Auditory Processing and Stuttering: Preliminary data

Auditory Processing and Stuttering: Preliminary data | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Auditory Processing and Stuttering: Preliminary data Ioannidou Eleftheria, Nikolaos P Moschopoulos, Tatsiopoulou Paraskevi, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7526955/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Stuttering is a neurodevelopmental speech disorder with unclear etiology, linked with auditory processing deficits and associated with Left Ear Advantage. The exact connection between stuttering and auditory processing remains undetermined. The purpose of the current study is to evaluate auditory processing in children with stuttering. Methods The clinical group comprised of nine children diagnosed with stuttering, while the control group consisted of nine typically developing children without stuttering. The participants completed an auditory processing battery test including Speech recognition in Babble test, Gaps in Noise test, Dichotic Digits test and Word Recognition-Rhythm Component test. The Mann- Whitney U test was conducted using the Statistical Package for the Social Sciences (SPSS) software to analyze the collected data. Additionally, the laterality index was calculated for both groups. Results The clinical group showed a statistically significant decreased performance in the gap detection task and in the Word Recognition-Rhythm Component test. The clinical group exhibited a left ear advantage, while the control group exhibited right ear advantage. Discussion These findings indicate that temporal resolution deficits may be present in stuttering which is consistent with the existing literature. Moreover, in this study children with stuttering exhibit a left ear advantage, whereas earlier research has reported inconsistent patterns. Given the small sample size, further studies with larger cohorts are needed to clarify these results. Conclusion The present study provides evidence that children who stutter may present auditory temporal processing deficits and atypical auditory asymmetry, highlighting potential risks for broader auditory processing difficulties. These findings underscore the importance of comprehensive assessment of hearing and auditory processing in this population to maximize the therapeutic outcome through auditory training. Auditory processing stuttering temporal resolution rhythm children with stuttering hearing Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION Stuttering is a neurodevelopmental disorder characterized by atypical speech motor planning development and is included in ICD-11 as developmental speech fluency disorder [ 1 ]. It is estimated that stuttering emerges during early developmental period affecting 5–8% of the total population with higher prevalence among males [ 2 ]. About 1% of this population will continue to stutter in adulthood [ 2 ] having severe impact in children’s psychological health and social interaction [ 3 ]. The speech of people who stutter (PWS) is characterized by frequent or pervasive disruption of the normal rhythmic flow and rate of speech characterised by repetitions and prolongations in sounds, syllables, words, and phrases, as well as blocking and word avoidance or substitutions [ 1 ]. The exact underlying causes of stuttering remain unknown. According to the current theories, stuttering is considered as a dynamic multifactorial phenomenon, which emerges due to the impact of complex interactions between atypical speech motor control system, auditory processing, and other cognitive, linguistic, genetic, and psychological factors [ 4 ]. Auditory processing -particularly temporal processing- has been increasingly highlighted as a key factor in stuttering. It has been supported that speech dysfluency occurs due to insufficient neural encoding for temporal features at the early stages of auditory pathway [ 5 ]. These timing deficits lead to discrepancies between the predicted (feedforward) and actual (feedback) auditory consequences of speech [ 6 ]. When these mismatches occur, the brain attempts to correct them by restarting the syllable, leading to repetitions commonly observed in PWS [ 7 ]. The crucial role of auditory temporal processing in the functioning of the auditory feedback control system indicates that auditory temporal processing may contribute to the observed speech errors [ 8 , 9 ]. Auditory temporal processing may involve different stages along the central auditory nervous system from more peripheral (closer to the cochlear nuclei) to more central ones (closer to the hemispheres) [ 10 ]. From a clinical perspective, temporal processing evaluation using psychoacoustic tests shows that children who stutter have poorer than expected temporal processing abilities [ 11 , 12 ] which tend to improve with auditory training [ 13 ]. Specific tests of auditory temporal processing that show deficits are the Duration Pattern Test [ 11 , 14 ], the Pitch Pattern Sequence Test [ 14 ], as well as the Random Gap Detection Test [ 9 ]. This shows that there might be a specific type of auditory processing disorder, that of a temporal deficit one, co-existing with stuttering [ 15 ]. Additionally, children who stutter (CWS) exhibited poorer performance in backward-masking tasks [ 12 ] and, in speech in noise perception test [ 14 ] while their performance in dichotic listening task seems to be controversial, particularly in the context of the Ear Advantage. In 1969, Curry & Gregrory revealed that PWS do not exhibit the conventional Right Ear Advantage (REA) [ 16 ], which is in accordance with Cerebral Dominance Theory. This theory suggests that stuttering arises as a direct consequence of reduced specialization in the left hemisphere for speech and language perception [ 17 ]. However, later studies have shown inconsistent findings, with some reporting reduced REA in stutterers compared to controls, while others found no significant differences [ 18 – 20 ]. Recent studies suggest that the atypical cerebral dominance found in some individuals who stutter may not apply to all cases highlighting the heterogeneity of auditory processing abilities in stuttering [ 21 ]. These additional deficits point to an auditory processing disorder not necessarily limited to the temporal component. Summarizing research findings, it may be concluded that there is a connection between auditory processing and stuttering. However, there is no consensus regarding the way that auditory processing affects stuttering and whether clinical evaluation of auditory processing is of importance when attempting therapy for stuttering in children. Additionally, there are no consolidated research findings for CWS within the language population of the researchers of this study. The aim of this study is to assess auditory processing in this specific cohort to provide preliminary data on this topic. The test battery used in the current study differs from those in previous research, as it includes a test for auditory rhythm perception, the Word Recognition-Rhythm Component (WRRC), as well as the Gaps-In-Noise test (GIN), which is not commonly used in CWS. Additionally, the battery includes a Speech in Babble (SinB) test and a Dichotic Digits (DD) test. Finally, this research reexamines the controversial findings regarding the reversal of REA in CWS. The hypothesis of the current research is that CWS will exhibit reduced performance in auditory processing test compared to the control group and they will exhibit Left Ear Advantage (LEA) instead of the common REA. In case this hypothesis is verified this may be of direct interest to ENT medical doctors when performing hearing evaluation [ 22 ]. MATERIALS AND METHODS Participants Eighteen children aged 7-12 years participated in the present study. The clinical group consisted of eight males and one female (mean age of 9.4 years) all of whom were right-handed. The handedness was determined using the Edinburgh Handedness Inventory. The gender imbalance reflects the higher prevalence of stuttering among males [2]. For consistency, the control group consisted of six males and three females, with a mean age of 9.4 years, including only one left-handed participant. CWS were selected from private speech and language therapy centers, while children without stuttering were recruited from the community. The characteristics of each group are presented in Table 1 The inclusion criteria for CWS were: 1) diagnosis of stuttering by a neurologist or developmental pediatrician based on DSM-5, 2) age range of 7 and 12 years old, 3) peripheral hearing thresholds no greater than 15 dBHL for the frequencies of 250-8000 Hz. The inclusion criteria for the control group were: 1) typical development without any speech fluency disorder or other disorders, 2) age range between 7 and 12 years old, 3) peripheral hearing thresholds no greater than 15 dBHL for the frequencies of 250-8000 Hz. All participants presented hearing sensitivity bilaterally as revealed by pure-tone thresholds of 15 dBHL or better at all examined frequencies between 250 and 8000 Hz. Research integrity The current study was approved by the bioethics committee of the authors affiliated Medical School (6.626; 14.06.2022). All parents of the participants provided informed consent for their children’s participation in the current study. Tests To examine the auditory processing abilities, the current study uses exclusively behavioral-based assessment avoiding the use of invasive and expensive electrophysiologic equipment. This test battery was selected due to its reliability in differentiating children with auditory processing disorder from those who do not have auditory processing disorder, as well as its validity in capturing auditory processing difficulties in children with disorders such as learning disabilities [23, 24]. Additionally, this test battery consisted of four tests, each evaluating a different aspect of auditory processing. The different auditory processing components assessed by each test are briefly presented in Table 2. The existent age-related norms for the tests included in this battery are provided in Appendix A [23]. The evaluation took place in a quiet room using over-the-ear headphones, in a random order for each participant at 60 dBHL. The duration of the procedure was approximately one and a half hours and participants could take breaks if needed. Speech in Babble (SinB) is a monaural test that evaluates speech perception in real-life situations using 50 bisyllabic words. Participants are instructed to repeat the word heard after each trial. Prior to each target word, the instruction "say the word" is provided. The test involves five different Signal-Noise Ratios (SNR) which are presented with a fixed order from the easiest to the most difficult for each ear. The outcome measure is the SNR threshold at which the 50% of the items are correctly identified. Therefore, a higher SNR value indicates poorer performance. Each participant received both a word-based and a syllable-based score [23, 25]. The Gaps-in-Noise (GIN) is a monaurally test that consists of 60 segments of white noise, each lasting 6 seconds. In each noise segment, there are one, two, or three gaps. In some noise segments, there are no gaps at all. The duration of the gaps ranges from 2 to 20 milliseconds. Each gap of a specific duration is presented six times throughout the test. The participants were instructed to raise their hand when detecting a gap within the white noise. A practice segment was provided before the main test. The outcome measures the gap detection threshold for each ear with higher thresholds indicating poorer performance [26]. The Dichotic Digits (DD) test , designed in the 1980s comprises two practice trials and the main assessment with naturally spoken numbers ranging from 1 to 9. Each ear simultaneously receives a distinct pair of digits, and the listener is required to repeat the four digits. A total of forty patterns are presented. Before each trial, a pure tone is played as a cue to capture the participant's attention. The outcome measures the percentage of correct identifications for each ear [27]. For the DD test the Laterality Index (LI) was calculated according to the following formula [28]: The Word Recognition-Rhythm Component (WRRC) assess speech recognition in three conditions: rhythmic condition (RH), non-rhythmic condition (NR), and unsynchronized condition (UnSc). In all conditions, the acoustic stimulus is presented to both ears. Each auditory stimulus consists of four small beats followed by the bisyllabic target word within a noise segment. In the RH condition, a rhythmic pulse is synchronized with the target word, in the NR condition a non-rhythmic pulse is used and in the UnSc condition a rhythmic pulse is used, which is unsynchronized with the target word [29]. For the administration of the WRRC test, MATLAB software is utilized. For each participant, three primary and six secondary outcomes were reported. The primary outcomes relate to the total number of correctly identified syllables in each condition. The six secondary outcomes are related to the number of correct identifications of the first syllable and the second syllable separately in each condition. Given that 16 bisyllabic words are presented in each condition, the maximum performance could be 32 correct syllable identifications. The impact of synchronized and unsynchronized rhythm is expressed through two different measures: the Synchronized Rhythm Effect Percentage (SREP) and the Unsynchronized Rhythm Effect Percentage (UREP) [30]. Positive values in either measure indicate a positive rhythm effect, suggesting improved recognition in rhythm-related conditions. Values equal to 0 imply no effect, indicating that recognition remains unchanged across conditions. Negative values indicate a negative rhythm effect, suggesting decreased recognition in rhythm-related conditions [30]. The calculation of the values of SREP and UREP was conducted according to the following mathematic formulas [30]: Statistical Analysis The collected data were statistically analyzed using Statistical Package for the Social Sciences Software (SPSS) version 27.0. The data exhibited abnormal distribution since the z-scores for skewness and kurtosis were not between -1,96 and +1,96 [31]. Therefore, the non-parametric test Mann-Whitney U was used for statistical analysis. RESULTS The current study aimed to test the following hypotheses: (i) that CWS have auditory processing deficits compared to typically developing age matched children and (ii) that CWS exhibit LEA. Performance in auditory processing The individual performance results for the clinical group are presented in Table 3 and 4. In both tables, the atypical performance of each participant, relative to age-related norms, is highlighted. The individual performance results for the control group are shown in Table 5 and 6. In both tables, the atypical performance of each participant, relative to age-related norms, is highlighted. The average performance of the clinical group was compared to that of the control group using the non-parametric Mann-Whitney U test. These statistical analysis results for all auditory processing tests, except for the WRRC, are presented in Table 7. The corresponding results related to the WRRC test, including the SREP and UREP values, are presented in Table 8. At the individual level, more CWS were found to exhibit auditory processing deficits across a greater number of tests compared to the control group. These results are consistent with the clinical group’s performance as CWS exhibited reduced performance in nearly all tasks compared to the control group. Statistical analysis of the SinB test revealed no statistically significant differences between the two groups for the right ear at either the word-based or syllable-based score levels. However, for the left ear, the differences approached statistical significance across both scoring methods. The results for the word-based SinB scores for both groups are presented in Figure 1, while the corresponding syllable-based results are shown in Figure 2. Statistically significant differences were observed between the two groups in the GIN test. The control group recognized smaller gaps, with an average duration of 6ms in both ears. In contrast, the clinic group detected gap of 8 ms in the right ear and 7 ms in the left ear on average (Figure 3). The performance difference in this auditory temporal processing test between the two groups was statistically significant for the right ear, while for the left ear, the difference was not statistically significant. In the dichotic listening test, the clinical group demonstrated reduced performance in the right ear compared to the control group, but the difference was not statistically significant. In the left ear, the clinical group performed better than the control group, though this difference was not statistically significant. These results are demonstrated in Figure 4. In the WRRC test there was a statistically significant difference between the two groups in the recognition of the first syllable in the NR condition. The total performance for both groups in each condition of WRRC test is presented in Figure 5. The SREP value for the clinical group indicates that 7.23% more syllables were correctly identified when words were synchronized with the rhythm, compared to conditions where there was no rhythm, while the control group recognized 3.71% more syllables under the same condition. The value of UREP for the clinical group means that 10.06% more syllables were identified when words were not synchronized with the rhythm, compared to conditions where the rhythm is absent, while the control group recognized 1.23% more syllables. These results suggest that the clinical group was more positively influenced by the presence of rhythm in the auditory stimulus, even when the rhythm was not synchronized with the target word, as reflected in the higher SREP and UREP values compared to the control group. However, the difference in SREP and UREP values between the two groups was not statistically significant. LEA in Children with Stuttering In the DD test, the clinical group demonstrated superiority of the left ear, while the control group exhibited better performance from the right ear. However, this difference in ear performance was not statistically significant. In the GIN test, a significant difference in ear performance was observed only in the right ear, whereas in SinB test, the difference in ear performance between groups was nearly statistically significant only in the left ear. The results of each ear performance for each group are summarized in Table 9. The LI was calculated to assess the magnitude of lateralized auditory processing, with the results presented in Table 10. A positive score indicates REA, while a negative score indicates LEA [28]. The clinical group exhibited a negative LI, indicating LEA, while the control group had a positive LI, indicating REA. These results suggest that CWS tend to exhibit LEA. In conclusion, statistically significant differences between the two groups were observed in the GIN test in the right ear and in the non-rhythm condition of the WRRC test. A trend toward statistically significant differences was noted in the SinB task for the left ear at the syllable level. Additionally, CWS demonstrated LEA. DISCUSSION Despite the small number of participants this study provides significant preliminary data on the relationship between auditory processing and stuttering. The results of the current study revealed that CWS demonstrate significantly reduced performance in the GIN test and in the non-rhythm condition of WRRC test than the control group. Moreover, CWS performed poorer than the control group in SinB test in the right and in the left ear. That difference in performance between the two groups in SinB test had a trend toward statistically significant difference only for the left ear. Furthermore, CWS performed better in DD test in the left ear and appeared to have a negative LI. The reduced performance in the GIN task is directly related to deficiencies in temporal resolution, indicating that CWS have difficulties perceiving rapid changes in auditory stimuli [ 32 ]. Deficits in temporal resolution in CWS were identified using the GIN test and in adults using the RGDT test [ 8 , 11 ]. Auditory temporal processing plays a key role in perceiving prosodic elements such as rhythm and rapid speech components and is essential for speech perception and spoken language processing skills. These temporal elements are vital in the auditory feedback pathway to produce fluent speech [ 9 ]. By providing feedback on the timing of speech, the auditory system enables the brain to anticipate the timing of upcoming speech sounds. Research suggests that speech is continuously monitored and adjusted through the modulation of the auditory feedback timing [ 33 ]. Given that speech is a fast, dynamic motor process, all its underlying neural components should function with precise timing [ 34 ]. Therefore, disruptions in auditory temporal processing can impact fluent speech production and may contribute to stuttering’s onset or aggravation [ 35 ]. Additionally, inadequate temporal resolution may be a causal factor in the difficulties of CWS recognizing speech in noisy environments [ 36 ]. This phenomenon is further confirmed by the results of the current study, as the clinical group, which demonstrated deficits in temporal processing, also showed decreased performance in the SinB task for the left ear compared to the control group. These findings indicate that CWS may have difficulties in recognizing speech in noisy environments. In a series of studies, Howell et al. concluded that CWS are more affected by backward masking compared to the control group and there is a positive correlation between backward masking tasks performance and stuttering severity [ 12 ]. Moreover, the performance in the backward masking task serves as a predictive factor regarding whether stuttering will persist or be overcome [ 37 , 38 ]. In the WRRC test, CWS showed significantly reduced performance only in the NR condition. However, they demonstrated improved performance in RH condition, indicating that rhythm presence in auditory stimulus is beneficial for CWS. Despite this, it has been shown that CWS exhibit significant deficits in rhythm perception and synchronization [ 33 , 39 ]. Moreover, CWS demonstrate reduced ability to create and maintain an internal rhythm, attributed to diminished rhythmic processing skills [ 40 ]. In the present study, the clinical group exhibited LEA as it had negative LI, indicating that in CWS the right hemisphere is dominant for the auditory processing of speech and language. Additionally, the significant difference observed between the two groups in the GIN test for the right ear might be due to the right ear being prevailing in the control group but not in the clinical group. These findings are directly related to the controversial theory of cerebral dominance, which suggests that in individuals who stutter, the right hemisphere becomes the dominant hemisphere for speech and language due to delayed development of the left hemisphere [ 17 ]. An interesting finding is that individuals who overcome stuttering, either spontaneously or through therapy, tend to reconfigure the language function of the left hemisphere [ 41 ]. However, this pattern is not universal as some people who stutter exhibit typical left hemisphere dominance or mixed patterns, reflecting the heterogeneity of stuttering neurobiology [ 19 , 20 ]. According to the literature and the preliminary results of the current study CWS exhibit auditory processing deficits. Consequently, auditory processing assessment may be useful for CWS, and auditory training could be integrated to interventions targeting this population. In a recent study, it was suggested that incorporating auditory temporal training into therapeutic interventions can reduce stuttering severity [ 15 ]. However, other research involving acoustically controlled auditory training in a small sample of CWS demonstrated improvements in auditory processing skills without significant effects on speech fluency [ 42 ]. Notably, there is evidence indicating that CWS improve their auditory processing abilities following speech therapy sessions which indicates that the combination of auditory trainings with long periods of speech therapy could enhance the overall effectiveness of stuttering interventions [ 43 ]. The present study demonstrates that auditory processing deficits may be present in stuttering. Moreover, it provides evidence that CWS perform better with the left ear, and they have a negative LI indicating that the right hemisphere is dominant for speech and language in children with stuttering. A fundamental limitation of the current study is the relatively small sample size and the exclusion of participants' history of otitis media. Additionally, exploring the correlation between auditory processing deficits and the severity of stuttering would be beneficial. Future research could provide valuable information for designing more effective therapeutic intervention programs for CWS and could help in evaluating the effectiveness of auditory training for these children. CONCLUSIONS The results of this preliminary study indicate that not all auditory processing components are deficient in stuttering. Even though the study sample is small, statistically significant deficits in the group of CWS were documented. A clinical implication for this is the need for evaluating auditory processing in this clinical group. Any deficits found may provide a basis for auditory training. Specifically, it was found that children diagnosed with stuttering: Showed significantly reduced performance in the GIN test, a phenomenon related to deficits in temporal processing. Presented significantly reduced performance in the non-rhythmic condition of the WRRC test. Performed better with the left ear and had a negative LI, providing evidence of atypical right-hemisphere lateralization for speech and language processing. Declarations Ethics Approval and Consent to practice: It is clearly stated in “Research Integrity” section that “The current study was approved by the bioethics committee of the authors’ affiliated Medical School (6.626; 14.06.2022). All parents of the participants provided informed consent for their children’s participation in the current study.” Consent for publication: All authors consent to the publication. Availability of data and material: All data generated or analysed during this study are included in this published article [and its supplementary information files]. Competing interest: On behalf of all authors, the corresponding author states that there is no conflict of interest. Funding: No funding was available for the current study. References ICD-11 (2025) https://icd.who.int/en . 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J Fluen Disord 55:135–144 de Alencar PBA, Lucas P, de Bortoli A, Bernert E, Rodrigues LM, Branco-Barreiro LP FCA (2020) Acoustically controlled auditory training in children with speech disfluency: a case report. Rev CEFAC 22:e5420 Ismail N, Shalaby A, Sallam Y, Behairy R, Alsaeed A (2023) Auditory Processing Abilities of Children who Stutter: Effect of Speech Therapy. Egypt J Ear Nose Throat Allied Sci 24:1–14 Tables Tables 1 to 10 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files AppendixAuditoryProcessingandStutteringPreliminarydata.docx Tables.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 05 Mar, 2026 Reviews received at journal 05 Mar, 2026 Reviewers agreed at journal 12 Feb, 2026 Reviews received at journal 25 Dec, 2025 Reviewers agreed at journal 10 Dec, 2025 Reviewers agreed at journal 07 Dec, 2025 Reviewers invited by journal 22 Oct, 2025 Editor assigned by journal 04 Sep, 2025 Submission checks completed at journal 04 Sep, 2025 First submitted to journal 03 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":26939,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePerformance in SinB test for both groups (word-based scores)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this figure, the performance of both groups regarding the word-based scores are presented. The minimum value is shown at the bottom of the whisker. The maximum value is shown at the top of the whisker. The mean value is represented by the symbol “X,” and the median value is represented by the line inside the box. Individual data points that fall outside the expected range are shown as bullets and represent statistical outliers. Higher values indicate poorer performance.\u003c/p\u003e\n\u003cp\u003eNotes: SinB_RE_Words, Speech in Babble for the Right Ear (word-based scores); SinB_LE_Words, Speech in Babble for the Left Ear (word-based scores)\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7526955/v1/271585bdfb8b2b9e6a0fb072.png"},{"id":95064984,"identity":"7d1d976c-0d72-493b-9f1d-9fd6dbf5083f","added_by":"auto","created_at":"2025-11-04 01:23:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":28490,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePerformance in SinB test for both groups (syllable-based scores)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this figure, the performance of both groups regarding the syllable-based scores are presented. The minimum value is shown at the bottom of the whisker. The maximum value is shown at the top of the whisker. The mean value is represented by the symbol “X,” and the median value is represented by the line inside the box. Higher values indicate poorer performance.\u003c/p\u003e\n\u003cp\u003eNotes: SinB_RE_Syllabic, Speech in Babble for the Right Ear (syllable-based scores); SinB_LE_Syllabic, Speech in Babble for the Left Ear (syllable-based scores)\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7526955/v1/d59a03bfe1e0e335026c1c3e.png"},{"id":95064988,"identity":"ddfaf686-6e50-49bb-967c-3714ce70a230","added_by":"auto","created_at":"2025-11-04 01:23:55","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":20885,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePerformance in GIN test for both groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this figure, the performance regarding GIN test for both groups is presented. The minimum value is shown at the bottom of the whisker. The maximum value is shown at the top of the whisker. The mean value is represented by the symbol “X,” and the median value is represented by the line inside the box. Higher values indicate poorer performance.\u003c/p\u003e\n\u003cp\u003eNotes: GIN- RE, Gaps-In-Noise for the Right Ear; GIN-LE, Gaps-In-Noise for the Left Ear\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7526955/v1/5a95affb16b9755fc8ec4730.png"},{"id":95223247,"identity":"90fccbca-4cc7-410f-a1bb-309006757fd4","added_by":"auto","created_at":"2025-11-05 16:21:54","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":27273,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePerformance in DD test for both groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this figure, the performance regarding DD test for both groups is presented. The minimum value is shown at the bottom of the whisker. The maximum value is shown at the top of the whisker. The mean value is represented by the symbol “X,” and the median value is represented by the line inside the box.\u003c/p\u003e\n\u003cp\u003eNotes: DD-RE, Dichotic Digits for the Right Ear; DD-LE, Dichotic Digits for the Left Ear\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7526955/v1/18ebc78f5f1d285219481fe4.png"},{"id":95223780,"identity":"47976b13-dd5c-43da-9367-473a9394a2d3","added_by":"auto","created_at":"2025-11-05 16:22:49","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":25315,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePerformance in WRRC test for both groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this figure, the performance regarding WRRC test for both groups is presented for each condition (RH-total, NR-total, UnSc-total) separately. The minimum value is shown at the bottom of the whisker. The maximum value is shown at the top of the whisker. The mean value is represented by the symbol “X,” and the median value is represented by the line inside the box.\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-7526955/v1/6a6bc810d807da59536a0ed8.png"},{"id":95230260,"identity":"ea4c4e10-45cf-4402-84f6-ade8b2062ecc","added_by":"auto","created_at":"2025-11-05 16:37:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":804426,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7526955/v1/28873aa2-16d6-46be-970d-a75512f62c14.pdf"},{"id":95224350,"identity":"e4c08dcd-52f1-4199-b68c-74fcdf2e0ad5","added_by":"auto","created_at":"2025-11-05 16:23:39","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16177,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixAuditoryProcessingandStutteringPreliminarydata.docx","url":"https://assets-eu.researchsquare.com/files/rs-7526955/v1/21643b087481fdf6871bbc9c.docx"},{"id":95223672,"identity":"19e83194-9d7c-4d18-ba77-9ae5d633806b","added_by":"auto","created_at":"2025-11-05 16:22:40","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":52680,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7526955/v1/cfe6ea3ac852250f6cc1d094.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Auditory Processing and Stuttering: Preliminary data","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eStuttering is a neurodevelopmental disorder characterized by atypical speech motor planning development and is included in ICD-11 as developmental speech fluency disorder [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is estimated that stuttering emerges during early developmental period affecting 5\u0026ndash;8% of the total population with higher prevalence among males [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. About 1% of this population will continue to stutter in adulthood [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] having severe impact in children\u0026rsquo;s psychological health and social interaction [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The speech of people who stutter (PWS) is characterized by frequent or pervasive disruption of the normal rhythmic flow and rate of speech characterised by repetitions and prolongations in sounds, syllables, words, and phrases, as well as blocking and word avoidance or substitutions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The exact underlying causes of stuttering remain unknown. According to the current theories, stuttering is considered as a dynamic multifactorial phenomenon, which emerges due to the impact of complex interactions between atypical speech motor control system, auditory processing, and other cognitive, linguistic, genetic, and psychological factors [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAuditory processing -particularly temporal processing- has been increasingly highlighted as a key factor in stuttering. It has been supported that speech dysfluency occurs due to insufficient neural encoding for temporal features at the early stages of auditory pathway [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These timing deficits lead to discrepancies between the predicted (feedforward) and actual (feedback) auditory consequences of speech [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. When these mismatches occur, the brain attempts to correct them by restarting the syllable, leading to repetitions commonly observed in PWS [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The crucial role of auditory temporal processing in the functioning of the auditory feedback control system indicates that auditory temporal processing may contribute to the observed speech errors [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAuditory temporal processing may involve different stages along the central auditory nervous system from more peripheral (closer to the cochlear nuclei) to more central ones (closer to the hemispheres) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. From a clinical perspective, temporal processing evaluation using psychoacoustic tests shows that children who stutter have poorer than expected temporal processing abilities [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] which tend to improve with auditory training [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Specific tests of auditory temporal processing that show deficits are the Duration Pattern Test [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], the Pitch Pattern Sequence Test [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], as well as the Random Gap Detection Test [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This shows that there might be a specific type of auditory processing disorder, that of a temporal deficit one, co-existing with stuttering [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAdditionally, children who stutter (CWS) exhibited poorer performance in backward-masking tasks [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and, in speech in noise perception test [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] while their performance in dichotic listening task seems to be controversial, particularly in the context of the Ear Advantage. In 1969, Curry \u0026amp; Gregrory revealed that PWS do not exhibit the conventional Right Ear Advantage (REA) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], which is in accordance with Cerebral Dominance Theory. This theory suggests that stuttering arises as a direct consequence of reduced specialization in the left hemisphere for speech and language perception [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, later studies have shown inconsistent findings, with some reporting reduced REA in stutterers compared to controls, while others found no significant differences [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Recent studies suggest that the atypical cerebral dominance found in some individuals who stutter may not apply to all cases highlighting the heterogeneity of auditory processing abilities in stuttering [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. These additional deficits point to an auditory processing disorder not necessarily limited to the temporal component.\u003c/p\u003e\u003cp\u003eSummarizing research findings, it may be concluded that there is a connection between auditory processing and stuttering. However, there is no consensus regarding the way that auditory processing affects stuttering and whether clinical evaluation of auditory processing is of importance when attempting therapy for stuttering in children. Additionally, there are no consolidated research findings for CWS within the language population of the researchers of this study. The aim of this study is to assess auditory processing in this specific cohort to provide preliminary data on this topic. The test battery used in the current study differs from those in previous research, as it includes a test for auditory rhythm perception, the Word Recognition-Rhythm Component (WRRC), as well as the Gaps-In-Noise test (GIN), which is not commonly used in CWS. Additionally, the battery includes a Speech in Babble (SinB) test and a Dichotic Digits (DD) test. Finally, this research reexamines the controversial findings regarding the reversal of REA in CWS. The hypothesis of the current research is that CWS will exhibit reduced performance in auditory processing test compared to the control group and they will exhibit Left Ear Advantage (LEA) instead of the common REA. In case this hypothesis is verified this may be of direct interest to ENT medical doctors when performing hearing evaluation [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003ch2\u003eParticipants\u003c/h2\u003e\n\u003cp\u003eEighteen children aged 7-12 years participated in the present study. The clinical group consisted of eight males and one female (mean age of 9.4 years) all of whom were right-handed. The handedness was determined using the Edinburgh Handedness Inventory. The gender imbalance reflects the higher prevalence of stuttering among males [2]. For consistency, the control group consisted of six males and three females, with a mean age of 9.4 years, including only one left-handed participant. CWS were selected from private speech and language therapy centers, while children without stuttering were recruited from the community. The characteristics of each group are presented in Table 1\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria for CWS were: 1) diagnosis of stuttering by a neurologist or developmental pediatrician based on DSM-5, 2) age range of 7 and 12 years old, 3) peripheral hearing thresholds no greater than 15 dBHL for the frequencies of 250-8000 Hz. The inclusion criteria for the control group were: 1) typical development without any speech fluency disorder or other disorders, 2) age range between 7 and 12 years old, 3) peripheral hearing thresholds no greater than 15 dBHL for the frequencies of 250-8000 Hz. \u0026nbsp;All participants presented hearing sensitivity bilaterally as revealed by pure-tone thresholds of 15 dBHL or better at all examined frequencies between 250 and 8000 Hz.\u003c/p\u003e\n\u003ch2\u003eResearch integrity\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe current study was approved by the bioethics committee of the authors affiliated Medical School (6.626; 14.06.2022). All parents of the participants provided informed consent for their children\u0026rsquo;s participation in the current study.\u003c/p\u003e\n\u003ch2\u003eTests\u003c/h2\u003e\n\u003cp\u003eTo examine the auditory processing abilities, the current study uses exclusively behavioral-based assessment avoiding the use of invasive and expensive electrophysiologic equipment. This test battery was selected due to its reliability in differentiating children with auditory processing disorder from those who do not have auditory processing disorder, as well as its validity in capturing auditory processing difficulties in children with disorders such as learning disabilities [23, 24]. Additionally, this test battery consisted of four tests, each evaluating a different aspect of auditory processing. The different auditory processing components assessed by each test are briefly presented in Table 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe existent age-related norms for the tests included in this battery are provided in Appendix A [23]. The evaluation took place in a quiet room using over-the-ear headphones, in a random order for each participant at 60 dBHL. The duration of the procedure was approximately one and a half hours and participants could take breaks if needed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSpeech in Babble (SinB)\u003c/strong\u003e is a monaural test that evaluates speech perception in real-life situations using 50 bisyllabic words. Participants are instructed to repeat the word heard after each trial. Prior to each target word, the instruction \u0026quot;say the word\u0026quot; is provided. The test involves five different Signal-Noise Ratios (SNR) which are presented with a fixed order from the easiest to the most difficult for each ear. The outcome measure is the SNR threshold at which the 50% of the items are correctly identified.\u0026nbsp;Therefore, a higher SNR value indicates poorer performance. Each participant received both a word-based and a syllable-based score [23, 25].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Gaps-in-Noise (GIN)\u0026nbsp;\u003c/strong\u003eis a monaurally test that consists of 60 segments of white noise, each lasting 6 seconds. In each noise segment, there are one, two, or three gaps. In some noise segments, there are no gaps at all. The duration of the gaps ranges from 2 to 20 milliseconds. Each gap of a specific duration is presented six times throughout the test. The participants were instructed to raise their hand when detecting a gap within the white noise.\u0026nbsp;A practice segment was provided before the main test. The outcome\u0026nbsp;measures the gap detection threshold for each ear with higher thresholds indicating poorer performance [26].\u003c/p\u003e\n\u003cp\u003eThe\u003cstrong\u003e\u0026nbsp;Dichotic Digits (DD) test\u003c/strong\u003e, designed in the 1980s comprises two practice trials and the main assessment with naturally spoken numbers ranging from 1 to 9. Each ear simultaneously receives a distinct pair of digits, and the listener is required to repeat the four digits. A total of forty patterns are presented. Before each trial, a pure tone is played as a cue to capture the participant\u0026apos;s attention. The outcome measures the percentage of correct identifications for each ear [27]. For the DD test the Laterality Index (LI) was calculated according to the following formula [28]:\u003c/p\u003e\n\u003cp\u003eThe \u003cstrong\u003eWord Recognition-Rhythm Component\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(WRRC)\u003c/strong\u003e assess speech recognition in three conditions: rhythmic condition (RH), non-rhythmic condition (NR), and unsynchronized condition (UnSc). In all conditions, the acoustic stimulus is presented to both ears. Each auditory stimulus consists of four small beats followed by the bisyllabic target word within a noise segment. In the RH condition, a rhythmic pulse is synchronized with the target word, in the NR condition a non-rhythmic pulse is used and in the UnSc condition a rhythmic pulse is used, which is unsynchronized with the target word [29]. For the administration of the WRRC test, MATLAB software is utilized. For each participant, three primary and six secondary outcomes were reported. The primary outcomes relate to the total number of correctly identified syllables in each condition. The six secondary outcomes are related to the number of correct identifications of the first syllable and the second syllable separately in each condition. Given that 16 bisyllabic words are presented in each condition, the maximum performance could be 32 correct syllable identifications. The impact of synchronized and unsynchronized rhythm is expressed through two different measures: the Synchronized Rhythm Effect Percentage (SREP) and the Unsynchronized Rhythm Effect Percentage (UREP) [30]. Positive values in either measure indicate a positive rhythm effect, suggesting improved recognition in rhythm-related conditions. Values equal to 0 imply no effect, indicating that recognition remains unchanged across conditions. Negative values indicate a negative rhythm effect, suggesting decreased recognition in rhythm-related conditions [30]. The calculation of the values of SREP and UREP was conducted according to the following mathematic formulas [30]:\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n\u003cp\u003eThe collected data were statistically analyzed using Statistical Package for the Social Sciences Software (SPSS) version 27.0. The data exhibited abnormal distribution since the z-scores for skewness and kurtosis were not between -1,96 and +1,96 [31]. Therefore, the non-parametric test Mann-Whitney U was used for statistical analysis.\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe current study aimed to test the following hypotheses: (i) that CWS have auditory processing deficits compared to typically developing age matched children and (ii) that CWS exhibit LEA.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003ePerformance in auditory processing\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe individual performance results for the clinical group are presented in Table 3 and 4. In both tables, the atypical performance of each participant, relative to age-related norms, is highlighted.\u003c/p\u003e\n\u003cp\u003eThe individual performance results for the control group are shown in Table 5 and 6. In both tables, the atypical performance of each participant, relative to age-related norms, is highlighted.\u003c/p\u003e\n\u003cp\u003eThe average performance of the clinical group was compared to that of the control group using the non-parametric Mann-Whitney U test. These statistical analysis results for all auditory processing tests, except for the WRRC, are presented in Table 7. The corresponding results related to the WRRC test, including the SREP and UREP values, are presented in Table 8.\u003c/p\u003e\n\u003cp\u003eAt the individual level, more CWS were found to exhibit auditory processing deficits across a greater number of tests compared to the control group. These results are consistent with the clinical group\u0026rsquo;s performance as CWS exhibited reduced performance in nearly all tasks compared to the control group.\u003c/p\u003e\n\u003cp\u003eStatistical analysis of the SinB test revealed no statistically significant differences between the two groups for the right ear at either the word-based or syllable-based score levels. However, for the left ear, the differences approached statistical significance across both scoring methods. The results for the word-based SinB scores for both groups are presented in Figure 1, while the corresponding syllable-based results are shown in Figure 2. Statistically significant differences were observed between the two groups in the GIN test. The control group recognized smaller gaps, with an average duration of 6ms in both ears. In contrast, the clinic group detected gap of 8 ms in the right ear and 7 ms in the left ear on average (Figure 3). The performance difference in this auditory temporal processing test between the two groups was statistically significant for the right ear, while for the left ear, the difference was not statistically significant. In the dichotic listening test, the clinical group demonstrated reduced performance in the right ear compared to the control group, but the difference was not statistically significant. In the left ear, the clinical group performed better than the control group, though this difference was not statistically significant. These results are demonstrated in Figure 4.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the WRRC test there was a statistically significant difference between the two groups in the recognition of the first syllable in the NR condition. The total performance for both groups in each condition of WRRC test is presented in Figure 5. The SREP value for the clinical group indicates that 7.23% more syllables were correctly identified when words were synchronized with the rhythm, compared to conditions where there was no rhythm, while the control group recognized 3.71% more syllables under the same condition. The value of UREP for the clinical group means that 10.06% more syllables were identified when words were not synchronized with the rhythm, compared to conditions where the rhythm is absent, while the control group recognized 1.23% more syllables. These results suggest that the clinical group was more positively influenced by the presence of rhythm in the auditory stimulus, even when the rhythm was not synchronized with the target word, as reflected in the higher SREP and UREP values compared to the control group. However, the difference in SREP and UREP values between the two groups was not statistically significant.\u003c/p\u003e\n\u003ch2\u003eLEA in Children with Stuttering\u003c/h2\u003e\n\u003cp\u003eIn the DD test, the clinical group demonstrated superiority of the left ear, while the control group exhibited better performance from the right ear. However, this difference in ear performance was not statistically significant. In the GIN test, a significant difference in ear performance was observed only in the right ear, whereas in SinB test, the difference in ear performance between groups was nearly statistically significant only in the left ear. The results of each ear performance for each group are summarized in Table 9.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The LI was calculated to assess the magnitude of lateralized auditory processing, with the results presented in Table 10. \u0026nbsp;A positive score indicates REA, while a negative score indicates LEA [28]. The clinical group exhibited a negative LI, indicating LEA, while the control group had a positive LI, indicating REA. These results suggest that CWS tend to exhibit LEA.\u003c/p\u003e\n\u003cp\u003eIn conclusion, statistically significant differences between the two groups were observed in the GIN test in the right ear and in the non-rhythm condition of the WRRC test. A trend toward statistically significant differences was noted in the SinB task for the left ear at the syllable level. Additionally, CWS demonstrated LEA.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e Despite the small number of participants this study provides significant preliminary data on the relationship between auditory processing and stuttering. The results of the current study revealed that CWS demonstrate significantly reduced performance in the GIN test and in the non-rhythm condition of WRRC test than the control group. Moreover, CWS performed poorer than the control group in SinB test in the right and in the left ear. That difference in performance between the two groups in SinB test had a trend toward statistically significant difference only for the left ear. Furthermore, CWS performed better in DD test in the left ear and appeared to have a negative LI.\u003c/p\u003e\u003cp\u003eThe reduced performance in the GIN task is directly related to deficiencies in temporal resolution, indicating that CWS have difficulties perceiving rapid changes in auditory stimuli [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Deficits in temporal resolution in CWS were identified using the GIN test and in adults using the RGDT test [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Auditory temporal processing plays a key role in perceiving prosodic elements such as rhythm and rapid speech components and is essential for speech perception and spoken language processing skills. These temporal elements are vital in the auditory feedback pathway to produce fluent speech [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. By providing feedback on the timing of speech, the auditory system enables the brain to anticipate the timing of upcoming speech sounds. Research suggests that speech is continuously monitored and adjusted through the modulation of the auditory feedback timing [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Given that speech is a fast, dynamic motor process, all its underlying neural components should function with precise timing [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Therefore, disruptions in auditory temporal processing can impact fluent speech production and may contribute to stuttering\u0026rsquo;s onset or aggravation [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAdditionally, inadequate temporal resolution may be a causal factor in the difficulties of CWS recognizing speech in noisy environments [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This phenomenon is further confirmed by the results of the current study, as the clinical group, which demonstrated deficits in temporal processing, also showed decreased performance in the SinB task for the left ear compared to the control group. These findings indicate that CWS may have difficulties in recognizing speech in noisy environments. In a series of studies, Howell et al. concluded that CWS are more affected by backward masking compared to the control group and there is a positive correlation between backward masking tasks performance and stuttering severity [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Moreover, the performance in the backward masking task serves as a predictive factor regarding whether stuttering will persist or be overcome [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the WRRC test, CWS showed significantly reduced performance only in the NR condition. However, they demonstrated improved performance in RH condition, indicating that rhythm presence in auditory stimulus is beneficial for CWS. Despite this, it has been shown that CWS exhibit significant deficits in rhythm perception and synchronization [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Moreover, CWS demonstrate reduced ability to create and maintain an internal rhythm, attributed to diminished rhythmic processing skills [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the present study, the clinical group exhibited LEA as it had negative LI, indicating that in CWS the right hemisphere is dominant for the auditory processing of speech and language. Additionally, the significant difference observed between the two groups in the GIN test for the right ear might be due to the right ear being prevailing in the control group but not in the clinical group. These findings are directly related to the controversial theory of cerebral dominance, which suggests that in individuals who stutter, the right hemisphere becomes the dominant hemisphere for speech and language due to delayed development of the left hemisphere [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. An interesting finding is that individuals who overcome stuttering, either spontaneously or through therapy, tend to reconfigure the language function of the left hemisphere [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. However, this pattern is not universal as some people who stutter exhibit typical left hemisphere dominance or mixed patterns, reflecting the heterogeneity of stuttering neurobiology [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e According to the literature and the preliminary results of the current study CWS exhibit auditory processing deficits. Consequently, auditory processing assessment may be useful for CWS, and auditory training could be integrated to interventions targeting this population. In a recent study, it was suggested that incorporating auditory temporal training into therapeutic interventions can reduce stuttering severity [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, other research involving acoustically controlled auditory training in a small sample of CWS demonstrated improvements in auditory processing skills without significant effects on speech fluency [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Notably, there is evidence indicating that CWS improve their auditory processing abilities following speech therapy sessions which indicates that the combination of auditory trainings with long periods of speech therapy could enhance the overall effectiveness of stuttering interventions [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe present study demonstrates that auditory processing deficits may be present in stuttering. Moreover, it provides evidence that CWS perform better with the left ear, and they have a negative LI indicating that the right hemisphere is dominant for speech and language in children with stuttering. A fundamental limitation of the current study is the relatively small sample size and the exclusion of participants' history of otitis media. Additionally, exploring the correlation between auditory processing deficits and the severity of stuttering would be beneficial. Future research could provide valuable information for designing more effective therapeutic intervention programs for CWS and could help in evaluating the effectiveness of auditory training for these children.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThe results of this preliminary study indicate that not all auditory processing components are deficient in stuttering. Even though the study sample is small, statistically significant deficits in the group of CWS were documented. A clinical implication for this is the need for evaluating auditory processing in this clinical group. Any deficits found may provide a basis for auditory training.\u003c/p\u003e\u003cp\u003eSpecifically, it was found that children diagnosed with stuttering:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eShowed significantly reduced performance in the GIN test, a phenomenon related to deficits in temporal processing.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePresented significantly reduced performance in the non-rhythmic condition of the WRRC test.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePerformed better with the left ear and had a negative LI, providing evidence of atypical right-hemisphere lateralization for speech and language processing.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul type=\"square\"\u003e\n \u003cli\u003eEthics Approval and Consent to practice: It is clearly stated in “Research Integrity” section that “The current study was approved by the bioethics committee of the authors’ affiliated Medical School (6.626; 14.06.2022).\u0026nbsp;All parents of the participants provided informed consent for their children’s participation in the current study.”\u003c/li\u003e\n \u003cli\u003eConsent for publication: All authors consent to the publication.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAvailability of data and material: All data generated or analysed during this study are included in this published article [and its supplementary information files].\u003c/li\u003e\n \u003cli\u003eCompeting interest: On behalf of all authors, the corresponding author states that there is no conflict of interest.\u003c/li\u003e\n \u003cli\u003eFunding: No funding was available for the current study.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eICD-11 (2025) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://icd.who.int/en\u003c/span\u003e\u003cspan address=\"https://icd.who.int/en\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 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Springer Science \u0026amp; Business Media\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLotfi Y, Dastgerdi ZH, Farazi M, Moossavi A, Bakhshi E (2020) Auditory temporal processing assessment in children with developmental stuttering. Int J Pediatr Otorhinolaryngol. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijporl.2020.109935\u003c/span\u003e\u003cspan address=\"10.1016/j.ijporl.2020.109935\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHowell P, Rosen S, Hannigan G, Rustin L (2000) Auditory Backward-Masking Performance by Children Who Stutter and its Relation to Dysfluency Rate. Percept Mot Skills 90:355\u0026ndash;363\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeihing J, Chermak GD, Musiek FE (2015) Auditory Training for Central Auditory Processing Disorder. Semin Hear 36:199\u0026ndash;215\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAsal S, Abdou RM (2014) The study of central auditory processing in stuttering children. Egypt J Otolaryngol 30:357\u0026ndash;361\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFARAZI M, HOSSEINI DASTGERDI Z, LOTFI Y, MOOSSAVI A, BAKHSHI E (2023) Effect of an Auditory Temporal Training Program on Speech Fluency of Children with Developmental Stuttering. Iran J Child Neurol 17:39\u0026ndash;53\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCurry FKW, Gregory HH (1969) The Performance of Stutterers on Dichotic Listening Tasks Thought to Reflect Cerebral Dominance. J Speech Hear Res 12:73\u0026ndash;82\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTravis LE (1978) The Cerebral Dominance Theory of Stuttering: 1931\u0026ndash;1978. 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Cogn Behav Neurol 17:224\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIliadou VM, Bamiou D-E, Keith W, Purdy SC, Thai-Van H (2024) It is time to change the way we think about hearing evaluation. Eur Arch Otorhinolaryngol 281:3261\u0026ndash;3264\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSidiras CI, Vasiliki Vivian, Chermak GD, Nimatoudis I (2020) Assessment of Functional Hearing in Greek-Speaking Children Diagnosed with Central Auditory Processing Disorder. J Am Acad Audiol 27:395\u0026ndash;405\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIliadou V, Bamiou D-E, Kaprinis S, Kandylis D, Kaprinis G (2009) Auditory Processing Disorders in children suspected of Learning Disabilities\u0026mdash;A need for screening? Int J Pediatr Otorhinolaryngol 73:1029\u0026ndash;1034\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSofokleous V, Marmara M, Panagiotopoulos GK et al (2020) Test-retest reliability of the Greek Speech-in-babble test (SinB) as a potential screening tool for auditory processing disorder. Int J Pediatr Otorhinolaryngol 131:109848\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMusiek FE, Shinn JB, Jirsa R, Bamiou D-E, Baran JA, Zaida E (2005) GIN (Gaps-In-Noise) Test Performance in Subjects with Confirmed Central Auditory Nervous System Involvement. Ear Hear 26:608\u0026ndash;618\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTzavaras A, Kaprinis G, Gatzoyas A (1981) Literacy and hemispheric specialization for language: Digit dichotic listening in illiterates. Neuropsychologia 19:565\u0026ndash;570\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEichele T, Nordby H, Rimol LM, Hugdahl K (2005) Asymmetry of evoked potential latency to speech sounds predicts the ear advantage in dichotic listening. Cogn Brain Res 24:405\u0026ndash;412\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSidiras C, Iliadou V, Nimatoudis I, Reichenbach T, Bamiou D-E (2017) Spoken Word Recognition Enhancement Due to Preceding Synchronized Beats Compared to Unsynchronized or Unrhythmic Beats. Front NeuroSci 11\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSidiras C, Iliadou VV, Nimatoudis I, Bamiou D-E (2020) Absence of Rhythm Benefit on Speech in Noise Recognition in Children Diagnosed With Auditory Processing Disorder. Front NeuroSci 14\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCramer D, Howitt DL (2004) The SAGE Dictionary of Statistics: A Practical Resource for Students in the Social Sciences. SAGE\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRance G, McKay C, Grayden D (2004) Perceptual Characterization of Children with Auditory Neuropathy. Ear Hear 25:34\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWieland EA, McAuley JD, Dilley LC, Chang S-E (2015) Evidence for a rhythm perception deficit in children who stutter. Brain Lang 144:26\u0026ndash;34\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBeal DS, Cheyne DO, Gracco VL, Quraan MA, Taylor MJ, De Nil LF (2010) Auditory evoked fields to vocalization during passive listening and active generation in adults who stutter. NeuroImage 52:1645\u0026ndash;1653\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKikuchi Y, Ogata K, Umesaki T, Yoshiura T, Kenjo M, Hirano Y, Okamoto T, Komune S, Tobimatsu S (2011) Spatiotemporal signatures of an abnormal auditory system in stuttering. NeuroImage 55:891\u0026ndash;899\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSavelkoul EM, Zebrowski PM, Feldstein S, Cole-Harding S (2007) Coordinated interpersonal timing in the conversations of children who stutter and their mothers and fathers. J Fluen Disord 32:1\u0026ndash;32\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHowell P, Williams SM (2004) Development of Auditory Sensitivity in Children Who Stutter and Fluent Children. Ear Hear 25:265\u0026ndash;274\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHowell P, Davis S, Williams SM (2006) Auditory abilities of speakers who persisted, or recovered, from stuttering. J Fluen Disord 31:257\u0026ndash;270\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFalk S, M\u0026uuml;ller T, Dalla Bella S (2015) Non-verbal sensorimotor timing deficits in children and adolescents who stutter. Front Psychol 6\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePicoloto LA, Cardoso ACV, Cerqueira AV, de Oliveira CMC (2017) Effect of delayed auditory feedback on stuttering with and without central auditory processing disorders. Codas 29:1\u0026ndash;7\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKell CA, Neumann K, Behrens M, von Gudenberg AW, Giraud AL (2018) Speaking-related changes in cortical functional connectivity associated with assisted and spontaneous recovery from developmental stuttering. J Fluen Disord 55:135\u0026ndash;144\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ede Alencar PBA, Lucas P, de Bortoli A, Bernert E, Rodrigues LM, Branco-Barreiro LP FCA (2020) Acoustically controlled auditory training in children with speech disfluency: a case report. Rev CEFAC 22:e5420\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIsmail N, Shalaby A, Sallam Y, Behairy R, Alsaeed A (2023) Auditory Processing Abilities of Children who Stutter: Effect of Speech Therapy. Egypt J Ear Nose Throat Allied Sci 24:1\u0026ndash;14\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 10 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-otolaryngology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Otolaryngology](https://ejo.springeropen.com/)","snPcode":"43163","submissionUrl":"https://submission.springernature.com/new-submission/43163/3","title":"The Egyptian Journal of Otolaryngology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Auditory processing, stuttering, temporal resolution, rhythm, children with stuttering, hearing","lastPublishedDoi":"10.21203/rs.3.rs-7526955/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7526955/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eStuttering is a neurodevelopmental speech disorder with unclear etiology, linked with auditory processing deficits and associated with Left Ear Advantage. The exact connection between stuttering and auditory processing remains undetermined. The purpose of the current study is to evaluate auditory processing in children with stuttering.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThe clinical group comprised of nine children diagnosed with stuttering, while the control group consisted of nine typically developing children without stuttering. The participants completed an auditory processing battery test including Speech recognition in Babble test, Gaps in Noise test, Dichotic Digits test and Word Recognition-Rhythm Component test. The Mann- Whitney U test was conducted using the Statistical Package for the Social Sciences (SPSS) software to analyze the collected data. Additionally, the laterality index was calculated for both groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe clinical group showed a statistically significant decreased performance in the gap detection task and in the Word Recognition-Rhythm Component test. The clinical group exhibited a left ear advantage, while the control group exhibited right ear advantage.\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e\u003cp\u003eThese findings indicate that temporal resolution deficits may be present in stuttering which is consistent with the existing literature. Moreover, in this study children with stuttering exhibit a left ear advantage, whereas earlier research has reported inconsistent patterns. Given the small sample size, further studies with larger cohorts are needed to clarify these results.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe present study provides evidence that children who stutter may present auditory temporal processing deficits and atypical auditory asymmetry, highlighting potential risks for broader auditory processing difficulties. These findings underscore the importance of comprehensive assessment of hearing and auditory processing in this population to maximize the therapeutic outcome through auditory training.\u003c/p\u003e","manuscriptTitle":"Auditory Processing and Stuttering: Preliminary data","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-04 01:23:50","doi":"10.21203/rs.3.rs-7526955/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-05T15:39:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-05T15:34:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214666761316192759087163956874111737898","date":"2026-02-12T21:47:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-25T13:26:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153378258554813929396805262876030278859","date":"2025-12-11T04:42:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"326980810155986648904922950661640698333","date":"2025-12-08T03:57:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-22T18:33:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-04T11:30:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-04T11:30:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"The Egyptian Journal of Otolaryngology","date":"2025-09-03T12:19:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-otolaryngology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Otolaryngology](https://ejo.springeropen.com/)","snPcode":"43163","submissionUrl":"https://submission.springernature.com/new-submission/43163/3","title":"The Egyptian Journal of Otolaryngology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"72e81c06-b687-40ae-9880-d66aee9e7f67","owner":[],"postedDate":"November 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-01T21:09:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-04 01:23:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7526955","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7526955","identity":"rs-7526955","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}