The Effectiveness of Cognitive Rehabilitation on Executive Functions and Severity of ‎Fluency Disorder in Children with Childhood Onset Fluency Disorder

Document Type : Original Article

Authors

1 Department of Psychology, Faculty of Human Sciences, Islamic Azad university, Saveh, Iran

2 Department of Speech Therapy, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran

3 Department of Psychology, Faculty of Psychology, Institute of Management and Planning, Tehran, Iran

Abstract

Purpose:
Stuttering is one of the most common speech disorders. A large number of studies have been claimed the relationship between the various dimensions of executive functions and childhood onset fluency disorder. Additionally, its relationship with the sustained attention, response control, working memory have been measured.
 
Methods:
Using available sampling, 20 children between 7 to 12 years of ages with childhood onset fluency disorder were selected based on the criteria of the research, and tested by (N BACK). In order to measure working memory and continuous performance, test was used to assess sustained attention, and go no go test, to evaluate response control. Also, children with childhood onset fluency disorder were assessed by SS% test for assessing the stuttering severity. They were then randomly divided into the experimental and control groups. The experimental group exposed to 15 sessions with 45 length of cognitive-rehabilitation. Then, the post-test was taken from both groups. The experimental group was followed up to 3 months later and tests were performed again.
Results:
The results of covariance analysis and dependent t-test showed that there was a significant difference between sustained attention (p=0.022), working memory (p=0.035) and response control(P=0.039) and stuttering severity (P=0.013) in pretest and posttest in children in childhood onset fluency disorder. Semi difference is observed in executive functions (P=0.056) in the pre-test and post-test. Also, the results of bonfrroni post hoc test for assessing the sustainability of treatment over a 3 month period showed that our treatment method was effective on sustained attention, working memory and executive functions, and its effect was constant during follow-up period. But cognitive rehabilitation has been effective on response control but its effect has not been stable over time.
Conclusion:
It can be concluded from the research findings that cognitive rehabilitation method is effective on stuttering severity and increases executive functions in children with childhood onset fluency disorder and can be used as a treatment method.

Keywords


  1. Heitman RR, Asbjornsen A, and Helland, T. Attention functions in speech fluency disorderd. Taylor and francis health siences 2004; 29(3): 119-127.
  2. American psychiatric association, Diagnostic and statistical manual of mental disorders. fifth edition. Washington.D.C: American psychiatric association; 2013: chapter 3: 45.
  3. Alizadeh H. Relationship between أeurocognitive executive functions and developmental disorders. J cognit sci 2002;14 (4): 23-34. [Persian]
  4. Malia K, Law P, Bewick K, Danziger S, et al. Recalommendations for best practice in cognitive rehabilitation therapy.USA: The society for cognitive rehabilitation; 2004.
  5. Dhatri S D, Kumar U A, Santosh M. Comparison of working memory abilities in adults who do and do not stutter. J Indian Speech Language Hearing Assoc 2017; 31: 42-7.
  6. Rocha MS, Yaruss JS & Rato JR. Temperament, Executive Functioning, and Anxiety in School-Age Children Who Stutter. J front psychol. 2019; 10 (4): 22-44.
  7. Bahrami H, Nejati V, Pouretemad H. Acomparitive study of phonemic and semantic verbal fluency in children and adolescents with Developmental stuttering. zjrms 2014; 16(5): 41-44
  8. Ntourou K, Anderdon JD. and Wagovich SA. Executive function and childhood stuttering: Parent ratings and evidence from a behavioral task. J fluency dis 2018; 56: 18-32
  9. Costelloe S, Davis S, Cavenagh P& Doneva SP. Attention levels in young children who stutter, Applied Neuropsychology: Child 2019; 8(4): 355-365.
  10. Karimi H, jones M, O Brian S, Onslow M. Clinician percent syllables stuttered, clinician severity ratings and speaker severity ratings: are they interchangeable. Int j lang comu dis 2014; 40(3): 364-368.
  11. Saifpanahi S, Sobhani Rad D, Afzali M, Izanloo S, et al. An investigation of the Correlation between Phonological and Visual Working Memory with Severity of Stuttering in 6-12 Years-Old Children. JPSR 2015; 4(4): 20-26. [Persian]
  12. Vander lienden L, Hartsuiker R, Szmalec A. Cognitive control and stuttering [Thesis] .[Belgium]: universitiet Ghent; 2012-2013.
  13. Eggers K, Denil LF, Van Den Bergh BH. Inhibitory control in childhood stuttering. J fluency dis 2010; 38(1): 1-13.
  14. Ofoe LC, Anderson JD, Ntourou K. Short-Term Memory, Inhibition, and Attention in Developmental Stuttering: A Meta-Analysis. Journal of Speech Lang Hear Res 2018; 61(7): 1626-1648. 
  15.  Markett S, Bleek B, Reuter M., Prüss H, et al. Impaired motor inhibition in adults who stutter – evidence from speech-free stop-signal reaction time tasks. J Neuropsychol 2016; 91(1): 444-450.
  16. Piispala J, Kallio M, Bloigu R, Jansson-Verkasalod E. Delayed N2 response in Go condition in a visual Go/Nogo ERP study in children who stutter. J Fluency Dis 2016; 48(1): 16-26.
  17.  Eichorn N, Marton K, Pirutinsky S. Cognitive flexibility in preschool children with and without stuttering disorders. J Fluency Dis 2017; 57: 123-135.
  18. Nejati V, Pouretemad H, Bahrami H. Attention training in rehabilitation of children with developmental stuttering. j neurorehabilitation 2014; 32(2): 297-303.
  19. Craig A, Tran Y. Trait and social anxiety in adults with chronic stuttering: conclusions following meta-analysis. j fluency dis 2014; 40: 35-43.
  20. Schecker M, Pirnay-Dummer P, Schmidtke K, Hentrich-Hesse T, Bordchart D. Cognitive Interventions in Mild Alzheimer's Disease: A Therapy-Evaluation Study on the Interaction of Medication and Cognitive Treatment. J cog rehab 2013; 3(1): 301-311.
  21. Yu Z, Jiang S, Jia z, Xiao H, Zhou M. Study on Language Rehabilitation for Aphasia. Chin med j 2017; 130(12): 1491-1497.
  22. Carrie A, Des Roches CA, Swathi Kiran S. Technology-Based Rehabilitation to Improve Communication after Acquired Brain Injury. J front neurosci 2017; 11: 382-394
  23. Kasaeean K, Kia manesh AR, Bahrami H. The comparison of working memory and attention keeping in students with and without learning disorders. Jld 2013; 3(4):112-123. [Persian]
  24. Hadian Fard H, Shokr Kon H, Mehrabizadeh Honarmand M. Preparing and constructing the Persian form of continues performance test. J Psychol 2000; 4(4):388-404 [Persian]
  25. Ran DK, Rao ShL. Developmet and standardization of the measurement of inhibition. Delhi psy j 2013; 16(1): 90-97.
  26. Ghadiri F, Ashayeri H, Ghazi tabatabaee M. Cognitive rehabilitation role in reducing executive functions disabilities and obsessive-compulsive symptoms in pschizo obsessive patients. j rehab 2006; 4(7): 15-24. [Persian]
  27. Yarus M. Real time analysis of speech fluency. J speech lang path 1998; 312-322.
  28. Birstein A. Stuttering is a Speech Disorder. Childhood-Onset Fluency Disorder (Stuttering). An information handout USA: 2015; 0-6.
  29. Herrera C, Chambona BF, Michel V, Pabana B. Positive effects of computer-based cognitive training in adults with mild cognitive impairment.  J Neuropsy 2012; 50(8): 1871-1881.
  30. Mc Cullough SW. Treatment of language and memory in patients with Alzheimer's disease. Arkansas: University of Arkansas; 2010: 37.
  31. Yuen MC, Chu SY, Wong CH and Ng KF., Development and Pilot Test for Stuttering Self-Monitoring Solution using Telehealth.   International communication Systems & NETworkS (COMSNETS) 2021; Bangalore, India: 650-655.
  32. Amiri M. Effect of anxiety on childrenwith stuttering and normal children. JEE 2009; 8(3): 95-103. [Persian]
  33. Bloemsma JM, Boer F, Arnold. Comorbid anxiety and neurocognitive dysfunctions in children with ADHD. Eur Child Adolesc Psychiatry 2013; 22, 225-234.