The effect of table tennis exercise with cognitive approach on selective attention and severity of stuttering in children with developmental stuttering disorder

Stuttering is known as the most prevalent mental speech disorder. Studies indicate a direct relationship between stuttering and poor attention control. People with stuttering have difficulty concentrating and adjusting attention. Because of difficulty in stuttering treatment as the child grows and ages, it is essential to follow up on this disorder in childhood. Scientists use various therapies, including cognitive therapy, art therapy, and hypnosis, to treat stutterers. Numerous studies have supported the benefits of exercise in controlling cognitive processes, including selective attention, planning, organization, flexibility, and retention associated with working memory.  Recently, researchers have recognized that instead of using a simple aerobic exercise, using physical activities with a cognitive approach is more beneficial for cognition development. In the present study, a racket sport, ping pong, is used for intervention. Research has shown that ping pong exercises as a physical and cognitive physical activity can improve attention and concentration. Therefore, the present study aimed to study the effect of a ping-pong training session on selective attention and stuttering severity in children with stuttering.

 The present study was a case study. In this study, the A-B-A-B design was used. Two boys and a girl with the stuttering disorder ranged 6 to 7 years old were selected. The code of ethics (IR.UI.REC.1398.034) was obtained from the Scientific Research Committee of the University of Isfahan, and the childrenchr('39')s parents completed the consent form. The intervention consisted of 24 sessions of ping pong exercises intending to improve selective attention. Selective attention and stuttering intensity were assessed by the Stroop test and stuttering intensity scale, respectively.  Stroop and stuttering intensity tests were used at intervals of one day between (5 times) to achieve childchr('39')s first baseline (A). Then, the children entered the first intervention stage (B). Intervention time for each child was 16 sessions of ping pong exercises, three sessions a week. In the second stage, the intervention was stopped for one month, and only Stroop and stuttering tests were taken from children (Achr('39')). Then, in the second stage, the intervention was performed again for one month. After that, in the second intervention phase, one month of the intervention was performed again, in which the subjects practiced for eight sessions (Bchr('39')). In this phase, participants entered the training process, and after each training session, the mentioned tests were retaken.

After analyzing the data, the results of the present study showed that the percentage of non-overlapping points (PND) of the subjects for selective attention was 18%, 75% and, 66%, respectively, and the percentage of non-overlapping points (PND) for stuttering intensity, respectively 72%, 68%, and 75% were obtained. Since the higher, the percentage of non-overlapping data, the more confident the intervention can be considered effective. So, according to the obtained results, ping pong exercises were effective on selective attention and the severity of stuttering in children.

Findings of the present study revealed that ping pong exercises were effective in improving selective attention. According to previous studies, ping pong exercises require complex physical coordination and adaptation to constant change, so hard-working cognitive processing requires high cognitive control, decision speed, and especially attention and concentration to improve cognitive functions. In addition, the results of the present study showed that ping-pong exercises were also effective in reducing the severity of stuttering in children. Besides, the research has indicated that there is a relationship between speech mastery and attention. Ping-pong exercises may have reduced stuttering in children by improving selective attention and inhibitory control. The present study is a single case study. It is suggested that in future research, researchers conduct a similar study with a larger sample size so that the results are generalizable.