Executive Functions in Childhood Stuttering: A Systematic Review

Year 2020, Volume: 3 Issue: 3, 356 - 381, 31.12.2020

Fatmanur Durmuş , Mehmet Emrah Cangi , Ayça Bilge

Abstract

Purpose: Executive Function (EF) is an umbrella term that refers to a collection of interrelated functions that are responsible for purposeful and target-directed behaviour. In a more detailed definition, EF is a term for several higher-order cognitive prosses, such as inhibition of prepotent responses, planning of behaviour, planning of action, hypothesis generation, cognitive flexibility, judgment, decision making, and feedback management. The role of EF in childhood stuttering has been a subject of increased attention in recent years. This study aims to investigate the behavioural studies of executive functions in children who stutter (CWS) systematically. In context, answers to the following questions were sought: (a)What are the behavioural tasks used in research? (b)What are the characteristics of the sample used in the study? (c)Which executive functions have been evaluated? (d)What differences have been observed between groups? Method: This systematic review report was made based on recommendations of the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Regarding the study, keywords “childhood stuttering”, “executive functions”, “working memory”, “inhibition control”, ‘children who stutter’, “cognitive flexibility” and synonyms were browsed in PubMed, MEDLINE, ScienceDirect, Wiley Online Library, Google Scholar electronic databases. To be included in the systematic review, a study had to (a) be written in English or Turkish, (b) appeared in peer-reviewed journals and published between January 2013 and March 2020, (c) include both CWS and children who not stutter (CWNS), (d) have monolingual participants between the ages of 3 and 18 years, (e) include participants with no speech and language difficulties (except for stuttering in the experimental group), (f) examine at least one of three cognitive processes (working memory, inhibition control, cognitive flexibility) using by behavioural measures. Reviews, meta-analyzes, theses, oral presentations or poster presentations were excluded. Results: A total of 1197 articles were found after the preliminary screening of the databases. Among these articles, a total of 16 research studies met the eligibility criteria and were included in the present review. All the articles concerning the scope of the investigation were examined under the heading of EF domain, sample size, participant age, measures used, study design and findings. A total of 605 participants, 296 CWS and 309 typically developing children, were included in these studies. Sample sizes across studies range from 22 to 84 participants. The age range of the participants varies between 3 to 16 years. Conclusion: The results have shown that CWS show poor performance with some tasks that measure cognitive flexibility, working memory and inhibition control skills. Further studies that involve more complex and more behavioural tasks related to the nature of the disorder will brighten the relationship between executive functions and stuttering.

Keywords

cognitive flexibility, working memory, childhood stuttering, inhibition control, executive function

Çocukluk Çağı Kekemeliğinde Yürütücü İşlevler: Sistematik Derleme

Abstract

Amaç: Yürütücü işlevler çalışma belleği, ketleme ya da bilişsel esneklik gibi hedefe yönelik ve amaçlı davranışlardan sorumlu olan, birbirleriyle ilişkili süreçleri içermektedir. Bu fonksiyonlar güncel literatürde sıklıkla performans temelli veri toplama araçları ile incelenmektedir. Bu süreçlerin çocukluk çağı kekemeliğindeki rolü de araştırma alanında giderek artan bir ilgi odağı olmuştur. Bu çalışmada çocukluk çağı kekemeliğinde yürütücü işlevleri davranışsal görevlere dayanarak değerlendiren çalışmaların sistematik olarak incelenmesi amaçlanmaktadır. Yöntem: Sistematik derlemede, PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) bildirgesi rehber alınmıştır. Tarama sürecinde PubMed, Medline, ScienceDirect, Wiley Online Library, Google Scholar elektronik veri tabanlarında “kekemelik”, “çocukluk çağı kekemeliği”, “yürütücü işlevler”, “çalışma belleği”, “ketleme” “bilişsel esneklik” anahtar kelimelerinin İngilizce karşılıkları kullanılmıştır. İngilizce veya Türkçe hakemli dergilerde 2013 ve 2020 tarihleri arasında yayımlanan, çalışma grubu 3-18 yaş arasındaki tek dilli katılımcılardan oluşan ve davranışsal ölçümler kullanılarak üç bilişsel süreçten (çalışma belleği, ketleme, bilişsel esneklik) en az birini inceleyen çalışmalar derlemeye dahil edilmiştir. Bulgular: Tarama sonucunda 1197 çalışmaya ulaşılmış ve bu çalışmaların 16’sı dahil etme kriterlerini karşılamıştır. Derlemeye dahil edilen çalışmaların tümünün uluslararası literatürde yayımlanan çalışmalar olduğu görülmüştür. Çalışmalarda 296 kekemeliği olan ve 309 tipik gelişim gösteren birey olmak üzere toplam 605 katılımcı yer almıştır. Çalışmaların katılımcı sayısı 22 ile 84 katılımcı arasında değişmektedir. Çalışmalarda yer alan katılımcıların yaş aralıkları ise 3 ile 16 arasındadır. Çalışmalarda en çok çalışılan bileşenin ketleme, en az incelenen bileşenin ise bilişsel esneklik olduğu görülmüştür. Sonuç: Kekemeliği olan çocukların, bir grup olarak, bilişsel esneklik, çalışma belleği ve ketleme becerisi gerektiren bazı görevlerde güçlük yaşadığına dair önemli araştırma delillerine ulaşılmıştır. Ancak konunun daha iyi anlaşılabilmesi için bozukluğun doğasının göz önünde bulundurulduğu ve daha karmaşık davranışsal görevlerin kullanıldığı çalışmalara ihtiyaç vardır.

Keywords

bilişsel esneklik, çalışma belleği, çocukluk çağı kekemeliği, ketleme, yürütücü işlev

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