Experiences of Teasing and Bullying in Children Who Stutter

• Page 1 of 4 • Citation: Kikuchi Y, Umezaki T, Sawatsubashi M, Taura M, Yamaguchi Y, et al. (2019) Experiences of Teasing and Bullying in Children Who Stutter. Int Arch Commun Disord 2:013. doi.org/10.23937/26434148/1710013 Accepted: December 07, 2019; Published: December 09, 2019 Copyright: © 2019 Kikuchi Y, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

voluntary repetitions or prolongations of words or syllables, or interruptions in flow of speech, known as blocks [1,2]. Some children may comment on another child's stuttering out of curiosity or interest. Such comments may be hurtful to a child who stutters (CWS), even when bullying was not the intent [3]. The consequences of being bullied and teased during childhood may increase social anxiety, reduce self-esteem, and lead to poorer peer relationships, among other things [4,5]. Indeed, at least 40% of adults who stutter also have a social anxiety disorder [6]. Early detection and prevention of teasing and bullying associated with stuttering is therefore needed.
Although the terms bullying and teasing are often used interchangeably, it is helpful to distinguish them [7]. In Japan, bullying refers to non-friendly exchanges between peers; this definition is based on legislation aimed at preventing bullying at elementary, junior high, and senior high schools [8]. Teasing, on the other hand, refers to an enjoyable exchange between friends, without any malicious intent. Stuttering typically arises in children aged 2-4 years, and according to parents' questionnaire, children as young as 2-years-old have been found to be aware of their own stuttering [9]. Bullying behavior can be ranked from mild to severe; imitation is classified as mild bullying [10]. In addition to being imitated, CWS are also of-

Introduction
Stuttering is a speech disorder characterized by in-

Results
The proportion of CWS who were questioned, imitated, or laughed at is depicted in Table 1 and Figure 1. The average proportion of children who were questioned was 44.2% (0% at age three; 13% at age four; 35% at age five; 38% at age six; 64% at age seven; 67% at age eight; 75% at age nine; 50% at age ten; 83% at age eleven; and 75% at age twelve), those who were imitated was 30.8% (14% at age three; 13% at age four; 25% at age five; 29% at age six; 64% at age seven; 28% at age eight; 75% at age nine; 38% at age ten; 0% at age eleven; and 50% at age twelve), and ones who were laughed at was 26.7% (7% at age three; 13% at age four; 40% at age five; 21% at age six; 21% at age seven; 33% at age eight; 25% at age nine; 38% at age ten; 33% at age eleven; and 50% at age twelve). The total proportion of children who were questioned, imitated, and laughed at was 66.6% (21% at age three; 25% at age four; 70% at age five; 54% at age six; 71% at age seven; 78% at age eight; 100% at age nine; 63% at age ten; 83% at age eleven; and 100% at age twelve). There were no gender differences. ten questioned and laughed at. The aim of this study was to interview CWS aged 3-12 years on their experiences of being questioned, imitated, or laughed at, and to determine whether these incidents left them feeling unhappy.
• Has anyone imitated the way you speak?
• Has anyone laughed at your speech?
We also asked if they felt unhappy or happy about these incidents. This study was approved by the institutional review board of Kyushu University (29-117) and  7-15, who stuttered frequently, experienced bullying behaviors. Blood and Blood [4] examined adults who stuttered, using 46 items of the Retrospective Bullying Questionnaire (RBQ); their findings showed that 30.6% of participants were bullied in primary school, 27.8% in secondary school, and 11.1% in university. Furthermore, Hugh-Jones and Smith [12] reported that 75% of adults who stuttered believed that the bullying they experienced in school had affected their academic performance. There were many strategies of addressing bullying [3,13] and Yaruss et al [14] summarized six key steps to prevent and minimize bullying: (1) Educating children about stuttering; (2) Educating children about bullying; (3) Helping children change the way they think and feel about their stuttering through desensitization, cognitive restructuring, and acceptance activities; (4) Helping children learn to use appropriately assertive responses that decrease the likelihood of bullying; (5) Educating peers and bystanders about stuttering and bullying so that they are more likely to respond in helpful ways; and (6) Educating parents, teachers, and administrators about how they can create an environment where it is not okay to bully, but it is okay to stutter.
The limitation of this study was the lack of data on stuttering severity of the participants, and it is likely that more severe stuttering may lead to an increase in bullying severity. However, even CWS who had a minimal stutter in our examination were bullied by their classmates; stuttering severity may not be the only factor determining the severity of bullying.

Key Messages
• A large proportion of children who stutter are questioned, imitated, and laughed at.
• Children who stutter are bullied from as young as four-years-old.
The percentage of CWS who were unhappy with being questioned, imitated, or laughed at is depicted in Figure 2. The distribution of CWS who were unhappy, was 0% at age three; 50% at age four; 100% at age five; 92.3% at age six; 100% at age seven; 100% at age eight; 100% at age nine; 100% at age ten; 100% at age eleven; and 100% at age twelve.

Discussion
This is the study to ask CWS as young as age three and over about their attitudes to being questioned, imitated, or laughed at regarding their stuttering. The proportion of CWS who were questioned exceeded those who were imitated or laughed at. Ezrati-Vinacour et al [11] reported that preschool children with normal fluency are fully aware of stuttering-like disfluencies at age five. Half of four-year-old CWS did not feel unhappy about being questioned, imitated, or laughed at. We recommend that physicians and speech language pathologists ask CWS over age four whether they were questioned, imitated, or laughed at, to detect bullying associated with stuttering.
We did not find three-year-olds who felt unhappy with being questioned, imitated, or laughed at. Boey et al [9] found that children are aware of their own stuttering from as early as two years old, based on parental-reported unambiguous verbal and non-verbal reactions in response to stuttering. However, the study by Boey et al [9] explored difficulties of CWS from the perspective of parents, while our study examined children's memories of experiences with their peers. The difference in findings may be related to children's ability to process experiences and emotions, which increases with age.
There are some studies on bullying detection. Langevin et al [10], with the help of 19 items of The Teasing/Bullying Questionnaire for Children Who Stutter (TBQ-CS), reported that nearly 60% of children aged The proportion of CWS who were "unhappy" with being questioned, imitated, or laughed at, according to age.
• Bullying impacts people who stutter into adulthood.
• Psychological effects of bullying should be addressed by holistic treatment.