Purpose This study described the proportion of children who stutter who exhibit Attention Deficit Hyperactivity Disorder (ADHD) symptoms, manifesting in inattentive and hyperactive/impulsive behaviours. Children who stutter with these challenging behaviours may not respond as quickly and successfully to stuttering treatment. A preliminary exploration of differences in treatment responsiveness for children with and without ADHD symptoms was undertaken.
Method Participants were 185 preschool children who stutter who had completed stuttering therapy within 3 months prior to study commencement. Differences between groups of children who stutter with and without elevated ADHD symptoms were investigated, in terms of pre-treatment stuttering features (stuttering severity and typography), demographic variables (age at onset, time between onset and commencement of therapy, family history and sex) and treatment data (post-treatment stuttering severity and number of sessions to achieve discharge criteria).
Results One-half (50%) of participants exhibited elevated ADHD symptoms. These children required 25% more clinical intervention time to achieve successful fluency outcomes than children without elevated ADHD symptoms. Findings suggest that more ADHD symptoms, increased pre-treatment stuttering severity, and male sex were associated with poorer responsiveness to stuttering treatment.
Conclusion The large proportion of children exhibiting elevated ADHD symptoms, and the increase in clinical contact time required in this subgroup to achieve successful fluency outcomes, is suggestive of the need for clinicians to tailor stuttering intervention to address these concomitant behaviour challenges. Findings support the use of careful caseload management strategies to account for individual differences between children, and strengthen prognostic information available to parents and clinicians.
Contemporary multidimensional models of early stuttering highlight interactions between language, phonology, physiology, temperament and behaviour in children predisposed to the neurodevelopmental disorder of stuttering (Smith & Weber, 2016, 2017). Inherent in such models is the importance of early intervention given the importance of neuroplasticity (Chang, Erickson, Ambrose, Hasegawa-Johnson, & Ludlow, 2008), and the importance of considering individual factors that may affect treatment outcomes. While successful early stuttering interventions have been reported (De Sonneville-Koedoot, Stolk, Rietveld, & Franken, 2015; Guitar et al., 2015; Millard, Nicholas, & Cook, 2008; Yaruss, Coleman, & Hammer, 2006), authors caution that not all therapies work for every child (Smith & Weber, 2016; Yaruss et al., 2006). This was the case, for example, in the recent RESTART randomised controlled clinical trial comparing the efficacy of direct and indirect stuttering therapies (De Sonneville-Koedoot et al., 2015). An average of 26% of children who received treatment (46 out of the 176) across both therapy approaches still required therapy at 18 months post treatment, indicating that the disorder had not yet been fully remediated. Type of treatment (i.e., direct or indirect), as well as interactions between treatment type and time in therapy, age, stuttering severity and time close to onset, were examined and found not to be predictive of treatment outcomes (De Sonneville-Koedoot et al., 2015). This underscores the need to consider additional factors to achieve positive treatment outcomes for children who do not respond to stuttering therapy.
Empirical data is required to objectively capture the important prevalence of elevated ADHD symptoms in children with early developmental stuttering disorders. This study identified approximately half of the children in early stuttering caseloads as presenting with concomitant self-regulation challenges. Furthermore, this study explored the significant negative effect of elevated ADHD symptoms on stuttering treatment responsiveness and thus provides support for future prospective studies of treatments that address elevated ADHD symptomology as well as the child’s stuttering. Finally, results yielded provide direction for future caseload and waitlist management, and potentially more informed individual prognostic information for parents of children who stutter who we treat in the future.