The Role of Executive Function in Developmental Stuttering

Abstract

Developmental stuttering is a complex disorder and children who stutter form a heterogeneous group. Most contemporary researchers would agree that multiple factors, including those associated with linguistic, motor, sensory, and emotional processes, are likely involved in its development and/or maintenance. There is growing evidence, however, that cognitive processes also play a role. In this article, we briefly review behavioral and parent-report studies of executive function in children who stutter, the findings of which have generally suggested that these skills may be challenging for at least some children who stutter. We then consider how deficits in executive function could provide an explanatory account for not only the multifactorial nature of developmental stuttering but also the considerable amount of variability that exists among individuals who stutter.

Keywords

executive function - stuttering - fluency disorders - memory - inhibition - flexibility

Disclosures

Financial: J.D.A. is a full-time, salaried associate professor in the Department of Speech and Hearing Sciences at Indiana University, whose research is funded by the National Institute on Deafness and Other Communication Disorders, National Institutes of Health (R01DC012517; PI: J. Anderson). L.C.O. is a doctoral student in the Department of Speech and Hearing Sciences at Indiana University who receives funding from the department.

Nonfinancial: No relevant nonfinancial relationships exist for either author.

• References

• 1 Center on the Developing Child at Harvard University. Building the Brain's “Air Traffic Control” System: How Early Experiences Shape the Development of Executive Function: Working Paper No. 11; 2011 . Available at: http://www.developingchild.harvard.edu . Accessed June 3, 2019
• 2 Baggetta P, Alexander PA. Conceptualization and operationalization of executive function. Mind Brain Educ 2016; 10: 10-33
• 3 Packwood S, Hodgetts HM, Tremblay S. A multiperspective approach to the conceptualization of executive functions. J Clin Exp Neuropsychol 2011; 33 (04) 456-470
• 4 Karr JE, Areshenkoff CN, Rast P, Hofer SM, Iverson GL, Garcia-Barrera MA. The unity and diversity of executive functions: a systematic review and re-analysis of latent variable studies. Psychol Bull 2018; 144 (11) 1147-1185
• 5 Lehto JE, Juujärvi P, Kooistra L, Pulkkinen L. Dimensions of executive functioning: evidence from children. Br J Dev Psychol 2003; 21: 59-80
• 6 Garon N, Bryson SE, Smith IM. Executive function in preschoolers: a review using an integrative framework. Psychol Bull 2008; 134 (01) 31-60
• 7 Diamond A. Executive functions. Annu Rev Psychol 2013; 64: 135-168
• 8 Baddeley A. The episodic buffer: a new component of working memory?. Trends Cogn Sci 2000; 4 (11) 417-423
• 9 Baddeley A. Working memory and language: an overview. J Commun Disord 2003; 36 (03) 189-208
• 10 Chevalier N, Wiebe SA, Huber KL, Espy KA. Switch detection in preschoolers' cognitive flexibility. J Exp Child Psychol 2011; 109 (03) 353-370
• 11 Diamond A. Why improving and assessing executive functions early in life is critical. In: Griffin JA, McCardle P, Freund LS. , eds. Executive Function in Preschool-Age Children: Integrating Measurement, Neurodevelopment, and Translational Research. Washington, DC: America Psychological Association; 2016: 11-43
• 12 Kronenberger WG, Pisoni DB. Neurocognitive functioning in deaf children with cochlear implants. In: Knoors H, Marschark M. , eds. Evidence-Based Practice in Deaf Education. New York: Oxford University Press; 2018: 363-396
• 13 Müller U, Jacques S, Brocki K, Zelazo PD. The executive functions of language in preschool children. In: Winsler A, Fernyhough C, Montero I. , eds. Private Speech, Executive Functioning, and the Development of Verbal Self-Regulation. New York: Cambridge University Press; 2009: 53-68
• 14 Pisoni DB, Conway CM, Kronenberger W, Henning S, Anaya E. Executive function, cognitive control, and sequence learning in deaf children with cochlear implants. In: Marshark M, Spencer PE. , eds. The Oxford Handbook of Deaf Studies, Language, and Education. New York: Oxford University Press; 2010: 439-457
• 15 Pisoni DB, Conway CM, Kronenberger W, Horn DL, Karpicke J, Henning S. Efficacy and effectiveness of cochlear implants in deaf children. In: Marschark M, Hauser P. , eds. Deaf Cognition: Foundations and Outcomes. New York: Oxford University Press; 2008
• 16 Graf Estes K, Evans JL, Else-Quest NM. Differences in the nonword repetition performance of children with and without specific language impairment: a meta-analysis. J Speech Lang Hear Res 2007; 50 (01) 177-195
• 17 Pauls LJ, Archibald LM. Executive functions in children with specific language impairment: a meta-analysis. J Speech Lang Hear Res 2016; 59 (05) 1074-1086
• 18 Vugs B, Cuperus J, Hendriks M, Verhoeven L. Visuospatial working memory in specific language impairment: a meta-analysis. Res Dev Disabil 2013; 34 (09) 2586-2597
• 19 Ntourou K, Conture EG, Lipsey MW. Language abilities of children who stutter: a meta-analytical review. Am J Speech Lang Pathol 2011; 20 (03) 163-179
• 20 Zhou Q, Chen SH, Main A. Commonalities and differences in the research, on children's effortful control and executive function: a call for an integrated model of self-regulation. Child Dev Perspect 2012; 6: 112-121
• 21 Kraft SJ, Ambrose N, Chon H. Temperament and environmental contributions to stuttering severity in children: the role of effortful control. Semin Speech Lang 2014; 35 (02) 80-94
• 22 Kraft SJ, Lowther E, Beilby J. The role of effortful control in stuttering severity in children: replication study. Am J Speech Lang Pathol 2019; 28 (01) 14-28
• 23 Ofoe LC, Anderson JD, Ntourou K. Short-term memory, inhibition, and attention in developmental stuttering. J Speech Lang Hear Res 2018; 61 (07) 1626-1648
• 24 Byrd CT, Sheng L, Ratner NB, Gkalitsiou Z. Veridical and false recall in adults who stutter. J Speech Lang Hear Res 2015; 58 (01) 28-42
• 25 Byrd CT, Vallely M, Anderson JD, Sussman H. Nonword repetition and phoneme elision in adults who do and do not stutter. J Fluency Disord 2012; 37 (03) 188-201
• 26 Dhatri SD, Kumar UA, Santosh M. Comparison of working memory abilities in adults who do and do not stutter. J Indian Speech Lang Hear Assoc 2017; 31: 42-47
• 27 Eichorn N, Marton K, Schwartz RG, Melara RD, Pirutinsky S. Does working memory enhance or interfere with speech fluency in adults who do and do not stutter? Evidence from a dual-task paradigm. J Speech Lang Hear Res 2016; 59 (03) 415-429
• 28 Markett S, Bleek B, Reuter M. , et al. Impaired motor inhibition in adults who stutter–evidence from speech-free stop-signal reaction time tasks. Neuropsychol 2016; 1: 444-450
• 29 Yang Y, Jia F, Fox PT, Siok WT, Tan LH. Abnormal neural response to phonological working memory demands in persistent developmental stuttering. Hum Brain Mapp 2019; 40 (01) 214-225
• 30 Anderson JD, Wagovich SA. Explicit and implicit verbal response inhibition in preschool-age children who stutter. J Speech Lang Hear Res 2017; 60 (04) 836-852
• 31 Eggers K, De Nil LF, Van den Bergh BRH. Inhibitory control in childhood stuttering. J Fluency Disord 2013; 38 (01) 1-13
• 32 Piispala J, Määttä S, Pääkkönen A, Bloigu R, Kallio M, Jansson-Verkasalo E. Atypical brain activation in children who stutter in a visual Go/Nogo task: an ERP study. Clin Neurophysiol 2017; 128 (01) 194-203
• 33 Piispala J, Starck T, Jansson-Verkasalo E, Kallio M. Decreased occipital alpha oscillation in children who stutter during a visual Go/Nogo task. Clin Neurophysiol 2018; 129 (09) 1971-1980
• 34 Eggers K, De Nil LF, Van den Bergh BRH. Exogenously triggered response inhibition in developmental stuttering. J Fluency Disord 2018; 56: 33-44
• 35 Eggers K, Jansson-Verkasalo E. Auditory attentional set-shifting and inhibition in children who stutter. J Speech Lang Hear Res 2017; 60 (11) 3159-3170
• 36 Piispala J, Kallio M, Bloigu R, Jansson-Verkasalo E. Delayed N2 response in Go condition in a visual Go/Nogo ERP study in children who stutter. J Fluency Disord 2016; 48: 16-26
• 37 Harrewijn A, Schel MA, Boelens H, Nater CM, Haggard P, Crone EA. Children who stutter show reduced action-related activity in the rostral cingulate zone. Neuropsychologia 2017; 96: 213-221
• 38 Kühn S, Haggard P, Brass M. Intentional inhibition: how the “veto-area” exerts control. Hum Brain Mapp 2009; 30 (09) 2834-2843
• 39 Centers for Disease Control and Prevention. 2019 Child Development. Available at: https://www.cdc.gov/ncbddd/childdevelopment/index.html . Accessed June 5, 2019
• 40 Eggers K, De Nil LF, Van den Bergh BRH. Temperament dimensions in stuttering and typically developing children. J Fluency Disord 2010; 35 (04) 355-372
• 41 Embrechts M, Ebben H, Franke P, van de Poel C. Temperament: a comparison between children who stutter and children who do not stutter. In: Bosshardt HG, Yaruss S, Peters H. , eds. Proceedings of the Third World Congress on Fluency Disorders: Theory, Res, Treatment, and Self-Help. The Netherlands: Nijmegen Press; 2000: 557-562
• 42 Anderson JD, Wagovich SA. Relationships among linguistic processing speed, phonological working memory, and attention in children who stutter. J Fluency Disord 2010; 35 (03) 216-234
• 43 Ntourou K, Anderson JD, Wagovich SA. Executive function and childhood stuttering: parent ratings and evidence from a behavioral task. J Fluency Disord 2018; 56: 18-32
• 44 Gioia GA, Espy KA, Isquith PK. BRIEF-P: Behavior Rating Inventory of Executive Function-Preschool Version: Professional Manual. Psychol Assessment Resources; 2003 . Available at: https://www.parinc.com/Products/Pkey/26 . Accessed June 5, 2019
• 45 Hakim HB, Ratner NB. Nonword repetition abilities of children who stutter: an exploratory study. J Fluency Disord 2004; 29 (03) 179-199
• 46 Anderson JD, Wagovich SA, Hall NE. Nonword repetition skills in young children who do and do not stutter. J Fluency Disord 2006; 31 (03) 177-199
• 47 Oyoun HA, Dessouky HE, Shohdi S, Fawzy A. Assessment of working memory in normal children and children who stutter. J Am Sci 2010; 6: 562-569
• 48 Pelczarski KM, Yaruss JS. Phonological memory in young children who stutter. J Commun Disord 2016; 62: 54-66
• 49 Bakhtiar M, Abad AD, Panahi MS. Nonword repetition ability of children who do and do not stutter and covert repair hypothesis. Indian J Med Sci 2007; 61 (08) 462-470
• 50 Sasisekaran J, Byrd C. Nonword repetition and phoneme elision skills in school-age children who do and do not stutter. Int J Lang Commun Disord 2013; 48 (06) 625-639
• 51 Smith A, Goffman L, Sasisekaran J, Weber-Fox C. Language and motor abilities of preschool children who stutter: evidence from behavioral and kinematic indices of nonword repetition performance. J Fluency Disord 2012; 37 (04) 344-358
• 52 Weber-Fox C, Spruill III JE, Spencer R, Smith A. Atypical neural functions underlying phonological processing and silent rehearsal in children who stutter. Dev Sci 2008; 11 (02) 321-337
• 53 Anderson JD, Wagovich SA, Brown BT. Phonological and semantic contributions to verbal short-term memory in young children with developmental stuttering. J Speech Lang Hear Res 2019; 62 (03) 644-667
• 54 Coady JA, Evans JL. Uses and interpretations of non-word repetition tasks in children with and without specific language impairments (SLI). Int J Lang Commun Disord 2008; 43 (01) 1-40
• 55 Archibald LMD, Joanisse MF, Munson B. Motor control and nonword repetition in specific working memory impairment and SLI. Top Lang Disord 2013; 33 (03) 255-267
• 56 Reilly J, Donaher J. Verbal working memory skills of children who stutter: a preliminary investigation. Contemp Issues Commun Sci Disord 2005; 32: 38-42
• 57 Stokić M, Nenadović V, Đoković S. Short-term verbal memory and psychophysiological response to emotion-related words in children who stutter. Spec Eduk Rehabil 2012; 11: 565-583
• 58 Kaganovich N, Wray AH, Weber-Fox C. Non-linguistic auditory processing and working memory update in pre-school children who stutter: an electrophysiological study. Dev Neuropsychol 2010; 35 (06) 712-736
• 59 Sasisekaran J, Basu S. The influence of executive functions on phonemic processing in children who do and do not stutter. J Speech Lang Hear Res 2017; 60 (10) 2792-2807
• 60 Sasisekaran J, Brady A, Stein J. A preliminary investigation of phonological encoding skills in children who stutter. J Fluency Disord 2013; 38 (01) 45-58
• 61 Sasisekaran J, Byrd CT. A preliminary investigation of segmentation and rhyme abilities of children who stutter. J Fluency Disord 2013; 38 (02) 222-234
• 62 Gathercole SE, Willis CS, Baddeley AD, Emslie H. The children's test of nonword repetition: a test of phonological working memory. Memory 1994; 2 (02) 103-127
• 63 Wagner R, Torgesen J, Rashotte C. CTOPP: Comprehensive Test of Phonological Processing. 2nd ed. Austin, TX: Pro-ed; 1999
• 64 Dollaghan C, Campbell TF. Nonword repetition and child language impairment. J Speech Lang Hear Res 1998; 41 (05) 1136-1146
• 65 Gardner MF. Test of Auditory-Perceptual Skills TAPS. Hydesville: Psychological and Educational Publications; 1985
• 66 Gardner MF. Test of Auditory-Perceptual Skills—Revised TAPS-R. Hydesville: Psychological and Educational Publications; 1996
• 67 Wechsler D. Wechsler Memory Scale. 3rd ed. San Antonio, TX: The Psychol Corporation; 1997
• 68 Woods DL, Kishiyamaa MM, Lund EW. , et al. Improving digit span assessment of short-term verbal memory. J Clin Exp Neuropsychol 2011; 33 (01) 101-111
• 69 Anderson JD, Wagovich SA, Ofoe L. Cognitive flexibility in developmental stuttering. Poster presented at: Annual Meeting of the American Speech-Language-Hearing Association; November 2015; Denver, CO
• 70 Eichorn N, Marton K, Pirutinsky S. Cognitive flexibility in preschool children with and without stuttering disorders. J Fluency Disord 2018; 57: 37-50
• 71 Anderson JD, Pellowski MW, Conture EG, Kelly EM. Temperamental characteristics of young children who stutter. J Speech Lang Hear Res 2003; 46 (05) 1221-1233
• 72 Schwenk KA, Conture EG, Walden TA. Reaction to background stimulation of preschool children who do and do not stutter. J Commun Disord 2007; 40 (02) 129-141
• 73 DiDonato Brumbach AC, Goffman L. Interaction of language processing and motor skill in children with specific language impairment. J Speech Lang Hear Res 2014; 57 (01) 158-171
• 74 Hill EL. Non-specific nature of specific language impairment: a review of the literature with regard to concomitant motor impairments. Int J Lang Commun Disord 2001; 36 (02) 149-171
• 75 Zelaznik HN, Goffman L. Generalized motor abilities and timing behavior in children with specific language impairment. J Speech Lang Hear Res 2010; 53 (02) 383-393
• 76 Montgomery JW, Evans JL, Gillam RB. . Memory and language in children with SLI. In: Packiam Alloway T. , ed. Working Memory and Clinical Developmental Disorders: Theories, Debates and Interventions. London: Routledge; 2018: 27-37
• 77 Torrington Eaton C, Ratner NB. An exploration of the role of executive functions in preschoolers' phonological development. Clin Linguist Phon 2016; 30 (09) 679-695
• 78 Waring R, Eadie P, Rickard Liow S, Dodd B. The phonological memory profile of preschool children who make atypical speech sound errors. Clin Linguist Phon 2018; 32 (01) 28-45
• 79 Schmeichel BJ. Attention control, memory updating, and emotion regulation temporarily reduce the capacity for executive control. J Exp Psychol Gen 2007; 136 (02) 241-255
• 80 Nejati V, Pouretemad HR, Bahrami H. Attention training in rehabilitation of children with developmental stuttering. NeuroRehabilitation 2013; 32 (02) 297-303