Temperament Characteristics in Children With Vocal Fold Nodules: A Cross-Sectional Comparative Study

Vocal fold nodules (VFNs) are among the most common causes of pediatric dysphonia and are frequently associated with phonotraumatic vocal behaviors. Although previous studies have examined personality and behavioral characteristics in children with VFNs, temperament-related factors remain relatively understudied. This study aimed to investigate temperament characteristics in children with VFNs, compare them with control peers, and explore their relationship with parent-reported voice handicap.

A total of 102 children participated in this cross-sectional comparative study, including 51 children diagnosed with VFNs and 51 sex-matched controls with a comparable age distribution. Parents completed the Pediatric Voice Handicap Index (PVHI) and age-appropriate temperament questionnaires. The Short Temperament Scale for Children was administered to children aged 4-7 years, whereas the School-Age Temperament Inventory was used for children aged 8-11 years. Group comparisons and correlation analyses were conducted using non-parametric statistical methods.

Children with VFNs demonstrated significantly higher PVHI scores than controls across all subscales and total scores (all P < 0.001). Among children aged 4-7 years, children with VFNs showed significantly higher reactivity scores (P = 0.025). Among children aged 8-11 years, children with VFNs exhibited higher negative reactivity (P = 0.022) and activity levels (P = 0.004), together with lower task persistence (P = 0.003), compared with controls. Among younger children with VFNs, lower persistence was associated with higher PVHI physical and total scores. Among older children with VFNs, negative reactivity was positively associated with the PVHI total score, whereas activity was positively associated with the PVHI functional and emotional scores.

Children with VFNs differed from control peers in certain parent-reported temperament dimensions. These findings indicate associations between the presence of VFNs and temperament characteristics but do not establish whether temperament contributes to phonotraumatic voice use or to the development or maintenance of VFNs. Prospective studies incorporating direct measures of voice-use behaviors are needed to clarify these relationships.