What do people who stutter want--fluency or freedom?

Expectations from stuttering therapy: Qualitative content analysis of client's perspective in Kannada-speaking adults who stutter

PURPOSE

The current study was carried out to explore clients' expectations from stuttering therapy using the qualitative content method in the Indian context.

METHOD

Twenty-one Kannada-speaking adults who stutter between the age range of 18-33 years participated in the study. The procedure involved three phases, including the formulation of semi-structured interview questions, data collection and analysis. Inductive content analysis was used to determine the categories and sub-categories arising from the participants verbatim. The frequency count of emerging sub-categories was completed, and the data was interpreted.

RESULTS

The overall analysis of the data obtained from 21 participants generated three categories under the theme of expectations from speech therapy. The categories generated included beliefs and understanding of stuttering, stuttering and related behaviours, and goals and outcome of therapy.

CONCLUSION

Selecting personalised goals and techniques during therapy is necessary to improve client satisfaction. This study helps clinicians to understand the anticipatory beliefs of Kannada-speaking adults who stutter and educate them about achievable and realistic goals, leading to shared decision-making to ensure better quality of life and satisfaction in everyday speaking situations.

The reliability of simultaneous versus individual data collection during stuttering assessment

BACKGROUND

Speech-language pathologists often multitask in order to be efficient with their commonly large caseloads. In stuttering assessment, multitasking often involves collecting multiple measures simultaneously.

AIMS

The present study sought to determine reliability when collecting multiple measures simultaneously versus individually.

METHODS & PROCEDURES

Over two time periods, 50 graduate students viewed videos of four persons who stutter (PWS) and counted the number of stuttered syllables and total number of syllables uttered, and rated speech naturalness. Students were randomly assigned to one of two groups: the simultaneous group, in which all measures were gathered during one viewing; and the individual group, in which one measure was gathered per viewing. Relative and absolute intra- and inter-rater reliability values were calculated for each measure.

OUTCOMES & RESULTS

The following results were notable: better intra-rater relative reliability for the number of stuttered syllables for the individual group (intraclass correlation coefficient (ICC) = 0.839) compared with the simultaneous group (ICC = 0.350), smaller intra-rater standard error of measurement (SEM) (i.e., better absolute reliability) for the number of stuttered syllables for the individual group (7.40) versus the simultaneous group (15.67), and better inter-rater absolute reliability for the total number of syllables for the individual group (88.29) compared with the simultaneous group (125.05). Absolute reliability was unacceptable for all measures across both groups.

CONCLUSIONS & IMPLICATIONS

These findings show that judges are likely to be more reliable when identifying stuttered syllables in isolation than when simultaneously collecting them with total syllables spoken and naturalness data. Results are discussed in terms of narrowing the reliability gap between data collection methods for stuttered syllables, improving overall reliability of stuttering measurements, and a procedural change when implementing widely used stuttering assessment protocols.

WHAT THIS PAPER ADDS

What is already known on the subject The reliability of stuttering judgments has been found to be unacceptable across a number of studies, including those examining the reliability of the most popular stuttering assessment tool, the Stuttering Severity Instrument (4th edition). The SSI-4, and other assessment applications, involve collecting multiple measures simultaneously. It has been suggested, but not examined, that collecting measures simultaneously, which occurs in the most popular stuttering assessment protocols, may result in substantially inferior reliability when compared to collecting measures individually. What this paper adds to existing knowledge The present study has multiple novel findings. First, relative and absolute intra-rater reliability were substantially better when stuttered syllables data were collected individually compared to when the same data were collected simultaneously with total number of syllables and speech naturalness data. Second, inter-rater absolute reliability for total number of syllables was also substantially better when collected individually. Third, intra-rater and inter-rater reliability were similar when speech naturalness ratings were given individually compared to when they were given while simultaneously counting stuttered and fluent syllables. What are the potential or actual clinical implications of this work? Clinicians can be more reliable when identifying stuttered syllables individually compared to when they judge stuttering along with other clinical measures of stuttering. In addition, when clinicians and researchers use current popular protocols for assessing stuttering that recommend simultaneous data collection, including the SSI-4, they should instead consider collecting stuttering event counts individually. This procedural change will lead to more reliable data and stronger clinical decision making.

Fostering Positive Stuttering Identities Using Stutter-Affirming Therapy

PURPOSE

School-age children and adolescents frequently have difficulty developing positive identities around their stuttering. Many students experience both physical and social consequences from stuttering. The great lengths that speakers go to try to hide their stuttering and to speak fluently increase their difficulty. As long as school-age children who stutter try to identify as fluent speakers, they will have difficulty lessening the negative impact of stuttering on their lives. Fortunately, many people who stutter also report positive stuttering experiences. Speech-language pathologists can use these positive experiences to help school-age children grow more comfortable with stuttering. They can also help school-age children reduce some of the speaking effort and social stigma that leads them to try to conceal their stuttering in the first place. To accomplish both these goals, I propose a stutter-affirming therapy.

METHOD

This clinical focus article summarizes previous research about identity development in stuttering. I discuss a therapy approach I call stutter-affirming therapy. In elucidating this approach, I discuss practical ways that speech-language pathologists can use to help school-age children develop positive stuttering identities through easier speaking and stuttering. I ground these examples in a case study of a 12-year-old boy who stutters.

DISCUSSION

stutter-affirming therapy focuses on conditioning the speaker's reaction to stuttering in ways that move toward and embrace stuttering (stutterphilic reactions) rather than in ways that move away from and reject stuttering (stutterphobic reactions). Speech-language pathologists can help school-age children who stutter foster positive stuttering identities using the three priorities of stutter-affirming therapy. First, reject fluency by reducing stutterphobic and increasing stutterphilic reactions to stuttering. Second, value stuttering by discovering what speakers gain from it. Third, create an environment in which it is easier to stutter through education, advocacy, disclosure, and voluntary stuttering.

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.

Avoidance Reduction Therapy for School-Age Children Who Stutter

Avoidance Reduction Therapy for Stuttering (ARTS) is a behavioral therapy for children and adults that incorporates speech therapy and counseling to reduce learned physical and socioemotional struggle that constitute the problem for the stutterer.a While stuttering is a neurodevelopmental difference, efforts to mask a stigmatized identity can contribute to avoidance, shame, and fear of speaking. This article provides theoretical foundations for therapy principles, describes the processes of self-acceptance and change, and outlines therapy goals and activities using child-friendly explanations and case study vignettes.

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.

A Point of View About Fluency

PURPOSE

This article presents several potential concerns with the common usage of the term fluency in the study of stuttering and people who stutter (or, as many speakers now prefer, stutterers). Our goal is to bridge gaps between clinicians, researchers, and stutterers to foster a greater sense of collaboration and understanding regarding the words that are used and meanings that are intended.

METHOD

We begin by reviewing the history of the term fluency. We then explore its usage and current connotations to examine whether the term meaningfully describes constructs that are relevant to the study of the stuttering condition.

RESULTS

By highlighting current research and perspectives of stutterers, we conclude that the term fluency (a) is not fully inclusive, (b) encourages the use of misleading measurement procedures, (c) constrains the subjective experience of stuttering within a false binary categorization, and (d) perpetuates a cycle of stigma that is detrimental to stutterers and to the stuttering community as a whole.

CONCLUSIONS

We recommend that researchers and clinicians cease referring to stuttering as a fluency disorder and simply refer to it as stuttering. Furthermore, we recommend that researchers and clinicians distinguish between moments of stuttering (i.e., what stutterers experience when they lose control of their speech or feel stuck) and the overall lived experience of the stuttering condition.

Contemporary Theories of Stuttering Development

The article presents a theoretical analysis of contemporary models of persistent stuttering development in children and adults at the current period of development of science. The accumulated amount of scientific knowledge suggests that stuttering has a neurological basis: it is associated with disorders in the structure and function of the brain. On this basis, there have been emerged models of stuttering that link the cause of a speech disorder with an unstable speech motor system. Theories and models of stuttering based on cognitive and language processing are likely to be useful in that they have explanatory power in relation to the mechanisms that play an important role in the production of key symptoms of stuttering. Considering that stuttering is a complex disorder, the logical result of this was the proposal of multifactorial models of impaired speech fluency. The presented overview may be useful to psychiatrists, clinical psychologists, speech therapists, teachers, and practitioners interacting with children and adults with stuttering and other speech fluency disorders.

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.

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.

Reliability of judgments of stuttering-related variables: The effect of language familiarity

Previous studies demonstrate mixed results and some methodological limitations regarding judges' ability to reliably assess stuttering-related variables in an unfamiliar language. The present study examined intra- and inter-rater reliability for percent syllables stuttered (%SS), stuttering severity (SEV), syllables per minute (SPM), and speech naturalness (NAT) when English-speaking judges viewed speech samples in English and in a language with which they had no or minimal familiarity (Spanish). Over two time periods, 21 judges viewed eight videos of four bilingual persons who stutter. Data were analyzed for relative and absolute intra- and inter-rater reliability as well as for an effect of language on time period differences. Intra- and inter-rater relative reliability were good or excellent for all measures in both languages, with the exception of inter-rater relative reliability for NAT in both languages and %SS in Spanish. Intra-rater absolute reliability was acceptable in both languages for NAT and SEV and unacceptable in both for SPM and %SS. Inter-rater absolute reliability in both languages was unacceptable for all measures, even with judges with the same training. There was a clinically significant effect of language on %SS scores, but, despite a statistically significant effect of language for SPM and SEV, the differences were not clinically significant. Results indicate that reliability across and within languages varies by measure and is impacted by intra- vs. inter-rater reliability, relative vs. absolute reliability, and language familiarity. Modifications in training may be able to address some of the limitations found, particularly with regard to SPM and NAT.

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.

The Communication Benefits of Participation in Camp Dream. Speak. Live.: An Extension and Replication

School-based guidelines often require that treatment focuses on minimizing or eliminating stuttered speech. The purpose of this study was to examine the benefits of explicit training in communication competencies to children who stutter without targeting stuttered speech. Thirty-seven children (ages 4-16) completed Camp Dream. Speak. Live., an intensive group treatment program which targets the psychosocial needs and communication of children who stutter. Outcome measures included the Overall Assessment of the Speaker's Experience of Stuttering (OASES), the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (KiddyCAT), and the Patient Reported Measurement Information System (PROMIS) Pediatric Peer Relationships Short Form (PROMIS Peer Relationships) and Parent Proxy Peer Relationships Short Form (PROMIS Parent Proxy). Pre- and posttreatment public presentations were rated on nine core verbal and nonverbal communication competencies by a neutral observer. Similar to previous studies, participants demonstrated significant improvements in communication attitudes (OASES) and perceived ability to establish peer relationships (PROMIS Peer Relationships), particularly school-aged participants (ages 7-16). Participants also demonstrated significant improvement in eight of the nine communication competencies. Findings suggest that, in addition to the psychosocial gains of programs such as Camp Dream. Speak. Live., children who stutter benefit from explicit training in communication skills, and these gains are not dependent on the presence of stuttered speech.

School-Based Speech-Language Pathologists' Perceived Self-Efficacy in Conducting Multidimensional Treatment With Children Who Stutter

Purpose The purposes of this study were to examine the self-efficacy of school-based speech-language pathologists (SLPs) in conducting multidimensional treatment with children who stutter (CWS) and to identify correlates of self-efficacy in treating speech-related, social, emotional, and cognitive domains of stuttering. Method Three hundred twenty randomly selected school-based SLPs across the United States responded to an online survey that contained self-efficacy scales related to speech, social, emotional, and cognitive components of stuttering. These ratings were analyzed in relation to participants' beliefs about stuttering treatment and their comfort level in treating CWS, perceived success in therapy, and empathy levels, in addition to their academic and clinical training in fluency disorders as well as demographic information. Results Overall, SLPs reported moderate levels of self-efficacy on each self-efficacy scale and on a measure of total self-efficacy. Significant positive associations were observed between SLPs' self-efficacy perceptions and their comfort level in treating CWS, self-reported success in treatment, beliefs about the importance of multidimensional treatment, and self-reported empathy. There were some discrepancies between what SLPs believed was important to address in stuttering therapy and how they measured success in therapy. Conclusions Among school-based SLPs, self-efficacy for treating school-age CWS with a multidimensional approach appears stronger than previously reported; however, more progress in training and experience is needed for SLPs to feel highly self-efficacious in these areas. Continuing to improve clinician self-efficacy for stuttering treatment through improved academic training and increased clinical experiences should remain a high priority in order to enhance outcomes for CWS. Supplemental Material https://doi.org/10.23641/asha.12978194.

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.

Clinical Trial for Stuttering Treatment: pilot study about dog participation in the therapy session

PURPOSE

To verify the effect of dog intervention on the regular session of speech therapy for developmental stuttering in adults.

METHODS

The study involved young adults and adults with developmental stuttering. The study sample was composed of eight participants, six males and two females, ranging in age from 16 to 45 years. Participants were divided into two groups: G1 - those who underwent treatment for stuttering with the presence of a dog-therapist in the therapy room and G2 - those who underwent treatment for stuttering without the presence of the dog therapist. We included a control group, G3, composed of fluent participants, matched in age and sex to G1 and G2 to control the natural variability of speech fluency.

RESULTS

Comparative results between the groups indicated that the group that performed the treatment without the presence of the dog achieved better performance, evolution and efficacy rates.

CONCLUSION

for the population in this study, the dog intervention on speech therapy did not improve treatment.

Student clinicians' and clients' perceptions of the therapeutic alliance and outcomes in stuttering treatment

PURPOSE

The purpose of this study was to examine how the therapeutic alliances (TA) of graduate student clinicians and adult clients who stutter relate to perceived treatment outcomes.

METHODS

Student clinicians (N = 42) and adult clients who stutter (N = 22) completed a survey assessing their TA strength and perception of treatment outcomes. Responses were analyzed to determine similarities and differences in how clinicians and clients relate the TA to perceptions of treatment effectiveness, progress, and outcome satisfaction.

RESULTS

Results suggest that clinicians and clients who stutter both relate the TA to treatment outcome, but in different ways. While clinicians associate the TA most with treatment effectiveness and client progress, clients relate the TA most to outcome satisfaction.

CONCLUSION

Clinicians should be aware that for adult clients who stutter, outcome satisfaction is related to the degree of shared understanding, agreement on daily tasks, and bond they experience with their clinician. To ensure a strong TA and client satisfaction, clinicians should actively seek their clients' perspective regarding TA status.

We Have a Voice: Exploring Participants' Experiences of Stuttering Modification Therapy

PURPOSE

Qualitative data were obtained from 8 people who stutter about their experiences and changes they perceived following attendance of an intensive group therapy intervention. Measures that related to reductions in stuttering, improved communicative confidence, and impacts on stuttering and quality of life were used to complement the qualitative data.

METHOD

Eight participants attended a group stuttering modification course for adults who stutter. They reported their experiences of therapy and perceived changes in a focus group immediately after therapy and at a semistructured interview 6 months post-therapy. Participants completed 5 additional quantitative standardized outcome measures at 3 data collection points (before and directly after therapy and 6 months post-therapy). These measures provided information about stuttering severity and frequency, use of avoidance strategies, attitude change, communicative confidence, quality of life, and locus of control.

RESULTS

Thematic analysis of the qualitative data identified 4 main areas: thoughts, feelings, and behaviors before therapy and motivation for seeking therapy; direct experience of the course; learning outcomes and challenges and solutions for maintaining change; and ways in which attending therapy had made a difference. These reported changes were supported by the quantitative measures that demonstrated improved communicative confidence; increased self-awareness; affective, behavioral, and cognitive changes; reduced use of avoidance strategies; and lower impact of stuttering on quality of life.

CONCLUSIONS

The qualitative analyses confirmed positive speech and attitude changes consequent on participants' attendance at stuttering modification therapy. These changes, further corroborated by quantitative measures, were linked to reports of improved quality of life. Further research is required to investigate the effectiveness of this form of therapy empirically and from the client's perspective.

Characteristics of adults who stutter by treatments sought

Several treatment approaches are available for adults who stutter, including speech treatment, cognitive behaviour therapy (CBT) treatment for anxiety, and a combination of both. It is useful to determine whether any differences exist between adults who stutter enrolled in different types of treatment. Therefore, the purpose of this study was to compare demographic, speech, and psychological characteristics of adults who stutter enrolled in speech, psychological, and combined treatment programs. Participants were 288 adults who stuttered (18-80 years) enrolled in one of three different treatment programs: Speech Treatment for stuttering (n = 134), Anxiety Treatment for anxiety about stuttering (n = 70), or Speech Treatment for Stuttering With or Without Anxiety Treatment (n = 84). Participants completed a range of demographic, speech, and psychological measures prior to the start of treatment. A significantly higher proportion of participants in the Anxiety Treatment group were in a personal relationship than the other treatment groups. The Anxiety Treatment group had higher average age than the other treatment groups. The Speech Treatment group also demonstrated significantly higher self-rated stuttering severity than the Anxiety Treatment group, even though there were no significant difference between groups for clinician-rated percentage of syllables stuttered. Although most characteristics of adults who stuttered did not vary by treatment type, the present findings suggest that adults who stutter enrolled in speech treatment perceived their stuttering as more severe, which may have prompted treatment seeking. Further research is needed regarding the supportive influence of personal relationship for those with the disorder.

Cognitive bias modification for social anxiety in adults who stutter: a feasibility study of a randomised controlled trial

OBJECTIVE

To determine the feasibility and acceptability of a computerised treatment for social anxiety disorder for adults who stutter including identification of recruitment, retention and completion rates, large cost drivers and selection of most appropriate outcome measure(s) to inform the design of a future definitive trial.

DESIGN

Two-group parallel design (treatment vs placebo), double-blinded feasibility study.

PARTICIPANTS

31 adults who stutter.

INTERVENTION

Attention training via an online probe detection task in which the stimuli were images of faces displaying neutral and disgusted expressions.

MAIN OUTCOME MEASURES

Psychological measures: Structured Clinical Interview Global Assessment of Functioning score; Liebowitz Social Anxiety Scale; Social Phobia and Anxiety Inventory; State-Trait Anxiety Inventory; Unhelpful Thoughts and Beliefs about Stuttering. Speech fluency: percent syllables stuttered. Economic evaluation: resource use questionnaire; EuroQol three-dimension questionnaire.Acceptability: Likert Scale questionnaire of experience of trial, acceptability of the intervention and randomisation procedure.

RESULTS

Feasibility of recruitment strategy was demonstrated. Participant feedback indicated that the intervention and definitive trial, including randomisation, would be acceptable to adults who stutter. Of the 31 participants who were randomised, 25 provided data at all three data collection points.

CONCLUSIONS

The feasibility study informed components of the intervention. Modifications to the design are needed before a definitive trial can be undertaken.

TRIAL REGISTRATION NUMBER

I SRCTN55065978; Post-results.

Communication restriction in adults who stutter: Part II

This article presents a follow-up study to Lee, van Dulm, Robb, and Ormond (2015). The aim was to explore communication restriction in adults with stuttering (AWS) using typical language measures and systemic functional linguistics (SFL) analyses. The article compared the pre- and post-treatment performance of AWS in language productivity and complexity, transitivity, modality, appraisal, and theme. Ten-minute conversational samples were obtained from 20 AWS before and after participation in intensive stuttering treatment. Transcripts were analysed for quantity and complexity of verbal output, and frequency of transitivity, modality, appraisal and theme resources. Between pre- and post-treatment, the following differences were observed: (1) a significant increase in frequency of modal operators, and trends approaching significance for (2) increased language complexity (3) increased language expressing appraisal. These changes suggest increased flexibility of language use in AWS following treatment, particularly towards interpersonal engagement. The value of SFL to this area of research is discussed.

Integrating functional measures with treatment: a tactic for enhancing personally significant change in the treatment of adults and adolescents who stutter

PURPOSE

It is proposed that stuttering treatment, particularly for adults and adolescents who stutter, may benefit from more inventive and extensive use of functional measurement-measures that are also treatment agents. Such measures can be tailored to produce more personally significant and evidence-based treatment benefits. They may be especially useful when employed in conjunction with partial self-management and performance-contingent procedures.

METHOD

Previous approaches to the definition of stuttering treatment goals and the measurement of stuttering treatment outcomes are critically reviewed. Suggestions for improvements are presented within the framework of an evidence-based and relatively standardized stuttering treatment.

RESULTS AND CONCLUSION

Results from a review of existing literature and from 2 case studies show that 2 specific personally significant problems, saying one's name and addressing large audiences, were improved by implementing these strategies in treatment. Functional measures directly connected to treatment, and partially self-managed performance-contingent schedules, merit further research as methodologies that are suitable for conducting personally significant and evidence-based treatments with adults and adolescents who stutter.

Five-year longitudinal treatment outcomes of the ISTAR Comprehensive Stuttering Program

Replicated evidence of satisfactory 1- and 2-year post-treatment outcomes has been reported for the Comprehensive Stuttering Program (CSP). However, little is known about longer term outcomes of the CSP. Yearly follow-up measures were obtained from 18 participants for 5 consecutive years. At 5-year follow-up, participants were maintaining clinically and statistically significant reductions in stuttering and increases in rates of speech relative to pre-treatment measures. Standardized effect sizes were large. There were no significant differences among the immediate post-treatment and five follow-up measures, indicating that speech gains achieved by the end of the treatment program were stable over the 5-year follow-up period. Insufficient return rates for self-report data for the third to fifth follow-up measurement occasions prohibited analyzing these data. However, non-significant differences among the immediate post-treatment and two follow-up measures indicated that improvements achieved by the end of treatment in speech-related confidence, and perceptions of struggle, avoidance, and expectancy to stutter were stable over the 2-year follow-up period. Significant differences among the speech-related communication attitudes scores indicated that improvements in attitudes made at the end of the treatment program were less stable. Taken together, these results provide further and longer term evidence of the effectiveness of the CSP.

EDUCATIONAL OBJECTIVES

Readers will be able to: (1) describe the main components of the Comprehensive Stuttering Program (2) describe a methodology for determining clinically meaningful maintenance of stuttering reductions, and (3) describe the durability and stability of improvements in speech and self-report measures across time.