News & Stories
Stuttering and anxiety: what's the connection?
March 12, 2024
Written by: Stephany Daniel, Yanni Liu
Dr. Yanni Liu’s new paper, Brain response to errors in children who stutter, was recently published in the Journal of Fluency Disorders.
In this paper, our researchers sought to better understand the connection between stuttering and anxiety. Long-established studies show that about half of all adults who stutter report social anxiety disorders that significantly impact their quality of life. But do children who stutter also experience these higher levels of anxiety? Does their anxiety grow with age? This study is the first one of its kind, investigating signs of anxiety within the brains of preschool-aged and school-aged children who stutter.
We sat down with Dr. Liu to learn more about this research, why it's important and what it can teach us about the role anxiety plays in developmental stuttering.
Who participated in this study? What did the participants do?
Liu: A total of 50 children, aged 3 to 9, participated in the study, including 26 children who stutter and 24 age- and gender-matched controls. They played a computer game called the 'Zoo' task where they pressed a button quickly when they saw animal pictures (Go Trials) and withheld their response when they saw an orangutan (No-Go trials). This task is designed to elicit errors and is commonly used in developmental research.
According to your paper, while the children played this computer game the team focused on taking two measurements of the children’s brains: the error-related negativity (ERN) and the error positivity (Pe). For those unfamiliar with these two measures, can you briefly explain what they are?
Liu: The error-related negativity (ERN) is a brain signal that quickly pops up when we make a mistake, helping us notice and correct errors. It comes from parts of the brain involved in controlling our actions and emotions. After the ERN, there's another signal called the error positivity (Pe), which helps us realize we've made a mistake and learn from it. These signals get stronger as we grow older, and they help us get better at monitoring our behavior and handling our feelings.
How does collecting these values help us understand the connection between stuttering and anxiety?
Liu: Collecting brain activity data, like ERN and Pe, helps us grasp how stuttering and anxiety connect. ERN is a marker of anxiety, usually stronger in anxious people. Yet in younger kids, this might not hold true, suggesting age matters in this link. Stuttering is also linked to anxiety, especially in older folks. But in children, especially younger ones, this link isn't fully clear. Some studies hint at more anxiety in stuttering kids, while others suggest social effects might cause anxiety later. Understanding how brain activity relates to anxiety and stuttering can uncover why both happen. For instance, if anxious kids have stronger brain reactions to errors, it might worsen stuttering. Exploring this link can help uncover a common mechanism and inform interventions targeting both stuttering and anxiety in kids.
The conclusion of this study was surprising with results that were different from the team’s expectations. Can you share what was so surprising and why?
Liu: The conclusion of our study was unexpected as we found no significant differences between how the brains of children who stutter and those who don't stutter react when they make mistakes—contrary to our expectations based on studies of adults who stutter. This surprise may be due to factors like the wide range of ages studied, varying recovery stages from stuttering, and a relatively small sample size. However, we did observe that older kids who stutter seemed to react more strongly in their brains when they made mistakes. This suggests that as stuttering kids get older, increased demands on speech and heightened awareness of stuttering, together with an exaggerated error-monitoring system, could lead to more long-term stuttering and anxiety. Surprisingly, we didn't find a clear link between this brain reaction and anxiety levels, likely due to generally low anxiety levels in the kids we studied. Overall, our study underscores the need for more research to understand why some kids stutter and how we can better support them.
Will you continue studying ERN and Pe in children? What do you hope to learn?
Liu: Definitely! I've been looking at ERN and Pe in kids with different brain conditions like OCD, anxiety, ADHD and now stuttering. I want to keep going with this research. My plan is to set up studies that follow kids over a long time and include more of them. Our recent study gave us some cool insights into how kids who stutter pay attention to mistakes, but we need to dig deeper. By watching more kids for a longer time, we can figure out how these brain activities develop in kids who stutter. Also, we want to see how it's linked to things like anxiety and how severe their stuttering is. This can help us find better ways to support kids who stutter.
Speaking of supporting kids who stutter, how do you see this research helping people who stutter in the future?
Liu: This research helps people who stutter in a few ways. First, by understanding how kids process mistakes in their brains, we can create better ways to help them. We can track brain activity over time to figure out which kids might struggle with stuttering for a long time and then give them the right kind of help. Also, by looking at how mistakes, anxiety and stuttering are connected, we can find ways to help kids manage their worries and talk more confidently. Understanding how stuttering works in the brain could even lead to new treatments, like using special techniques to stimulate parts of the brain that might help with speaking more smoothly. Overall, this research aims to find better ways to support kids who stutter and help them speak more easily.