Early Childhood Professionals' Management of Young Children Who Stutter: A Cross-Sectional Study

PURPOSE

Early childhood professionals must accurately identify, refer, and treat children who stutter (CWS) within the scope of their respective roles to ensure each child receives the best possible care. This study aimed to investigate similarities and differences between the practices of speech-language pathologists (SLPs), preschool teachers, and public health nurses when they initially meet a young child reported as stuttering.

METHOD

This cross-sectional study was conducted in Norway. A sample of 342 early childhood professionals (126 preschool teachers, 95 public health nurses, and 121 SLPs) completed an online survey about their management practices with young children reported as stuttering. Descriptive statistics, ordinal regression, and chi-square analyses were used to analyze data.

RESULTS

Initial management practices reflected the different roles and competencies of each profession. Less than 15% of SLPs reported they have access to guidelines for working with CWS. This figure was even lower for public health nurses (6.5%) and preschool teachers (12%). The most common recommendations provided to parents by all professions was giving the child time to talk and maintaining eye contact. Each profession's referral for further speech-language pathology management was most commonly influenced by stuttering severity. All professions reported collaborating about management of CWS; the most common reported collaboration was with preschool teachers.

CONCLUSIONS

Initial management practices varied between professions; however, differences largely reflected the roles and competencies of each profession. The development of guidelines and interdisciplinary seminars is recommended to develop a more complementary approach across professions to improve management practices and ensure young CWS receive the best possible care.

Comparison of Stuttering Severity and Anxiety During Standard and Challenge Phone Calls

PURPOSE

This study was designed to answer three questions. (a) Does percentage of syllables stuttered (%SS) differ between standard and challenge phone calls. (b) Does anxiety differ between standard and challenge phone calls. (c) Is there a relationship between %SS and anxiety during standard and challenge phone calls?

METHOD

Participants were 230 adults diagnosed with stuttering, who were participants from five clinical trials. Each participant received two 10-min phone calls at pretreatment and a further two phone calls 6 months or 20 weeks postrandomization. One phone call was standard, and the other presented challenge: occasionally disagreeing with, interrupting, and talking over participants, or asking for clarification of their views.

RESULTS

Statistically significant, but clinically minor, increases of %SS and anxiety occurred during the challenge phone calls. There was a statistically significant association between %SS and anxiety.

CONCLUSIONS

Variable phone call procedures to assess stuttering severity in clinical trials are not likely to spuriously inflate or deflate treatment outcomes to a clinically important extent. Regardless, the present results suggest that there is statistical merit in controlling the nature of phone calls during clinical trials with the simple and replicable method developed in this report. Additionally, there is procedural merit in the challenge phone call procedure; it is a more valid representation of the challenges of everyday speech than the standard procedure. However, a disadvantage of the challenge phone call procedure is the practical issues associated with its use. The clinical and theoretical applications of the results are discussed.

Speech kinematic variability in adults who stutter is influenced by treatment and speaking style

AIM

We tested whether completion of the Comprehensive Stuttering Program (CSP) is associated with a reduction in speech kinematic variability relative to pre-treatment when adults who stutter (AWS) use a casual speaking manner or fluency skills.

RATIONAL

Kinematic variability is higher in AWS suggesting a sensorimotor vulnerability; however, it is not clear whether high variability is a trait related to the underlying disorder or reflects the mutable state of stuttering. Speech restructuring intervention such as the CSP could support more consistent articulatory control and stable movement patterns.

METHODOLOGY

Thirteen AWS were tested before and after completing the CSP while 11 adults who do not stutter (AWNS) completed a single session. Participants were instructed to use a casual manner of speaking in the first post-treatment session. In the second post-treatment condition, the AWS employed their fluency skills at a control speaking rate. An optical tracking system captured lower lip movements while participants spoke two English phrases and a complex nonword. Across-utterance kinematic variability was measured using the spatiotemporal index (STI) and within-utterance variability was measured with recurrence quantification analysis (RQA).

RESULTS

There was a positive treatment outcome based on significant reductions in percentage syllables stuttered (%SS) during speaking and reading, decreases in stuttering severity and improved perceptions of stuttering and communication confidence. The STI of the AWS decreased significantly after treatment for both speaking styles. The RQA variables indicated that AWS used a less stereotyped and more flexible manner of speaking in the casual condition after treatment, but speech movement regularity increased when using fluency skills.

CONCLUSIONS

The AWS showed a significant decrease in labial kinematic variability alongside a successful treatment outcome involving speech restructuring and cognitive behavioral techniques. These changes in across-utterance and within-utterance kinematic indices demonstrate that effective stuttering treatment can promote speech motor stability along with fluent speech.

Stuttering and the social model

Stuttering has traditionally been thought of as a defect located within an individual. As such, stuttering is caused by pathology, leading to impaired communication and reduced quality of life. Research from this medical tradition has looked to understand the etiology of stuttering to develop curative therapeutic approaches. From this frame, professionals and academics are experts and holders of knowledge; people who stutter the recipients of this expertise. The social model emerged from within the disability rights movement and offers a counter narrative. It sees the way society is structured as disabling rather than physical impairment itself. Disability is experienced when a person is unable to participate fully in society through a mismatch between their body and the environment around them; thus, disability becomes a dynamic process, not an inherent characteristic. The social model highlights society's norms and values, and, in the case of stuttering, demonstrates how society is designed for, and expects, fluent speakers. From this frame, people who stutter are the experts of their experience and holders of knowledge; professionals and academics are their allies, collaborators, and advocates for social change. This theoretical framework poses challenging questions of the foundational theories upon which stuttering therapy is historically rooted. They call into question the hierarchical structures, power dynamics and even purpose of stuttering therapy and research. In this discussion paper, we will explore the social model of disability and its implications for stuttering therapy and research. We discuss the benefits of a social model approach as well as its limitations.

Regarding 'Speech-language pathology students' perceptions of simulation-based learning experiences in stuttering'

As final year medical students, we have had first-hand experience of the significant addition that simulation-based learning can provide for healthcare education. After reading the 2021 paper 'Speech-language pathology students' perceptions of simulation-based learning experiences in stuttering' by Penman et al., we were shown once again the benefits of simulation-based learning. Having said that, we felt there were many crucial aspects omitted in the simulation-based learning program created by Penman et al. for this research article. Therefore, we attempt to highlight these issues with the hope that as students also studying towards a career in healthcare, we can build on the well-developed program created by Penman et al. and make educators aware of the possible areas of improvement in healthcare education.

Systematic review of implementation quality of non-pharmacological stuttering intervention trials for children and adolescents

PURPOSE

This narrative systematic review in line with PRISMA guidelines aims to investigate the implementation quality of previously published group comparison clinical trials of stuttering interventions for children and adolescents (under age 18 years).

METHODS

We searched for publications in the databases Eric, PsychInfo, PubMed and Web of Science using the search terms 'stutt*' or 'stamm*'and 'intervention', 'trial' or 'treatment'. We reviewed the implementation elements reported in studies and how these elements were used to report intervention outcomes.

RESULTS

3,017 references published between 1974-2019 were identified. All references were screened for eligibility using predefined selection criteria resulting in 21 included studies. The implementation quality details reported varied between studies. Existing studies most commonly lacked details about the support system provided to SLPs administering the interventions and monitoring of treatment fidelity both in the clinical setting and in the home environment. Support systems for participant's parents and treatment dosage were generally well reported. Dosage was the most common implementation quality element considered in analyses of treatment effect and within discussions of findings.

CONCLUSION

Findings highlight the need for future clinical trials of stuttering interventions to closely adhere to systematic guidelines for reporting implementation quality to ensure reliability of trial outcomes. A checklist for reporting clinical trials of non-pharmacological stuttering interventions is proposed.

Improving young children's stuttering attitudes in Poland: Evidence for a cross-cultural stuttering inclusion program

BACKGROUND

Young, nonstuttering children around the world have been shown to hold negative stuttering attitudes characterized by limited knowledge about stuttering and how to be a helpful listener. Educational programming using the Attitude Change & Tolerance program (Weidner, 2015, InterACT) has shown promise in improving American children's stuttering attitudes (Weidner, St. Louis, & Glover, 2018), but the utility of the program in other countries is unknown. The purpose of this study was to examine the efficacy of the InterACT program among nonstuttering Polish children.

METHOD

This study was a replication of Weidner et al. (2018). Participants included 43 nonstuttering preschool and first grade Polish children. Children's stuttering attitudes were measured using the Public Opinion Survey of Human Attributes-Stuttering/Child (Weidner & St. Louis, 2014) before and after participating in the Polish translation of the InterACT program.

RESULTS

Pre-post results showed statistically significant improvements in children's overall stuttering attitudes. Most notably, children became more knowledgeable about how to be a supportive listener.

CONCLUSION

This study provides further evidence that young children worldwide have uninformed or negative stuttering attitudes, which are amenable to improvement. It also provides support for the translatability and cultural relevance of the InterACT program.

Conversational speech of school-age children after syllable-timed speech treatment for stuttering

Purpose: The purpose of this laboratory study was to investigate whether rhythmic speech was primarily responsible for stuttering reductions in four school-aged children after the instatement stage of the Westmead Program of syllable-timed speech (STS) intervention. The study was designed to inform further development of the program. Reduction in variability of vowel duration is a marker of STS, and it was predicted that this would be present in the children's conversational speech after Stage 1 of the program if they were using STS. To strengthen such a finding, it was also predicted that there would be no reduction in articulation rate, sentence complexity, and utterance length after treatment, as there is evidence that reductions in these can reduce stuttering. Perceptual judgments of speech quality after treatment were also made by independent listeners.Method: Participants were four children, ages 8-11 years, who completed Stage 1 of an STS program and whose stuttering had reduced significantly. Pre-treatment (PRE) and post-treatment (POST) within-clinic audio-visual recordings of conversational speech were analysed for percentage of syllables stuttered, variability of vowel duration, articulation rate, and length and complexity of utterance. Four blinded listeners made perceptual judgments of speech quality in the POST recordings.Result: Recordings of all children showed that variability of vowel duration clearly reduced from the PRE to POST speech samples. Importantly, articulation rate and language use were not compromised. Some possible indicators of rhythmicity were identified in one child in the perceptual study.Conclusion: The findings suggest that STS was primarily responsible for the clinically significant reductions in stuttering after Stage 1 of the program. There is an urgent need for more evidence-based interventions for stuttering in this age group and further development of STS interventions is warranted.

Obtaining consensus on core components of stuttering intervention for adults: An e-Delphi Survey with key stakeholders

BACKGROUND

Evidence-based practice involves the synthesis of multiple forms of evidence to inform clinical decision-making and treatment evaluation. Practice- and patient-based evidence are two forms of evidence that are under-represented in the stuttering literature. The collection of such knowledge is essential to support the design and delivery of effective stuttering interventions for adults.

AIMS

To build stakeholder consensus on the core components of intervention for adults who stutter, and to establish a guiding framework for the design and development of evidence-based interventions for adults who stutter.

METHODS & PROCEDURES

Adults who stutter and speech and language therapists (SLTs) with experience in providing stuttering intervention participated in the three-round e-Delphi Survey focused on: (1) identifying key stuttering intervention components, including principles, practices, and structural and contextual elements; and (2) obtaining group consensus on stuttering intervention components. Statements were categorized using the International Classification of Functioning, Disability and Health (ICF) model adapted to the study of stuttering.

OUTCOMES & RESULTS

A total of 48 individuals agreed to participate: 48/48 (100%) completed the Round 1 questionnaire, 40/48 (83%) responded to Round 2 and 36/40 (90%) participated in Round 3. Following content analysis of Round 1, 101 statements were developed, and consensus was achieved on 89 statements perceived as representing the core components of stuttering intervention for adults. Categorization of these statements reflected the key stuttering intervention components relating to personal reactions to stuttering, limitations in life participation and environmental factors.

CONCLUSIONS & IMPLICATIONS

Consensus on the core components of stuttering intervention was reached through engagement with key stakeholders. The evidence-based framework presented highlights the range of key intervention components a clinician should consider when designing interventions for adults who stutter.

WHAT THIS PAPER ADDS

What is already known on the subject Evidence-based practice endorses the synthesis of multiple knowledge forms including research, practice and patient evidence to support clinical decision-making and treatment evaluation. The stuttering literature is characterized by an over-representation of efficacy evidence, with significantly less practice and patient evidence to guide clinical practice. What this paper adds to existing knowledge This study adds valuable practice- and patient-based evidence for effective stuttering intervention components for adults who stutter. These relate to personal reactions to stuttering, limitations in life participation and environmental factors. What are the potential or actual clinical implications of this work? This research presents a stakeholder-informed framework for stuttering intervention to guide SLTs working with adults who stutter in designing evidence-based interventions. The framework supports the adoption of a person-centred approach to intervention to ensure each client's unique needs, preferences, values and desired outcomes are explored and integrated into therapy.

Parental perceptions towards childhood stuttering in Sri Lanka

INTRODUCTION

Parental perceptions towards stuttering is an important consideration as parents play a crucial role in the initial identification and management of stuttering in young children. Although several studies have been conducted on parental perceptions towards childhood stuttering in other countries, little is known about how stuttering is perceived and managed by parents in Sri Lanka.

AIMS

This study explored Sri Lankan parents' perceptions towards childhood stuttering and their experiences regarding attending speech and language therapy for stuttering.

METHODOLOGY

Using a qualitative approach, 15 parents of children who stutter were recruited from a stuttering clinic at a state university in Sri Lanka. Parents participated in semi-structured interviews with the first author. The interviews were conducted via telephone in Sinhala language, recorded, transcribed verbatim in Sinhala and then translated into English. The data were analysed using thematic analysis.

RESULTS

Five themes emerged from the data: (1) limited knowledge about stuttering and management (2) influence of religion and culture on stuttering (3) variable responses to stuttering (4) impact of stuttering on the parent and child (5) impact and engagement in speech therapy.

CONCLUSION

The findings highlighted the need to educate the Sri Lankan public about stuttering as a communication disorder and raise awareness about the profession of speech language therapy in the country. Specifically, it is important for other health professionals and teaching professionals to learn more about stuttering, so that appropriate early referrals can be made for speech and language therapy, lessening the impact on children and their families.

Influence of gestures on the intelligibility and comprehensibility of utterances with stuttering events in individuals with Down syndrome

INTRODUCTION

Individuals with Down syndrome (DS) often stutter, which can affect their speech intelligibility. Previous research has shown that manual signs can enhance speech intelligibility and comprehensibility. It remains unclear to what extent spontaneous hand gestures, such as iconic and beat gestures, may enhance intelligibility and/or comprehensibility during utterances with stuttering events.

METHODS

Eleven individuals with DS who stutter provided video-recorded speech samples. From these samples, 60 utterances containing a stuttering event were selected. In half of them, the stuttering events were accompanied by gestures; in the other half, the stuttering events were not accompanied by gestures. The samples were shown to 250 assessors who were blind to the study's goals. Each sample was shown in three visibility conditions: 1) video-with-audio, 2) video-with-audio but with the speaker's mouth covered and 3) audio-only. The assessors rated speech intelligibility on a 7-point Likert scale and transcribed the speech sample. The effect of gesture production, gesture type and the visibility conditions on comprehensibility and intelligibility was examined with a hierarchical multiple linear regression.

RESULTS

When a speaker had used a gesture during a stuttering event, the Likert scale score increased with 0.47 and the accuracy of transcription with 9.07%. There was no difference in effect between the different gesture types. Despite the effect from gesture use, there was no effect of the visibility conditions on the Likert scale or transcription score.

CONCLUSIONS

Gestures positively affect intelligibility and comprehensibility of utterances with stuttering events in individuals with DS by altering the speech production. The possibility of beat gestures as a therapy method should be examined, with caution for the development of maladaptive behaviours.

The Fluency Trust Residential Course for young people who stutter: A pragmatic feasibility study

INTRODUCTION

A feasibility study of The Fluency Trust Residential Course (FTRC) for adolescents who stutter was conducted. The study aimed to measure key areas of a feasibility trial, for example, recruitment and retention, outcome measure completion, outcome measure reliability, and acceptability of the intervention to inform future research into the FTRC.

METHODS

Quantitative and qualitative methods were used. Participants were 23 adolescents (12-17 years), 23 parents and 2 Speech-Language Pathologists (SLPs) from the FTRC. Data collection included: outcome measure collection via a pre-test post-test quasi-experimental design (including two baseline measures), intervention fidelity checklists, semi-structured interviews with adolescents to explore acceptability of the intervention and semi-structured interviews with SLPs to explore their experiences of research participation and views on a future trial.

RESULTS

Recruitment, retention and outcome measure completion levels were all 100%. Intervention fidelity was 95% and there were no adverse events. Outcome measures showed good test- re-test reliability: Progress Questionnaire Child Intraclass Correlation Coefficient (ICC) = 0.87 (95% CI = 0.69-0.94 sig< 0.001) and Progress Questionnaire Parent ICC = 0.88 (95% CI = 0.70-0.95 sig< 0.001). Descriptive statistics showed that group medians and means of all outcome measures shifted in a positive direction between pre and post-tests (9 weeks follow-up). Twenty-five percent of young people showed changes on the Progress Questionnaire Child that were above the minimal important difference. Seventy-five percent of parents showed changes on the Progress Questionnaire Parent that were above the minimal important difference. Acceptability of the intervention by adolescents was high. SLPs reported participation was manageable and they were pleased to be part of the research.

CONCLUSION

Quantitative and qualitative data suggest that a future definitive trial of the FTRC is indicated after additional development work and feasibility testing. Recommendations for further research are included.

Contemporary issues with stuttering: The Fourth Croatia Stuttering Symposium

PURPOSE

During the 2019 Fourth Croatia Clinical Symposium, speech-language pathologists (SLPs), scholars, and researchers from 29 countries discussed speech-language pathology and psychological practices for the management of early and persistent stuttering. This paper documents what those at the Symposium considered to be the key contemporary clinical issues for early and persistent stuttering.

METHODS

The authors prepared a written record of the discussion of Symposium topics, taking care to ensure that the content of the Symposium was faithfully reproduced in written form.

RESULTS

Seven contemporary issues for our field emerged from the Symposium.

CONCLUSION

Effective early intervention is fundamental to proper health care for the disorder. However, as yet, there is no consensus about the timing of early intervention and how it should be managed. Currently, clinical translation is a barrier to evidence-based practice with early stuttering, and proactive strategies were suggested for junior SLPs. Apprehension emerged among some discussants that treatment of early stuttering may cause anxiety. For persistent stuttering, assessment procedures were recommended, as were strategies for dealing with childhood bullying. There was agreement that SLPs are the ideal professionals to provide basic cognitive-behavior therapy for clients with persistent stuttering. Questions were raised about our discipline standards for basic professional preparation programs for stuttering management.

Psychological characteristics of early stuttering

PURPOSE

The purpose of this study was to use psychological measures of pre-schoolers who stutter and their parents to inform causal theory development and influence clinical practices. This was done using data from a substantive clinical cohort of children who received early stuttering treatment.

METHOD

The cohort (N = 427) comprised parents and their children who were treated with the Lidcombe Program, the Westmead Program, and the Oakville Program. The study incorporated demographic information, stuttering severity, and child and parent psychological measures prior to treatment.

RESULT

The cohort revealed nothing unusual about behavioural and emotional functioning, or the temperaments, of pre-school children that would influence treatment, be targeted during treatment, or influence causal theory development. However, a third of parents were experiencing moderate to high life stressors at the time of seeking treatment, and half the parents failed first-stage screening for Anankastic Personality Disorder.

CONCLUSION

The present results are consistent with a number of previous reports that showed that the population of pre-schoolers who stutter have no unusual psychological profiles. Hence, these results suggest that the association between mental health and stuttering later in life is a consequence of the disorder rather than being a part of its cause. The finding of the life stress of parents who seek stuttering treatment for pre-school children has potential clinical importance and warrants further investigation. Further psychological research is required about parents of pre-school children who stutter, because half the parents in the cohort failed the screener for Anankastic Personality Disorder. This is of interest because a previous study associated screening failure for another personality disorder (Impulsive Personality Disorder) with treatment dropout for early childhood stuttering.

Interventions for children and adolescents who stutter: A systematic review, meta-analysis, and evidence map

PURPOSE

This systematic review critically appraises and maps the evidence for stuttering interventions in childhood and adolescence. We examine the effectiveness of speech-focused treatments, the efficacy of alternative treatment delivery methods and identify gaps in the research evidence.

METHODS

Nine electronic databases and three clinical trial registries were searched for systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with children (2-18 years) who stutter. Pharmacological interventions were excluded. Primary outcomes were a measure of stuttering severity and quality assessments were conducted on all included studies.

RESULTS

Eight RCTs met inclusion criteria and were analysed. Intervention approaches included direct (i.e. Lidcombe Program; LP) and indirect treatments (e.g. Demands and Capacities Model; DCM). All studies had moderate risk of bias. Treatment delivery methods included individual face-to-face, telehealth and group-based therapy. Both LP and DCM approaches were effective in reducing stuttering in preschool aged children. LP had the highest level of evidence (pooled effect size=-3.8, CI -7.3 to -0.3 for LP). There was no high-level evidence for interventions with school-aged children or adolescents. Alternative methods of delivery were as effective as individual face-to-face intervention.

CONCLUSION

The findings of this systematic review and evidence mapping are useful for clinicians, researchers and service providers seeking to understand the existing research to support the advancement of interventions for children and adolescence who stutter. Findings could be used to inform further research and support clinical decision-making.

Applying the Transtheoretical Model to Stuttering Management Among Adolescents: Part I. Scale Development

Purpose This article is the first in a two-part series on the application of the Transtheoretical Model to stuttering management among adolescents. In this article, we describe the process of developing measures to assess stage of change (SOC) by defining behaviors of stuttering management, as well as the two primary cognitive constructs that underlie one's readiness to make behavioral change: decisional balance (DB) and situational self-efficacy (SSE). This work hinges on the ability to develop an operational definition of what it means to successfully manage or do something positive about one's stuttering. Method We used an iterative process to develop the three scales. Through qualitative analysis of key informant interview and focus group transcripts with 24 adolescents who stutter and 26 clinicians specializing in stuttering, we developed stuttering-specific SOC, DB, and SSE scales. The drafted scales were cognitively tested with nine adolescents who stutter. Results Thematic analysis yielded a three-part definition of successful stuttering management that formed the basis for the SOC scale: (a) learning and using strategies to modify speech or stuttering, (b) changing negative thoughts and attitudes regarding stuttering, and (c) talking without avoiding sounds, words, or situations. Results from this analysis support a broader view of successful stuttering management; that is, it is likely that doing so requires more than just behavior change, which has long been considered the main objective of stuttering treatment. Additional analyses yielded pros and cons of managing stuttering (62 items for the DB scale) and situations in which it is difficult to manage stuttering (39 items for the SSE scale). Conclusions Qualitative analyses provided a three-part definition of "stuttering management" and a comprehensive pool of items that would allow measurement of DB and SSE that underlie readiness to manage stuttering among adolescents. In the companion article in this two-part series, we describe the next step in scale development: exploratory scale validation of the drafted SOC, DB, and SSE scales.

Applying the Transtheoretical Model to Stuttering Management Among Adolescents: Part II. Exploratory Scale Validation

Purpose This article is the second in a two-part series on the application of the Transtheoretical Model to stuttering management among adolescents. The purpose of this article was to apply and explore the validity of newly developed Transtheoretical measures for adolescents who stutter. Method The online survey was completed by a national sample of 173 adolescents who stutter between the ages of 13 and 21 years. The multipart survey included a Stage of Change scale, Decisional Balance scale, and Situational Self-Efficacy scale. Participants also completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES), either the teenage or adult version depending on the participant's age, so preliminary construct validity of the new scales could be examined. Exploratory factor analyses were conducted to determine model fit and reduce the scales to the most meaningful items. External validity of the three-part survey was examined by comparing OASES scores across stage of change as well as evaluating the functional relations between the three scales. Results Adolescents' readiness to manage stuttering could be clearly described with five discrete stages, although most of the respondents reported being in the Maintenance stage. The pros of managing stuttering reliably predicted stage placement. Internal consistency of the scales ranged from good to excellent. OASES scores differed across stages of readiness in complex but predictable ways. Conclusions These findings suggest that the Transtheoretical Model fits the target behaviors involved stuttering management among adolescents. Further examination of the application of the model to validate a stage-based framework for change among individuals who stutter is warranted.

Consensus Guidelines for the Assessments of Individuals Who Stutter Across the Lifespan

Purpose This project sought to develop consensus guidelines for clinically meaningful, comprehensive assessment procedures for people who stutter across the lifespan. Method Twelve expert clinicians and researchers who have written extensively about stuttering provided detailed descriptions of the type of data that they routinely collect during diagnostic evaluations of preschool children, school-age children, adolescents, and adults who stutter. Iterative content analysis, with repeated input from the respondents, was used to identify core areas that reflect common domains that these experts judge to be important for evaluating stuttering for varying age groups. Results Six core areas were identified as common components of a comprehensive evaluation of stuttering and people who stutter. These areas should be included to varying degrees depending upon the age and needs of the client or family. The core areas include the following: (a) stuttering-related background information; (b) speech, language, and temperament development (especially for younger clients); (c) speech fluency and stuttering behaviors; (d) reactions to stuttering by the speaker; (e) reactions to stuttering by people in the speaker's environment; and (f) adverse impact caused by stuttering. Discussion These consensus recommendations can help speech-language pathologists who are uncertain about appropriate stuttering assessment procedures to design and conduct more thorough evaluations, so that they will be better prepared to provide individualized and comprehensive treatment for people who stutter across the lifespan.

Speech-language pathology students' perceptions of simulation-based learning experiences in stuttering

BACKGROUND

Research suggests that some speech-language pathologists are uncomfortable treating people who stutter. Accessing quality clinical education experiences in stuttering is difficult given the ongoing rise in students enrolled in speech-language pathology programmes and the limited number of stuttering-specific placements available. Simulation-based learning is a viable option for providing speech-language pathology students with practical experience in a safe learning environment. Whilst research has found that simulation-based learning experiences in stuttering assist in the development of students' clinical skills, students' perceptions of participating in stuttering simulation-based learning are yet to be explored.

AIMS

To investigate speech-language pathology students' comfort, anxiety, knowledge and confidence in the management of stuttering at the commencement of an academic stuttering course and before and following participation in a stuttering simulation-based learning programme.

METHODS & PROCEDURES

This study used a cross-sectional survey design. Participants were 105 undergraduate and graduate entry masters speech-language pathology students enrolled at an Australian university. Students engaged in a stuttering simulation-based learning programme embedded within an existing academic course on the management of stuttering. A purposefully developed survey was administered at three time points: pre-course (T1), pre-simulation (T2) and post-simulation (T3) in order to explore students' comfort and anxiety levels, and perceptions of their knowledge and confidence in stuttering management. Descriptive statistics were used to report the medians and range of students' responses. Changes across all time points and between each of the time points were determined using the Friedman test and the Wilcoxon signed rank test, respectively.

OUTCOMES & RESULTS

Statistically significant differences (p < 0.001) were observed on all matched survey items (n = 96) across all time points. Between each time point, a significant difference in students' perceived knowledge levels was found with small to large effect sizes. However, there was no difference in students' perceived comfort and anxiety levels between the time points of pre-course and pre-simulation. Open-ended responses on the post-simulation survey revealed that students valued learning about stuttering within a simulation-based learning environment.

CONCLUSIONS & IMPLICATIONS

Simulation-based learning experience in stuttering management was valued by students. When accompanied by theoretical content, participation in a stuttering simulation-based learning programme supported students to feel more comfortable and less anxious about working with people who stutter. This finding has implications for the development of clinical skills in the assessment and treatment of adults who stutter.

WHAT THIS PAPER ADDS

What is already known on this subject Simulation is a teaching approach used within speech-language pathology to support the development of students' clinical skills. Simulation provides a safe learning environment for students, an opportunity for repeated practice and is valued by students. What this paper adds to existing knowledge This study explored students' perceptions of their comfort, anxiety, knowledge and confidence in working with people who stutter before and following participation in a simulation-based learning programme. It describes a stuttering simulation-based learning programme that can be embedded into speech-language pathology programme curricula. What are the potential or actual clinical implications of this work? The stuttering simulation-based learning programme detailed in this study can be applied and embedded in speech-language pathology curricula. It can be used to support the development of students' confidence in the assessment and management of stuttering.

Does a simulation-based learning programme assist with the development of speech-language pathology students' clinical skills in stuttering management?

BACKGROUND

Simulation-based learning can be used in university programmes to provide speech-language pathology students with essential clinical experiences. However, limited research has explored the use of simulation to support students' development of skills in clinical practice with people who stutter.

AIMS

(1) To evaluate students' clinical skills in managing stuttering within a simulation-based learning programme; (2) to develop an assessment tool, the Standardised Patient Interview Rating Scale for Stuttering (SPIRS-Stuttering); and (3) to conduct a preliminary investigation of its validity in measuring students' performance.

METHODS & PROCEDURES

Speech-language pathology students (n = 114) participated in a simulation-based stuttering programme in addition to academic coursework in fluency disorders. Students' clinical skills were assessed over two simulation sessions using the SPIRS-Stuttering tool, adapted from an earlier iteration of the SPIRS tool. Content validity, intra-rater reliability and internal consistency of the SPIRS-Stuttering tool were also explored.

OUTCOMES & RESULTS

Students demonstrated a statistically significant improvement in stuttering clinical skills between sessions 1 and 4 of the simulation-based stuttering programme. Good content validity was achieved for the SPIRS-Stuttering tool with a low level of intra-rater reliability and variable internal consistency.

CONCLUSIONS & IMPLICATIONS

This study identified that students' clinical skills in stuttering improved during participation in a simulation-based programme undertaken in conjunction with an academic course on fluency disorders. The results of this study support the inclusion of this learning modality in university programme curricula. Whilst the SPIRS-Stuttering tool enabled assessment of speech-language pathology students' clinical skills in stuttering management, further exploration of reliability is required.

WHAT THIS PAPER ADDS

What is already known on this subject Within speech-language pathology, simulation-based learning is a teaching approach used in university clinical programme curricula. Simulation-based learning is used as an opportunity for students to gain specific clinical skills, particularly if clinical experiences are readily not available. Research in speech-language pathology has revealed that students value simulation because it provides a safe learning environment. What this study adds to existing knowledge There are fewer opportunities for students to gain clinical experience in the management of stuttering in adults. This study explored students' clinical skill development within a stuttering simulation-based learning programme. Additionally, it detailed the development and preliminary investigation of validity of the SPIRS-Stuttering, an assessment tool used in a simulation-based learning environment. What are the potential or actual clinical implications of this work? Students' clinical skills in the assessment and management of stuttering in adults, as measured by the SPIRS-Stuttering, improved during participation in the stuttering simulation-based learning programme. Further investigation of validity of the SPIRS-Stuttering tool is required to confidently measure students' performance. The stuttering simulation-based learning programme can be used to provide students with an opportunity to develop their clinical skills in stuttering, a practice area in speech-language pathology that is not always available to students.

Parents' Perceptions of the Overall Impact of Stuttering on Young Children

Introduction Research has revealed the presence of emotional, behavioral, and cognitive reactions in young children who stutter; however, prior studies have not examined the overall impact of stuttering on young children's lives. Such information is necessary for improving understanding of how stuttering affects young children and for ensuring appropriate early intervention. Method This study employed an adaptation of the Overall Assessment of the Speaker's Experience of Stuttering for School-Age Children that was designed to ask parents about their perceptions of the impact of stuttering on their young children. Thirty-eight parents of young children who stutter (2-5 years of age) provided their perceptions of the impact of stuttering on their children. Parents rated how certain they were in their judgments using a 5-point scale to provide an indication of their confidence in proxy ratings of impact. Results Results indicated that, on average, parents perceived that stuttering affected their children negatively. Qualitatively, parents provided descriptions of the impact of stuttering on their children's quality of life, communication difficulties across people and situations, and reactions to stuttering; they also commented on their own feelings and strategies for handling impact. On average, parents perceived themselves to be certain in rating the impact of stuttering on their children. Conclusions Results indicated that parents identified adverse impact in their children's lives. Even though parents considered themselves to be certain in their impact ratings, clinicians and researchers should also assess the perspective of the children if appropriate. This is because present findings reveal that parents may not have insight into all aspects of impact, in particular, cognitive reactions to stuttering. Still, parents' perceptions of impact are important for clinicians to consider when giving recommendations for therapy, as they can provide important insight into the family's needs.

Non-pharmacological interventions for stuttering in children six years and younger

BACKGROUND

Stuttering, or stammering as it is referred to in some countries, affects a child's ability to speak fluently. It is a common communication disorder, affecting 11% of children by four years of age. Stuttering can be characterized by sound, part word or whole word repetitions, sound prolongations, or blocking of sounds or airflow. Moments of stuttering can also be accompanied by non-verbal behaviours, including visible tension in the speaker's face, eye blinks or head nods. Stuttering can also negatively affect behavioural, social and emotional functioning.

OBJECTIVES

Primary objective To assess the immediate and long-term effects of non-pharmacological interventions for stuttering on speech outcomes, communication attitudes, quality of life and potential adverse effects in children aged six years and younger. Secondary objective To describe the relationship between intervention effects and participant characteristics (i.e. child age, IQ, severity, sex and time since stuttering onset) at pretest.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsycINFO, nine other databases and two trial registers on 16 September 2020, and Open Grey on 20 October 2020. There were no limits in regards to language, year of publication or type of publication. We also searched the reference lists of included studies and requested data on unpublished trials from authors of published studies. We handsearched conference proceedings and programmes from relevant conferences.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) and quasi-RCTs that assessed non-pharmacological interventions for stuttering in young children aged six years and younger. Eligible comparators were no intervention, wait list or management as usual.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We identified four eligible RCTs, all of which compared the Lidcombe Program to a wait-list control group. In total, 151 children aged between two and six years participated in the four included studies. In the Lidcombe Program, the parent and their child visit a speech and language therapist (SLT) in a clinic. One study conducted clinic visits by telephone. In each clinic visit, parents were taught how to conduct treatment at home. Two studies took place in Australia, one in New Zealand and one in Germany. Two studies were conducted for nine months, one for 16 weeks and one for 12 weeks. The frequency of clinic visits and practice sessions at home varied within the programme. One study was partially funded by the Rotary Club, Wiesbaden, Germany; and one was funded by the National Health and Medical Research Council of Australia. One study did not report funding sources and another reported that they did not receive any funding for the trial.  All four studies reported the outcome of stuttering frequency. One study also reported on speech efficiency, defined as articulation rate. No studies reported the other predetermined outcomes of this review, namely stuttering severity; communication attitudes; emotional, cognitive or psychosocial domains; or adverse effects.  The Lidcombe Program resulted in a lower stuttering frequency percentage syllables stuttered (% SS) than a wait-list control group at post-test, 12 weeks, 16 weeks and nine months postrandomization (mean difference (MD) -2.16, 95% confidence interval (CI) -3.48 to -0.84, 4 studies, 151 participants; P = 0.001; very low-certainty evidence).  However, as the Lidcombe Program is designed to take one to two years to complete, none of the participants in these studies had finished the complete intervention programme at any of the data collection points. We assessed stuttering frequency to have a high risk of overall bias due to high risk of bias in at least one domain within three of four included studies, and to have some concern of overall bias in the fourth, due to some concern in at least one domain. We found moderate-certainty evidence from one study showing that the Lidcombe Program may increase speech efficiency in young children. Only one study reported outcomes at long-term follow-up. The long-term effect of intervention could not be summarized, as the results for most of the children in the control group were missing. However, a within-group comparison was performed between the mean % SS at randomization and the mean % SS at the time of extended follow-up, and showed a significant reduction in frequency of stuttering.  AUTHORS' CONCLUSIONS: This systematic review indicates that the Lidcombe Program may result in lower stuttering frequency and higher speech efficiency than a wait-list control group in children aged up to six years at post-test. However, these results should be interpreted with caution due to the very low and moderate certainty of the evidence and the high risk of bias identified in the included studies. Thus, there is a need for further studies from independent researchers, to evaluate the immediate and long-term effects of other non-pharmacological interventions for stuttering compared to no intervention or a wait-list control group.

Evaluation of an integrated fluency and Acceptance and Commitment Therapy intervention for adolescents and adults who stutter: Participant perspectives

PURPOSE

Childhood-onset stuttering is a neurodevelopmental disorder that may cause pervasive negative consequences for adults who stutter. In addition to significant challenges in personal, social, and emotional domains, stuttering has been shown to impose an economic burden on adults who stutter. Intervention for adults who stutter has historically addressed speech fluency more so than the covert psychosocial aspects of the disorder. There is an identified clinical need for holistic, efficacious, and cost-effective stuttering interventions that meet consumer needs. The purpose of the present study is to evaluate a novel, integrated intervention that combined traditional fluency techniques with Acceptance and Commitment Therapy, from the perspective of the adults who stutter who participated in the intervention.

METHOD

Twenty-eight adults who stutter completed the intervention program. Participants were invited to complete an online post-program written survey (including qualitative comments) and a semi-structured interview to explore their evaluations of the program with respect to its authenticity, acceptability, and social validity.

RESULTS

Participants perceived positive psychosocial changes as a result of the program, and were satisfied with the program overall. Qualitative thematic analyses of the written survey comments and the semi-structured interviews identified two major themes: factors specific to the intervention and factors specific to the therapeutic process. Several important sub-themes were also identified.

CONCLUSION

Findings support the authenticity, acceptability, and social validity of an integrated fluency and psychosocial intervention for stuttering. Findings also highlight the need for consideration of the consumer voice in the management of stuttering disorders, in keeping with person-centred care.

Perspectives of stuttering treatment: Children, adolescents, and parents

PURPOSE

Researchers investigated whether children who stutter (CWS), adolescents who stutter (ADWS), and their parents preferred treatment focused on changing speech or communicating regardless of stuttering.

METHODS

Twenty-four parents and their CWS (n = 11, ages 8;0-12;11) or ADWS (n = 13, ages 13;0-17;11) answered questions about their preferences for stuttering treatment via an internet-based survey; an additional 11 surveys were filled in only by parents without responses by their child/adolescent. The researchers compared responses of the parents and their children, as well as between the two age groups and years in treatment (less than five years versus five or more years).

RESULTS

Views tended to be mixed without any clear trends based on age. Just over half of the CWS, ADWS, and parents of CWS indicated a general tendency for therapy satisfaction; however, less years of treatment were associated with more satisfaction. When presented with a specific scenario, a higher proportion of parents expressed focus on their child saying what they want to say, regardless of stuttering. Otherwise, preferences were mixed on therapy goals of speaking freely vs. speaking more fluently.

CONCLUSIONS

Preferences for treatment goals do not predictably vary based on age or years in treatment; given the small sample size, these findings should be considered with caution. Given the variability in responses, it is evident that stuttering treatment for school-age children and adolescents should be individualized. These results also emphasize the importance of communication, education, and applying a person-centered approach when providing stuttering intervention to children, adolescents, and their parents.

Perceptions of self-efficacy in providing multidimensional school-age stuttering therapy among board certified fluency specialists in the United States

PURPOSE

The purpose of this study was to document fluency specialists' self-efficacy beliefs for providing multidimensional treatment to children who stutter and to identify cognitive, affective, and behavioral correlates of self-efficacy.

METHOD

Sixty-six Board Certified Specialists in Fluency in the United States completed an online survey measuring self-efficacy in providing multidimensional stuttering therapy, perceived importance of multidimensional aspects of therapy, feelings of comfort in providing therapy, perceived treatment success, and employment and demographic questions. Open-ended questions were also asked for participants to describe why they chose to specialize and what benefits they received from it.

RESULTS

Participants reported high levels of self-efficacy (averages above 9 on a scale from 0 to 10) in speech-related, cognitive, emotional, and social domains of stuttering therapy, as well as high levels of comfort and clinical success. Higher ratings of overall self-efficacy were significantly correlated with beliefs about the importance of multidimensional treatment, τ = 0.27, treatment comfort, τ = 0.25, and self-reported treatment success, τ = .49. Responses indicated that many participants believed that their self-efficacy grew because of specialty certification.

CONCLUSION

Although not the same as treatment outcome data, self-efficacy among clinical service providers is an important variable to consider. Board Certified Specialists in Fluency in the United States report very high levels of self-efficacy for school-age stuttering treatment. The process of certification helps to increase self-efficacy and provides a means for advertising competence in stuttering treatment. This information could help in recruiting the next generation of fluency specialists.

A Preliminary Comparison of In-Person and Telepractice Evaluations of Stuttering

Purpose The purpose of this study was to compare in-person and telepractice evaluations of stuttering with adult participants. The research questions were as follows: Is an evaluation for stuttering via telepractice equivalent to an in-person evaluation in terms of (a) duration of individual evaluation tasks and overall length of the evaluation, (b) clinical outcomes across evaluating clinicians, and (c) participant experience? Method Participants were 14 adults who stutter (males = 11; age range: 20-68) who were simultaneously assessed via telepractice and in-person. Comprehensive evaluations included analysis of the speaker's stuttering, evaluation of the speaker's perceptions and attitudes about stuttering, and language testing. Evaluations were administered by either an in-person clinician or a telepractice clinician but were simultaneously scored by both clinicians. Participants were randomly assigned to the in-person-led assessment condition or the telepractice-led assessment condition. Results No statistically significant differences were found between the in-person and telepractice-led evaluations in terms of overall evaluation task duration, evaluation clinical outcomes, or participants' reported experiences. That is, telepractice evaluations for stuttering in adults may be an equivalent option to in-person evaluations. Conclusions Results of this preliminary study indicate that telepractice evaluations of stuttering may be comparable to in-person evaluations in terms of duration, clinical outcomes, and participant experiences. The current study supports the notion that telepractice evaluations may be a viable option for adult clients who stutter. Clinical considerations and future directions for research are discussed.

Effectiveness of nonpharmacological stuttering interventions on communication and psychosocial functioning in adults: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To conduct a systematic review and meta-analysis of the research evidence examining the effectiveness of nonpharmacological stuttering therapy on communication and psychosocial functioning for adults who stutter.

METHODS

A systematic search of nine electronic databases for studies published from database inception to December 2018 was completed to identify randomized controlled trials of interventions for adults with developmental stuttering. Two reviewers independently screened articles and assessed methodological quality using the Cochrane risk-of-bias tool. Treatment outcomes were classified using the International Classification of Functioning, Disability and Health (ICF) framework.

RESULTS

The search yielded nine randomized controlled trials, comprising 276 participants, using a diverse range of interventions which were classified into four categories: speech restructuring interventions; speech restructuring plus psychological interventions; interventions with stimulating techniques and interventions targeting anxiety. Meta-analysis showed that interventions did not demonstrate a significant pooled difference when compared to comparison groups in improving speech fluency (standardized mean difference [SMD] = -0.35, 95% confidence interval [CI] -1.14 to 0.45, I²   = 81%, P = .39), overall experience of stuttering (mean difference [MD] = -0.10, 95% CI -0.36 to 0.15, I²   = 0%, P = .43) and quality of life (SMD = -0.32, 95% CI -0.83 to 0.19, I²   = 0%, P = .21).

CONCLUSIONS

This article identified a diverse range of treatments and outcome measures for adults who stutter, with meta-analysis highlighting no significant pooled difference between intervention and comparator groups in improving communication and psychosocial functioning.

Natural recovery from stuttering for a clinical cohort of pre-school children who received no treatment

PURPOSE

The natural stuttering recovery rate by adulthood is high. Community cohort studies suggest a much lower rate during the first 18 months after onset, but this may be different for clinical cohorts of pre-school aged children. The present research and case presentations add to data reported by Franken et al. by investigating early natural recovery for a clinical cohort.

METHOD

Participants were 16 pre-school children presenting to a clinic with stuttering onset 1-15 months earlier. The children were studied for a mean of 19.4 months (84.3 weeks) using parent report and clinician identification of stuttering from recorded conversations. The children received no treatment during the study. Data were obtained for each participant and are presented graphically.

RESULT

Experienced speech-language pathologists detected stuttering in the recordings of 3 of 4 children identified as recovered by their parents. Only 1 of the 16 children (6.3%) was confirmed as recovered.

CONCLUSION

There is no reason to believe that the early natural recovery rate for clinically presenting children is different from community cohorts. Parent report of natural recovery during the pre-school years needs to be confirmed by clinician observation of the child's speech; otherwise, there is risk of harmful false negative identification. The present data support the Yairi et al. different recovery pathways for children who stutter.

Variability of Stuttering: Behavior and Impact

Purpose It has long been known that stuttering behaviors vary across time and situation. Preliminary evidence suggests that this variability negatively affects people who stutter and that stuttering behaviors are more variable than adverse impact associated with stuttering. More information is needed to determine how variability affects people who stutter and what the clinical and research implications of variability may be. Method Two hundred and four adults who stutter participated in a mixed-methods study exploring (a) how variability of stuttering affects people who stutter in comparison to other aspects of the condition and (b) which aspects of the overall experience of stuttering are variable. Results Analyses indicated that variability is very commonly experienced by people who stutter and that it is among the most frustrating aspects of the condition. Qualitative analyses revealed that variability is experienced in all aspects of the stuttering condition, including the observable behavior other affective, behavioral, and cognitive reactions; and the adverse impact of stuttering. Notable individual differences were found in terms of which specific aspects of the condition were more variable for different respondents. Overall, analyses revealed that the variability of different aspects of stuttering can be viewed in a hierarchy from most variable to least variable: more external aspects (e.g., frequency, duration), more internal aspects (e.g., covert behaviors, physical tension), and cognitive-affective experiences (e.g., negative thoughts, feelings, and self-image). Discussion These findings suggest that variability is a common and burdensome aspect of the experience of stuttering and underscore the importance of considering variability in stuttering behavior, reactions, and impact in research, assessment, and treatment for adults who stutter.

Speech and Anxiety Management With Persistent Stuttering: Current Status and Essential Research

Purpose The purpose of this review article is to provide an overview of the current evidence base for the behavioral management of stuttering and associated social anxiety. Method We overview recent research about stuttering and social anxiety in the context of contemporary cognitive models of social anxiety disorder. That emerging evidence for self-focused attention and safety behavior use with those who stutter is considered in relation to current treatment approaches for stuttering: speech restructuring and social anxiety management. Results The emerging information about social anxiety and stuttering suggests a conflict between the two clinical approaches. For those clients who wish to control their stuttering and where speech restructuring is deemed the most suitable approach, it is possible that speech restructuring may (a) induce or increase self-focused attention, (b) promote the use of safety behaviors, and (c) become a safety behavior itself. This conflict needs to be explored further within clinical and research contexts. Conclusions The issues raised in this review article are complex. It appears that evidence-based speech treatment procedures are in conflict with current best-practice treatment procedures that deal with social anxiety. In this review article, we propose directions for future research to inform the development of improved treatments for those who stutter and recommendations for interim clinical management of stuttering.

International expert perspectives on the principles and components of effective intervention for adults who stutter

BACKGROUND

While evidence-based practice is widely endorsed by researchers, clinicians and professional bodies as a guiding framework for the provision of quality care to clients, the reliance on efficacy evidence may overshadow the benefits of other knowledge forms in supporting intervention design and evaluation. Due consideration needs to be given to varied forms of evidence, including practice and patient evidence. Stuttering intervention for adults is one area in which there is a significant shortage of practice-based research literature.

AIMS

This study aimed to add to practice evidence by exploring the perspectives of international researchers and clinical experts on the components of effective stuttering intervention. This practice-based evidence will be used to inform the multi-stakeholder co-design of an evidence-based stuttering intervention for adults.

METHODS & PROCEDURES

Criteria defining expertise were developed based on a review of the literature. Experts were recruited using purposive sampling and snowballing. Seventeen international experts were approached, of which 10 completed semi-structured interviews. Interview questions were developed and centred on five topics: the nature of stuttering; efficacy evidence base; intervention techniques, principles of effective intervention; and outcome measurement.

OUTCOMES & RESULTS

Inductive thematic analysis identified three overarching themes: 'One size doesn't fit all', 'A really collaborative relationship where we are both bringing our sense of expertise to this' and 'Some of the most frustrating things'.

CONCLUSIONS & IMPLICATIONS

These findings emphasize the complexity of stuttering intervention, the need for individually tailored treatments and the role of multiple factors, beyond therapeutic technique, that influence treatment outcomes. Findings also demonstrate the benefit of collecting practice-based evidence to support clinical decision-making and intervention evaluation. What this paper adds What is already known on the subject Evidence-based practice involves the synthesis of multiple forms of knowledge, including research, practice and patient evidence to support clinical decision-making and intervention evaluation. Research evidence for stuttering intervention effectiveness is the dominant form of knowledge in stuttering literature, while other forms such as practice and patient evidence are less represented. What this paper adds to existing knowledge This study provides valuable practice evidence for effective stuttering intervention components, including individually tailored intervention, person-related factors and therapeutic alliance. It highlights the need to consider multiple forms of knowledge to guide the design and evaluation of intervention. What are the potential or actual clinical implications of this work? Clinicians should adopt a person-centred care approach when designing and evaluating an intervention for adults who stutter. Multiple factors beyond therapeutic technique influence treatment outcomes and should be incorporated into any intervention for adults who stutter.

STUTTERING: INITIATING FACTORS, EVOLUTION, HEALING PERSPECTIVES

Despite high amount of incidents, no scientific paper existed up to now in Georgia dealing with the stuttering. In present essay the views over are collated. It is confirmed that the phenomenon reflects the speech rate and/or the rhythm distortions created by convulsive type involuntary contractions of voice-producing muscles. The disorder is either congenital or acquired. Complicated pregnancy and/or delivery, heavy and/or recurred somatic diseases, speech-formation delay, conflicting social situations appear the main provoking/supporting factors of. The stuttering covers physical and psychological symptoms. The physicals are manifested in speech muscle twitches, while the psychological in phobias. Neurotic and neurotic-like stuttering types are differentiated. The neurotics arise on the background of psychological disorders, the linkage of the neurotic-likes with any concrete factor being mostly difficult or impossible. It is emphasized that the stuttering treatment demands the complex application of pedagogical and medical means and aims the cure of the whole organism, while predominantly of the nervous system, and improvement of mode-of-life conditions of the sufferer. The necessity of the cure of associated diseases is emphasized. It is stated that the stuttering psychotherapy implies the blockage of mental disturbances, while the speech recovery trials intends the establishment of adequate voice, articulation, and respiratory functions. In utilized habilitation/rehabilitation means the particular attention has to draw to initiation of well-balanced logo-rhythms. The regulation of hemisphere speech-center function is a primary target of the vocal exercises applied. Achievements attained in study sessions are regularly spread over the vital situations. The favorable social environment is also regarded as an important item for the pathology defeat. The significance of the systematic cure interventions is emphasized the frequent and/or long-term pauses between being judged as the cause of habit remissions happened. Just compound and customary treatment and active involvement of parents and other family members in applied efforts ensure the better chances for the positive care output.

Predictors of Lidcombe Program treatment dropout and outcome for early stuttering

BACKGROUND

Information is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts treatment prognosis.

AIMS

To investigate the predictors of treatment dropout and treatment outcome for children who were treated for early stuttering with the Lidcombe Program (N = 277).

METHODS & PROCEDURES

A total of 32 variables were used as predictors in regression analyses of short- and medium-term Lidcombe Program outcome, and of treatment dropout.

OUTCOMES & RESULTS

Regression analyses associated children who have better language skills and easy temperament with better treatment outcome, although only a small portion of the variance of treatment outcome was accounted for by these variables. There was an association between treatment dropout and parental scores on a personality screening tool relating to their impulsivity.

CONCLUSIONS & IMPLICATIONS

Variables identified as predictors of Lidcombe Program treatment outcome were statistically significant, but not clinically significant. They did not account for a clinically substantive portion of treatment outcomes. Findings about parental impulsivity and their relationship with intervention drop-out require replication with prospective methods and comprehensive assessment of parent psychological status. This is particularly important because parents are involved in conducting all early interventions. What this paper adds What is already known on the subject Information is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts Lidcombe Program treatment outcome. What this paper adds to existing knowledge There are predictors of Lidcombe Program treatment outcome that are statistically significant, but none are clinically significant. What are the potential or actual clinical implications of this work? Clinicians can tell parents that nothing has been found that can assist with making prognostic indications about treatment outcome for their children.

Neurogenic Stuttering: Etiology, Symptomatology, and Treatment

Background:

Neurogenic stuttering is a subtype of acquired stuttering, and it is characterized by disfluencies associated with acquired brain damage.

Objective:

To provide an insight into pathophysiology, symptomatology, differential diagnosis, assessment, and treatment of neurogenic stuttering through a critical review of the literature.

Methods:

Studies published during the past and recent years were searched and analyzed on neurogenic stuttering.

Results:

Neurogenic stuttering is a complex disorder. The pathophysiological mechanism of neurogenic stuttering is not yet fully understood. It appears with several neurological diseases and conditions, and the use of some drugs. Differential diagnosis of neurogenic and psychogenic stuttering is a challenge for clinicians. Treatment usually requires a joint effort from speech therapists and doctors, most often neurologists

Conclusion:

Although research on neurogenic stuttering can be found in the literature, the complexity of this disorder still requires detailed monitoring and studying to provide the best treatment for patients.

Stuttering therapy through telepractice in Turkey: A mixed method study

PURPOSE

The effectiveness of telepractice in stuttering therapy in Turkey may be unclear, but there is good evidence for the efficaciousness of it from other countries, e.g., Australia. The purpose of the present study is to compare the outcomes of telepractice and in-person therapy delivery on traditional stuttering treatment and explore telepractice stuttering therapy experience in Turkey.

METHODS

20 adults who stutter participated in the study. Half the participants received treatment via telepractice, while the others were provided with services in-clinic. Based on a convergent parallel mixed-method research, quantitative (Study 1) and qualitative data (Study 2) were collected in parallel, analyzed separately, and then combined. Study 1 included a non-inferiority controlled trial, repeated measures, quasiexperimental design. Within the scope of the quantitative research, the objective clinical data, including the scale and assessment scores, were collected from two groups in three stages. Study 2 used the phenomenology approach to assess the qualitative aspects of our study.

RESULTS

According to the quantitative findings in Study 1, the effectiveness of telepractice and in-person in the post-test and follow up is not significantly different. The following themes emerged out of the qualitative data analysis in Study 2: expectation, telepractice-participant suitability and advantages of telepractice, technology, therapy techniques and clinician skills, therapeutic components, satisfaction, and preference.

CONCLUSION

The triangulation of quantitative and qualitative findings indicated that these data sets were compatible in general. The results show that telepractice is equally effective as the in-person method as a service delivery method for adults who stutter.

Verbal Contingencies in the Lidcombe Program: A Noninferiority Trial

Purpose The Lidcombe Program is an efficacious and effective intervention for early stuttering. The treatment is based on parent verbal response contingent stimulation procedures, which are assumed to be responsible for treatment effect. The present trial tested this assumption. Method The design was a parallel, open plan, noninferiority randomized controlled trial. In the experimental arm, the five Lidcombe Program verbal contingencies were removed from parent instruction. The primary outcome was beyond-clinic percentage syllables stuttered at 18-month follow-up. Seventy-four children and their parents were randomized to one of the two treatment arms. Results Findings of noninferiority were inconclusive for the primary outcome of stuttering severity, based on a margin of 1.0 percentage syllables stuttered. Conclusions The inconclusive finding of noninferiority means it is possible that verbal contingencies make some contribution to the Lidcombe Program treatment effect. However, considering all primary and secondary outcomes, an overriding impression from the trial is a similarity of outcomes between the control and experimental arms. The clinical applications of the trial are discussed, along with further research that is needed.

An Evaluation of an Integrated Stuttering and Parent-Administered Self-Regulation Program for Early Developmental Stuttering Disorders

Purpose This study reports findings from a clinical trial that implemented an early stuttering treatment program integrated with evidence-based parenting support (EBPS) to children who stutter (CWS) with concomitant self-regulation challenges manifested in elevated attention-deficit/hyperactivity disorder (eADHD) symptoms and compared those outcomes to CWS receiving stuttering treatment without EBPS. Method Participants were 76 preschool CWS and their parent(s). Thirty-six of these children presented with eADHD and were quasirandomized into two groups: stuttering treatment only (eADHD_standard) or stuttering treatment integrated with EBPS (eADHD_integrated). The remaining children did not meet criteria for eADHD symptoms and received stuttering treatment only (No-eADHD_standard). Pre, post, and 3-month follow-up measures of stuttering treatment outcomes as well as treatment effects on measures of child behavior difficulties and parenting practices were examined. Results Significant reduction in stuttering was found for all groups. However, the eADHD_integrated group showed a greater reduction in stuttering frequency than the eADHD_standard group, and at follow-up, stuttering frequencies in the eADHD_integrated group matched those of children in the No-eADHD_standard group, while stuttering in the eADHD_standard group remained significantly higher. Children with eADHD symptoms who received the integrated program also required significantly less stuttering intervention time than those children with eADHD symptoms who received stuttering treatment only. Families in the eADHD_integrated group reported large and significant improvements in child behavior and parenting practices. Conclusion This study provides support for an early treatment program for CWS. The integrated stuttering and self-regulation management program for CWS with eADHD symptoms proved successful for fluency and behavioral improvements, which were sustained at follow-up.

Pediatrician Referral Practices for Children Who Stutter

Purpose Given the marked increase in evidence-based information regarding the nature/treatment of stuttering, coupled with the fact that pediatricians tend to be one of the initial points of contact for parents who suspect their preschool-age child may stutter, this study explored pediatricians' (a) accuracy in identifying children who may stutter and (b) likelihood of referring children who present with a profile indicative of stuttering to speech-language pathologists. Method Pediatricians recruited nationally through professional organizations completed a 5- to 7-min online survey that probed stuttering identification and referral practices via responses to experimental case vignettes. Each vignette featured a 4-year-old boy with a family history of stuttering whose mother reported signs of stuttering and manipulation of two factors: stuttering during the pediatrician visit (or not) and negative communication attitude (or not). Results Our findings suggest pediatricians' identification and referral of children who may stutter is largely prompted by observation of overt speech behaviors and/or negative communication attitude. Participants' gender, years in practice, and experience working with children who stutter did not influence likelihood of referral. Conclusions Results indicate pediatricians are less likely to implement a "wait and see" approach with young children who stutter today than in the past. Unlike other common child onset diagnoses, however, parent report of atypical behavior does not yield pediatrician referral to a specialist. Future education and advocacy efforts directed toward pediatricians should emphasize inclusion of factors other than direct observation of stuttering behavior that may warrant referral (e.g., parent report).

Effect of muscular activation on surrounding motor networks in developmental stuttering: A TMS study

Previous studies regarding developmental stuttering (DS) suggest that motor neural networks are strongly affected. Transcranial magnetic stimulation (TMS) was used to investigate neural activation of the primary motor cortex in DS during movement execution, and the influence of muscle representations involved in movements on "surrounding" ones. TMS was applied over the contralateral abductor digiti minimi (ADM) motor representation, at rest and during the movement of homologue first dorsal interosseous muscles (tonic contraction, phasic movements cued by acoustic signalling, and "self-paced" movements). Results highlighted a lower cortico-spinal excitability of ADM in the left hemisphere of stutterers, and an enhanced intracortical inhibition in their right motor cortex (in comparison to fluent speakers). Abnormal intracortical functioning was especially evident during phasic contractions cued by "external" acoustic signals. An exaggerated inhibition of muscles not directly involved in intended movements, in stuttering, may be useful to obtain more efficient motor control. This was stronger during contractions cued by "external" signals, highlighting mechanisms likely used by stutterers during fluency-evoking conditions.

Temperament and early stuttering intervention: Two perspectives

PURPOSE

To discuss clinical applications of research findings about temperament and early stuttering.

METHOD

A "1000-bytes" format (Onslow & Millard, 2012) was used to provide readers with contemporaneous observation of a "conversation" between the authors. The conversation is proceeded by a prologue and followed by concluding statements from each author.

RESULTS

One author contended that comprehensive, multidimensional assessment of temperament domains is essential during clinical management of early stuttering, and the results of that assessment are best incorporated into a multifactorial treatment approach. The other author contested that view, arguing that such an approach is not empirically justifiable at present.

CONCLUSIONS

The authors agree about the salience of research on temperament and early stuttering but have different perspectives about the topic when applied to providing health care for early stuttering.

A systematic review of interventions for adults who stutter

PURPOSE

To examine the effectiveness of (i) face to face interventions (ii) models of service delivery and (iii) psychological treatments combined with speech-focused interventions for adults who stutter.

METHODS

Five electronic databases and three clinical trial registries were searched. Systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with adults who stutter were included. Pharmaceutical interventions were excluded. Primary outcomes included a measure of stuttering severity. Risk of bias assessment was conducted on included studies and overall quality of the evidence was graded.

RESULTS

Five RCTS, four registered trials and three systematic reviews met inclusion criteria. Intervention approaches included speech restructuring programs (e.g. Camperdown Program) and transcranial direct current stimulation (tDCS). One study investigated cognitive behaviour therapy (CBT) alongside speech restructuring. Overall, studies were classified low risk of bias and good quality. Speech restructuring was included in all but one study (tDCS study) and had the most evidence i.e. supported by the greatest number of RCTs. On average, stuttering frequency was reduced by 50-57 % using speech restructuring approaches. No study reduced stuttering to the same level as community controls who don't stutter. The study on tDCS reduced stuttering frequency by 22-27 %. Speech restructuring delivered via telehealth was non-inferior to face-to-face intervention. One study reported CBT was an effective adjunct to speech restructuring interventions.

CONCLUSION

Speech restructuring interventions were found to reduce stuttering in adults, however degree and maintenance of fluency varied. The body of evidence surrounding tDCS and psychological interventions is limited. Replication studies should be considered.

Clinical Trials of Adult Stuttering Treatment: Comparison of Percentage Syllables Stuttered With Self-Reported Stuttering Severity as Primary Outcomes

Purpose In a companion paper, we found no statistical reason to favor percentage syllables stuttered (%SS) over parent-reported stuttering severity as a primary outcome measure for clinical trials of early stuttering. Hence, considering the logistical advantages of the latter measure, we recommended parent-reported stuttering severity for use as an outcome measure. The present report extends the prior analysis to a comparison of %SS with self-reported stuttering severity (SRSS) for use as an outcome measure in clinical trials of stuttering treatments for adults. Method We analyzed data from four randomized clinical trials for adults that incorporated %SS and SRSS data at prerandomization and at 6 months post randomization. We analyzed the distributions associated with the two measures, their agreement, and their estimates of effect sizes. Results The positively skewed distribution of %SS warrants much reservation about its value as a clinical trial outcome measure. This skew causes inherent instability because of spurious data associated with low scores, which occur commonly at the low end of such a distribution. This inherent instability is compounded by inherent problems with absolute reliability of %SS measures. These problems are reduced with the much more normal distribution of SRSS. Conclusions The logistical arguments in favor of SRSS apply similarly to adults as they do when parents report the stuttering severity of their children. However, there are statistical reasons to favor SRSS over %SS measures as a primary outcome of clinical trials with adult participants: SRSS has acceptable discriminant validity and a normal distribution, and it is less error prone than %SS. We recommend SRSS as a primary outcome for clinical trials of adults with stuttering.

The Role of Behavioral Inhibition for Conversational Speech and Language Characteristics of Preschool-Age Children Who Stutter

Purpose The purpose of this study was to investigate whether preschool-age children who stutter (CWS) were more likely to exhibit a temperamental trait of behavioral inhibition (BI), a correlate of shyness, than children who do not stutter (CWNS) and whether this temperamental trait affected preschool-age children's speech fluency and language complexity during a conversation with an unfamiliar adult. Method Sixty-eight preschool-age children (31 CWS, 37 CWNS) participated. The degree of BI was assessed by measuring the latency to their sixth spontaneous comment and the number of all spontaneous comments during a conversation with an unfamiliar examiner (following Kagan et al.'s [1987] methodology). Parent report of shyness from the Children's Behavior Questionnaire served as an indirect measure of BI. Children's language complexity was assessed by measuring their mean length of utterance and the number of words spoken. For CWS, the frequency of stuttering and the negative impact of stuttering were also assessed. Results First, we found no between-group differences in the degree of BI across the behavioral observation measures. However, CWS were rated shyer by parents than CWNS. Second, for CWS only, higher BI was associated with less complex utterances and fewer words spoken. Third, for CWS, higher BI was associated with fewer stuttered disfluencies produced. Conclusions This study provides empirical evidence that BI to the unfamiliar may have salience for childhood stuttering as it affected the quantity and quality of language spoken with an unfamiliar adult. Clinical implications of high BI for the assessment and treatment of preschool-age stuttering are discussed.

What do people search for in stuttering therapy: Personal goal-setting as a gold standard?

PURPOSE

Stuttering affects people in individual ways, and there are multiple factors which may influence a person's goals when seeking therapy. Even though there is a common consensus that speech-language pathologists should discuss the individual's goals and expectations for stuttering therapy and outcomes, few studies have systematically investigated this issue. The aims of the present study were to investigate individual motivations and goal-setting related factors in stuttering therapy. The associations between self-reported impact of stuttering and the participants' perceptions of stuttering interference in communication, speaking abilities, and relationships with other people were also investigated.

METHOD

This study is part of a wider-ranging treatment study of individualized stuttering management tailored to the participants' personal goals and preferences. A mixed method, multiple single-case design was used to address the research questions. Twenty-one adults, age 21-61 years, took part in a pretherapy interview, which also included two quantitative measures: the Client Preferences for Stuttering Therapy-Extended version (CPST-E) and the Overall Assessment of Speakers' Experience of Stuttering-Adult version (OASES-A). Findings from the study sample was compared with a Norwegian reference group, in order to check for the representativeness of the study sample.

RESULTS

Quantitative data showed that most participants wanted to focus on both physical and psychological aspects of therapy, and that 95% considered 'to gain a sense of control over the stuttering' as important. Participants' perspectives on their speaking ability and stuttering interference in communication were identified as central factors, particularly in social and professional settings. These outcomes aligned well with the finding of avoidance behaviors, such as avoiding words and speaking situations. Qualitative data identified four main areas that the participants wanted to improve: speech fluency, emotional functioning, activity and participation, and understanding of their stuttering.

CONCLUSION

The study confirms that multiple and individual factors may influence the person's goals for therapy. Goals were mainly anchored in participants' wish of better coping in real world settings. A high degree of avoidance behavior was reported, suggesting that anxiety, and in particular linguistic-related anxiety needs to be taken into account when addressing social anxiety in fluency disorders.

Reliability and validity of the UTBAS-TR (The Unhelpful Thoughts and Beliefs Scale-the Turkish version) in the Turkish population

Purpose: This paper decribes the development of the Turkish adaptation of UTBAS (UTBAS-TR) and reports the results concerning its applicability and psychometric structure.Method: The sample consisted of 81 males and 19 females diagnosed with developmental stuttering in two centres. Test-retest reliability score was obtained by correlating results of repeated aplications of the scale within a one-week interval and a paired t-test was calculated to see the differences in the total and UTBAS I, II and III scores. The internal consistency was assessed using the Cronbach's alpha. Construct validity was also assessed by examining inter-scale correlations and with the correlations of the UTBAS-TR with two other scales (State-Trait Anxiety Inventory (STAI) and Beck Anxiety Inventory (BAI)).Result: The internal consistency of the UTBAS-TR and the test and retest reliability score was statiıstically significant. The correlation between UTBAS-TR total score and the UTBAS-TR I, II and III correlations were high. A significant correlation was observed between UTBAS-TR total score with State Anxiety Inventory. However, the correlations between UTBAS-TR-Total Score and Trait Anxiety Inventory and Beck Anxiety Inventory were low.Conclusion: The UTBAS-TR proved to be suitable for use with the Turkish population.

Three Lidcombe program clinic visit options: a phase II trial

PURPOSE

Weekly clinic visits are recommended in the Lidcombe Program Treatment Guide (Packman et al., 2015). That specification is based on traditional speech-language pathology practices rather than empirical research, and two studies have suggested that such a format does not always occur in clinical communities. This research was conducted to determine the relative efficacy of different Lidcombe Program models of clinic visits.

METHOD

Thirty-one children were randomized to three different service delivery models: twice-weekly, weekly and fortnightly (once every two weeks) clinic visits. All children were treated with the Lidcombe Program following manualised procedures. Measures of percentage syllables stuttered were obtained from beyond clinic audio recordings pre- and post-randomization.

RESULTS

Results showed that the twice-weekly and fortnightly treatment formats were not suitable for all families. However, the fortnightly outcomes at 9 months post-randomization were comparable with those attained during weekly clinic visits.

CONCLUSIONS

These results justify further, large-scale clinical trialling to compare weekly Lidcombe Program clinic visits with schedules involving less frequent clinic visits.