Summary: Rates of anxiety are higher in children and adolescents who stammer and stutter, a new study reports.
Children and adolescents who stammer report elevated symptoms of anxiety compared with non-stammering peers, according to a new review of evidence led by UCL researchers.
The study, published in the Journal of Speech, Language and Hearing Research and also involving the Western Norway University of Applied Sciences, combined and re-analyzed findings from 11 previous studies that had compared children and adolescents (two to 18 years) who do and do not stammer on symptoms of anxiety and depression.
Although there was substantial variation in reported anxiety symptoms across studies, overall, children and adolescents who stammer report higher anxiety symptoms than peers. There were too few studies concerning depression to reliably comment on risk for youth who stammer.
Stammering affects around 5–8 percent of school-aged children. Heightened risk for anxiety in adults who stammer is well documented, but little is known about the onset of anxiety in this population.
Lead author, Ph.D. candidate Ria Bernard (UCL Psychology & Language Sciences), said: “An important finding from this review is that children and adolescents who stammer are not a homogeneous group. It is likely that a multitude of factors are involved in both risk and resilience for anxiety in this population. We were unable to robustly look at potential moderating factors with the data available and so there is a need for further research in this area.”
The high variability in outcome means that not all young people who stammer experience anxiety. The authors suggest that elevated anxiety may reflect other risk factors such as exposure to bullying, access to therapy, or family history of anxiety and depression, which may increase risk or resilience in children and adolescents who stammer.
Few studies reported these additional variables, so it is currently unclear what factors contribute to this increased risk.
Most importantly, these findings cannot address the impact of intervention on anxiety. Intervention approaches may focus on improving fluency, strategies for coping with dysfluent speech, or a combination of the two.
The study results do, however, highlight the need to carefully monitor the mental health and well-being of children and adolescents who stammer.
Action for Stammering Children Charity who funded this research in collaboration with the Economic and Social Research Council (ESRC), said: “The findings from this review are important when thinking about how we best support children who stammer and their families. Early identification and access to Speech and Language Therapy services are vital to improving well-being and ensuring that children receive the support that they need.”
The authors emphasize that the studies reviewed predominantly examined anxiety in mid-childhood. Additionally, the lack of longitudinal studies make it hard to understand why some children who stammer experience greater symptoms of anxiety while others do not. Ideally, longitudinal studies that follow large groups of children who stammer over time would help us understand the association between stammering and anxiety over the course of development.
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“Anxiety and Depression Symptoms in Children and Adolescents Who Stutter: A Systematic Review and Meta-Analysis” by Ria Bernard et al. Journal of Speech, Language, and Hearing Research
Anxiety and Depression Symptoms in Children and Adolescents Who Stutter: A Systematic Review and Meta-Analysis
The purpose of this study was to investigate whether there are elevated symptoms of anxiety or depression in children and adolescents (aged 2–18 years) who stutter, and to identify potential moderators of increased symptom severity.
We conducted a preregistered systematic review of databases and gray literature; 13 articles met criteria for inclusion. A meta-analysis using robust variance estimation was conducted with 11 cohort studies comparing symptoms of anxiety in children and adolescents who do and do not stutter. Twenty-six effect sizes from 11 studies contributed to the summary effect size for anxiety symptoms (851 participants). Meta-analysis of depression outcomes was not possible due to the small number of studies.
The summary effect size indicates that children and adolescents who stutter present with increased anxiety symptoms (g = 0.42) compared with nonstuttering peers. There were insufficient studies to robustly analyze depression symptoms, and qualitative review is provided. No significant between-groups differences were reported in any of the depression studies.
Preliminary evidence indicates elevated symptoms of anxiety in some children and adolescents who stutter relative to peers. There was a tendency toward higher depression scores in this population, although reported between-groups differences did not reach statistical significance. These findings require replication in larger, preferably longitudinal studies that consider factors that may moderate risk. Nevertheless, our findings highlight a need for careful monitoring of mental health and well-being in young people who stutter.