing Children During the Pandemic.

The authors investigated parent mental health during the COVID-19 pandemic and its association with parenting behaviors of parents of children who are deaf or hard of hearing. An electronic survey was distributed to parents (N = 103). The results showed that they were experiencing elevated anxiety, depression, and symptoms of post-traumatic stress disorder. A combined model demonstrated that parental distress was significantly associated with depression and with parental reports of symptoms indicating significantly higher distress. Parental distress was also significantly associated with parenting strategies: Parents who endorsed positive strategies reported significantly lower levels of distress, while parents who endorsed negative strategies reporting significantly higher levels. It was found that screening protocols to identify parents in need of support are crucial, particularly among the parent population considered in the present study. Additionally, access to mental health services and evidence-based positive parenting programs is essential.

Disparities in Unmet Health Care Needs Among US Children During the COVID-19 Pandemic.

The COVID-19 pandemic disrupted pediatric health care in the United States, and this disruption layered on existing barriers to health care. We sought to characterize disparities in unmet pediatric health care needs during this period. We analyzed data from Wave 1 (October through November 2020) and Wave 2 (March through May 2021) of the COVID Experiences Survey, a national longitudinal survey delivered online or via telephone to parents of children aged 5 through 12 years using a probability-based sample representative of the US household population. We examined 3 indicators of unmet pediatric health care needs as outcomes: forgone care and forgone well-child visits during fall 2020 through spring 2021, and no well-child visit in the past year as of spring 2021. Multivariate models examined relationships of child-, parent-, household-, and county-level characteristics with these indicators, adjusting for child's age, sex, and race/ethnicity. On the basis of parent report, 16.3% of children aged 5 through 12 years had forgone care, 10.9% had forgone well-child visits, and 30.1% had no well-child visit in the past year. Adjusted analyses identified disparities in indicators of pediatric health care access by characteristics at the level of the child (eg, race/ethnicity, existing health conditions, mode of school instruction), parent (eg, childcare challenges), household (eg, income), and county (eg, urban-rural classification, availability of primary care physicians). Both child and parent experiences of racism were also associated with specific indicators of unmet health care needs. Our findings highlight the need for continued research examining unmet health care needs and for continued efforts to optimize the clinical experience to be culturally inclusive.

Differences in Receipt of Time Alone with Healthcare Providers Among US Youth Ages 12-17.

Time to meet privately with a health care provider can support optimal adolescent health, but numerous barriers exist to implementing this practice routinely. We examined parent reports on their children aged 12 to 17 from a nationally generalizable sample to quantify the presence of time alone with health care providers at the state and national level, as well as socio-contextual correlates using logistic regression analysis. We estimated that only 1 in 2 adolescents had a confidential discussion at their last medical visit. Certain child, family, and health care factors were associated with lower likelihood for having had confidential discussions. Specifically, adolescents who were Asian; did not have mental, emotional, or behavioral problems; were uninsured; or lived in households with parents who were immigrants, less educated, or did not speak English had significantly lower odds for having had time alone compared with referent groups. Clinical and structural efforts to rectify these gaps may assist a broader share of youth in benefiting from private health care discussions with providers.

Utility of the 3Di short version in the identification and diagnosis of autism in children at the Kenyan coast.

The precise epidemiological burden of autism is unknown because of the limited capacity to identify and diagnose the disorder in resource-constrained settings, related in part to a lack of appropriate standardised assessment tools and health care experts. We assessed the reliability, validity, and diagnostic accuracy of the Developmental Diagnostic Dimensional Interview (3Di) in a rural setting on the Kenyan coast. Using a large community survey of neurodevelopmental disorders (NDDs), we administered the 3Di to 2,110 children aged between 6 years and 9 years who screened positive or negative for any NDD and selected 242 who had specific symptoms suggestive of autism based on parental report and the screening tools for review by a child and adolescent psychiatrist. On the basis of recorded video, a multi-disciplinary team applied the Autism Diagnostic Observation Schedule to establish an autism diagnosis. Internal consistency was used to examine the reliability of the Swahili version of the 3Di, tetrachoric correlations to determine criterion validity, structural equation modelling to evaluate factorial structure and receiver operating characteristic analysis to calculate diagnostic accuracy against Diagnostic Statistical Manual of Mental Disorders (DSM) diagnosis. The reliability coefficients for 3Di were excellent for the entire scale {McDonald's omega (ω) = 0.83 [95% confidence interval (CI) 0.79-0.91]}. A higher-order three-factor DSM-IV-TR model showed an adequate fit with the model, improving greatly after retaining high-loading items and correlated items. A higher-order two-factor DSM-5 model also showed an adequate fit. There were weak to satisfactory criterion validity scores [tetrachoric rho = 0.38 (p = 0.049) and 0.59 (p = 0.014)] and good diagnostic accuracy metrics [area under the curve = 0.75 (95% CI: 0.54-0.96) and 0.61 (95% CI: 0.49-0.73] for 3Di against the DSM criteria. The 3Di had a moderate sensitivity [66.7% (95% CI: 0.22-0.96)] and a good specificity [82.5% (95% CI: 0.74-0.89)], when compared with the DSM-5. However, we observed poor sensitivity [38.9% (95% CI: 0.17-0.64)] and good specificity [83.5% (95% CI: 0.74-0.91)] against DSM-IV-TR. The Swahili version of the 3Di provides information on autism traits, which may be helpful for descriptive research of endophenotypes, for instance. However, for accuracy in newly diagnosed autism, it should be complemented by other tools, e.g., observational clinical judgment using the DSM criteria or assessments such as the Autism Diagnostic Observation Schedule. The construct validity of the Swahili 3Di for some domains, e.g., communication, should be explored in future studies.

Behavioral inhibition and social maladjustment: The moderation role of social behaviors during cooperative and competitive peer interactions.

Behavioral inhibition (BI) is a temperamental characterized in early childhood by intense wariness and negative affect toward novelty, and is linked to children's emotional symptoms and peer problems. How children behave or respond toward diverse social contexts can influence the relation between BI and social adjustment. This study investigated the effect of children's affiliative and antagonistic behavior in cooperative and competitive contexts on the relation between early BI and social adjustment using a longitudinal design. Children's BI (at age 2) was assessed via laboratory observations. Affiliative and antagonistic behaviors (at age 4) were coded during a dyadic truck game in the cooperative and competitive contexts. Children's emotional symptoms and peer problems (at age 4) were assessed using parental reports. These results suggest that high affiliative behavior in the cooperative context was linked to a reduced level of peer problems in inhibited children. Interestingly, highly antagonistic behavior in the competitive context was linked to a reduced level of emotional symptoms in inhibited children. These findings extend our understanding of the role social behavior plays in the social adjustment of behaviorally inhibited children by highlighting the contribution of socially appropriate behaviors in social contexts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Children's behavioural and emotional reactions towards living with congenital heart disease in Saudi Arabia: A grounded theory study.

A high incidence of children with congenital heart disease (CHD) was found in Saudi Arabia (SA). International literature reports that children with CHD exhibit behavioural and emotional issues due to experiencing hospitalisation and clinical treatments combined with a dearth of qualitative understanding of the experiences of younger children with CHD. Therefore, the aim was to explore the behaviour and emotions of 4-10-year-olds with CHD in SA through children's accounts of their own experiences and parental proxy reports of children's behaviour and emotions. Charmaz's constructivist grounded theory (GT) approach was used. Twenty single semi-structured interviews of 10 child/parent dyads were undertaken at a hospital clinic in SA. Children's interviews were combined with an arts-based approach using drawings, pictures and faces of emotions (emojis). Constant comparison analysis was undertaken. Consolidated Criteria for Reporting Qualitative Research guidelines was followed in reporting this study. A substantive GT: children's behavioural and emotional reactions towards stressors related to living with CHD was developed and provides new insights into children's and parents' perceptions of the children's behavioural and emotional reactions to living with CHD in SA. The theory proposes that children's reactions to living with CHD relate to medical treatment stressors, sociocultural stressors and physical change stressors. Several further factors influenced children's responses to these stressors. Children and parents in SA contributed to a new understanding of the relationship between CHD and children's behavioural and emotional reactions. In addition, findings support the need for early assessment of behaviour and emotions among children with CHD and the application of preventative and supportive measures for the children and their families in SA. Before the research commenced, the developmental appropriateness of the proposed arts-based data collection tools was tested with three healthy children aged 6-9 years old; the tools were then revised accordingly before the interviews were undertaken.

Measuring Developmental Delays: Comparison of Parent Report and Direct Testing.

Developmental assessment is part of a comprehensive autism evaluation. During in-person evaluations, developmental assessment is completed via direct testing by an examiner. In telehealth evaluations, developmental assessment relies on caregiver-report instruments. This study examined correspondence between caregiver report and direct testing of developmental skills. Participants were 93 children, aged 18-42 months, undergoing evaluation for possible autism spectrum disorder (ASD). Caregivers were interviewed with the Developmental Profile, 4th edition (DP-4) via telehealth platform and children were tested in person 2-4 weeks later using the Mullen Scales of Early Learning (MSEL). Correlations between the DP-4 and MSEL were high (ranging from 0.50 to 0.82) across standard scores, age equivalents, and functional categories, as well as across individual subtests and overall composite scores. The high convergent validity found in this study suggests that the DP-4 provides a suitable proxy for direct developmental testing using the MSEL in the context of telehealth evaluations for ASD in young children, delivering a good estimate of both developmental functioning and presence of delays. Data were obtained from registered clinical trial NCT05047224, date of registration 2021-09-07.

Parent and Provider Differences in Ratings of Mental Health and Neurodevelopmental Concerns in Children with Neurologic Disorders

Children with neurologic disorders face increased risks for mental health and neurodevelopmental conditions, with information often limited to parent report. To better understand mental health and neurodevelopmental needs in this population, a retrospective chart review of a convenience sample of children with neurologic disorders referred for a neuropsychological evaluation was conducted in the present study to explore interrater agreement between care team members (referring providers, parents, pediatric neuropsychologist). Qualitative and quantitative data were collected from the evaluation reports of 129 youth (9:0–17:11 years old; 51.2% of female sex) with neurologic disorders (i.e., 38.0% traumatic brain injury, 27.1% epilepsy, 14.7% premature birth, 7.8% pediatric cancer, 3.9% prenatal substance exposure, and 14.7% other) who completed an evaluation in 2019. Over half the youth were flagged for unmet neurodevelopmental and mental health concerns and analyses revealed low interrater agreement for mental health concerns (κ = .324), better agreement for neurodevelopmental concerns (κ = .511), and low sensitivity of referring providers (Se = .326) and parents (Se = .366). One-way analyses of variance uncovered important factors (e.g., symptom severity, adaptive skills) that may account for missed concerns. Findings guide recommendations to strengthen methods for understanding mental health and/or neurodevelopmental concerns in children with neurologic disorders.

Correspondence between consonant inventories obtained using modified naturalistic listening in real time (NLRT) and parent report

ObjectiveThe current study examined the correspondence between consonant inventories obtained using the modified NLRT approach and parent report. DesignProspective comparative study. SettingMultisite institutional. ParticipantsParticipants included 70 children with repaired CP + L (mean age = 16 months) who were participating in the multicenter study. ProceduresParents of participants were asked to record approximately two hours of their child's vocalizations/words at home using a Language ENvironmental Analysis (LENATM) recorder. Four ten-minute audio-recorded samples of vocalizations were extracted from the original recording for each participant and analyzed for size of consonant inventory. Parent reported consonant inventory was compared to coder identified consonant inventory. Coders identified an in-inventory consonant using two different criteria: 2+ tokens of each consonant were required in the first analysis and 10+ tokens of each consonant were required in the second analysis. ResultsCoder identified consonant inventory was larger (mean = 7.90) than that reported by parents (mean = 6.06) when a minimum of two tokens per consonant was required for inclusion of a consonant in inventory, while the inventory transcribed by coders was smaller (mean = 4.46) than that reported by parents when inclusion criteria required a minimum of ten tokens per consonant. ConclusionsAlthough the mean number of consonants in inventory between coders and parents was slightly closer using the 10+ versus 2+ criterion for consonant inclusion, the difference was not significant enough to recommend one protocol over the other.

The impact of maternal anxiety during pregnancy on children's eczema and allergic rhinitis: The Ma'anshan birth cohort study

ObjectiveThe objective of this study was to investigate the associations between maternal exposure to anxiety during pregnancy and the susceptibility of offspring to eczema and allergic rhinitis and the possibility of sensitivity periods and cumulative effects. MethodsThe study's sample consisted of 3160 mother-child pairs from the Ma'anshan Birth Cohort Study. Maternal anxiety was repeatedly measured in the 1st, 2nd, and 3rd trimesters of pregnancy using the Chinese version of the Pregnancy-Related Anxiety Scale. Information regarding children's eczema and allergic rhinitis diagnoses was collected through parental reports at 12, 24, 36 and 48 months of age. Binary logistic regression models were used for statistical analysis and corrected for multiple comparisons using the false discovery rate (FDR) method. ResultsChildren whose mothers experienced anxiety throughout pregnancy had the highest odds of developing total eczema (aOR 1.45, 95% CI 1.02–2.07) and total allergic rhinitis (aOR 1.67, 95% CI 1.17–2.37) between the ages of 6 and 48 months. The higher the trajectory of the maternal anxiety scores throughout pregnancy, the higher the odds of total eczema (aOR 1.65, 95% CI 1.14–2.40) and allergic rhinitis (aOR 1.84, 95% CI 1.28–2.66) in their offspring. The association between maternal anxiety and children's eczema was mainly concentrated in the first 24 months, whereas the association with allergic rhinitis was mainly concentrated in the 36–48 months. ConclusionMaternal anxiety during any trimester of pregnancy, especially with a consistently high trajectory of anxiety scores, was associated with higher odds of children's eczema and allergic rhinitis.

Investigating the relationship between socio-demographic variables of parents, digital literacy and parental mediation practices in the digital age: Nigeria in focus

This study utilised a school-based survey with parent reports across 1,050 Nigerian parents to investigate the socio-demographic variables influencing parental media mediation and examine digital literacy as a mediator of demographic variables and parental mediation. The sample comprised 1,050 parents aged 25-65 who had children aged 13-18 years living with them. The participants were parents of children in the targeted schools in Lagos. Confirmatory factor analysis (CFA) and structural equation modelling (SEM) were applied to analyse the collected data to investigate the relationship among the demographic variables, parents' digital literacy, and parental mediation practices. It was revealed that the socio-demographic variables (the age and gender of parent and child, marital status and educational qualification) directly influenced parental mediation types. The indirect effect of the mediating variable offers further evidence that parents' digital literacy can enhance mediation strategies for parents in Nigerian families.

Prospective Evaluation of Health-Related Quality-of-Life in Children with Craniosynostosis.

To investigate health-related quality of life (HRQL) in children aged 2 to 7 years, who have undergone surgery for craniosynostosis. Cross-sectional survey. A tertiary pediatric academic medical center. Children with craniosynostosis who underwent surgical correction, and who were 2-7 years old at the time of the study. Children from families that did not speak English were excluded. Caregivers were asked to fill out the Pediatric Quality of Life Inventory (PedsQL) Core Parent Report and the PedsQL Cognitive Functioning Scale. PedsQL: Psychosocial Health Summary Score, Physical Health Summary Score, Total Core Score, Cognitive Functioning Scale Score. Scores range from 0 to 100, with higher scores reflecting greater QoLSubject factors: comorbidities, syndromic status, type of craniosynostosis, type of surgery. The study included 53 subjects, of whom 13.2% had a syndrome. Core and cognitive scores did not depend on presence of a syndrome or suture involved. Subjects who underwent posterior cranial distraction achieved higher Total Core Scores than subjects who underwent open vault remodeling. Among subjects with sagittal craniosynostosis, there was a tendency for higher scores among children who underwent minimally-invasive surgery compared to those who underwent open vault remodeling. This study demonstrates similar HRQL among children with and without a syndrome, higher HRQL among children undergoing posterior cranial distraction than those undergoing open vault remodeling, and trends towards higher HRQL in children with sagittal craniosynostosis who underwent minimally-invasive surgery compared to those who underwent open vault remodeling.

Toe Walking in a Formerly Preterm Child: Is it Just Cerebral Palsy?

AbstractSpastic diplegic cerebral palsy (CP) is common among children born preterm and is a known cause of toe walking. By contrast, pediatric tumors of the conus medullaris are rare. We report the case of a 28-month-old formerly extremely preterm male with global developmental delay who presented with toe walking, constipation, and asymmetric hypertonia of the lower extremities. Brain imaging revealed periventricular leukomalacia, ex-vacuo ventricular dilation, and cerebellar dysplasia consistent with a diagnosis of CP secondary to perinatal injury. Lumbar spine imaging obtained due to his worsening constipation and pain while walking demonstrated an intramedullary, well-circumscribed, contrast-enhancing lesion in the conus medullaris. Postresection pathology revealed a pilocytic astrocytoma. Following surgery, the patient had improved constipation and lower extremity tone, allowing him to walk with bilateral heel strike. His symptomatic improvement supported the contribution of the tumor to his bowel dysfunction and gait abnormality.This case of comorbid CP and conus pilocytic astrocytoma in a child with toe walking supports careful consideration of possible concurrent neurologic pathologies in the setting of atypical history and physical exam findings, such as pain while walking and bowel/bladder dysfunction. A higher degree of suspicion and consideration of parental report of pain while walking is especially important in cases in which the patient's ability to report subjective symptoms, such as pain, subtle bowel/bladder dysfunction, and sensory changes, is limited.

The Functional Vision for Communication Questionnaire (FVC-Q): Exploring Parental Report of Non-Speaking Children's Fixation Skills Using a Structured History-Taking Approach

ABSTRACT This paper explores whether a structured history-taking tool yields useful descriptions of children’s looking skills. Parents of 32 children referred to a specialist communication clinic reported their child’s looking skills using the Functional Vision for Communication Questionnaire (FVC-Q), providing descriptions of single object fixation, fixation shifts between objects and fixation shifts from object to person. Descriptions were compared with clinical assessment. 24/32 children were reported to have some limitation in fixation. Limitation was subsequently seen in 30/32 children. Parental report and assessment agreed fully in 23/32 (72%). The largest area of discrepancy was object-person fixation shifts, with five children not observed to show this behavior despite its being reported. Findings indicate a structured questionnaire yields description of fixations, which correspond well with clinical assessment. Descriptions supported discussion between parents and clinicians. It is proposed that the FVC-Q is a valuable tool in supporting clinicians in eliciting information about fixation skills.

The Role of Fundamental Movement Skills and Spatial Abilities in the Relationship between Physical Activity and Mathematics Achievement in Primary School Children.

Research has demonstrated positive relationships between fundamental movement skills (FMS) and mathematics achievement in children, and this relationship may be mediated by spatial ability. Engaging in physical activity (PA) may also have positive outcomes on mathematics achievement; however, no study has investigated this network of relationships together. This study aimed to examine the relationship between PA and mathematics achievement, and the mediating effects of FMS and spatial abilities, in primary school children. Using a cross-sectional design, data were collected from 182 children (aged 7 to 8 years old) across four schools in England. Objective moderate-to-vigorous PA (MVPA) levels and subjective parental reports of their children's PA participation were collected. Children's FMS were assessed, along with their performance on four spatial ability tasks and a mathematics test. Mediation analyses revealed no significant mediation effects of FMS and spatial abilities on the positive significant relationship between MVPA and mathematics achievement; however, spatial ability partially mediated the relationship between FMS and mathematics achievement. These results suggest that FMS and spatial ability may not be related to MVPA in this network of relationships, but children with more mature FMS perform better in mathematics due to them performing better on specific spatial ability tasks.

Hearing aid wear time and its impact on vocabulary in preschoolers with moderately severe to profound hearing loss

Objective This study aimed to explore how the consistency of hearing aid (HA) use impacts vocabulary performance in children with moderately severe to profound hearing loss and determine the amount of HA use time associated with better vocabulary outcomes. Design Personal wear time percentage (WTP) was an indicator of HA use consistency, and the information on HA wear time was collected from both parent reports and datalogs. Pearson's correlations were performed to investigate the associations between hearing loss severity, WTP and vocabulary performance. Standard vocabulary scores among children below and above three WTP cutoff values (80%, 85%, and 90%) were examined to determine the WTP amount that yielded significantly better vocabulary outcomes. Study sample Forty-seven children aged 36–79 months and their caregivers. Results Both parent reports and datalogs WTP significantly correlated with vocabulary outcomes. Parent-reported WTP were found to be predictive of datalogs WTP. Apart from hearing thresholds, HA fitting age and maternal education level, datalogs WTP was a significant independent predictor of vocabulary performance. Children with ≥ 90% WTP were more likely to perform better on vocabulary tests than those with < 90% WTP. Conclusion The findings support the potential benefits of consistent HA use for vocabulary development.

Code-switching and Code-mixing: A gap in the Stuttering Literature

Code-switching and code-mixing are self-management communication strategies for bilinguals to achieve a specific communication goal. Interestingly, bilingual children and adults who stutter use code-switching as a speaking strategy whenever they anticipate stuttering. However, there is a lack of comprehensive reviews and clear explanation of code-switching and code-mixing behaviors in bilingual stuttering adults and children. Thus, the present narrative review focuses on identifying studies and its gaps related to code-switching and code-mixing behaviors in stuttering. Only studies that directly tested the code-switching and code-mixing abilities of bilingual children and adults with stuttering or assessed these skills via self and parent reports were included. The findings comprised seven research from the literature on stuttering and code-switching and mixing, of which only three were published as articles, one as a thesis, two as unpublished dissertations, and one as a conference poster. Furthermore, not all of the published research focused solely on code-switching, and none of the studies concluded that code-switching is a deliberate communication strategy adopted by bilingual children and adults who stutter. Population, theoretical, methodological, knowledge, and empirical research gaps have all been found from the literature. In addition, a thorough investigation ought to concentrate on the nature, types, levels and self-reported experiences of code-switching and mixing among the bilingual children and adults who stutter.