الفهرس 
StutteringOnly 14 pages are availabe for public view
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Abstract
Stuttering is a generic term that describes speech that does not follow normal, conventional rhythm (Lavid, 2003). According to The American Speech- Language Hearing Association (ASHA) stuttering is a speech event that contains intraphonemic disruption, part-word repetitions, monosyllabic whole word repetitions, prolongations and silent fixations (blocks). It begins during childhood and in some cases, lasts throughout life. The disorder is characterized by disruptions in the production of speech sounds, also called disfluencies (AHSA, 1999).
The incidence of developmental stuttering is about 5%, and its recovery rate is up to about 80%, resulting in a prevalence of developmental stuttering in about 1% of the adult population ( Yairi & Ambrose, 2013).
Data from clinical and epidemiological samples show that stuttering is often co-morbid with Axis I psychiatric disorders such as, Attention Deficit Hyperactivity Disorder (ADHD) (Healey & Reid, 2003), Depression, anxiety and anxiety related disorders (Blood et al,2007) including social phobia and Obsessive Compulsive Disorders (OCD) (Blood et al,2003;. Unfortunately, the expected number of stutterers with co-morbid disorders is somewhat unclear and seems to vary considerably among studies (Healey & Reid, 2003).
The concomitant of stuttering with other disorders exaggerates the disability of stuttering and exerts more negative influences on individual’s academic occupational, social, emotional and psychological adjustment. So, once stuttering is associated with a psychiatric disorder, the clinicians will be confronted with a great challenge of deciding how to diagnose and manage the co-morbid disorder and stuttering when both are dentified (Curlee, 1999).
It is generally indicated that young children who stutter, when compared to children who do not stutter regarding temperament, are (a) less successful in maintaining attention and adapting to their environment (Embrechts et al, 2000).Patients with ADHD reported high novelty seeking and high harm avoidance (Anckarsäter et al,2006). Depressed patients exhibited statistically significant higher scores for harm avoidance and lower scores for self-directedness compared to healthy controls (Celikel et al, 2009). Many studies showed a correlation between the temperamental dimension of Harm Avoidance, and anxiety symptoms or disorders (Cloninger et al, 2012; Nyman et al, 2011; Jylhä & Isometsä, 2006; Jiang et al, 2003; Ball et al, 2002; Sangorrin et al, 1998) with HA scores increasingly higher with increasing of the illness severity.
Recent studies of parents of stutterers and parents of non stutterers produced mixed results. Some indicate that parents of stutterers are more anxious or more rejecting, while others find no differences (Guitar,2013). Research with adolescents has consistently shown the experience of cold, unavailable caregiving to be associated with depression (e.g. Biggam & Power, 1998; Chambers et al, 2000a, 2000b; Rapee, 1997). Relatedly, numerous studies have demonstrated that caregiving characterized by controlling and intrusive parental behaviour is also related to depression (e.g. Martin & Waite, 1994; McFarlane et al, 1995; Patton et al, 2001). It was also found that perceived parental psychological pressure correlated positively with trait anxiety among the adolescents. Perceived parental warmth was positively associated with active coping and negatively correlated with trait anxiety in the adolescents. The group with the authoritarian parenting style showed higher scores on anxiety (Wolfradt, 2003). Recent research found that parents of ADHD children were less self-confident, self-reported less warm and involved with their children, and used more corporal punishment than parents of children without ADHD (Alizadeh et al, 2007).
The Aim of this work was to study co-morbid psychiatric disorder in children with stuttering, assess the risk factors for developing psychiatric comorbidity in a stuttering children and elaborate the impact of psychiatric disorders on the severity of stuttering.
This study was conducted on 69 stuttering patients between the age of 6-18 years recruited from Phoniatrics clinic in Ain Shams University hospital. After an oral consent, personal data was collected followed by socioeconomic, IQ, psychiatric, temperament and perceived parenting assessment using Arabic versions of Fahmy and El Sherbini’s social classification, Stanford–Binet Intelligence 4th edition, MINI-KID, junior temperament and character inventory, and perceived parenting scales. At last the severity of stuttering was assessed using SSI3.
The subjects were then classified into two subgroups, group ”A”: 37 subjects with psychiatric co-morbidity (cases) and group ”B”: 34 subjects without psychiatric co-morbidity (controls). The two groups were compared regarding family history of stuttering and psychiatric disorder, socioeconomic and educational level, the parental style, child temperament and the severity of stuttering.
Results revealed that almost half the patient had psychiatric disorder comorbid to stuttering. The most prevalent was anxiety disorders namely social anxiety disorders followed by ADHD. When comparing between children and adolescence anxiety, depressive disorders and OCD and related disorders were found to be more prevalent in adolescence, and ADHD was more prevalent in the children.
Patients with psychiatric comorbidity had higher mean age than those without whithout. Harm avoidance temperament was found higher in patients with psychiatric comorbidty especially those diagnosed with with anxiety disorders OCD and related disorders. Self directedness was lower in the patients with OCD.
There was no any relation between the perceived parenting and the presence of psychiatric comorbidity. Mother and father dependence was significantly higher in patients with depressive disorders. Mother dependence was also higher in patients with OCD and related disorders. Stuttering severity was found higher in patients with psychiatric comorbidity, and it was inversely related to self directedness. Elder age, higher harm avoidance and gender were significant predictors for the occurrence of psychiatric comorbidity among stutterers.
In children, more females were found to have psychiatric comorbidity. Self-transcendence was found higher with comorbid psychiatric illness. Again there was no any relation between the perceived parenting and the presence of psychiatric comorbidity.
The only findings found in adolescence were high scores of harm avoidance and low scores of self-directedness in the presence of psychiatric disorders.