Purpose: The aim of this study is to examine the relationship between phonological awareness skills, working memory performance, and stuttering severity in children with stuttering and comorbid speech sound disorders (SSD).
Method: In this study, the relational screening model was the descriptive method that was used. Before the study, approval was obtained from the Üsküdar University Non-Interventional Ethics Committee. Written informed consent was obtained from all participants, and the entire process was carried out in accordance with the principles of the Declaration of Helsinki. Twenty-five monolingual Turkish-speaking children were recruited from rehabilitation centres located in Istanbul in this study (11 girls, 14 boys), aged between 6 and 8 years. All of the participants were diagnosed with stuttering and comorbid SSD by an experienced speech and language therapist. Other inclusion criteria of the study were not using any medication that may affect their cognitive functions and having no known or identified mental, auditory, visual, or physical problems. The data collection tools used in the study included the articulation subtest (SET) of the Turkish Articulation and Phonology Test (SST), the Turkish Phonological Awareness Test (FFT), the Working Memory Scale, and the Turkish version of the Stuttering Severity Instrument–Fourth Edition (SSI-4). Statistical analyses were conducted by using IBM Statistical Package for the Social Sciences (SPSS) version 27. Prior to the analysis, the normality assumptions of the measurement tools were evaluated using the skewness and kurtosis tests. The direction and strength of the relationships between the scales were examined using Pearson correlation analysis.
Results: A moderate negative correlation was found between stuttering severity and articulation skills (r = -.45, p= < .05). A strong negative correlation was identified between phonological awareness skills (measured by FFT) and stuttering severity (r = -.59, p < .01). However, there was no significant correlation between working memory (raw scores) and stuttering severity (r = -.13, p >.05).
Conclusion: Overall, it can be concluded that stuttering severity is negatively correlated with phonological awareness and articulation skills. In other words, findings suggest that higher phonological awareness skills is negatively correlated with stuttering severity, emphasizing the need for inclusion of phonological awareness activities in stuttering therapies. No significant relationship was found between working memory and stuttering severity. The absence of a significant correlation between working memory and stuttering severity indicates that working memory capacity may not have a direct impact on the severity of stuttering. However, the fact that verbal memory skills were low and visual memory performance was relatively high suggests that children may use cognitive compensation strategies. In addition, the fact that the visual memory subtest scores of children who stutter were higher than the verbal subtest scores supports the claim that this may be a compensatory mechanism. In sum, this study highlights the importance of the inclusion of phonological awareness and articulation abilities that speech and language therapists should consider in the assessment and intervention processes for children with stuttering and SSD.
phonological awareness, speech sound disorder, stuttering, stuttering severity, working memory
American Speech-Language-Hearing Association (ASHA), (2020). Fluency Disorders (Practice Portal). Erişim Adresi: [www.asha.org/practice portal/clinical-topics/fluency-disorders/]. Erişim Tarihi: 20/01/2020.
Anderson, J.D. & Conture, E.G. (2000). Language abilities of children who stutter: A preliminary study. Journal of Fluency Disorders, 25(4), 283-304. https://doi.org/10.1016/S0094-730X(00)00089-9
Anderson, J.D. & Wagovich, S.A. (2010). Relationships among linguistic processing speed, phonological working memory, and attention in children who stutter. Journal of Fluency Disorders, 35(3), 216-234. https://doi.org/10.1016/j.jfludis.2010.04.003
Anderson, J. D., Wagovich, S. A., ve Hall, N. (2006). Nonword repetition skills in young children who do and do not stutter. Journal of Fluency Disorders, 31(3), 177–199. https://doi.org/10.1016/j.jfludis.2006.05.001
Ateş, N. A., & Günhan, N. (2020). Konuşma Sesi Bozukluğu Olan ve Olmayan Çocukların Dil ve Bilişsel Gelişimlerinin İlişkisi. Dil Konuşma ve Yutma Araştırmaları Dergisi, 3(3), 241-269.
Atılgan, E. ve Ege, P. (2020). 4-7 yaş arasındaki kekemeliği olan ve olmayan çocukların anlamsız sözcük tekrarı becerilerinin karşılaştırılması. Dil, Konuşma ve Yutma Araştırmaları Dergisi, 3(3), 270-300.
Aydın-Uysal, A. & Erim, A. (2021). The Comparison Of Working Memory Performance In Children With and Without Stuttering. Ankara Üniversitesi Eğitim Bilimleri Fakültesi Özel Eğitim Dergisi, 22(4), 827-845. https://doi.org/10.21565/ozelegitimdergisi.795687
Baddeley, A.D. ve Hitch G.J. (2019). The phonological loop as a buffer store: An update. Cortex, 112, 91-106. https://doi.org/10.1016/j.cortex.2018.05.015
Bakhtiar, M., Abad Ali D.A. ve Sadegh, S.P. (2007). Nonword repetition ability of children who do and do not stutter and covert repair hypothesis. Indian Journal of Medical Sciences, 61, 462-470.
Büyüköztürk, Ş. (2019). Sosyal Bilimler için Veri Analizi El Kitabı. 25. Baskı. Ankara: Pegem Akademi Yayınları.
Byrd, C. T., Conture, E. G., ve Ohde, R. N. (2007). Phonological priming in young children who stutter: Holistic versus incremental processing. American Journal of Speech-Language Pathology, 16(1), 43-53. https://doi.org/10.1044/1058-0360(2007/006)
Byrd, C.T., McGill, M., ve Usler, E. (2015). Nonverbal repetition and phoneme elision in adults who do and do not stutter: Vocal versus nonvocal performance differences. Journal of Fluency Disorders, 44, 17-31. https://doi.org/10.1016/j.jfludis.2015.01.004
Chang, S.-E., Ohde, R. N., & Conture, E. G. (2002). Coarticulation and formant transition rate in young children who stutter. Journal of Speech, Language, and Hearing Research, 45(4), 676–688. https://doi.org/10.1044/1092-4388(2002/054)
Clark, C.E., Conture, E.G., Walden, T.A., ve Lambert, W.E. (2013). Speech sound articulation abilities of preschool age children who stutter. Journal of Fluency Disorders, 38(4), 325-341. https://doi.org/10.1016/j.jfludis.2013.09.004
Conture, E. G., Kelly, E. M., ve Walden, T. A. (2013). Temperament, speech and language: An overview. Journal of Communication Disorders, 46(2), 125-142. doi: 10.1016/j.jcomdis.2012.11.002.
Coulter, C. E., Anderson, J. D., ve Conture, E. G. (2009). Childhood stuttering and dissociations across linguistic domains: A replication and extension. Journal of Fluency Disorders, 34(4), 257–278. https://doi.org/10.1016/j.jfludis.2009.10.005
Craig, A., Hancock, K., Tran, Y., Craig, M. ve Peters, K. (2002) Epidemiology of stuttering in the community across the entire life span, Journal of Speech, Language and, Hearing Research, 45(6), 1097–1105. https://doi.org/10.1044/1092-4388(2002/088)
Demir, N. & Yılmaz, E. (2018). Türkçe Ses Bilgisi. Anadolu Üniversitesi, Eskişehir.
Ergül, C., Yılmaz, Ç. Ö., ve Demir, E. (2018). 5-10 Yaş grubu çocuklara yönelik geliştirilmiş çalışma belleği ölçeğinin geçerlik ve güvenirliği. Eğitimde Kuram ve Uygulama, 14(2), 187-214. https://doi.org/10.17244/eku.427280
Eyilikeder-Tekin, S. (2021). Türkçe konuşan okul öncesi dönemdeki kekemeliği olan ve olmayan çocukların dil, sesletim, sesbilgisel farkındalık ve yürütücü işlev becerilerinin incelenmesi, [Yayınlanmamış Doktora Tezi]. Anadolu Üniversitesi, Sağlık Bilimleri Enstitüsü, Eskişehir.
Gerçek, E. (2018). Yönetici işlevlerin, kekemelik terapisi kazancını ve kazancı sürdürmeyi yordamaya etkisinin araştırılması. [Yayınlanmamış Doktora Tezi]. Anadolu Üniversitesi, Sağlık Bilimleri Enstitüsü, Eskişehir.
Gregg, B.A. & Yairi, E. (2007). Phonological skills and dysfluency levels in preschool children who stutter. Journal of Communication Disorders, 40(2), 97-115. https://doi.org/10.1016/j.jcomdis.2006.04.003
Güleryüz, F. F. (1995). 2-6 yaş aralığındaki kekemelik problemi olan ve olmayan çocukların artikülasyon özelliklerinin karşılaştırılması. [Yayınlanmamış Doktora Tezi]. Hacettepe Üniversitesi, Çocuk Sağlığı ve Eğitimi Programı, Ankara.
Hahs-Vaughn, D. L., & Lomax, R. G. (2020). An introduction to statistical concepts (4th ed.). Routledge.
Hakim, H.B. & Ratner, N.B. (2004). Nonword repetition abilities of children who stutter: an exploratory. Journal of Fluency Disorders, 29(3), 179-199. doi: 10.1016/j.jfludis.2004.06.001.
Hamzaçebioğlu, Y. (2024). 6-8 yaş arası kekemeliği olan çocukların fonolojik becerilerinin incelenmesi [Yayınlanmamış Yüksek Lisans Tezi]. Kapadokya Üniversitesi, Lisansüstü Eğitim, Öğretim ve Araştırma Enstitüsü, Nevşehir.
Kahramaner, M. (2018). Kekeme çocuklarda fonolojik bellek ve görsel-mekansal bellek değerlendirilmesi. [Yayınlanmamış Yüksek Lisans Tezi]. Hacettepe Üniversitesi, Sağlık Bilimleri Enstitüsü, Ankara.
Karasar, N. (1999). Bilimsel Araştırma Yöntemi. 6. Basım, Nobel Yayın Dağıtım. Ankara.
Kazanoğlu, D., Doğan, M., ve Ünal Logacev, Ö. (2020). Türkçe Fonolojik Farkındalık Testi: Geliştirilmesi, Geçerlilik ve Güvenirlilik Çalışması. Turkiye Klinikleri Journal of Health Sciences/Türkiye Klinikleri Sağlık Bilimleri Dergisi, 5(1). doi: 10.5336/healthsci.2019-70156
Leech K.A., Ratner N., Brown B., ve Weber C.M. (2017). Preliminary evidence that growth in productive language differentiates childhood stuttering persistence and recovery. J Speech Lang Hear Res. 60(11), 3097–109. https://doi.org/10.1044/2017_JSLHR-S-16-0371
Louko, L.J., Edwards, M.L ve Conture, E.G. (1999). Phonological characteristics of young stutterers and their normally fluent peers:Preliminary Observations. Journal of Fluency Disorders,15(4), 191-210. https://doi.org/10.1016/0094-730X(90)90001-9
Mutlu, A. İ., Tirank, Ş. B., ve Gündüz, B. (2020). 6 ve 16 yaş okul çocukları arasındaki SSI-4-TR/KEŞİDA-4 Dördüncü Baskısının Türkçe Versiyonunun Güvenilirliği ve Geçerliliği. İzmir Demokrasi Üniversitesi Sağlık Bilimleri Dergisi, 3(2), 135-144.
Oyoun, H. A., El Dessouky, H., Shohdi, S. ve Fawzy, A. (2010). Assessment of working memory in normal children and children who stutter. Journal of American Science, 6(11), 562-6.
Pelczarski, K.M. (2011). Phonological processing abilities of adults who stutter. [Doctoral Dissertation, University of Pittsburg]. Graduate Faculty of the School of Health and Rehabilitation Sciences.
Pelczarski, K.M. ve Yaruss, J.S. (2014). Phonological encoding of young children who stutter. Journal of Fluency Disorders, 39, 12-24. https://doi.org/10.1016/j.jfludis.2013.10.003
Pelczarski, K.M. ve Yaruss, J.S. (2016). Phonological memory in young children who stutter. Journal of Communication Disorders, 62, 54-66. https://doi.org/10.1016/j.jcomdis.2016.05.006
Pellowski, M. W., & Conture, E. G. (2005). Lexical priming in picture naming of young children who do and do not stutter. Journal of Speech, Language, and Hearing Research, 48(2), 278-294. https://doi.org/10.1044/1092-4388(2005/019)
Pellowski, M.W, Conture, E.C. ve Anderson, J. (2000). Articulatory and phonological assessment of children who stutter. Journal of Fluency Disorders, 25 (3), 257-258. https://doi.org/10.1016/S0094-730X(00)80344-7
Postma, A. & Kolk, H. (1993). The Covert Repair Hypothesis- Prearticulatory repair processes in normal and stuttered disfluencies. Journal of Speech, Language, and Hearing Research, 36(3), 472- 487. https://doi.org/10.1044/jshr.3603.472
Riley, G. (2009). Stuttering Severity Instrument for Children and Adults. 4th ed., Austin, TX: Pro-Ed Publishing.
Riley, G., & Riley (2000). J., A Revised Component Model For Diagnosing And Treating Children Who Stutter, Contemp. Issues Commun. Sci. Disord., 27(Fall), 188-199. https://doi.org/10.1044/cicsd_27_F_188
Sasisekaran, J. & Byrd, C.T. (2013). A preliminary investigation of segmentation and rhyme abilities of children who stutter. Journal of Fluency Disorders, 38(2), 222 234. https://doi.org/10.1016/j.jfludis.2012.12.004
Smith A., Goffman L., Sasisekaran J., ve Weber-Fox C. (2012) Language and Motor abilities of preschool children who stutter: evidence from behavioral and kinematic indices of nonword repetition performance. Journal of Fluency Disorders, 37(4), 344-58. https://doi.org/10.1016/j.jfludis.2012.06.001
Spencer, C. & Weber-Fox, C. (2014). Preschool speech articulation and nonword repetition abilities may help predict eventual recovery or persistence of stuttering. Journal of Fluency Disorders, 41, 32-46. https://doi.org/10.1016/j.jfludis.2014.06.001
Topbaş, S. (2017). Sesletim Sesbilgisi Testi Kullanım Yönergesi. Detay Yayıncılık. Ankara.
Tredway, M. (2013). Cognitive Aspects of Stuttering. Undergraduate Honors Theses. 45.
https://thekeep.eiu.edu/honors_theses/45
Walden, T. A., Frankel, C. B., Buhr, A. P., Johnson, K. N., Conture, E. G., & Karrass, J. M. (2012). Dual diathesis-stressor model of emotional and linguistic contributions to developmental stuttering. Journal of abnormal child psychology, 40(4), 633–644. https://doi.org/10.1007/s10802-011-9581-8
Wolk, L., Edwards, M.L. ve Conture, E.G. (1993). Coexistence of stuttering and disordered phonology in young children. Journal of Speech, Language and Hearing Research, 36(5), 906-917. https://doi.org/10.1044/jshr.3605.906
Yaruss, J.S. & Conture, E.G. (1996). Stuttering and phonological disorders in children examination of the Covert Repair Hypothesis. Journal of Speech, Language and Hearing Research, 39(2), 349-364. https://doi.org/10.1044/jshr.3902.349
Zebrowski, P.M. & Conture, E.G. (1998) Influence Of Nontreatment Variables On Treatment Effectiveness For School-Age Children Who Stutter, In: Treatment Efficacy For Stuttering: A Search For Empirical Bases, A.K.Cordes, R.J. Ingham (Eds.), Singular Publishing Group, Inc., San Diego, 293-310.