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Sex Differences in Childhood Stuttering and Coexisting Developmental Disorders

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Title: Sex Differences in Childhood Stuttering and Coexisting Developmental Disorders
Language: English
Authors: Patrick M. Briley, Sandra Merlo, Charles Ellis
Source: Journal of Developmental and Physical Disabilities. 2022 34(3):505-527.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 23
Publication Date: 2022
Document Type: Journal Articles
Reports - Research
Descriptors: Children, Adolescents, Stuttering, Comorbidity, Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorders, Intellectual Disability, Learning Disabilities, Seizures, Age Differences, Gender Differences
Assessment and Survey Identifiers: National Health Interview Survey
DOI: 10.1007/s10882-021-09811-y
ISSN: 1056-263X
1573-3580
Abstract: Stuttering and other developmental disorders are known to affect more male than female children. The present study compared: (1) stuttering prevalence in males and females at discrete ages and (2) prevalence of coexisting developmental disorders in male and female children who stutter (CWS). Data were obtained from the National Health Interview Survey (from 2010 to 2015). The sample comprised 62,450 total children, ages 3 to 17 years. Children in the current sample were those identified by their caregivers as having stuttered in the past 12 months. Rate of stuttering and data on five concomitant disorders (attention deficit hyperactivity disorder--ADHD; autism spectrum disorder; intellectual disability; learning disability; and seizures) were compared between male and female CWS and across three age categories: 3-5, 6-10, and 11-17 years. There were 1231 CWS, 852 males and 379 females, in the sample. Overall prevalence rates were 1.3%, 95% [CI 1.0, 1.6] for females, and 2.6%, 95% [CI 2.1, 3.2] for males, where prevalence rates decreased as age increased. For the total sample, male-to-female ratio was 2.0:1, 95% [CI 1.9, 2.5]. For coexisting developmental disorders, male CWS were at greater odds of having ADHD (OR = 2.32, 95% CI [1.62, 3.31]) and at lower odds than females of experiencing seizures (OR = 0.370, 95% [CI 0.214, 0.638]). Prevalence data at discrete ages revealed a different course of stuttering in early childhood for female and male children. Implications of sex differences, on the presence of ADHD and seizures/epilepsy among CWS, are discussed.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1430932
Database: ERIC
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  Value: <anid>AN0156935473;jdp01jun.22;2022May20.04:26;v2.2.500</anid> <title id="AN0156935473-1">Sex Differences in Childhood Stuttering and Coexisting Developmental Disorders </title> <p>Stuttering and other developmental disorders are known to affect more male than female children. The present study compared: (<reflink idref="bib1" id="ref1">1</reflink>) stuttering prevalence in males and females at discrete ages and (<reflink idref="bib2" id="ref2">2</reflink>) prevalence of coexisting developmental disorders in male and female children who stutter (CWS). Data were obtained from the National Health Interview Survey (from 2010 to 2015). The sample comprised 62,450 total children, ages 3 to 17 years. Children in the current sample were those identified by their caregivers as having stuttered in the past 12 months. Rate of stuttering and data on five concomitant disorders (attention deficit hyperactivity disorder—ADHD; autism spectrum disorder; intellectual disability; learning disability; and seizures) were compared between male and female CWS and across three age categories: 3–5, 6–10, and 11–17 years. There were 1231 CWS, 852 males and 379 females, in the sample. Overall prevalence rates were 1.3%, 95% [CI 1.0, 1.6] for females, and 2.6%, 95% [CI 2.1, 3.2] for males, where prevalence rates decreased as age increased. For the total sample, male-to-female ratio was 2.0:1, 95% [CI 1.9, 2.5]. For coexisting developmental disorders, male CWS were at greater odds of having ADHD (OR = 2.32, 95% CI [1.62, 3.31]) and at lower odds than females of experiencing seizures (OR =.370, 95% [CI.214,.638]). Prevalence data at discrete ages revealed a different course of stuttering in early childhood for female and male children. Implications of sex differences, on the presence of ADHD and seizures/epilepsy among CWS, are discussed.</p> <p>Keywords: Stuttering; Sex; Prevalence; ADHD; Seizures</p> <p>Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10882-021-09811-y.</p> <hd id="AN0156935473-2">Introduction</hd> <p>Stuttering is a communication disorder that typically begins in early childhood, between 2 and 5 years of age (Yairi & Ambrose, [<reflink idref="bib62" id="ref3">62</reflink>]). Parents usually are the first ones to notice observable behaviors of stuttering in their child, which may include part-word repetitions, sound prolongations, and postural fixations during speech, and other concomitant behaviors involving the face, the head, or extremities (Yaruss, [<reflink idref="bib63" id="ref4">63</reflink>]). Parents of CWS have exhibited success in the identification of stuttering in their child both by experimental research (Einarsdóttir & Ingham, [<reflink idref="bib24" id="ref5">24</reflink>]; Zebrowski & Conture, [<reflink idref="bib64" id="ref6">64</reflink>]) and professional judgment (Curlee, [<reflink idref="bib19" id="ref7">19</reflink>]). Ultimately, recognition of these stuttering behaviors in childhood occurs in approximately 8% of children (Yairi & Ambrose, [<reflink idref="bib62" id="ref8">62</reflink>]). Due to high rates of natural recovery, which are estimated at roughly 90%, the lifetime prevalence is approximately 0.7% (Yairi & Ambrose, [<reflink idref="bib62" id="ref9">62</reflink>]). Previous data supports similar incidence and prevalence patterns, but trajectories of stuttering throughout childhood remain unclear.</p> <hd id="AN0156935473-3">Stuttering Prevalence in Childhood</hd> <p>Although the lifetime prevalence of stuttering is accepted to be approximately 0.7% (Yairi & Ambrose, [<reflink idref="bib62" id="ref10">62</reflink>]), prevalence changes according to age. In a randomized study with 12,131 Australian citizens, Craig et al. ([<reflink idref="bib17" id="ref11">17</reflink>]) found a greater stuttering prevalence in early and late childhood (1.4%) and a lower prevalence in adolescence (0.5%). Briley and Ellis ([<reflink idref="bib6" id="ref12">6</reflink>]), analyzing data on 62,450 American children and adolescents from the National Health Interview Survey (NHIS), also found a decreasing stuttering prevalence with age, although with higher rates (i.e., approximately 2.5% in early and late childhood, and 1.4% in adolescence). Differences in prevalence rates between both studies are likely a result of differing methodologies. Craig et al.'s ([<reflink idref="bib17" id="ref13">17</reflink>]) identification of stuttering relied on evaluation of observable behaviours of stuttering, which could potentially result in under-identification due to the variable nature of stuttering and those people who stutter (PWS) who demonstrate more covert than observable symptoms, such as anticipation of stuttering, which can lead to avoidances of sounds, words, people, places, or situations (Jackson et al., [<reflink idref="bib33" id="ref14">33</reflink>]). Additionally, identification of stuttering in Briley and Ellis' ([<reflink idref="bib6" id="ref15">6</reflink>]) sample relied on parental/caregiver report, which did not require the presence of observable behaviors of stuttering at the time of the interview. Parents may not be fully aware of the full nature of stuttering (e.g., the unobservable experiences of stuttering), possibly resulting in under-estimation of stuttering in the Briley and Ellis sample as well. Therefore, these differences in methodologies highlight some of the contributors to variance in reports rates of stuttering.</p> <p>Stuttering prevalence decreases with age, although evidence suggests an increase in the male to female ratio (Yairi & Ambrose, [<reflink idref="bib62" id="ref16">62</reflink>]). In Craig et al.'s ([<reflink idref="bib17" id="ref17">17</reflink>]) study, the male to female ratio was 2.3:1, 3.3:1, and 4:1 in early childhood, late childhood, and adolescence, respectively. Boyle et al. ([<reflink idref="bib5" id="ref18">5</reflink>]), using NHIS data from 1997 to 2008, analyzed 119,367 American children and adolescents regarding the prevalence of developmental disorders. Although stuttering was found to be significantly higher in early and late childhood (2%) compared to adolescence (1.2%), only a single male to female ratio was provided for the whole sample (2.5:1). Further comparisons involving stuttering across sex include a variety of other designs. Ingham et al.'s ([<reflink idref="bib32" id="ref19">32</reflink>]) finding of similar and contrasting brain activations in males and female adults who stutter. Ingham et al. ([<reflink idref="bib32" id="ref20">32</reflink>]) found that activation of supplementary motor area and inferior lateral pre-motor area was positively correlated to stuttering in males, and activation of basal ganglia was positively correlated to stuttering in females. Additionally, Suresh et al. ([<reflink idref="bib57" id="ref21">57</reflink>]) found differences in chromosomal linkages to stuttering as a function of sex (i.e., on chromosome 7 for males and on chromosome 21 for females), suggesting sex contributions to stuttering outcomes. It is possible that sex differences in the stuttering genetic component (Suresh et al., [<reflink idref="bib57" id="ref22">57</reflink>]) are related to sex differences in brain activation (Ingham et al., [<reflink idref="bib32" id="ref23">32</reflink>]) and, ultimately, to the biased sex ratio in stuttering prevalence. Although sex differences in stuttering prevalence are well-accepted in the literature, further studies are needed for a more refined understanding of the course of stuttering in each sex, and possibly a better understanding regarding the trajectory of the biased sex ratio. This new information could result in more specific and appropriate clinical recommendations depending on the child's sex.</p> <hd id="AN0156935473-4">Stuttering and Coexisting Developmental Disorders</hd> <p>Research findings show evidence that stuttering commonly co-occurs with other developmental disorders. Boulet et al. ([<reflink idref="bib4" id="ref24">4</reflink>]), using NHIS data from 1997 to 2005, analyzed 95,132 children and adolescents regarding the presence of developmental disorders. They found the co-occurrence of developmental disorders to be considerably high among CWS, who were reported to have high rates of attention-deficit disorder and attention-deficit/hyperactivity disorder (ADD/ADHD; 43.1%), learning disability (58.0%), mental retardation (15.1%), and seizures (13.7%). Recently, Briley and Ellis ([<reflink idref="bib6" id="ref25">6</reflink>]) used merged data from 2010 to 2015 NHIS where they too found the coexistence of developmental disorders, when compared to children who do not stutter (CWNS), to be higher among CWS, who were found to have significantly higher rates of intellectual disability (7.6%), learning disability (32.9%), ADHD/ADD (25.6%), seizures (5.3%), and autism/Asperger's/PDD (8.0%).</p> <p>There is minimal population data on stuttering and coexisting developmental disorders, and data on similarities or differences in these co-occurrences as a function of sex is even more limited. In a relatively small sample with 132 PWS, comprised of 103 males and 29 females, Sudhi et al. ([<reflink idref="bib55" id="ref26">55</reflink>]) found co-existing developmental disorders, such as learning disability and delayed speech and language, to be more prevalent among male CWS when compared to females. Blood et al. ([<reflink idref="bib3" id="ref27">3</reflink>]) also found sex differences in 2628 CWS regarding co-occurring disorders, with males being significantly more impacted by articulation and phonology disorders, learning disabilities, and literacy disorders. As evidenced, stuttering commonly coexists with other developmental disorders, where both may be influenced by the differentiating factor of sex. However, there is a paucity of evidence merging these two factors. Clarifying these differences would introduce considerations in both etiological research and approaches to clinical management.</p> <hd id="AN0156935473-5">Stuttering and Population-Based Studies</hd> <p>There are several advantages in conducting studies with large, representative samples (Raghavan et al., [<reflink idref="bib47" id="ref28">47</reflink>]). As data are obtained using randomization procedures applied to wide geographical areas, derived estimates are representative of the entire population (Raghavan et al., [<reflink idref="bib47" id="ref29">47</reflink>]). Also, population data usually relates to thousands of people, which make them particularly valuable to low prevalence disorders, such as stuttering, in which large sample sizes are difficult to obtain. On the other hand, population data can be limited by the "validity of ascertainment" since surveys may rely on personal reports (Raghavan et al., [<reflink idref="bib47" id="ref30">47</reflink>]). However, this may be not a problem in the case of stuttering because previous research (Einarsdóttir & Ingham, [<reflink idref="bib24" id="ref31">24</reflink>]; Zebrowski & Conture, [<reflink idref="bib64" id="ref32">64</reflink>]) demonstrated that parents are capable of correctly identifying stuttering in their child, based on observable symptomatology. In both studies (Einarsdóttir & Ingham, [<reflink idref="bib24" id="ref33">24</reflink>]; Zebrowski & Conture, [<reflink idref="bib64" id="ref34">64</reflink>]), stuttering was not operationally defined, but instead, the parents were asked to judge what they thought to be stuttering. Nevertheless, given the small samples of these studies, it is reasonable to conclude that there is a possibility that prevalence figures may be influenced by definitions of stuttering, accuracy of reports, and differentiation between typical and atypical disfluencies.</p> <p>Analyzing current NHIS data offers one approach of preliminary unraveling of some of the perplexities of stuttering. Raghavan et al. ([<reflink idref="bib47" id="ref35">47</reflink>]) suggested that population data can provide critical information regarding patterns of speech disorders. The current study represents further analysis of data from Briley and Ellis ([<reflink idref="bib6" id="ref36">6</reflink>]), with particular interest in determining the impact of sex on the course of stuttering and if sex differences are present in those CWS with reported coexisting developmental disorders.</p> <p>Therefore, the objective of this study is twofold: (<reflink idref="bib1" id="ref37">1</reflink>) to explore the prevalence of male and female CWS for discrete ages from 3 to 17 years and (<reflink idref="bib2" id="ref38">2</reflink>) to explore the co-occurrence of developmental disorders among male and female CWS across three age ranges: 3–5 years, 6–10 year, and 11–17 years, using a large national representative sample of children residing in the US. The results of this study have the potential to contribute to more specific clinical recommendations, depending on the child's sex, regarding stuttering itself as well as coexisting developmental disorders.</p> <hd id="AN0156935473-6">Material and Methods</hd> <p></p> <hd id="AN0156935473-7">Study Sample</hd> <p>This study used six years of merged data from the 2010 to 2015 NHIS (Center for Disease Control, [<reflink idref="bib11" id="ref39">11</reflink>], [<reflink idref="bib12" id="ref40">12</reflink>], [<reflink idref="bib13" id="ref41">13</reflink>]). The same dataset and approach described here was used in Briley and Ellis ([<reflink idref="bib6" id="ref42">6</reflink>]). The NHIS is a national survey that occurs every year under the supervision of the National Center for Health Statistics, with a goal of monitoring the health of U.S. citizens. The NHIS uses household interviews of U.S. citizens for collecting data. Roughly 35,000–40,000 households are used in this survey in which the citizens do not reside in penal institutions, mental institutions, or homes for the elderly. Procedures for sampling include assigning primary sampling units (PSUs) for each state. PSUs may be a county or a comparable geographical territory to a state's county (Parsons et al., [<reflink idref="bib45" id="ref43">45</reflink>]). Sampling takes places from these stratified PSUs to ensure generation of reliable sampling of minority groups (Parsons et al., [<reflink idref="bib45" id="ref44">45</reflink>]). For selected households with children under 18 years of age, a sample child is randomly selected.</p> <p>The NHIS samples new participants every year, meaning it provides cross-sectional, but not longitudinal, data. The sample analyzed in the present study includes data from the 2010–2015 NHIS concerning childhood health issues. Detailed information regarding the survey's questionnaires and sampling design can be found on the website of the National Center for Health Statistics (Center for Disease Control, [<reflink idref="bib14" id="ref45">14</reflink>]). All the information related to the sample child is obtained from a caregiver that resides in the same household (Center for Disease Control, [<reflink idref="bib15" id="ref46">15</reflink>]). The children included in this sample are those whose caregiver responded definitively "yes" or "no" to the following question: "During the past 12 months, has [child name] had any of the following conditions... stuttering or stammering?" Thus, children whose caregivers responded "yes" to the above question were considered CWS, while children whose caregivers responded "no" were considered CWNS. In addition, the sample analyzed here only includes children whose caregivers answered "yes" or "no" to each of the coexisting developmental disorders, which are defined in detail in the following section.</p> <hd id="AN0156935473-8">Data Description</hd> <p></p> <hd id="AN0156935473-9">Demographic Characteristics</hd> <p>Respondents reported the race<bold>,</bold> age<bold>,</bold> geographical region, highest level of education by an adult in the family, and total combined family income. Data on each variable is provided and compared between male and female CWS. Additionally, each variable was compared between male and female CWS as a function of age. For age comparisons, three categories are reported: 3–5, 6–10, and 11–17 years. Utilization of the 3–5-year age range was intended to capture the most likely age reported in the literature when the onset of stuttering would occur – since data is not available for children 2-years of age. Additionally, the 6–10 and 11–17-year age ranges were most optimal for capturing pre- and post-puberty age ranges. Similar age categories were applied in previous studies (Briley & Ellis, [<reflink idref="bib6" id="ref47">6</reflink>]; Craig et al., [<reflink idref="bib17" id="ref48">17</reflink>]).</p> <hd id="AN0156935473-10">Prevalence Data on Male and Female Children Who Stutter</hd> <p>For those children identified by their caregivers as having stuttered in the past 12 months, point prevalence at discrete ages for females and males was computed separately. Sex ratio was computed as male to female ratio at discrete ages as well.</p> <hd id="AN0156935473-11">Coexisting Developmental Disorders in Children Who Stutter</hd> <p>The NHIS included questions pertaining to the presence of other developmental disorders and data for each was collected via caregiver report. Disorders investigated in the NHIS include: (a) ADHD/ADD; (b) autism/Asperger's/PDD; (c) intellectual disability; (d) learning disability; (e) seizures; and (f) any other developmental delay. Respondents were asked: "Has a doctor or health professional ever told you that [child name] had": (a) Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD); (b) autism, Asperger's disorder, pervasive developmental disorder or autism spectrum disorder; (c) an intellectual disability; and (d) any other developmental delay? Wording for learning disability was: "Has a representative from a school or a health professional ever told you that [child name] had a learning disability?". Finally, wording for seizures was: "During the past 12 months, has [child name] had any of the following conditions... Seizures?" Only children whose caregivers definitely responded "yes" or "no" to each of the above questions were included in the sample analyzed here.</p> <hd id="AN0156935473-12">Data Analysis</hd> <p>All analyses were conducted with SPSS Version 24 (IBM, [<reflink idref="bib31" id="ref49">31</reflink>]), utilizing SPSS' Complex Samples function. SPSS's Complex Samples function accounts for the complex sampling design of the NHIS using variables provided by the NHIS, including weighting of data, which allows for generalizability of findings. The two groups used for the current analyses (i.e., male and female CWS) were compared on the basis of race<bold>,</bold> age<bold>,</bold> geographical region, highest level of education by an adult in the family, total combined family income, and the presence of coexisting developmental disorders. Age was reported in years and the remaining variables were reported in percentages. All variables were compared across the three age ranges (i.e., 3–5, 6–10, and 11–17 years). For prevalence data, 95% confidence intervals (CI) of the mean were calculated for the whole sample in order to also provide the lowest and the highest estimators of the mean. For comparing categorical variables, chi-square test of independence was utilized, and independent samples t-tests were applied for comparing continuous variables. Multiple logistic regressions were performed to determine the odds of having a coexisting disorder among CWS, as a function of sex.</p> <hd id="AN0156935473-13">Results</hd> <p></p> <hd id="AN0156935473-14">Demographic Characteristics</hd> <p>Breakdowns of rate of stuttering and demographic information among male and female CWS by age group are included in Tables 1 and 2. Data from 2010 to 2015 NHIS included 1231 CWS. Among those CWS were 852 males (67.8%) and 379 females (32.2%). Sex differences in the composition of CWS were consistent across all age groups. Males comprised the majority of CWS in the 3–5 year range (62.5%); in the 6–10 year range (72.7%); and in the 11–17 year range (66.8%). White children comprised the majority of the sample of male (66.3%) and female CWS (62.9%), and when comparing between male and female CWS, no significant differences were present with regard to race <emph>X</emph><sups><emph>2</emph></sups><bold>(</bold>4.31, <bold><emph>N</emph></bold> = 1231) = 6.44, <emph>p</emph> = 0.184. On average, the male CWS were older (<emph>M</emph> = 9.03, <emph>SD</emph> = 4.20) than the female CWS (<emph>M</emph> = 8.82, <emph>SD</emph> = 4.50), though this difference was not significant <emph>t</emph> (1229) = 0.81, <bold><emph>p</emph></bold> = 0.481. The makeup of male and female CWS did not differ in geographical region, <emph>X</emph><sups><emph>2</emph></sups> (2.75, <emph>N</emph> = 1231) = 0.702, <emph>p</emph> = 0.883. Significant differences were not present in either highest level of education of adult in family, <emph>X</emph><sups><emph>2</emph></sups> (7.45, <emph>N</emph> = 1231) = 13.54, <emph>p</emph> = 0.242, or in total family income, <emph>X</emph><sups>2</sups> (3.79, <emph>N</emph> = 1231) = 10.41, <emph>p</emph> = 0.121, between male and female CWS.</p> <p>Table 1 Rates of stuttering of children in current sample of 2010 to 2015 national health interview surveys</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2" /><th align="left" colspan="2"><p>Total</p></th><th align="left" colspan="2"><p>Ages 3–5</p></th><th align="left" colspan="2"><p>Ages 6–10</p></th><th align="left" colspan="2"><p>Ages 11–17</p></th></tr><tr><th align="left"><p>Males = 32,186</p></th><th align="left"><p>Females = 30,264</p></th><th align="left"><p>Males = 6305</p></th><th align="left"><p>Females = 6086</p></th><th align="left"><p>Males = 9944</p></th><th align="left"><p>Females = 9403</p></th><th align="left"><p>Males = 15,937</p></th><th align="left"><p>Females = 14,775</p></th></tr></thead><tbody><tr><td align="left"><p>Total number of children who stutter (unweighted count)</p></td><td align="left"><p>852</p></td><td align="left"><p>379</p></td><td align="left"><p>224</p></td><td align="left"><p>120</p></td><td align="left"><p>318</p></td><td align="left"><p>119</p></td><td align="left"><p>310</p></td><td align="left"><p>140</p></td></tr><tr><td align="left"><p>Overall rate of stuttering (weighted %)</p></td><td align="left"><p><bold>2.6</bold></p></td><td align="left"><p><bold>1.3</bold></p></td><td align="left"><p><bold>3.2</bold></p></td><td align="left"><p><bold>1.9</bold></p></td><td align="left"><p><bold>3.3</bold></p></td><td align="left"><p><bold>1.3</bold></p></td><td align="left"><p><bold>1.9</bold></p></td><td align="left"><p><bold>1.0</bold></p></td></tr><tr><td align="left" /><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> <.001</bold></p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> <.001</bold></p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> <.001</bold></p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> <.001</bold></p></td></tr></tbody></table> </ephtml> </p> <p>Findings that are bolded are those results that are statistically significant at.05 alpha level</p> <p>Table 2 Demographic characteristics of children used in current sample from 2010 to 2015 national health interview surveys</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="3" /><th align="left" colspan="2"><p>Total</p></th><th align="left" colspan="2"><p>Ages 3–5</p></th><th align="left" colspan="2"><p>Ages 6–10</p></th><th align="left" colspan="2"><p>Ages 11–17</p></th></tr><tr><th align="left"><p>Males</p></th><th align="left"><p>Females</p></th><th align="left"><p>Males</p></th><th align="left"><p>Females</p></th><th align="left"><p>Males</p></th><th align="left"><p>Females</p></th><th align="left"><p>Males</p></th><th align="left"><p>Females</p></th></tr><tr><th align="left"><p>852</p></th><th align="left"><p>379</p></th><th align="left"><p>224</p></th><th align="left"><p>120</p></th><th align="left"><p>318</p></th><th align="left"><p>119</p></th><th align="left"><p>310</p></th><th align="left"><p>140</p></th></tr></thead><tbody><tr><td align="left" colspan="9"><p>Race breakdown among CWS (weighted %)</p></td></tr><tr><td align="left"><p> White</p></td><td align="left"><p>66.3</p></td><td align="left"><p>62.9</p></td><td align="left"><p>67.5</p></td><td align="left"><p>64.1</p></td><td align="left"><p><bold>67.6</bold></p></td><td align="left"><p><bold>67</bold></p></td><td align="left"><p>63.8</p></td><td align="left"><p>57.8</p></td></tr><tr><td align="left"><p> African American</p></td><td align="left"><p>25.5</p></td><td align="left"><p>27.3</p></td><td align="left"><p>22.8</p></td><td align="left"><p>28.1</p></td><td align="left"><p><bold>24.3</bold></p></td><td align="left"><p><bold>23</bold></p></td><td align="left"><p>28.9</p></td><td align="left"><p>30.8</p></td></tr><tr><td align="left"><p> American Indian/Alaska Native</p></td><td align="left"><p>1.3</p></td><td align="left"><p>2.9</p></td><td align="left"><p>1.1</p></td><td align="left"><p>3</p></td><td align="left"><p><bold>1.1</bold></p></td><td align="left"><p><bold>3</bold></p></td><td align="left"><p>1.6</p></td><td align="left"><p>2.6</p></td></tr><tr><td align="left"><p> Asian</p></td><td align="left"><p>2.3</p></td><td align="left"><p>2.5</p></td><td align="left"><p>2.9</p></td><td align="left"><p>0.8</p></td><td align="left"><p><bold>2.1</bold></p></td><td align="left"><p><bold>4.4</bold></p></td><td align="left"><p>2.3</p></td><td align="left"><p>2</p></td></tr><tr><td align="left"><p> Multiple</p></td><td align="left"><p>4.5</p></td><td align="left"><p>4.2</p></td><td align="left"><p>5.4</p></td><td align="left"><p>4.1</p></td><td align="left"><p><bold>4.9</bold></p></td><td align="left"><p><bold>2.3</bold></p></td><td align="left"><p>3.5</p></td><td align="left"><p>6</p></td></tr><tr><td align="left"><p> Unknown</p></td><td align="left"><p>0.1</p></td><td align="left"><p>0.4</p></td><td align="left"><p>0.2</p></td><td align="left"><p>–</p></td><td align="left"><p><bold>–</bold></p></td><td align="left"><p><bold>0.3</bold></p></td><td align="left"><p>–</p></td><td align="left"><p>0.8</p></td></tr><tr><td align="left" /><td align="left" colspan="2"><p><italic>p</italic> =.184</p></td><td align="left" colspan="2"><p><italic>p</italic> =.249</p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> =.027</bold></p></td><td align="left" colspan="2"><p><italic>p</italic> =.388</p></td></tr><tr><td align="left" colspan="9"><p>Age (3–17 years)</p></td></tr><tr><td align="left"><p> Mean (std. deviation)</p></td><td align="left"><p>9.03 (4.20)</p></td><td align="left"><p>8.82 (4.50)</p></td><td align="left"><p><bold>4.09 (.758)</bold></p></td><td align="left"><p><bold>3.81 (.813)</bold></p></td><td align="left"><p>7.86 (1.39)</p></td><td align="left"><p>7.85 (1.45)</p></td><td align="left"><p>13.81 (2.00)</p></td><td align="left"><p>13.94 (1.99)</p></td></tr><tr><td align="left" /><td align="left" colspan="2"><p><italic>p</italic> =.418</p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> =.002</bold></p></td><td align="left" colspan="2"><p><italic>p</italic> =.965</p></td><td align="left" colspan="2"><p><italic>p</italic> =.546</p></td></tr><tr><td align="left" colspan="9"><p>Region breakdown among CWS (weighted %)</p></td></tr><tr><td align="left"><p> Northeast</p></td><td align="left"><p>12.5</p></td><td align="left"><p>11.5</p></td><td align="left"><p>13.8</p></td><td align="left"><p>9.5</p></td><td align="left"><p><bold>11.5</bold></p></td><td align="left"><p><bold>13.7</bold></p></td><td align="left"><p>13</p></td><td align="left"><p>11.1</p></td></tr><tr><td align="left"><p> Midwest</p></td><td align="left"><p>20.8</p></td><td align="left"><p>22.5</p></td><td align="left"><p>13.4</p></td><td align="left"><p>19.1</p></td><td align="left"><p><bold>22.6</bold></p></td><td align="left"><p><bold>19.7</bold></p></td><td align="left"><p>23.8</p></td><td align="left"><p>28.1</p></td></tr><tr><td align="left"><p> South</p></td><td align="left"><p>43.2</p></td><td align="left"><p>42.2</p></td><td align="left"><p>48.5</p></td><td align="left"><p>49.6</p></td><td align="left"><p><bold>45.2</bold></p></td><td align="left"><p><bold>36.6</bold></p></td><td align="left"><p>36.8</p></td><td align="left"><p>41.1</p></td></tr><tr><td align="left"><p> West</p></td><td align="left"><p>23.5</p></td><td align="left"><p>23.9</p></td><td align="left"><p>24.3</p></td><td align="left"><p>21.9</p></td><td align="left"><p><bold>20.7</bold></p></td><td align="left"><p><bold>30.1</bold></p></td><td align="left"><p>26.4</p></td><td align="left"><p>19.7</p></td></tr><tr><td align="left" /><td align="left" colspan="2"><p><italic>p</italic> =.883</p></td><td align="left" colspan="2"><p><italic>p</italic> =.248</p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> =.043</bold></p></td><td align="left" colspan="2"><p><italic>p</italic> =.192</p></td></tr><tr><td align="left" colspan="9"><p>Highest education of adult in family of CWS (weighted %)</p></td></tr><tr><td align="left"><p> No high school diploma</p></td><td align="left"><p>18.1</p></td><td align="left"><p>18.1</p></td><td align="left"><p><bold>15.2</bold></p></td><td align="left"><p><bold>20.6</bold></p></td><td align="left"><p><bold>18.5</bold></p></td><td align="left"><p><bold>21.6</bold></p></td><td align="left"><p><bold>19.7</bold></p></td><td align="left"><p><bold>12.6</bold></p></td></tr><tr><td align="left"><p> High school Grad. or GED</p></td><td align="left"><p>22</p></td><td align="left"><p>25</p></td><td align="left"><p><bold>21.2</bold></p></td><td align="left"><p><bold>22.6</bold></p></td><td align="left"><p><bold>25.9</bold></p></td><td align="left"><p><bold>30.5</bold></p></td><td align="left"><p><bold>17.8</bold></p></td><td align="left"><p><bold>21.9</bold></p></td></tr><tr><td align="left"><p> Some college, no degree</p></td><td align="left"><p>20.2</p></td><td align="left"><p>24.9</p></td><td align="left"><p><bold>22.6</bold></p></td><td align="left"><p><bold>25.6</bold></p></td><td align="left"><p><bold>19.4</bold></p></td><td align="left"><p><bold>19.9</bold></p></td><td align="left"><p><bold>19.5</bold></p></td><td align="left"><p><bold>29.2</bold></p></td></tr><tr><td align="left"><p> Technical, vocational, academic or bachelor's degree</p></td><td align="left"><p>28.4</p></td><td align="left"><p>24.7</p></td><td align="left"><p><bold>27.4</bold></p></td><td align="left"><p><bold>22.8</bold></p></td><td align="left"><p><bold>25.1</bold></p></td><td align="left"><p><bold>21.7</bold></p></td><td align="left"><p><bold>33.4</bold></p></td><td align="left"><p><bold>28.9</bold></p></td></tr><tr><td align="left"><p> Master's, professional, or doctoral degree</p></td><td align="left"><p>11.2</p></td><td align="left"><p>7.3</p></td><td align="left"><p><bold>13.5</bold></p></td><td align="left"><p><bold>8.2</bold></p></td><td align="left"><p><bold>11.1</bold></p></td><td align="left"><p><bold>6.3</bold></p></td><td align="left"><p><bold>9.6</bold></p></td><td align="left"><p><bold>7.4</bold></p></td></tr><tr><td align="left" /><td align="left" colspan="2"><p><italic>p</italic> =.242</p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> =.015</bold></p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> =.021</bold></p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> =.024</bold></p></td></tr><tr><td align="left" colspan="9"><p>Total combined family income of CWS (weighted %)</p></td></tr><tr><td align="left"><p> $0–$34,999</p></td><td align="left"><p>47.1</p></td><td align="left"><p>53.2</p></td><td align="left"><p>43.7</p></td><td align="left"><p>52</p></td><td align="left"><p>51</p></td><td align="left"><p>54.6</p></td><td align="left"><p>44.8</p></td><td align="left"><p>52.8</p></td></tr><tr><td align="left"><p> $35,000–$74,999</p></td><td align="left"><p>24.7</p></td><td align="left"><p>24.3</p></td><td align="left"><p>24</p></td><td align="left"><p>23.4</p></td><td align="left"><p>22.7</p></td><td align="left"><p>22.5</p></td><td align="left"><p>27.6</p></td><td align="left"><p>27</p></td></tr><tr><td align="left"><p> $75,000–$99,999</p></td><td align="left"><p>7.6</p></td><td align="left"><p>9</p></td><td align="left"><p>10</p></td><td align="left"><p>10.7</p></td><td align="left"><p>6</p></td><td align="left"><p>7.8</p></td><td align="left"><p>7.8</p></td><td align="left"><p>8.8</p></td></tr><tr><td align="left"><p> $100,000 and over</p></td><td align="left"><p>15.6</p></td><td align="left"><p>10.1</p></td><td align="left"><p>16.5</p></td><td align="left"><p>10.9</p></td><td align="left"><p>15.1</p></td><td align="left"><p>12.6</p></td><td align="left"><p>15.7</p></td><td align="left"><p>8.4</p></td></tr><tr><td align="left"><p> Undefined/unknown</p></td><td align="left"><p>5</p></td><td align="left"><p>2.9</p></td><td align="left"><p>5.8</p></td><td align="left"><p>3.1</p></td><td align="left"><p>5.2</p></td><td align="left"><p>2.7</p></td><td align="left"><p>4.1</p></td><td align="left"><p>2.9</p></td></tr><tr><td align="left" /><td align="left" colspan="2"><p><italic>p</italic> =.121</p></td><td align="left" colspan="2"><p><italic>p</italic> =.255</p></td><td align="left" colspan="2"><p><italic>p</italic> =.485</p></td><td align="left" colspan="2"><p><italic>p</italic> =.266</p></td></tr></tbody></table> </ephtml> </p> <p>Findings that are bolded are those results that are statistically significant at.05 alpha level <emph>CWS</emph> children who stutter, <emph>GED</emph> general educational development high school equivalency diploma</p> <hd id="AN0156935473-15">Sex Differences in Childhood Stuttering</hd> <p>The overall prevalence of stuttering in females aged 3 to 17 years old was 1.3% (Table 1), with 95% CI [1.0–1.6%]. Successive estimates of stuttering prevalence in females can be seen in Fig. 1. Prevalence at age 3 (2.8%) was above the upper limit of the CI. From ages 4 to 14 years, stuttering prevalence in females decreased, with estimates laying within the CI or close to it. From 15 to 17 years, stuttering prevalence in females decreased even more (mean of 0.7%), with estimates under the inferior limit of the CI. Comparing the highest prevalence (at age 3) with the mean of the three lowest prevalences (at ages 15–17), the decline in the number of affected females was 75%.</p> <p>Graph: Fig. 1 Point prevalence reported on 852 male children and 379 female children who stutter from 3 to 17 years. Legend: Years of age are displayed on the x-axis, while prevalence (in percentages) is displayed on the y-axis. The lower and the upper solid lines represents 95% confidence interval 2.1–3.2%, respectively, for males. The lower and the upper dotted lines represents 95% confidence interval 1.0–1.6%, respectively, for females</p> <p>The overall prevalence of stuttering in males aged 3 to 17 years old was 2.6% (Table 1), with 95% CI [2.1–3.2%]. Successive estimates of stuttering prevalence in males are depicted in Fig. 1. At age 3, males had a stuttering prevalence near the inferior limit of the CI. The highest prevalence of stuttering in males occurred in a sustained manner from 4 to 7 years (mean of 3.9%). From 8 to 14 years, stuttering prevalence in males decreased, with estimates laying within the CI or close to it. Finally, from 15 to 17 years, stuttering prevalence in males decreased even more (mean of 1.6%), with estimates under the inferior limit of the CI. Comparing the mean of the highest stuttering prevalence (at ages 4–7) with the mean of the lowest prevalences (at ages 15–17), the decline in the number of affected males was 59%.</p> <p>The overall male-to-female stuttering ratio was 2.0:1 (Table 1), with 95% CI [1.9–2.5]. Successive estimates of sex ratio in stuttering can be seen in Fig. 2. At 3 years, the sex ratio of 0.7:1 was the most balanced in the data. At 4 years, a steeper sex ratio of 2.3:1 was seen due to a mixed effect of doubling male CWS and almost halving female CWS. From 4 to 17 years, sex ratios fluctuated between upper and inferior limits of the CI, with one measure far beyond the upper limit (at 7 years) and one measure far beyond the lower limit (at 13 years).</p> <p>Graph: Fig. 2 Sex ratio (male-to-female) of 1231 children who stutter from 3 to 17 years. Legend: Years of age are displayed on the x-axis, while prevalence (in percentages) is displayed on the y-axis. The lower and the upper interrupted lines represents 95% confidence interval 1.9–2.5, respectively</p> <hd id="AN0156935473-16">Coexisting Developmental Disorders in Male and Female Children Who Stutter</hd> <p>Findings revealed similarities and differences in the presence of coexisting developmental disorders among male and female CWS. Differences were present in the parental reports of ADHD/ADD and seizures. Specifically, ADHD/ADD was significantly more common among male CWS (30.3%) than female CWS (15.8%), <emph>X</emph><sups><emph>2</emph></sups> (<reflink idref="bib1" id="ref50">1</reflink>, _I_N_i_ = 1231) = 29.61, <emph>p</emph> < 0.001. In contrast, the presence of seizures was significantly more common among female CWS (9.0%) than male CWS (3.5%), <emph>X</emph><sups><emph>2</emph></sups> (<reflink idref="bib1" id="ref51">1</reflink>, _I_N_i_ = 1231) = 16.01, <emph>p</emph> < 0.001. See Table 3 for a breakdown of presence of coexisting developmental disorders by age groups.</p> <p>Table 3 Sex differences in coexisting developmental disorders found in children who stutter in 2010–2015 National Health Interview Surveys</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2" /><th align="left" colspan="2"><p>Total</p></th><th align="left" colspan="2"><p>Ages 3–5</p></th><th align="left" colspan="2"><p>Ages 6–10</p></th><th align="left" colspan="2"><p>Ages 11–17</p></th></tr><tr><th align="left"><p>Male CWS = 852</p></th><th align="left"><p>Female CWS = 379</p></th><th align="left"><p>Male CWS = 224</p></th><th align="left"><p>Female CWS = 120</p></th><th align="left"><p>Male CWS = 318</p></th><th align="left"><p>Female CWS = 119</p></th><th align="left"><p>Male CWS = 310</p></th><th align="left"><p>Female CWS = 140</p></th></tr></thead><tbody><tr><td align="left" rowspan="2"><p>Intellectual disability (weighted %)</p></td><td align="left"><p>7.8</p></td><td align="left"><p>7.2</p></td><td align="left"><p><bold>3</bold></p></td><td align="left"><p><bold>1.4</bold></p></td><td char="." align="char"><p>4.8</p></td><td align="left"><p>6</p></td><td align="left"><p>14.9</p></td><td align="left"><p>13.3</p></td></tr><tr><td align="left" colspan="2"><p><italic>p</italic> =.688</p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> =.001</bold></p></td><td align="left" colspan="2"><p><italic>p</italic> =.350</p></td><td align="left" colspan="2"><p><italic>p</italic> =.513</p></td></tr><tr><td align="left" rowspan="2"><p>Learning disability (weighted %)</p></td><td align="left"><p>33.7</p></td><td align="left"><p>31</p></td><td align="left"><p>17.5</p></td><td align="left"><p>11.7</p></td><td char="." align="char"><p>36.4</p></td><td align="left"><p>32.7</p></td><td align="left"><p>42.1</p></td><td align="left"><p>46.2</p></td></tr><tr><td align="left" colspan="2"><p><italic>p</italic> =.383</p></td><td align="left" colspan="2"><p><italic>p</italic> =.135</p></td><td align="left" colspan="2"><p><italic>p</italic> =.378</p></td><td align="left" colspan="2"><p><italic>p</italic> =.436</p></td></tr><tr><td align="left" rowspan="2"><p>ADHD/ADD (weighted %)</p></td><td align="left"><p><bold>30.3</bold></p></td><td align="left"><p><bold>15.8</bold></p></td><td align="left"><p><bold>14.3</bold></p></td><td align="left"><p><bold>4.2</bold></p></td><td char="." align="char"><p><bold>33.4</bold></p></td><td align="left"><p><bold>18.8</bold></p></td><td align="left"><p><bold>37.9</bold></p></td><td align="left"><p><bold>23</bold></p></td></tr><tr><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> <.001</bold></p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> <.001</bold></p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> <.001</bold></p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> =.001</bold></p></td></tr><tr><td align="left" rowspan="2"><p>Seizures (weighted %)</p></td><td align="left"><p><bold>3.5</bold></p></td><td align="left"><p><bold>9</bold></p></td><td align="left"><p>5.8</p></td><td align="left"><p>8.7</p></td><td char="." align="char"><p><bold>3.4</bold></p></td><td align="left"><p><bold>10.4</bold></p></td><td align="left"><p><bold>2</bold></p></td><td align="left"><p><bold>7.8</bold></p></td></tr><tr><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> <.001</bold></p></td><td align="left" colspan="2"><p><italic>p</italic> =.320</p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> <.001</bold></p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> <.001</bold></p></td></tr><tr><td align="left" rowspan="2"><p>Autism/Asperger's/PDD (weighted %)</p></td><td align="left"><p>9</p></td><td align="left"><p>5.7</p></td><td align="left"><p><bold>5.3</bold></p></td><td align="left"><p><bold>1.9</bold></p></td><td char="." align="char"><p>6.5</p></td><td align="left"><p>2.7</p></td><td align="left"><p>15</p></td><td align="left"><p>12</p></td></tr><tr><td align="left" colspan="2"><p><italic>p</italic> =.063</p></td><td align="left" colspan="2"><p><bold><italic>p</italic></bold><bold> =.003</bold></p></td><td align="left" colspan="2"><p><italic>p</italic> =.055</p></td><td align="left" colspan="2"><p><italic>p</italic> =.425</p></td></tr><tr><td align="left" rowspan="2"><p>Any other DD (weighted %)</p></td><td align="left"><p>25.3</p></td><td align="left"><p>21.1</p></td><td align="left"><p>20.7</p></td><td align="left"><p>15.1</p></td><td char="." align="char"><p>26.9</p></td><td align="left"><p>26.3</p></td><td align="left"><p>26.6</p></td><td align="left"><p>21.2</p></td></tr><tr><td align="left" colspan="2"><p><italic>p</italic> =.155</p></td><td align="left" colspan="2"><p><italic>p</italic> =.184</p></td><td align="left" colspan="2"><p><italic>p</italic> =.900</p></td><td align="left" colspan="2"><p><italic>p</italic> =.094</p></td></tr></tbody></table> </ephtml> </p> <p>Findings that are bolded are those results that are statistically significant at.05 alpha level <emph>CWS</emph> children who stutter, <emph>ADHD</emph> attention-deficit/hyperactivity disorder, <emph>ADD</emph> attention-deficit disorder, <emph>PDD</emph> pervasive developmental disorder</p> <p>In logistic models, with female CWS as the reference group, male CWS were at greater odds of parent/caregiver reporting ADHD/ADD (OR = 2.32, 95% CI [1.62, 3.31]). Though still significant at each classification, the likelihood of ADHD/ADD occurring in male CWS decreased with age: 3–5 year range (OR = 3.84, 95% CI [2.39, 6.16]); 6–10 year range (OR = 2.17, 95% CI [1.49, 3.16]); and 11–17 year range (OR = 2.05, 95% CI [1.34, 3.12]). In contrast, males were less likely than female CWS to experience seizures (OR = 0.370, 95% CI [0.214, 0.638]). Beginning in the 3–5 year range where a significant difference was not present in the likelihood of seizures (OR = 0.649, 95% CI [0.272, 1.55]), male CWS became increasingly and significantly <emph>less</emph> likely with age to experience seizures: 6–10 year range (OR = 0.302, 95% CI [0.154, 0.591]); 11–17 year range (OR = 0.240, 95% CI [0.125, 0.462]). Lastly, there were no significant differences between male and female CWS in the likelihood of any other disorder, with the exception of two differences at the 3–5 years age range. Male CWS were at greater odds of parent/caregiver reported intellectual disability (OR = 2.20, 95% CI [1.36, 3.54]) and autism (OR = 2.87, 95% CI [1.42, 5.82]) (See Table 4).</p> <p>Table 4 Measures of odds ratio of coexisting developmental disorders among male and female children who stutter from 2010 to 2015 National Health Interview Surveys</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="3" /><th align="left"><p>Total</p></th><th align="left"><p>Ages 3–5</p></th><th align="left"><p>Ages 6–10</p></th><th align="left"><p>Ages 11–17</p></th></tr><tr><th align="left" colspan="4"><p>OR [95% CI]</p></th></tr><tr><th align="left"><p>Male CWS</p></th><th align="left"><p>Male CWS</p></th><th align="left"><p>Male CWS</p></th><th align="left"><p>Male CWS</p></th></tr></thead><tbody><tr><td align="left" rowspan="2"><p>Intellectual disability</p></td><td align="left"><p>1.09</p></td><td align="left"><p>2.20**</p></td><td align="left"><p>0.782</p></td><td align="left"><p>1.15</p></td></tr><tr><td align="left"><p>[.710–1.68]</p></td><td align="left"><p>[1.36–3.54]</p></td><td align="left"><p>[.464–1.32]</p></td><td align="left"><p>[.756–1.74]</p></td></tr><tr><td align="left" rowspan="2"><p>Learning disability</p></td><td align="left"><p>1.13</p></td><td align="left"><p>1.61</p></td><td align="left"><p>1.18</p></td><td align="left"><p>0.847</p></td></tr><tr><td align="left"><p>[.856–1.50]</p></td><td align="left"><p>[.855–3.03]</p></td><td align="left"><p>[.817–1.69]</p></td><td align="left"><p>[.556–1.29]</p></td></tr><tr><td align="left" rowspan="2"><p>ADHD/ADD</p></td><td align="left"><p>2.32*</p></td><td align="left"><p>3.84*</p></td><td align="left"><p>2.17*</p></td><td align="left"><p>2.05**</p></td></tr><tr><td align="left"><p>[1.62–3.31]</p></td><td align="left"><p>[2.39–6.16]</p></td><td align="left"><p>[1.49–3.16]</p></td><td align="left"><p>[1.34–3.12]</p></td></tr><tr><td align="left" rowspan="2"><p>Seizures</p></td><td align="left"><p>.370*</p></td><td align="left"><p>0.649</p></td><td align="left"><p>.302**</p></td><td align="left"><p>.240*</p></td></tr><tr><td align="left"><p>[.214-.638]</p></td><td align="left"><p>[.272–1.55]</p></td><td align="left"><p>[.154-.59]</p></td><td align="left"><p>[.125-.462]</p></td></tr><tr><td align="left" rowspan="2"><p>Autism/Asperger's/PDD</p></td><td align="left"><p>1.64</p></td><td align="left"><p>2.87**</p></td><td align="left"><p>2.48</p></td><td align="left"><p>1.3</p></td></tr><tr><td align="left"><p>[.970–2.77]</p></td><td align="left"><p>[1.42–5.82]</p></td><td align="left"><p>[.951–6.44]</p></td><td align="left"><p>[.677–2.50]</p></td></tr><tr><td align="left" rowspan="2"><p>Any other developmental delay</p></td><td align="left"><p>1.27</p></td><td align="left"><p>1.47</p></td><td align="left"><p>1.03</p></td><td align="left"><p>1.35</p></td></tr><tr><td align="left"><p>[.913–1.76]</p></td><td align="left"><p>[.828–2.59]</p></td><td align="left"><p>[.670–1.58]</p></td><td align="left"><p>[.948–1.92]</p></td></tr></tbody></table> </ephtml> </p> <p>Female children who stutter within the previous 12-months is the reference group Findings that are bolded are those results that are statistically significant at.05 alpha level <emph>OR</emph> odds ratio, <emph>CI</emph> confidence interval, *<emph>p</emph> <.001; **<emph>p</emph> <.01</p> <hd id="AN0156935473-17">Discussion</hd> <p>The purpose of this study was to explore differences between male and female CWS in stuttering prevalence and in the coexistence of developmental disorders. Findings related to prevalence of stuttering revealed higher rates among males than females, and these differences were significant at all age ranges. These findings are similar to previous reports in the literature that show the presence of stuttering is greatest among males (Craig et al., [<reflink idref="bib17" id="ref52">17</reflink>]; Yairi & Ambrose, [<reflink idref="bib62" id="ref53">62</reflink>]). Indicative of the phenomenon of natural recovery (Chow & Chang, [<reflink idref="bib16" id="ref54">16</reflink>]), and possibly an effect of intervention in the youngest CWS, the rate of stuttering decreased with age in both male and female CWS. Regarding the specific differences in the coexistence of developmental disorders, male CWS were more likely to have ADHD/ADD and less likely to experience seizures than female CWS. The remainder of the discussion will focus on the findings of differences in stuttering and coexisting developmental disorders between male and female CWS.</p> <hd id="AN0156935473-18">Sex Differences in Childhood Stuttering</hd> <p>Data indicated that stuttering has a different course in female and male children. Data for the total sample suggested that stuttering peaks in females at 3 years, while in males the peak is longer and sustained from 4 to 7 years. Thus, the results of this study suggest that more parents/caregivers of female children than male children, included in the 2010 to 2015 NHIS surveys, reported observing stuttering behaviors at age 3. Although the data analyzed in this study are not longitudinal, results indicate the possibility of sex differences in natural recovery. Specifically, females who stutter may experience natural recovery at an earlier age than males who stutter. Clinically, for those therapies that may assist or nurture natural recovery of stuttering in young children (Millard et al., [<reflink idref="bib40" id="ref55">40</reflink>]; Miller & Guitar, [<reflink idref="bib41" id="ref56">41</reflink>]), the critical window may occur at a younger age in females than males who stutter. Therefore, parents, pediatricians, and those involved in early childhood education should be made aware that interventions are available and necessitated for those young children who are experiencing stuttering. An interesting finding was that the prevalence of stuttering in the sample decreased into adolescence (i.e., 10+ years old) for both male and female children, indirectly supporting the notion of natural recovery (Yairi & Ambrose, [<reflink idref="bib62" id="ref57">62</reflink>]). The reduction of stuttering, as a function of age, could possibly be aided by intervention (Yairi &Ambrose, [<reflink idref="bib62" id="ref58">62</reflink>]), especially among preschool children who stutter (Harris et al., [<reflink idref="bib28" id="ref59">28</reflink>]) who are still within the window of greatest likelihood of recovery.</p> <p>Data indicated the presence of varying sex ratios, dependent on age. At 3 years, the sex ratio of stuttering is more even, before increasing with age, representative of a steeper proportion of stuttering in males. The present study corroborates previous ones (Craig et al., [<reflink idref="bib17" id="ref60">17</reflink>]; Yairi & Ambrose, [<reflink idref="bib62" id="ref61">62</reflink>]), indicating a biased sex ratio in stuttering during childhood and adolescence. Nevertheless, sex ratios presented here are not as disparate as those obtained by Craig et al. ([<reflink idref="bib17" id="ref62">17</reflink>]). A consideration of the current study that should be addressed is the NHIS' exclusion of 2-year-old children. Given that a high number of children begin to stutter at this age (Yairi & Ambrose, [<reflink idref="bib62" id="ref63">62</reflink>]), more informed conclusions could be drawn from data offering this full picture. On the other hand, a major strength of this study is to present point prevalence data as a function of sex at discrete ages, which was previously noted as desirable (Yairi & Ambrose, [<reflink idref="bib62" id="ref64">62</reflink>]).</p> <p>Future studies may consider biological differences that explain the varying course of stuttering between males and females. Specifically, differences in brain development and maturation may be of importance to explain the finding of the earlier stuttering peak in females. A large neuroimaging study with individuals from 3 to 27 years indicated significant sex differences in brain maturation (Lenroot et al., [<reflink idref="bib37" id="ref65">37</reflink>]). In general, peak volumes of gray matter in the brain lobes and in the caudate nucleus were reached 1 or 2 years earlier in females (Lenroot et al., [<reflink idref="bib37" id="ref66">37</reflink>]). The earlier brain maturation experienced by female children is a potential underlying physiological factor to explain why females may begin to stutter before males. Current results indicate that, besides age, coexisting developmental disorders are also of importance to account for the differences between male and female CWS.</p> <hd id="AN0156935473-19">Differences in Coexisting Developmental Disorders Found in Male and Female Children Who Stutt...</hd> <p></p> <hd id="AN0156935473-20">ADHD/ADD</hd> <p>The odds of male CWS having ADHD/ADD were significantly greater than female CWS, however, the difference decreased with age. Rate of and differences in presence of ADHD in male and female CWS was greater in this sample (30.3% among male CWS and 15.8% among female CWS) than in Blood et al.'s ([<reflink idref="bib3" id="ref67">3</reflink>]) study. In their sample of 2268 CWS, with a mean age of 9.4 years, they found co-occurrence of attention deficit disorder to be 5.9% among 2060 male CWS and 5.8% among 568 female CWS. To our knowledge, this is the only other study comparing rates of ADHD in CWS, as a function of sex. The Blood et al. study used a national survey of speech-language pathologists to determine frequency of ADD among CWS, which may be one reason for the differences in reports between the two studies. Another explanation for the disparity in rates is the increased diagnosis in ADHD/ADD that has taken place since Blood et al.'s study (Visser et al., [<reflink idref="bib59" id="ref68">59</reflink>]), where, at the time, prevalence estimates of children ever diagnosed with ADHD were reported at 7.8%. Recently, rates of ADHD have been reported in children ages 2–17 years, where an estimated 9.4% were indicated as having, at some point, been diagnosed with ADHD and 8.4% were indicated as currently having ADHD (Danielson et al., [<reflink idref="bib20" id="ref69">20</reflink>]). As in the current study, rates of ADHD among all children increased with age and there was a significant difference in rates of ADHD as a function of sex. Future studies addressing neurobiological similarities and differences in male and female children, including those who do and do not stutter and those with and without ADHD, might provide critical pathophysiological evidence, contributing to etiological research. However, without data to contribute to that evidence base, the focus of this discussion will be on clinic relevance of present findings.</p> <p>Healey and Reid ([<reflink idref="bib29" id="ref70">29</reflink>]) provide considerations when providing therapeutic intervention to CWS with ADHD. Included in their recommendations are that clinicians remain attentive to environmental considerations that may heighten distractions, clinicians should ensure therapy takes place in small group settings, therapy is not physically restrictive, and the child's role in therapy does not remain passive for extended periods of time. For all CWS receiving some form of direct service, attentiveness is necessary for successful outcomes, and additional consideration should be given to those CWS with ADHD. For example, in the Lidcombe Program, which is an extensively researched intervention for young CWS (Shenker & Santayana, [<reflink idref="bib52" id="ref71">52</reflink>]), parents offer verbal contingencies to their child during conversations after moments of fluent and stuttered speech (Onslow et al., [<reflink idref="bib44" id="ref72">44</reflink>]). With one of the documented complaints of this format being that children can easily become disinterested with one activity or overly excitable which may increase stuttering behaviors (Onslow et al., [<reflink idref="bib44" id="ref73">44</reflink>]), it is necessary that the clinician assists the parent in ways to stay creative and engaging, while not overly stimulating the child. With this being a concern for all CWS, stimuli considerations are even more imperative for those CWS with ADHD.</p> <p>In older CWS, a goal that may be addressed in therapy is the implementation of preparatory sets (Van Riper, [<reflink idref="bib58" id="ref74">58</reflink>]). When used successfully, the person who stutters is instructed to alter temporal, and at times spatial, aspects of their motor plan. For example, temporal and spatial adaptations are achieved concurrently, as glottal opening is reduced (i.e., spatial adaptation) during periods of increased duration of phonation and/or sustained, sufficient subglottal air pressure (i.e., temporal adaptation). A certain level of attention is necessitated to implement this technique, as well as in the learning process of acquiring a correct model in the clinic setting. Therefore, when teaching this and other techniques, clinicians must ensure that the environment and presentation style are optimal for CWS with ADHD. With the differences found in the current study, these considerations should be emphasized when treating male CWS. However, potential biases in the referral and diagnosing of females with ADHD, due to the increased likelihood of females going unidentified when ADHD is not clearly observable (Mowlem et al., 20,198), gives cause for female CWS to be given full consideration in these regards as well.</p> <p>Another consideration when ADHD has been identified is the effect of medications used for ADHD on stuttering. Distinct patterns of effect of ADHD medications on stuttering have not been found (Healey & Reid, [<reflink idref="bib29" id="ref75">29</reflink>]; Riley & Riley, [<reflink idref="bib48" id="ref76">48</reflink>]), however, there have been reports of an increase in stuttering, seemingly as a result of ADHD medication (Burd & Kebeshian, [<reflink idref="bib8" id="ref77">8</reflink>]; Lavid et al., [<reflink idref="bib35" id="ref78">35</reflink>]; Riley & Riley, [<reflink idref="bib48" id="ref79">48</reflink>]). More recently, Donaher et al. ([<reflink idref="bib22" id="ref80">22</reflink>]) reported on a 10-year-old boy who presented with stuttering and ADHD. When treated with stimulant medication, the child experienced an increase in stuttering behaviors. After switching to non-stimulant medication, the child's stuttering behaviors reduced substantially, though impulsivity increased, and his focus decreased. In light of these findings, heightened observance is clearly required in male CWS, where ADHD is more prevalent (Willcutt, [<reflink idref="bib60" id="ref81">60</reflink>]), and in all CWS being treated for ADHD, to monitor management of behaviors related to ADHD and stuttering.</p> <hd id="AN0156935473-21">Seizures</hd> <p>In the present study, the trend for seizures among CWS was greater odds in females as age increased, and the disparity between male and female CWS grew with age. Idiopathic generalized epilepsies (IGE) that tend to manifest by means of tonic–clonic seizures (such as primary generalized epilepsy) or loss of awareness (such as childhood absence epilepsy) have a female predominance (Savic, [<reflink idref="bib49" id="ref82">49</reflink>]). On the other hand, simple partial epilepsies, which may not be related to tonic–clonic seizures or loss of awareness (such as benign epilepsy with centrotemporal spikes), have a male predominance (Savic, [<reflink idref="bib49" id="ref83">49</reflink>]). It could be argued that seizures most commonly occurring in females would be more easily recognized by caregivers and thus, more frequently reported, generating a bias in female data. However, among children who do <emph>not</emph> stutter (CWNS) from the dataset used in the current sample (61,219 CWNS), there were no sex difference in the estimated presence of seizure (0.6% among males and 0.7% among females; see supplementary material). Therefore, the increased prevalence of seizures among female CWS seems to be a robust finding. Considering that females in general are more prone to IGE (Savic, [<reflink idref="bib49" id="ref84">49</reflink>]), it is possible that female CWS may also be more prone to IGE, which represent up to 20% of all forms of epilepsies (Savic, [<reflink idref="bib49" id="ref85">49</reflink>]). As results from Briley and Ellis ([<reflink idref="bib6" id="ref86">6</reflink>]) and the present study suggest that CWS, particularly females, are highly susceptible to seizures, parents/caregivers may be advised regarding measures that may be taken to facilitate seizure prevention. An effective strategy may include providing appropriate care during febrile episodes for children younger than 5 years (Smith et al., [<reflink idref="bib53" id="ref87">53</reflink>]), providing adequate sleep (Gibbon et al., [<reflink idref="bib25" id="ref88">25</reflink>]), and avoiding medications that lower seizure threshold when possible (Buchanan, [<reflink idref="bib7" id="ref89">7</reflink>]).</p> <p>There are minimal reports showing rate of seizures/epilepsy among CWS. Boulet et al. ([<reflink idref="bib4" id="ref90">4</reflink>]) reported this rate to be 13.7% in a sample of 1530 CWS, though there was no differentiation between male and female CWS. Through a different lens, literature related to seizure disorders indicate that stuttering behaviors are more common in children with seizure disorders than in typical peers (Selassie et al., [<reflink idref="bib51" id="ref91">51</reflink>]; Steinberg et al., [<reflink idref="bib54" id="ref92">54</reflink>]). Also, medications used to treat seizures have been shown to have both positive and negative effects on stuttering (Altunel et al., [<reflink idref="bib1" id="ref93">1</reflink>]; Canevini et al., [<reflink idref="bib9" id="ref94">9</reflink>]; Catania et al., [<reflink idref="bib10" id="ref95">10</reflink>]; Gross-Tsur & Shalev, [<reflink idref="bib26" id="ref96">26</reflink>]; Karimzadeh et al., [<reflink idref="bib34" id="ref97">34</reflink>]; Nissani & Sanchez, [<reflink idref="bib43" id="ref98">43</reflink>]; Sechi et al., [<reflink idref="bib50" id="ref99">50</reflink>]). There are also case reports of childhood stuttering emerging (Deonna et al., [<reflink idref="bib21" id="ref100">21</reflink>]) as well as childhood stuttering remitting after a simple partial seizure (Manders & Bastijns, 1989). Thus, despite a possible relationship between stuttering and epilepsy being recognized for more than one century (Lebrun & Fabbro, [<reflink idref="bib36" id="ref101">36</reflink>]), we are far from a clear picture of this relationship.</p> <p>Several case reports suggest a relationship between the treatment of seizures and the observance of stuttering. Rachamallu et al. ([<reflink idref="bib46" id="ref102">46</reflink>]) and Horga et al. ([<reflink idref="bib30" id="ref103">30</reflink>]) reported iatrogenic stuttering, epileptiform activity on the electroencephalogram, and provoked seizures on two male adolescents being treated by clozapine. There are also several other reports of clozapine induced stuttering and generalized seizures in adults (Begum, [<reflink idref="bib2" id="ref104">2</reflink>]; Duggal et al., [<reflink idref="bib23" id="ref105">23</reflink>]; Hallahan et al., [<reflink idref="bib27" id="ref106">27</reflink>]; Supprian et al., [<reflink idref="bib56" id="ref107">56</reflink>]). Clozapine is an antipsychotic used to treat resistant schizophrenia and it is known to decrease seizure threshold (Horga et al., [<reflink idref="bib30" id="ref108">30</reflink>]; Rachamallu et al., [<reflink idref="bib46" id="ref109">46</reflink>]). Iatrogenic stuttering induced by clozapine is thought to be caused by epileptiform activity (Duggal et al., [<reflink idref="bib23" id="ref110">23</reflink>]; Supprian et al., [<reflink idref="bib56" id="ref111">56</reflink>]), suggesting shared neural underpinnings between both disorders. Collectively, future studies are needed to determine the possibility of shared neural underpinnings and to explore the possibility that medications used to control IGE may have a positive effect on stuttering.</p> <hd id="AN0156935473-22">Clinical Implications</hd> <p>The fact that the course of stuttering may be different for male and female children has important clinical implications. For females, stuttering being more prevalent at the age of 3 and declining at the ages of 4–5 implies a shorter temporal window for complete remission, necessitating that stuttering identification and treatment be expedited for females. In this case, the antiquated opinion to "wait and see" (Winters & Byrd, [<reflink idref="bib61" id="ref112">61</reflink>]) would be inappropriate and potentially harmful. Additionally, the finding of greater odds of seizures in females prompts a heightened awareness from parents, caregivers, and healthcare providers. The early identification of those cases at risk for seizures/epilepsy may favor prevention strategies, such as providing adequate sleep (Gibbon et al., [<reflink idref="bib25" id="ref113">25</reflink>]), as stated previously.</p> <p>For males, stuttering being more prevalent at the ages of 4–7 years provides a larger temporal window for identification and treatment. In addition, the finding of greater odds of ADHD for prompts a heightened awareness for this coexisting developmental disorder by those interacting with the child, including the speech-language pathologist. The earlier identification and treatment of ADHD allows the potential to guide the speech-language pathologist in adequately organizing the clinical setting to achieve optimal results (Healey & Reid, [<reflink idref="bib29" id="ref114">29</reflink>]).</p> <p>A final observation refers to the additional decline in stuttering prevalence for both males and females at the age of 15. One possibility is that some adolescents have learned how to compensate for their observable behaviors of stuttering to the point that their parents are not capable of recognizing it anymore. Considering that, at the age of 15 some of them have been stuttering for ten years or so, compensatory strategies may include positive reactions such as utilization of learned techniques or self-taught techniques, or strategies may include negative avoidance behaviors, which include avoidances of words, people, and situations. In any of these scenarios, the presence and severity of stuttering is not dependent on the presence of observable behaviors of stuttering (Manning & Beck, [<reflink idref="bib39" id="ref115">39</reflink>]). On the other hand, there is also the possibility that the observed decline in stuttering prevalence observed at the age 15 is indicative of late, natural recovery.</p> <hd id="AN0156935473-23">Future Directions</hd> <p>There are several aspects that should be addressed by future studies. The first refers to the report of time course for male and female CWS by other population-based studies. As stuttering is considered a low prevalence disorder, clarifying the pattern of different time courses for males and females may be more easily accomplished with large databases (Raghavan et al., [<reflink idref="bib47" id="ref116">47</reflink>]). As stated earlier, the corroboration of the finding that male and female CWS experience different time courses would have important clinical implications. Additionally, future studies should explore parental reports of recovery to self-reported recovery among PWS, using a comprehensive, operational definition of stuttering. Doing so would help clarify the true nature of the prevalence decline in the older age ranges. A second line of investigation refers to the coexisting developmental disorders. For ADHD, there is recommendation to organize the clinical setting appropriately (Healey & Reid, [<reflink idref="bib29" id="ref117">29</reflink>]). However, for seizures/epilepsy, the literature is limited in the relationship of this disorder with stuttering. For example, it is still not known if coexisting seizures/epilepsy decreases the probability of stuttering remission or if specific medication should be preferred in those cases where both disorders are coexistent.</p> <hd id="AN0156935473-24">Limitations</hd> <p>While results from this study are informative, they should be considered amidst several limitations. First, identification of children who stutter in the current sample is made by the parent or caregiver. As discussed previously, parents can reliably identify stuttering (Curlee, [<reflink idref="bib19" id="ref118">19</reflink>]). However, due to the covert nature of some of stuttering's symptoms, it is possible that some children in the NHIS who were identified by parents as being children who do not stutter, could actually be children who are characterized as children who stutter with more unobservable behaviors. Therefore, it is more likely that current estimates are under-representations than over-representations of the true prevalence of stuttering. Second, the population-based sample analyzed here did not include children at age 2. As stated previously, as stuttering onset can occur at this early age (Yairi & Ambrose, [<reflink idref="bib62" id="ref119">62</reflink>]), a broader understanding of different time courses for male and female CWS should include this age range as well. Another consideration about the current sample is the analyses included only those children who stutter whose parent or caregiver gave a definitive response about the presence of one of the coexisting developmental disorders. This approach resulted in 16 fewer males who stutter and 1 fewer female who stutters. Therefore, current prevalence findings are not notably impacted by our inclusion criteria.</p> <hd id="AN0156935473-25">Conclusions</hd> <p>Findings from this study support the notion of stuttering presenting a sex difference in time course and some variation on location of disruption based on the presence of different coexisting developmental disorders. In the current sample, including data from children ages 3 to 17 years, stuttering prevalence at discrete ages revealed that females showed a single peak of stuttering at 3 years, while males showed a longer and sustained peak from 4 to 7 years of age. Also, a biased sex ratio in childhood stuttering took place at age 4 when stuttering prevalence decreased for females and increased for males. Clinically, these findings suggest that stuttering may be considered as persistent as early as 4–5 years of age for females, with a later age for persistence in males. Additionally, findings from this study also indicate that male and female CWS are more likely to present with ADHD and seizures/epilepsy, respectively. Clinically, these findings suggest that both sexes be assessed for those specific coexisting developmental disorders to assure their early identification and treatment. Future research should work towards better understanding the shared neural processes in these disorders, along with those that differentiate the co-existence across sex. Progress on this front may result in etiological advancements in the area of stuttering.</p> <hd id="AN0156935473-26">Data Availability</hd> <p>Sources of data used in the current study have been made available in the manuscript.</p> <hd id="AN0156935473-27">Declarations</hd> <p></p> <hd id="AN0156935473-28">Ethical Approval</hd> <p>This study was reviewed and approved by the University Institutional Review Board (IRB) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.</p> <hd id="AN0156935473-29">Consent to Participate</hd> <p>The study consisted of national de-identified data. The study was approved by the IRB as exempt from written consent to participate.</p> <hd id="AN0156935473-30">Consent for Publication</hd> <p>The authors give the journal consent to publish the research reported in this manuscript and agree to all publication guidelines and standards.</p> <hd id="AN0156935473-31">Conflict of interest</hd> <p>The authors declare that they have no conflict of interest.</p> <hd id="AN0156935473-32">Supplementary Information</hd> <p>Below is the link to the electronic supplementary material.</p> <p>Graph: Supplementary file1 (DOCX 12 kb)</p> <hd id="AN0156935473-33">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0156935473-34"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Altunel A, Sever A, Altunel EÖ. 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  Label: ISSN
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  Data: 1056-263X<br />1573-3580
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Stuttering and other developmental disorders are known to affect more male than female children. The present study compared: (1) stuttering prevalence in males and females at discrete ages and (2) prevalence of coexisting developmental disorders in male and female children who stutter (CWS). Data were obtained from the National Health Interview Survey (from 2010 to 2015). The sample comprised 62,450 total children, ages 3 to 17 years. Children in the current sample were those identified by their caregivers as having stuttered in the past 12 months. Rate of stuttering and data on five concomitant disorders (attention deficit hyperactivity disorder--ADHD; autism spectrum disorder; intellectual disability; learning disability; and seizures) were compared between male and female CWS and across three age categories: 3-5, 6-10, and 11-17 years. There were 1231 CWS, 852 males and 379 females, in the sample. Overall prevalence rates were 1.3%, 95% [CI 1.0, 1.6] for females, and 2.6%, 95% [CI 2.1, 3.2] for males, where prevalence rates decreased as age increased. For the total sample, male-to-female ratio was 2.0:1, 95% [CI 1.9, 2.5]. For coexisting developmental disorders, male CWS were at greater odds of having ADHD (OR = 2.32, 95% CI [1.62, 3.31]) and at lower odds than females of experiencing seizures (OR = 0.370, 95% [CI 0.214, 0.638]). Prevalence data at discrete ages revealed a different course of stuttering in early childhood for female and male children. Implications of sex differences, on the presence of ADHD and seizures/epilepsy among CWS, are discussed.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1430932
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1430932
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1007/s10882-021-09811-y
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 23
        StartPage: 505
    Subjects:
      – SubjectFull: Children
        Type: general
      – SubjectFull: Adolescents
        Type: general
      – SubjectFull: Stuttering
        Type: general
      – SubjectFull: Comorbidity
        Type: general
      – SubjectFull: Attention Deficit Hyperactivity Disorder
        Type: general
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Intellectual Disability
        Type: general
      – SubjectFull: Learning Disabilities
        Type: general
      – SubjectFull: Seizures
        Type: general
      – SubjectFull: Age Differences
        Type: general
      – SubjectFull: Gender Differences
        Type: general
      – SubjectFull: National Health Interview Survey
        Type: general
    Titles:
      – TitleFull: Sex Differences in Childhood Stuttering and Coexisting Developmental Disorders
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Patrick M. Briley
      – PersonEntity:
          Name:
            NameFull: Sandra Merlo
      – PersonEntity:
          Name:
            NameFull: Charles Ellis
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 06
              Type: published
              Y: 2022
          Identifiers:
            – Type: issn-print
              Value: 1056-263X
            – Type: issn-electronic
              Value: 1573-3580
          Numbering:
            – Type: volume
              Value: 34
            – Type: issue
              Value: 3
          Titles:
            – TitleFull: Journal of Developmental and Physical Disabilities
              Type: main
ResultId 1