Summary
Introduction
Vocal fold nodules (VNs) in children are benign, bilateral, callous-like lesions at
the junction of the anterior third and posterior two-thirds of the true vocal folds.
Chronic, repetitive, and intense vocal behavior is often cited as the primary etiology;
however, difficulties with emotional adjustment may predispose some children towards
extreme and possibly phonotraumatic vocal activity, thereby contributing secondarily
to the development of VNs.
Objectives
This case-control study examined the association between features of emotional adjustment
and VNs in children.
Methods
Parents of children with VNs (N = 40, Mage = 7.5, SDage = 2.03) and two medical control groups [ie, voice disordered, but not VNs (VDCs;
N = 40, Mage= 7.09, SDage = 2.01) and vocally normal controls (VNCs; N = 40, Mage = 7.6, SDage = 1.54)] participated in the study. Features of emotional adjustment were assessed
using two inventories: the Parent Rating scale for Reactive and Proactive Aggression
and the Revised Child Anxiety and Depression Scale – Parent version.
Results
As compared with the VNCs, children with VNs were significantly more aggressive (P = 0.042, Cohen's d = 0.47) whereas the VDCs were more depressed (P = 0.013, Cohen's d = 0.60). Furthermore, VDCs experienced more separation anxiety than VNs (P = 0.038, Cohen's d = 0.45) and VNCs (P = 0.021, Cohen's d = 0.55). No other significant between-group differences were identified between the VNs
and VDCs.
Conclusions
When present, elevated aggression may represent a risk factor for VNs formation in
children, and possibly influence treatment outcomes. Therefore, the current results
highlight the importance of understanding the role of emotional adjustment in the
evaluation and treatment of dysphonia in children.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Measurement of vocal fold intraglottal pressure and impact stress.J Voice. 1994; 8: 132-144https://doi.org/10.1016/S0892-1997(05)80305-4
- Treatment of vocal nodules: options and outcomes.Am J Speech Lang Pathol. 1999; 8: 209-217https://doi.org/10.1044/1058-0360.0803.209
- The prevalence of vocal fold nodules in school age children.Int J Pediatr Otorhinolaryngol. 2004; 68: 09-412https://doi.org/10.1016/j.ijporl.2003.11.005
- Epidemiological study on vocal disorders in paediatric age.J Prev Med Hyg. 2008; 49: 1-5https://doi.org/10.15167/2421-4248/jpmh2008.49.1.109
- The psychosomatic aspects of children with vocal nodules.Arch Otolaryngol. 1975; 101: 591-595https://doi.org/10.1001/archotol.1975.00780390005002
- Attitudes of children with dysphonia.J Voice. 2008; 22: 197-209https://doi.org/10.1016/j.voice.2006.09.005
- Teachers’ perceptions of adolescent females with voice disorders.Lang Speech Hear Serv Sch. 2013; 44: 174-182https://doi.org/10.1044/0161-1461(2012/11-0097
- Otorhinolaryngologic findings in children with voice deviations.Ann Otol Rhinol Laryngol. 1968; 77: 1027-1041https://doi.org/10.1177/000348946807700603
- Psycho-behavioral characteristics of children with vocal nodules: WPBIC ratings.J Speech Hear Disord. 1989; 54: 306-312https://doi.org/10.1044/jshd.5403.306
- Van den Bergh BRH. factorial temperament structure in stuttering, voice-disordered, and typically developing children.J Speech Lang Hear Res. 2009; 52: 1610-1622https://doi.org/10.1044/1092-4388(2009/07-0065)
- Attention deficit hyperactivity disorder symptoms in children with vocal fold nodules.Int J Pediatr Otorhinolaryngol. 2016; 85: 5-7https://doi.org/10.1016/j.ijporl.2016.03.017
- Vocal characteristics in children with attention deficit hyperactivity disorder.J Voice. 2009; 23: 190-194https://doi.org/10.1016/j.jvoice.2007.09.044
- Personality features of children treated due to vocal nodules.Ann Univ Mariae Curie Sklodowska Med. 2002; 57: 53-57
- Personality traits of children with vocal fold nodules.J Voice. 2019; 33: 801.e1-801.e6https://doi.org/10.1016/j.jvoice.2018.05.001
- Personality in children with vocal fold nodules: a multitrait analysis.J Speech Lang Hear Res. 2021; 64: 3742-4758https://doi.org/10.1044/2021_JSLHR-21-00144
- Vocal fold nodules in school age children: attention deficit hyperactivity disorder as a potential risk factor.J Voice. 2015; 29: 287-291https://doi.org/10.1016/j.jvoice.2014.07.019
- Vocal fold nodules among Egyptian children and adolescents: behavior aspects.Egyptian J Ear Nose Throat Allied Sci. 2021; 22: 1-12
- Self-regulation in children with vocal fold nodules: a multilevel analysis.J Commun Disord. 2022; 97106203https://doi.org/10.1016/j.jcomdis.2022.106203
- Behavior rating inventory of executive function®, second edition (BRIEF®2).PAR Inc, 2015
- Personality, psychological factors, and behavioral tendencies in children with vocal nodules: a systematic review.J Voice. 2019; 33: 945.e1-945.e18https://doi.org/10.1016/j.jvoice.2018.07.016
- Emotional, social, educational adjustment of higher secondary school students in relation to academic achievement.J Educ Psychol. 2016; 10: 29-35https://doi.org/10.26634/jpsy.10.1.7070
- Developing mechanisms of self-regulation.Dev Psychopathol. 2000; 12: 427-441https://doi.org/10.1017/s0954579400003096
- Emotion understanding and regulation: Implications for positive school adjustment.in: LoBue V Pérez-Edgar K Buss KA Handbook of Emotional Development. Springer, 2019: 467-479
- The development of self-control of emotion: Intrinsic and extrinsic influences.Motivation and Emotion. 2003; 27: 7-26https://doi.org/10.1023/A:1023622324898
- Emotion understanding and regulation: implications for positive school adjustment.in: LoBue V Pérez-Edgar K Buss KA Handbook of Emotional Development. Springer, 2019: 439-467
- Emotion understanding, theory of mind, and prosocial orientation: relations over time in early childhood.J Posit Psychol. 2011; 6: 4-16https://doi.org/10.1080/17439760.2010.536776
- Theory of mind and emotion understanding predict moral development in early childhood.Br J Dev Psychol. 2010; 28: 871-889https://doi.org/10.1348/026151009x483056
- Screaming, yelling, whining and crying: categorical and intensity differences in vocal expressions of anger and sadness in children's tantrums.Emotion. 2011; 11: 1124-1133https://doi.org/10.1037/a0024173
- Temper tantrums in young children: 1. behavioral composition.J Dev Behav Pediatr. 2003; 24: 140-147https://doi.org/10.1097/00004703-200306000-00002
- Emotion regulation and aggression.Aggress Viol Behav. 2012; 17: 72-82https://doi.org/10.1016/j.avb.2011.09.006
- Studying children's intrapersonal emotion regulation strategies from the process model of emotion regulation.J Genet Psychol. 2017; 2: 73-88https://doi.org/10.1080/00221325.2016.1230085
- Emotional competence during childhood and adolescence.in: LoBue V Pérez-Edgar K Buss KA Handbook of Emotional Development. Springer, 2019: 467-479
- Emotions and the development of childhood depression: bridging the gap.Child Dev Perspect. 2008; 2: 141-148https://doi.org/10.1111/j.1750-8606.2008.000056.x
- Preschoolers’ emotion regulation strategy understanding: relations with emotion socialization and child self-regulation.Soc Dev. 2009; 18: 324-352https://doi.org/10.1111/j.1467-9507.2008.00503.x
- Emotion dysregulation, ODD and conduct problems in a sample of five and six-year-old children.Child Psychiatry Hum Dev. 2020; 51: 71-79https://doi.org/10.1007/s10578-019-00911-7
- Social skills and emotional and behavioral traits of preschool children.Soc Behav Person Int J. 2011; 39: 1281-1287https://doi.org/10.2224/sbp.2011.39.9.1281
- Temperamental anger and positive reactivity and the development of social skills: implications for academic competence during preadolescence.Early Educ Dev. 2018; 29: 747-761https://doi.org/10.1080/10409289.2017.1409606
- Vocal fold nodules in children.Curr Opin Otolaryngol Head Neck Surg. 2018; 26: 426-430https://doi.org/10.1097/MOO.0000000000000496
- Vocal fold nodules in children: preferable therapy.Int J Pediatr Otorhinolaryngol. 1999; 49: S303-S306https://doi.org/10.1016/s0165-5876(99)00181-0
- Behavioral characteristics of children with vocal fold nodules.J Voice. 2007; 21: 157-169https://doi.org/10.1016/j.jvoice.2005.11.004
- The motivation background of hyperkinetic dysphonia in children: a contribution to psychologic research in phoniatry.LOGOS. 1961; 4: 28-31
- Comparison of personality characteristics of children with and without vocal nodules based on Rorschach protocol interpretation.Acta Symbolica. 1974; 5: 43
- Psychodiagnostics: aDiagnostic Test Based on Perception.Grune & Stratton, 1942
- The Walker Problem Behavior Identification Checklist. (2nd ed.).Western Psychological Services, 1983
- Manual for the Child Behavior Checklist/4-18 and 1991 Profile.University of Vermont Department of Psychiatry, 1991
- Manual for the ASEBA School-Age Forms & Profiles.University of Vermont, Research Center for Children, Youth, & Families, 2001
- The frequency of perceived stress, anxiety, and depression in patients with common pathologies affecting voice.J Voice. 2008; 22: 478-488
- Stress, anxiety, somatic complaints and voice use in women with vocal nodules: preliminary findings.Am J Speech Lang Pathol. 1996; 5: 44-54
- Anxiety and depression in patients with vocal fold nodules, edema and polyps.Eur Arch Otorhinolaryngol. 2020; 277: 2493-2500
- Manual for the state-trait anxiety inventory.Consulting Psychologists Press, 1983
- An inventory for measuring depression.Arch Gen Psychiatry. 1961; 4: 561-571
- Pediatric voice handicap index (pVHI): a new tool for evaluating pediatric dysphonia.Int J Pediatr Otorhinolaryngol. 2007; 71: 77-82https://doi.org/10.1016/j.ijporl.2006.09.004
- Reliability and validity of the Dutch pediatric Voice Handicap Index.Int J Pediatr Otorhinolaryngol. 2017; 96: 15-20https://doi.org/10.1016/j.ijporl.2017.02.023
- The Damocles syndrome: psychological consequences of surviving childhood cancer.McGraw-Hill, 1981
- Symptoms of posttraumatic stress in young adult survivors of childhood cancer.J Clin Oncol. 2000; 18: 4060-4066https://doi.org/10.1200/JCO.2000.18.24.4060
- A meta-analysis of the effects of psychological interventions in pediatric oncology on outcomes of psychological distress and adjustment.J Pediatr Psychol. 2006; 31: 978-988https://doi.org/10.1093/jpepsy/jsj109
- A parent questionnaire for distinguishing between reactive and proactive aggression in children.Eur Child Adolesc Psychiatry. 2006; 15: 38-45https://doi.org/10.1007/s00787-006-0502-2
- Real-time hostile attribution measurement and aggression in children.Aggress Behav. 2014; 40: 409-420https://doi.org/10.1002/ab.21532
- Reactive and proactive aggression in children: areview of theory, findings and the relevance for child and adolescent psychiatry.Eur Child Adolesc Psychiatry. 2005; 14: 11-19https://doi.org/10.1007/s00787-005-0432-4
- Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale.Behav Res The. 2000; 38: 835-855https://doi.org/10.1016/s0005-7967(99)00130-8
- Research network on youth mental health. A psychometric analysis of the revised child anxiety and depression scale – parent version in a clinical sample.J Abnorm Child Psychol. 2010; 38: 249-260https://doi.org/10.1007/s10802-009-9363-8
- A psychometric evaluation of the revised child anxiety and depression scale – parent version in a school sample.J Abnorm Child Psychol. 2011; 39: 173-185https://doi.org/10.1007/s10802-010-9460-8
- The revised child anxiety and depression scale - short version: scale reduction via exploratory bifactor modeling of the broad anxiety factor.Psychol Assess. 2012; 24: 833-845https://doi.org/10.1037/a0027283
- The revised child anxiety and depression scale – parent version: extended applicability and validity for use with younger youth and children with histories of early-life caregiver neglect.J Psychopathol Behav Assess. 2015; 37: 705-718https://doi.org/10.1007/s10862-015-9494-x
- Using multivariate statistics (5th ed.).Allyn & Bacon/Pearson Education, 2007
- On the generalized distance in statistics.in: Proceedings of the National Institute of Sciences of India. 2. 1936: 49-55
- Statistical power analysis for the behavioral sciences.2nd ed. Lawrence Erlbaum Associates, Publishers, 1988
- Multivariate data analysis.7th ed. Pearson Education International, 2010
Corp I. IBM SPSS statistics for windows, version 26.0. IBM Corp; 2019.
- Social-information-processing factors in reactive and proactive aggression in children's peer groups.J Pers Soc Psychol. 1987; 53: 1146-1158https://doi.org/10.1037/0022-3514.53.6.1146
- Frustration-aggression hypothesis: Examination and reformulation.Psychol Bull. 1989; 106: 59-73https://doi.org/10.1037/0033-2909.106.1.59
- Social information-processing mechanisms on reactive and proactive aggression.Child Dev. 1996; 67: 993-1002https://doi.org/10.2307/1131875
- The voice of neurosis.Grune & Stratton;. 1954;
- Voice re-education of children with vocal nodules.Laryngoscope. 1962; 72: 45-53https://doi.org/10.1288/00005537-196201000-00004
Aronson AE. Clinical voice disorders. An interdisciplinary approach; 1985.
- Personality and voice disorders: a superfactor trait analysis.J Speech Lang Hear Res. 2000; 43: 749-768https://doi.org/10.1044/jslhr.4303.749
- Personality and voice disorders: a multitrait-multidisorder analysis.J Voice. 2000; 14: 521-548https://doi.org/10.1016/s0892-1997(00)80009-0
- Study of the influence of psychological factors in the etiology of vocal nodules in women.J Voice. 2013; 27: 129.e14-129.e20https://doi.org/10.1016/j.jvoice.2011.08.012
- Brief manual for the multidimensional personality questionnaire.University of Minnesota, 1982
- MMPI-2: Manual for administration and scoring.University of Minnesota Press, 1989
- Measurement of the type A behavior patter in children: assessment of children's competitiveness, impatience-anger, and aggression.Child Dev. 1980; 51: 466-475
- Conners’ Rating Scales—Revised.Multi-Health Systems Inc, 1997
- Emotional competence in children with externalizing and internalizing disorders.in: Lewis M. Sullivan M.W. Emotional development in atypical children. Lawrence Erlbaum Associates, 1996: 161-183
- Emotion regulation and understanding implications for child psychopathology and therapy.Clin Psychol Rev. 2002; 22: 189-222https://doi.org/10.1016/s0272-7358(01)00087-3
- Pediatric dysphonia: It's not about the Nodules.Int J Pediatr Otorhinolaryngol. 2019; 125: 147-152https://doi.org/10.1016/j.ijporl.2019.06.031
- Behavior, social competence, and voice disorders in childhood and adolescence.J Voice. 2016; 30: 677-683https://doi.org/10.1016/j.jvoice.2015.08.005
- Emotional/behavioral indicators in children and adolescents with and without vocal problems: self-evaluation and parental evaluation.J Voice. 2021; 35: 664.e1-664.e9https://doi.org/10.1016/j.jvoice.2019.12.025
- The strengths and difficulties questionnaire: aresearch note.J Child Psychol Psychiatry. 1997; 38: 581-586https://doi.org/10.1111/j.1469-7610.1997.tb01545.x
- General anesthesia, surgery and hospitalization in children and their effects upon cognitive, academic, emotional and sociobehavioral development – a review.Paediatr Anaesth. 2004; 14: 910-915https://doi.org/10.1111/j.1460-9592.2004.01350.x
- Signs of emotional disturbance three years after early hospitalization.J Pediatr Psychol. 1996; 21: 353-366https://doi.org/10.1093/jpepsy/21.3.353
- Psychological effects of repeated general anesthesia in children.Paediatr Anaesth. 2006; 16: 822-827https://doi.org/10.1111/j.1460-9592.2006.01867.x
- Emotional responses to peer praise in children with and without a diagnosed externalizing disorder.Merrill-Palmer Quarterly. 1994; 40: 60-81
- Conflict behaviors of maltreated and nonmaltreated children.Child Abuse Negl. 1993; 17: 455-464https://doi.org/10.1016/0145-2134(93)90020-6
- Reappraisal.(editors)in: Sander D Scherer KR Oxford Companion to the Affective Sciences. Oxford University Press, 2009329330
- Cognitive mechanisms in pediatric voice therapy–an initial examination.J Voice. 2021; (S0892-1997(21)00324-6)https://doi.org/10.1016/j.jvoice.2021.09.014
- Bringing the field of infant cognition and perception toward a biopsychosocial perspective.in: Calkins S.D. Handbook of infant development: A biopsychosocial approach. Guilford Press, 2015: 27-37
- Development and maturation of the pediatric human vocal fold lamina propria.Laryngoscope. 2005; 115: 4-15https://doi.org/10.1097/01.mlg.0000150685.54893.e9
- Voice initiation characteristics of normal children and children with vocal nodules: a preliminary investigation.J Commun Disord. 1976; 9: 83-94https://doi.org/10.1016/0021-9924(76)90032-0
- Pediatric vocal fold nodules etiology: what are its usual causes in children?.J Voice. 2018; 31: 506.e19-506.e23https://doi.org/10.1016/j.jvoice.2016.10.007
- A retrospective review of the progression of pediatric vocal fold nodules.JAMA Otolaryngol Head Neck Surg. 2014; 140: 233-236https://doi.org/10.1001/jamaoto.2013.6378
- Cognition and emotion in development.in: LoBue V. Pérez-Edgar K. Buss K.A. Handbook of emotional development (pp. 375–403). Springer Nature, Switzerland AG2019: 375-403
- Antecedent- and response-focused emotion regulation: divergent consequences for experience, expression, and physiology.J Pers Soc Psychol. 1998; 74: 224-237https://doi.org/10.1037//0022-3514.74.1.224
Article info
Publication history
Published online: December 09, 2022
Accepted:
October 25,
2022
Publication stage
In Press Corrected ProofFootnotes
Conference Presentations: The content of this article has been presented as a poster to The American Speech-Language Hearing Association Convention. Washington DC.
Financial Disclosure Statement: The authors have no financial relationships relevant to this article to disclose.
Identification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
