1
|
Nickless T, Davidson B, Finch S, Gold L, Dowell R. Aligned or misaligned: Are public funding models for speech-language pathology reflecting recommended evidence? An exploratory survey of Australian speech-language pathologists. HEALTH POLICY OPEN 2024; 6:100117. [PMID: 38510780 PMCID: PMC10950885 DOI: 10.1016/j.hpopen.2024.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
Government subsidised funding arrangements serve as an essential medium for families to access private speech-language pathology (SLP) services in Australia. This study aimed to investigate whether, from a provider perspective, contemporary public funding models (PFMs) align with best-available scientific evidence for management of children and young persons with swallowing and communication disorders within Australian private-practice settings. This exploratory study was distributed to paediatric speech-language pathologists throughout Australia via an online survey. A total of 121 valid surveys were completed by Australian speech-language pathologists with divergent career experiences. In comparing three familiar PFMs using mixed effects logistic regression models to estimate odds ratios, results indicated that perceived congruence with recommended scientific evidence for SLP management varied across PFMs: the odds of failing to align with scientific evidence was 4.92 times higher for Medicare's Chronic Disease Management Plan (MBS_CDMP) than for the National Disability Insurance Scheme; and 7.40 times higher in comparison to Medicare's Helping Children with Autism initiative. This study is the first to report on (in)congruence between PFMs that provide access to independent Australian SLP services for children and young persons and best available scientific evidence to inform clinical practice. Participants identified that: (a) four out of seven contemporary PFMs were unfamiliar to speech-language pathologists; and (b) MBS_CDMP initiative failed to align with the evidence-base for best scientific SLP management.
Collapse
Affiliation(s)
- T. Nickless
- Department of Audiology & Speech Pathology, The University of Melbourne, Australia
- Word By Mouth Speech Pathology, Melbourne, Australia
| | - B. Davidson
- Department of Audiology & Speech Pathology, The University of Melbourne, Australia
| | - S. Finch
- Statistical Consulting Centre, The University of Melbourne, Australia
| | - L. Gold
- Deakin Health Economics, School of Health & Social Development, Deakin University, Australia
| | - R. Dowell
- Department of Audiology & Speech Pathology, The University of Melbourne, Australia
- The Royal Victorian Eye & Ear Hospital, Melbourne, Australia
| |
Collapse
|
2
|
Leclercq AL, Waelkens V, Roelant E, Allegaert M, Verhaegen I, Claes K, Dauvister E, Snijders S, Eggers K, Moyse A, Van Eerdenbrugh S. Treatment for preschool age children who stutter: Protocol of a randomised, non-inferiority parallel group pragmatic trial with Mini-KIDS, social cognitive behaviour treatment and the Lidcombe Program-TreatPaCS. PLoS One 2024; 19:e0304212. [PMID: 38990808 PMCID: PMC11239023 DOI: 10.1371/journal.pone.0304212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 07/13/2024] Open
Abstract
Stuttering is a speech disorder in which the flow of speech is disrupted by involuntary repetitions of sounds, syllables, words or phrases, stretched sounds or silent pauses in which the person is unable to produce sounds and sound transitions. Treatment success is the highest if stuttering is treated before the age of 6 years, before it develops into "persistent" stuttering. Stuttering treatment programs that focus directly on the speech of the child, like the Lidcombe Program, have shown to be effective in this age group. Mini-KIDS is also a treatment that focuses directly on the speech of the child. It is possible that capturing the increased brain plasticity at this age in combination with creating optimal conditions for recovery underlie these treatments' success rate. A treatment focusing on the cognitions, emotions and behaviour of the child, the social cognitive behaviour treatment (SCBT), is also frequently delivered in Belgium. In this study we want to compare, and collect data on the effectiveness, of these three treatment programs: Mini-KIDS, SCBT and the Lidcombe Program (protocol registered under number NCT05185726). 249 children will be allocated to one of three treatment groups. Stuttering specialists will treat the child (and guide the parents) with Mini-KIDS, the SCBT or the Lidcombe Program. They will be trained to deliver the programs meticulously. At 18 months after randomisation, the speech fluency of the child and the attitude of the child and parent(s) towards speech will be measured. It is expected that the three programs will achieve the same (near) zero levels of stuttering in nearly all children and a positive attitude towards speech at 18 months after the start of treatment. The amount of treatment hours to reach the (near) zero levels of stuttering will be compared between the different programmes. For families as well as for the health system this could generate important information.
Collapse
Affiliation(s)
- Anne-Lise Leclercq
- Research Unit for a life-Course perspective on Health and Education (RUCHE), University of Liège, Liège, Belgium
| | - Veerle Waelkens
- Department of Speech and Language Pathology, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Ella Roelant
- Clinical Trials Center, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Mathias Allegaert
- Clinical Trials Center, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Iris Verhaegen
- Clinical Trials Center, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Kim Claes
- Clinical Trials Center, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Estelle Dauvister
- Research Unit for a life-Course perspective on Health and Education (RUCHE), University of Liège, Liège, Belgium
| | - Steffi Snijders
- Center of Expertise Care and Wellbeing, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Kurt Eggers
- Center of Expertise Care and Wellbeing, Thomas More University of Applied Sciences, Antwerp, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Psychology and Speech-Language Pathology, Turku University, Turku, Finland
| | - Astrid Moyse
- Research Unit for a life-Course perspective on Health and Education (RUCHE), University of Liège, Liège, Belgium
| | - Sabine Van Eerdenbrugh
- Center of Expertise Care and Wellbeing, Thomas More University of Applied Sciences, Antwerp, Belgium
| |
Collapse
|
3
|
Onslow M, Lowe R, Jelčić Jakšić S, Bernstein Ratner N, Chmela K, Lim V, Sheedy S. The Fifth Croatia Stuttering Symposium: Part I. Treatments for early stuttering. JOURNAL OF FLUENCY DISORDERS 2024; 79:106022. [PMID: 37995385 DOI: 10.1016/j.jfludis.2023.106022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE The Fifth Croatia Stuttering Symposium in 2022 continued the Fourth Croatia Stuttering Symposium 2019 theme of the connection between research and clinical practice. At the 2022 Symposium, there were 145 delegates from 21 countries. This paper documents the contents of the first of three Symposium modules. METHODS The module topic was that three treatments for early childhood stuttering are supported by randomized controlled trial evidence. A clinical situation was considered where a parent of a 3-year-old child asked what results to expect of stuttering treatment. RESULTS A distinguished scholar presented a 5-minute video interpretation of the research concerning the randomized controlled trial evidence for the three treatments. Three master clinicians then each presented a 2-minute video demonstration of how those research findings might be applied in a clinical situation. Following that, the convenors moderated a discussion between the distinguished scholar, master clinicians, and delegates regarding the research and how it applies to clinical practice.
Collapse
Affiliation(s)
- Mark Onslow
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia.
| | - Robyn Lowe
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | | | | | | | - Valerie Lim
- Singapore Institute of Technology, Singapore
| | - Stacey Sheedy
- South Western Sydney Local Health District, NSW, Australia; Ingham Institute for Applied Medical Research, NSW, Australia
| |
Collapse
|
4
|
Amato Maguire M, Onslow M, Lowe R, O'Brian S, Menzies R. Searching for Lidcombe Program mechanisms of action: Inter-turn speaker latency. CLINICAL LINGUISTICS & PHONETICS 2023; 37:1091-1103. [PMID: 36370111 DOI: 10.1080/02699206.2022.2140075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
The Lidcombe Program is a well-established and efficacious treatment for early stuttering, but little is currently known about its mechanisms of action. The present report explores the possibility that inter-turn speaker latency might be associated with such mechanisms of action. Inter-turn speaker latency was measured in audio recordings of children, parents, and clinicians conversing, taken during Lidcombe Program treatment consultations. Five clinicians reduced their inter-turn speaker latencies during clinical consultations when they were speaking to children, in comparison with when they were speaking to parents. It is possible that inter-turn speaker latency is associated with the Lidcombe Program treatment process vicariously, and this possibility requires further research.
Collapse
Affiliation(s)
- Monique Amato Maguire
- Australian Stuttering Research Centre, NSW, University of Technology Sydney, Ultimo, NSW, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, NSW, University of Technology Sydney, Ultimo, NSW, Australia
| | - Robyn Lowe
- Australian Stuttering Research Centre, NSW, University of Technology Sydney, Ultimo, NSW, Australia
| | - Sue O'Brian
- Australian Stuttering Research Centre, NSW, University of Technology Sydney, Ultimo, NSW, Australia
| | - Ross Menzies
- Australian Stuttering Research Centre, NSW, University of Technology Sydney, Ultimo, NSW, Australia
| |
Collapse
|
5
|
Matheson T, Arnott S, Donaghy M. Australian pre-service primary teachers' knowledge, attitudes, and skills regarding stuttering. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:710-721. [PMID: 36251645 DOI: 10.1080/17549507.2022.2125073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Purpose: Exploring Australian pre-service primary teachers' knowledge, attitudes, and classroom strategies regarding stuttering provides speech-language pathologists (SLPs) with information that can facilitate enhanced outcomes for school-aged children who stutter.Method: In this exploratory descriptive cross-sectional study, 51 final-year Bachelor of Education (Primary) students enrolled at an Australian university completed an online survey about stuttering.Result: Responses demonstrated positive and negative beliefs. Seventy-four per cent of pre-service teachers believed that stuttering has a psychological aetiology and that students who stutter are more likely to be shy or anxious. Participants agreed that their reactions and support offered would largely be based on their assumptions rather than knowledge.Conclusion: Pre-service primary teachers share similar misconceptions and unhelpful attitudes towards stuttering with previously evaluated populations. Implications for SLPs are discussed.
Collapse
Affiliation(s)
- Tim Matheson
- School of Allied Health, Australian Catholic University, Fitzroy, Australia
- Word by Mouth Speech Pathology, Mitcham, Australia
| | | | - Michelle Donaghy
- School of Allied Health, Australian Catholic University, Fitzroy, Australia
| |
Collapse
|
6
|
Carey B, Erickson S, Block S. A preliminary investigation of the mental health of parents of young children who stutter. JOURNAL OF COMMUNICATION DISORDERS 2023; 103:106329. [PMID: 37054521 DOI: 10.1016/j.jcomdis.2023.106329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 02/05/2023] [Accepted: 04/07/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION While research has shown that parents of preschool-aged children who stutter (CWS) may be negatively affected by their child's stuttering, few studies have investigated their mental health. If parents of CWS have poor mental health, this may impact stuttering treatment choices, the conduct of treatment, stuttering treatment outcomes, and the development of stuttering treatments. METHODS 82 parents (74 mothers and 8 fathers) of preschool-aged children who stutter (aged 1-5) were recruited upon application for an assessment for their child. A survey battery extracting quantitative and qualitative information about symptoms of potential depression, anxiety, stress, and psychological distress, as well as the emotional effect of stuttering on parents was administered and the results summarized. RESULTS Data from standardised measures revealed similar incidence as normative data for the presence of stress, anxiety or depression (1 in 6 parents) and distress (almost 1 in 5 parents). However, more than half of the participants reported experiencing a negative emotional effect due to their child's stuttering and a large proportion also reported that stuttering influenced their communication with their child. CONCLUSIONS Speech-language pathologists (SLPs) should broaden the scope of their duty of care to include the parents of CWS more fully. Parents should be provided with informational counselling or other support services that will help reduce worry and anxiety related to negative emotions.
Collapse
|
7
|
Bergþórsdóttir ÍÖ, Crowe K, Einarsdóttir JT. Implementation fidelity in parent-implemented interventions for stuttering. CLINICAL LINGUISTICS & PHONETICS 2022; 36:904-927. [PMID: 34553655 DOI: 10.1080/02699206.2021.1965659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
Knowledge of the fidelity with which interventions are delivered in research studies is crucial to meaningful examination of intervention impact. This paper presents a review of fidelity implementation (FOI) measurements in interventions jointly delivered by speech-language pathologists (SLP) and parents in research for preschool-aged children who stutter (CWS). Four key FOI components were examined: dosage, adherence, quality, responsiveness. Thirty-six studies met the inclusion criteria for this study. Articles were published between 1990 and 2020 described nine different interventions and examined CWS aged 2-6 years. No study reported all FOI components in both the clinical and the home setting and five did not report on any FOI component in either setting. The number of FOI components reported ranged from 0 to 4 in both clinical (M = 1.5) and home (M = 1.0) settings. Across studies, dosage was most often reported (n = 27, 75.0%) and responsiveness was least often reported (n = 16, 44.4%). The number of FOI components reported in articles did not increase over time, although a trend towards greater reporting in recent years was observed. Poor reporting of FOI in intervention research presents a serious methodological concern that impacts the ability of clinicians and researchers to interpret the findings of these studies. Rigorous measurement and reporting of FOI in future intervention studies is required in order to better inform evidence-based practices for interventions with CWS.
Collapse
Affiliation(s)
| | - Kathryn Crowe
- School of Health Science, University of Iceland, Reykjavik, Iceland
- School of Teacher Education, Charles Sturt University, Bathurst, Australia
| | | |
Collapse
|
8
|
Laiho A, Elovaara H, Kaisamatti K, Luhtalampi K, Talaskivi L, Pohja S, Routamo-Jaatela K, Vuorio E. Stuttering interventions for children, adolescents, and adults: a systematic review as a part of clinical guidelines. JOURNAL OF COMMUNICATION DISORDERS 2022; 99:106242. [PMID: 35751980 DOI: 10.1016/j.jcomdis.2022.106242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 05/01/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Stuttering may have a holistic effect on the quality of life of a person who stutters by limiting participation in social situations, resulting in feelings of isolation and frustration, leading to difficulties in education and employment and increasing the likelihood of mental health problems. Even young children who stutter may have negative experiences of speaking. Therefore, it is important to treat stuttering behavior effectively in both children and adults. The purpose of this paper was to systematically review group and case studies about the effectiveness of behavioral stuttering interventions to provide evidence-based guidelines for clinicians. METHODS Systematic data retrieval was conducted in four electronic databases (PsycINFO, CINAHL, PubMed, Cochrane). The assessment of search results was conducted according to predetermined inclusion and exclusion criteria by two independent judges. The methodological quality of each paper was assessed using strict criteria to include only high-quality research. RESULTS The search revealed 2293 results, and 38 papers (systematic reviews N=3, group design studies N=21 and case studies N=14) with acceptable methodological quality were included. The data show that there is most evidence about the treatment of early childhood stuttering, very little evidence about school-aged children and some evidence about adults. The most convincing evidence is about the Lidcombe Program in the treatment of young children who stutter, but also other methods have promising evidence. Our data imply that in the treatment of adults who stutter, holistic treatments may influence speech fluency and overall experience of stuttering behavior. Speech restructuring treatments may have a positive effect on overt characteristics of stuttering, but not on covert stuttering behavior. CONCLUSIONS The results of this review agree with earlier reviews about the treatment of young children. However, due to different inclusion criteria, this review also shows the benefits of holistic treatment approaches with adults and adolescents.
Collapse
Affiliation(s)
- Auli Laiho
- Finnish Association of Speech and Language Therapists; Voimavarakeskus Tempo Oy, Tempo - Stuttering Resource Center.
| | - Heli Elovaara
- Finnish Association of Speech and Language Therapists; Salon kaupunki, City of Salo.
| | - Kirsi Kaisamatti
- Finnish Association of Speech and Language Therapists; Coronaria Terapeija Oy.
| | - Katri Luhtalampi
- Finnish Association of Speech and Language Therapists; Logopedica.
| | - Liisa Talaskivi
- Finnish Association of Speech and Language Therapists; Kommunikointikeskus Kipinä Oy.
| | - Salla Pohja
- Finnish Association of Speech and Language Therapists; Voimavarakeskus Tempo Oy, Tempo - Stuttering Resource Center.
| | | | - Elsa Vuorio
- Finnish Association of Speech and Language Therapists; Private Practice.
| |
Collapse
|
9
|
Hofslundsengen H, Kirmess M, Guttormsen LS, Næss KAB, Kefalianos E. Systematic review of implementation quality of non-pharmacological stuttering intervention trials for children and adolescents. JOURNAL OF FLUENCY DISORDERS 2022; 71:105884. [PMID: 34798495 DOI: 10.1016/j.jfludis.2021.105884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/06/2021] [Accepted: 11/06/2021] [Indexed: 06/13/2023]
Abstract
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.
Collapse
Affiliation(s)
- Hilde Hofslundsengen
- Western Norway University of Applied Sciences, Faculty of Education, Arts and Sports, box 131, 6856 Sogndal, Norway.
| | - Melanie Kirmess
- University of Oslo, Department of Special Needs Education, Mail Box 1140 Blindern, 0318 Oslo, Norway; Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, 1453 Bjørnemyr, Norway.
| | - Linn Stokke Guttormsen
- University of Oslo, Department of Special Needs Education, Mail Box 1140 Blindern, 0318 Oslo, Norway.
| | - Kari-Anne Bottegaard Næss
- University of Oslo, Department of Special Needs Education, Mail Box 1140 Blindern, 0318 Oslo, Norway.
| | - Elaina Kefalianos
- University of Melbourne, Department of Audiology & Speech Pathology, Faculty of Medicine, Dentistry and Health Sciences, Level 2, 550 Swanston Street, Carlton, 3052, Australia.
| |
Collapse
|
10
|
Rojas Contreras D, Saavedra Rojas P, Aravena Gallardo SL. Intervención de la tartamudez en niños: una revisión integrativa de la literatura. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222427521s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMEN Objetivo: describir las metodologías de intervención implementadas durante los últimos años en niños con tartamudez Métodos: se realizó la búsqueda de artículos empíricos de tratamiento en niños con tartamudez entre los 2.5 a 7 años. Se consideraron artículos publicados entre enero del año 2014 a junio del año 2020. La búsqueda se realizó en las bases de datos Embase, WOS, Pubmed y Scopus. Junto a lo anterior se realizó un análisis de las referencias de los artículos seleccionados. Revisión de la Literatura: se seleccionaron 11 artículos de 1.099 revisados. Se observaron distintas propuestas de intervención de las cuales el Programa Lidcombe es el que mayor evidencia presenta. La mayoría de las investigaciones fueron realizadas en hablantes de lengua inglesa. Los participantes son evaluados tanto en aspectos lingüísticos como no lingüísticos. Todos consideraron la participación de los padres en la intervención. No hubo investigaciones con mediciones a más de 24 meses. Predomina la modalidad de intervención individual. Conclusión: se evidencian buenos resultados terapéuticos en todas las intervenciones revisadas. En las investigaciones que compararon dos tipos de tratamiento no se observó la superioridad de uno por sobre otro.
Collapse
|
11
|
Rojas Contreras D, Saavedra Rojas P, Aravena Gallardo SL. Stuttering intervention in children: an integrative literature review. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222427521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to describe intervention methodologies implemented in recent years in stuttering children. Methods: a search was performed for empirical articles on interventions in stuttering children aged 2.5 to 7 years. The search was carried out in Embase, WOS, Pubmed, and Scopus, considering articles published between January 2014 and June 2020. Literature Review: 11 articles were selected out of the 1,099 retrieved. Different approaches were observed, of which the Lidcombe program showed the most evidence. Most studies were conducted on English-speaking children and participants were assessed regarding linguistic and non-linguistic aspects. All studies considered parental involvement in the intervention. No investigation took measurements for more than 24 months. Individual interventions predominated. Conclusion: good therapeutic results were found in all reviewed interventions. Research comparing two types of treatments did not find one to be superior to the other.
Collapse
|
12
|
Brignell A, Krahe M, Downes M, Kefalianos E, Reilly S, Morgan A. Interventions for children and adolescents who stutter: A systematic review, meta-analysis, and evidence map. JOURNAL OF FLUENCY DISORDERS 2021; 70:105843. [PMID: 33743406 DOI: 10.1016/j.jfludis.2021.105843] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
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.
Collapse
Affiliation(s)
- Amanda Brignell
- Speech and Language Group, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
| | - Michelle Krahe
- Health Group, Griffith University, Southport, Queensland, 4222, Australia
| | - Martin Downes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Nathan, Queensland, 4111, Australia
| | - Elaina Kefalianos
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Sheena Reilly
- Health Group, Griffith University, Southport, Queensland, 4222, Australia
| | - Angela Morgan
- Speech and Language Group, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia.
| |
Collapse
|
13
|
Sjøstrand Å, Kefalianos E, Hofslundsengen H, Guttormsen LS, Kirmess M, Lervåg A, Hulme C, Bottegaard Næss KA. Non-pharmacological interventions for stuttering in children six years and younger. Cochrane Database Syst Rev 2021; 9:CD013489. [PMID: 34499348 PMCID: PMC8428330 DOI: 10.1002/14651858.cd013489.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
Collapse
Affiliation(s)
- Åse Sjøstrand
- Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - Elaina Kefalianos
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville, Australia
| | - Hilde Hofslundsengen
- Department of Language, Literature, Mathematics and Interpreting, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Linn S Guttormsen
- Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - Melanie Kirmess
- Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - Arne Lervåg
- Department of Education, University of Oslo, Oslo, Norway
| | - Charles Hulme
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Education, University of Oxford, Oxford, UK
| | | |
Collapse
|
14
|
Subasi M, Van Borsel J, Van Eerdenbrugh S. The Lidcombe Program for Early Stuttering in Non-English-Speaking Countries: A Systematic Review. Folia Phoniatr Logop 2021; 74:89-102. [PMID: 34289470 DOI: 10.1159/000517650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Lidcombe Program is a stuttering treatment approach for children between the ages of 3 and 6 years. Most papers about the Lidcombe Program, however, are based on studies conducted in native English-speaking countries. The aim of this paper is to systematically review the delivery and implementation of the Lidcombe Program in non-native English-speaking countries. SUMMARY A resource search was conducted between October and November 2019. Scopus, PubMed, ASHA, Cochrane Library, ERIC, Google Scholar, and SpeechBITE databases and reference lists of relevant papers were searched for the identification process. Joanna Briggs Institute tools were used for the appraisal of the studies. The search yielded 8 studies conducted in non-native English-speaking countries. The Lidcombe Program is efficacious in non-native English-speaking countries when delivered to both preschool and young school age children who stutter. It is reported to be delivered with minor changes and challenges. The number of weekly clinic visits and the total time needed to reach zero or near-zero stuttering levels with the Lidcombe Program can be up to 3 times greater in non-native English-speaking countries than in native English-speaking countries, mostly due to the increased time needed to introduce the parental verbal contingencies. Key Messages: Speech and language therapists practicing in non-native English-speaking countries are encouraged to use the Lidcombe Program for both preschool and young school age children who stutter, although this can take more time than that reported in native English-speaking countries. Further investigation to explore the therapy process with children and parents in non-native English-speaking countries is needed.
Collapse
Affiliation(s)
- Mustafa Subasi
- Department of Speech, Language, and Hearing Sciences, Ghent University, Ghent, Belgium.,Department of Speech and Language Therapy, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - John Van Borsel
- Department of Speech, Language, and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Sabine Van Eerdenbrugh
- Department of Speech Therapy and Audiology, Thomas More College of Applied Sciences, Antwerp, Belgium
| |
Collapse
|
15
|
Park V, Onslow M, Lowe R, Jones M, O'Brian S, Packman A, Menzies R, Block S, Wilson L, Harrison E, Hewat S. Predictors of Lidcombe Program treatment dropout and outcome for early stuttering. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:102-115. [PMID: 33251679 DOI: 10.1111/1460-6984.12586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 06/12/2023]
Abstract
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.
Collapse
Affiliation(s)
- Veronica Park
- Australian Stuttering Research Centre, The University of Sydney, Lidcombe, NSW, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, The University of Sydney, Lidcombe, NSW, Australia
| | - Robyn Lowe
- Australian Stuttering Research Centre, The University of Sydney, Lidcombe, NSW, Australia
| | - Mark Jones
- School of Population Health, The University of Queensland, Brisbane, QLD, Australia
| | - Sue O'Brian
- Australian Stuttering Research Centre, The University of Sydney, Lidcombe, NSW, Australia
| | - Ann Packman
- Australian Stuttering Research Centre, The University of Sydney, Lidcombe, NSW, Australia
| | - Ross Menzies
- Australian Stuttering Research Centre, The University of Sydney, Lidcombe, NSW, Australia
| | - Susan Block
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia
| | - Linda Wilson
- School of Community Health, Charles Sturt University, Albury/Wadonga, NSW, Australia
| | - Elisabeth Harrison
- Department of Linguistics, Macquarie University, Macquarie Park, NSW, Australia
| | - Sally Hewat
- School of Humanities and Social Science, The University of Newcastle, Newcastle, NSW, Australia
| |
Collapse
|
16
|
Donaghy M, O'Brian S, Onslow M, Lowe R, Jones M, Menzies RG. Verbal Contingencies in the Lidcombe Program: A Noninferiority Trial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3419-3431. [PMID: 32956008 DOI: 10.1044/2020_jslhr-20-00155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
Collapse
Affiliation(s)
- Michelle Donaghy
- Australian Catholic University, North Sydney, New South Wales, Australia
| | - Sue O'Brian
- Australian Stuttering Research Centre, University of Technology Sydney, New South Wales, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, University of Technology Sydney, New South Wales, Australia
| | - Robyn Lowe
- Australian Stuttering Research Centre, University of Technology Sydney, New South Wales, Australia
| | - Mark Jones
- School of Public Health, The University of Queensland, Herston, Australia
| | - Ross G Menzies
- Australian Stuttering Research Centre, University of Technology Sydney, New South Wales, Australia
| |
Collapse
|
17
|
Hewat S, Unicomb R, Dean I, Cui G. Treatment of Childhood stuttering using the Lidcombe Program in mainland China: case studies. SPEECH, LANGUAGE AND HEARING 2020. [DOI: 10.1080/2050571x.2018.1511106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Sally Hewat
- Discipline of Speech Pathology, The University of Newcastle, Callaghan, Australia
| | - Rachael Unicomb
- Discipline of Speech Pathology, The University of Newcastle, Callaghan, Australia
| | - Imogen Dean
- Discipline of Speech Pathology, The University of Newcastle, Callaghan, Australia
| | - Guangli Cui
- Orient Speech Therapy Center, Shenzhen, People’s Republic of China
| |
Collapse
|
18
|
Koushik S, Hewat S, Onslow M, Shenker R, Jones M, O'Brian S, Packman A, Menzies R, Harrison E, Wilson L. Three Lidcombe program clinic visit options: a phase II trial. JOURNAL OF COMMUNICATION DISORDERS 2019; 82:105919. [PMID: 31351345 DOI: 10.1016/j.jcomdis.2019.105919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/21/2019] [Accepted: 06/30/2019] [Indexed: 06/10/2023]
Abstract
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.
Collapse
Affiliation(s)
| | - Sally Hewat
- University of Newcastle, Newcastle, Australia.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Trajkovski N, O'Brian S, Onslow M, Packman A, Lowe R, Menzies R, Jones M, Reilly S. A three-arm randomized controlled trial of Lidcombe Program and Westmead Program early stuttering interventions. JOURNAL OF FLUENCY DISORDERS 2019; 61:105708. [PMID: 31121476 DOI: 10.1016/j.jfludis.2019.105708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/27/2019] [Accepted: 05/06/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE To compare two experimental Westmead Program treatments with a control Lidcombe Program treatment for early stuttering. METHOD The design was a three-arm randomized controlled trial with blinded outcome assessments 9 months post-randomization. Participants were 91 pre-school children. RESULTS There was no evidence of difference in percentage syllables stuttered at 9 months among groups. Dropout rates were substantive and may have been connected with novel aspects of the trial design: the use of community clinicians, no exclusion criteria, and randomization of children younger than 3 years of age. CONCLUSION The substantive dropout rate for all three arms in this trial means that any conclusions about the 9-month stuttering outcomes must be regarded as tentative. However, continued development of the Westmead Program is warranted, and we are currently constructing an internet version.
Collapse
Affiliation(s)
- Natasha Trajkovski
- Australian Stuttering Research Centre, Faculty of Health Science, The University of Sydney, NSW, Australia.
| | - Sue O'Brian
- Australian Stuttering Research Centre, Faculty of Health Science, The University of Sydney, NSW, Australia.
| | - Mark Onslow
- Australian Stuttering Research Centre, Faculty of Health Science, The University of Sydney, NSW, Australia.
| | - Ann Packman
- Australian Stuttering Research Centre, Faculty of Health Science, The University of Sydney, NSW, Australia.
| | - Robyn Lowe
- Australian Stuttering Research Centre, Faculty of Health Science, The University of Sydney, NSW, Australia.
| | - Ross Menzies
- Australian Stuttering Research Centre, Faculty of Health Science, The University of Sydney, NSW, Australia.
| | - Mark Jones
- School of Public Health, The University of Queensland, QLD, Australia.
| | - Sheena Reilly
- Menzies Health Institute Queensland, Griffith University, QLD, Australia; Murdoch Childrens Research Institute, Melbourne, Australia.
| |
Collapse
|
20
|
Onslow M, Lowe R. After the RESTART trial: six guidelines for clinical trials of early stuttering intervention. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:517-528. [PMID: 30773736 DOI: 10.1111/1460-6984.12463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 01/30/2019] [Accepted: 02/01/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The Rotterdam Evaluation Study of Stuttering Therapy randomized trial (RESTART) was seminal, comparing the Lidcombe Program with RESTART Demands and Capacities Model-based treatment (RESTART-DCM) for pre-school age children who stutter. AIMS To critique the methods of the RESTART trial to develop guidelines for its systematic replication and extension. Beyond that, to contribute to the refinement of existing methodological guidelines for early stuttering intervention. METHOD The discussion is organized around methodological issues of primary outcomes, treatment completion, clinician allegiance, treatment fidelity, age exclusions and no-treatment control reasoning. MAIN CONTRIBUTION We recommend six methodological guidelines to guide future clinical trials comparing the Lidcombe Program with RESTART-DCM, which can be applied to clinical trials of other early stuttering intervention methods: (1) incorporate a continuous measure of primary outcome; (2) ensure that all children in clinical trials have completed treatment; (3) eliminate potential bias due to clinician allegiance; (4) establish treatment fidelity within and beyond the clinic; (5) include children younger than 3 years in clinical trials; and (6) establish an estimate of treatment effect size at some stage of treatment development. CONCLUSION In addition to guiding future clinical research comparing RESTART-DCM and Lidcombe Program treatment, these recommendations may extend to influence positively other treatment developments for early stuttering.
Collapse
Affiliation(s)
- Mark Onslow
- Australian Stuttering Research Centre, The University of Sydney, Faculty of Health Sciences, Sydney, NSW, Australia
| | - Robyn Lowe
- Australian Stuttering Research Centre, The University of Sydney, Faculty of Health Sciences, Sydney, NSW, Australia
| |
Collapse
|
21
|
Marcotte AK. The Influence of Treatment on Children's Recovery From Stuttering: Comments on Kefalianos et al. (2017) and Leech et al. (2017). JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1364-1368. [PMID: 31058572 DOI: 10.1044/2019_jslhr-s-17-0437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose Two studies published recently in this journal sought to expand on previous attempts to explain and predict young children's recovery from stuttering. This letter addresses the influence of treatment on such research. Conclusions Recent publications from Kefalianos et al. (2017) and Leech, Bernstein Ratner, Brown, and Weber (2017) added to previous information that gender and language ability (or language growth) may be related to children's recovery from stuttering. The conclusions from both studies are difficult to interpret, however, because neither incorporated two factors known to influence children's recovery: a family history of recovery and, especially, the type and timing of treatment. Consideration of these two articles therefore raises multiple empirical, theoretical, and clinical issues that deserve to be fully addressed if our discipline is seeking to understand and to maximize recovery for young children who stutter.
Collapse
Affiliation(s)
- Anne K Marcotte
- Department of Communication Sciences and Special Education, University of Georgia, Athens
| |
Collapse
|
22
|
Karimi H, Onslow M, Jones M, O'Brian S, Packman A, Menzies R, Reilly S, Sommer M, Jelčić-Jakšić S. The Satisfaction with Communication in Everyday Speaking Situations (SCESS) scale: An overarching outcome measure of treatment effect. JOURNAL OF FLUENCY DISORDERS 2018; 58:77-85. [PMID: 30392583 DOI: 10.1016/j.jfludis.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 06/29/2018] [Accepted: 10/10/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The Consolidated Standards of Reporting Trials (CONSORT) statement strongly suggests one primary outcome for clinical trials, yet the outcomes of stuttering treatments span numerous behavioral and psychosocial domains. That presents a roadblock to eventual meta-analysis of clinical trials for adults who stutter. METHOD We propose a simple and convenient outcome measure for clinical trials of stuttering treatment for adults that spans whatever behavioral and psychosocial factors might impel clients to seek treatment: a nine-point scale of Satisfaction with Communication in Everyday Speaking Situations (SCESS). The scale consists of one question which is simple, brief, easy to administer, cost-free, and translatable into many languages. The present report develops the SCESS scale by determining its reliability, content validity, and construct validity. RESULTS Reliability, content validity, and construct validity of the SCESS were confirmed with statistically significant and substantive correlations with speech-related and anxiety-related measures. However, the SCESS did not correlate well with percentage syllables stuttered. Three behavioral and psychosocial measures had the highest correlation with the SCESS: total Overall Assessment of the Speaker's Experience of Stuttering, self-reported stuttering severity, and Unhelpful Thoughts and Beliefs about Stuttering. CONCLUSION The SCESS measure has potential to be applied as an overarching clinical trial outcome measure of stuttering treatment effect. This study provides some preliminary evidence for including it as a primary or secondary outcome in clinical trials of adult stuttering treatments. However, further studies are needed to establish the SCESS responsiveness to different stuttering treatments.
Collapse
Affiliation(s)
- Hamid Karimi
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW, 1825, Australia.
| | - Mark Onslow
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW, 1825, Australia.
| | - Mark Jones
- School of Public Health, University of Queensland, Level 2, Public Health Building, Herston Road, Herston QLD 4006, Australia.
| | - Sue O'Brian
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW, 1825, Australia.
| | - Ann Packman
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW, 1825, Australia.
| | - Ross Menzies
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW, 1825, Australia.
| | | | - Martin Sommer
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Germany.
| | | |
Collapse
|
23
|
Van Eerdenbrugh S, Packman A, O'Brian S, Onslow M. Challenges and Strategies for Speech-Language Pathologists Using the Lidcombe Program for Early Stuttering. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1259-1272. [PMID: 30347068 DOI: 10.1044/2018_ajslp-odc11-17-0185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The Lidcombe program is a treatment for preschool-age children who stutter. Studies indicate that its implementation is not always straightforward. In this study, challenges that parents and speech-language pathologists (SLPs) encounter when implementing the Lidcombe program were identified, and strategies to address them were sought. METHOD In Part 1, Lidcombe program treatment challenges were determined from 4 sources. In Part 2, 7 SLPs with 15 to 23 years of Lidcombe program experience were interviewed to develop strategies to respond to the identified treatment challenges. RESULT A template of the themes and a report with possible strategies are the outcomes of this study. A total of 124 themes were identified, mostly related to the implementation of Lidcombe program procedures. Strategies to deal with these challenges were formulated. CONCLUSIONS This study provides treatment challenges that parents or SLPs may encounter during the Lidcombe program. It also provides strategies that SLPs can suggest to address them. An added contribution of the findings is that SLPs in the clinic can now anticipate the sort of treatment challenges that parents may face. A summary of the findings will be made available on the Australian Stuttering Research Centre website and through the Lidcombe Program Trainers Consortium.
Collapse
Affiliation(s)
- Sabine Van Eerdenbrugh
- Thomas More University College, Antwerp, Belgium
- Australian Stuttering Research Centre, University of Technology, Sydney
| | - Ann Packman
- Australian Stuttering Research Centre, University of Technology, Sydney
| | - Sue O'Brian
- Australian Stuttering Research Centre, University of Technology, Sydney
| | - Mark Onslow
- Australian Stuttering Research Centre, University of Technology, Sydney
| |
Collapse
|
24
|
Onslow M, Jones M, O'Brian S, Packman A, Menzies R, Lowe R, Arnott S, Bridgman K, de Sonneville C, Franken MC. Comparison of Percentage of Syllables Stuttered With Parent-Reported Severity Ratings as a Primary Outcome Measure in Clinical Trials of Early Stuttering Treatment. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:811-819. [PMID: 29554191 DOI: 10.1044/2017_jslhr-s-16-0448] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 11/16/2017] [Indexed: 06/08/2023]
Abstract
PURPOSE This report investigates whether parent-reported stuttering severity ratings (SRs) provide similar estimates of effect size as percentage of syllables stuttered (%SS) for randomized trials of early stuttering treatment with preschool children. METHOD Data sets from 3 randomized controlled trials of an early stuttering intervention were selected for analyses. Analyses included median changes and 95% confidence intervals per treatment group, Bland-Altman plots, analysis of covariance, and Spearman rho correlations. RESULTS Both SRs and %SS showed large effect sizes from pretreatment to follow-up, although correlations between the 2 measures were moderate at best. Absolute agreement between the 2 measures improved as percentage reduction of stuttering frequency and severity increased, probably due to innate measurement limitations for participants with low baseline severity. Analysis of covariance for the 3 trials showed consistent results. CONCLUSION There is no statistical reason to favor %SS over parent-reported stuttering SRs as primary outcomes for clinical trials of early stuttering treatment. However, there are logistical reasons to favor parent-reported stuttering SRs. We conclude that parent-reported rating of the child's typical stuttering severity for the week or month prior to each assessment is a justifiable alternative to %SS as a primary outcome measure in clinical trials of early stuttering treatment.
Collapse
Affiliation(s)
- Mark Onslow
- The University of Sydney, Australian Stuttering Research Centre, Lidcombe, New South Wales
| | - Mark Jones
- The University of Queensland, School of Public Health, Faculty of Medicine, Brisbane, Australia
| | - Sue O'Brian
- The University of Sydney, Australian Stuttering Research Centre, Lidcombe, New South Wales
| | - Ann Packman
- The University of Sydney, Australian Stuttering Research Centre, Lidcombe, New South Wales
| | - Ross Menzies
- The University of Sydney, Australian Stuttering Research Centre, Lidcombe, New South Wales
| | - Robyn Lowe
- The University of Sydney, Australian Stuttering Research Centre, Lidcombe, New South Wales
| | - Simone Arnott
- Australian Catholic University, School of Allied and Public Health, Melbourne
| | - Kate Bridgman
- La Trobe University, Department of Human Communication Science, Melbourne, Australia
| | | | | |
Collapse
|
25
|
Van Eerdenbrugh S, Packman A, Onslow M, O'brian S, Menzies R. Development of an internet version of the Lidcombe Program of early stuttering intervention: A trial of Part 1. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 20:216-225. [PMID: 27908200 DOI: 10.1080/17549507.2016.1257653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/24/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE There is evidence that access to treatment for early stuttering is not available for all who need it. An internet version of the Lidcombe Program for early stuttering (Internet-LP) has been developed to deal with this shortfall. The LP is suitable for such development because it is delivered by parents in the child's everyday environment, with training by a speech-language pathologist. A Phase I trial of Internet-LP Part 1, comprising parent training, is reported here. METHOD Eight parents of pre-schoolers who stutter were recruited and six completed the trial. RESULT Post-trial assessment indicated that the parents scored well for identifying and measuring stuttering and for knowledge about conducting practice sessions, including how to present verbal contingencies during practice sessions. CONCLUSION The results prompted minor adjustments to Part 1 and guided the construction of Part 2, which instructs parents during the remainder of the treatment process.
Collapse
Affiliation(s)
- Sabine Van Eerdenbrugh
- a Australian Stuttering Research Centre, The University of Sydney , Lidcombe , Australia and
- b Thomas More University College , Antwerp , Belgium
| | - Ann Packman
- a Australian Stuttering Research Centre, The University of Sydney , Lidcombe , Australia and
| | - Mark Onslow
- a Australian Stuttering Research Centre, The University of Sydney , Lidcombe , Australia and
| | - Sue O'brian
- a Australian Stuttering Research Centre, The University of Sydney , Lidcombe , Australia and
| | - Ross Menzies
- a Australian Stuttering Research Centre, The University of Sydney , Lidcombe , Australia and
| |
Collapse
|
26
|
Nippold MA. Stuttering in Preschool Children: Direct Versus Indirect Treatment. Lang Speech Hear Serv Sch 2018; 49:4-12. [DOI: 10.1044/2017_lshss-17-0066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/12/2017] [Indexed: 11/09/2022] Open
Abstract
Purpose
The purpose of this article is to discuss the controversial topic of stuttering in preschool children and how to evaluate the options for treatment, emphasizing the role of external research evidence.
Method
A hypothetical but realistic case study of a 3-year-old boy who stutters is described. Two contrasting approaches to treatment are presented, the Lidcombe Program (LP) and the demands and capacities model (DCM). Studies published in peer-reviewed research journals that have examined the effectiveness of each approach are summarized and critiqued.
Results
The review indicates that the LP is the preferred treatment approach for stuttering in preschool children and that it offers the best opportunity for rapid success.
Conclusion
The LP should be carried out by knowledgeable, experienced, and flexible speech-language pathologists who are able to accommodate the individual needs and differences of every child and family.
Collapse
|
27
|
Unicomb R, Hewat S, Spencer E, Harrison E. Evidence for the treatment of co-occurring stuttering and speech sound disorder: A clinical case series. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:251-264. [PMID: 28290729 DOI: 10.1080/17549507.2017.1293735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 02/04/2017] [Indexed: 06/06/2023]
Abstract
PURPOSE There is a paucity of evidence to guide treatment for children with co-occurring stuttering and speech sound disorder. Some guidelines suggest treating the two disorders simultaneously using indirect treatment approaches; however, the research supporting these recommendations is over 20 years old. In this clinical case series, we investigate whether these co-occurring disorders could be treated concurrently using direct treatment approaches supported by up-to-date, high-level evidence, and whether this could be done in an efficacious, safe and efficient manner. METHOD Five pre-school-aged participants received individual concurrent, direct intervention for both stuttering and speech sound disorder. All participants used the Lidcombe Program, as manualised. Direct treatment for speech sound disorder was individualised based on analysis of each child's sound system. RESULT At 12 months post commencement of treatment, all except one participant had completed the Lidcombe Program, and were less than 1.0% syllables stuttered on samples gathered within and beyond the clinic. These four participants completed Stage 1 of the Lidcombe Program in between 14 and 22 clinic visits, consistent with current benchmark data for this programme. At the same assessment point, all five participants exhibited significant increases in percentage of consonants correct and were in alignment with age-expected estimates of this measure. Further, they were treated in an average number of clinic visits that compares favourably with other research on treatment for speech sound disorder. CONCLUSION These preliminary results indicate that young children with co-occurring stuttering and speech sound disorder may be treated concurrently using direct treatment approaches. This method of service delivery may have implications for cost and time efficiency and may also address the crucial need for early intervention in both disorders. These positive findings highlight the need for further research in the area and contribute to the limited evidence base.
Collapse
Affiliation(s)
- Rachael Unicomb
- a Speech Pathology Department, Faculty of Education and Arts , The University of Newcastle , Newcastle , Australia and
| | - Sally Hewat
- a Speech Pathology Department, Faculty of Education and Arts , The University of Newcastle , Newcastle , Australia and
| | - Elizabeth Spencer
- a Speech Pathology Department, Faculty of Education and Arts , The University of Newcastle , Newcastle , Australia and
| | - Elisabeth Harrison
- b Linguistics Department, Faculty of Human Sciences, Macquarie University , Sydney , Australia
| |
Collapse
|
28
|
McCulloch J, Swift MC, Wagnitz B. Case file audit of Lidcombe program outcomes in a student-led stuttering clinic. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:165-173. [PMID: 27070028 DOI: 10.3109/17549507.2016.1159336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/24/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE The current study aimed to benchmark clinical outcomes for preschool-aged clients (2;0-5;11 years old) that attended a student-led clinic and undertook the Lidcombe Program. METHOD A case file audit was undertaken for all preschool clients who attended the clinic between February 2008 and February 2013 and commenced the Lidcombe Program. Clients were grouped according to Stage 1 completion. A mixed ANOVA was used to test for differences between the groups in initial and final percentage syllables stuttered (%SS). Associations between case variable factors and treatment duration were investigated using Pearson correlations. RESULT Clients who completed Stage 1 had final %SS and severity rating (SR) scores comparable to the literature; however, the median Stage 1 duration was greater. Over half of the clients (57%) withdrew prior to completing Stage 1. These clients had a significantly higher %SS at final treatment session than their completing peers. Initial %SS and SR scores were the only case variables associated with treatment duration. CONCLUSION Students can achieve the same short-term treatment outcomes for children who stutter using the Lidcombe Program as the current published literature; however, treatment duration is greater and may impact completion. Implications of this for clinical education are discussed.
Collapse
Affiliation(s)
- Julia McCulloch
- a Flinders University, School of Health Sciences - Speech Pathology , Adelaide , South Australia , Australia
| | - Michelle C Swift
- a Flinders University, School of Health Sciences - Speech Pathology , Adelaide , South Australia , Australia
| | - Bianca Wagnitz
- a Flinders University, School of Health Sciences - Speech Pathology , Adelaide , South Australia , Australia
| |
Collapse
|
29
|
Bridgman K, Onslow M, O'Brian S, Jones M, Block S. Lidcombe Program Webcam Treatment for Early Stuttering: A Randomized Controlled Trial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:932-939. [PMID: 27617680 DOI: 10.1044/2016_jslhr-s-15-0011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 01/27/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Webcam treatment is potentially useful for health care in cases of early stuttering in which clients are isolated from specialized treatment services for geographic and other reasons. The purpose of the present trial was to compare outcomes of clinic and webcam deliveries of the Lidcombe Program treatment (Packman et al., 2015) for early stuttering. METHOD The design was a parallel, open plan, noninferiority randomized controlled trial of the standard Lidcombe Program treatment and the experimental webcam Lidcombe Program treatment. Participants were 49 children aged 3 years 0 months to 5 years 11 months at the start of treatment. Primary outcomes were the percentage of syllables stuttered at 9 months postrandomization and the number of consultations to complete Stage 1 of the Lidcombe Program. RESULTS There was insufficient evidence of a posttreatment difference of the percentage of syllables stuttered between the standard and webcam Lidcombe Program treatments. There was insufficient evidence of a difference between the groups for typical stuttering severity measured by parents or the reported clinical relationship with the treating speech-language pathologist. CONCLUSIONS This trial confirmed the viability of the webcam Lidcombe Program intervention. It appears to be as efficacious and economically viable as the standard, clinic Lidcombe Program treatment.
Collapse
Affiliation(s)
- Kate Bridgman
- Australian Stuttering Research Centre, The University of Sydney, New South WalesSchool of Allied Health, La Trobe University, Victoria, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, The University of Sydney, New South Wales
| | - Susan O'Brian
- Australian Stuttering Research Centre, The University of Sydney, New South Wales
| | - Mark Jones
- School of Population Health, The University of Queensland, Australia
| | - Susan Block
- School of Allied Health, La Trobe University, Victoria, Australia
| |
Collapse
|
30
|
Donaghy MA, Smith KA. Management options for pediatric patients who stutter: current challenges and future directions. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2016; 7:71-77. [PMID: 29388582 PMCID: PMC5683286 DOI: 10.2147/phmt.s77568] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Stuttering is a speech disorder, with onset often occurring in the preschool years. The prevalence of stuttering in young children is much higher than that in the general population, suggesting a high rate of recovery. However, we are unable to predict which children will recover without treatment, and it is widely acknowledged that stuttering therapy during childhood provides the best safeguard against chronic stuttering. This review reports on current evidence-based stuttering treatment options for preschoolers through to adolescents. We discuss the clinical challenges associated with treating pediatric clients who stutter at different stages of development and explore potential areas of treatment research that might serve to advance current clinical practice in the future.
Collapse
Affiliation(s)
- Michelle A Donaghy
- Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW
| | - Kylie A Smith
- Murdoch Childrens Research Institute, Royal Childrens Hospital.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
31
|
Andrews C, O'Brian S, Onslow M, Packman A, Menzies R, Lowe R. Phase II trial of a syllable-timed speech treatment for school-age children who stutter. JOURNAL OF FLUENCY DISORDERS 2016; 48:44-55. [PMID: 27498894 DOI: 10.1016/j.jfludis.2016.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/01/2016] [Accepted: 06/16/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE A recent clinical trial (Andrews et al., 2012) showed Syllable Timed Speech (STS) to be a potentially useful treatment agent for the reduction of stuttering for school-age children. The present trial investigated a modified version of this program that incorporated parent verbal contingencies. METHODS Participants were 22 stuttering children aged 6-11 years. Treatment involved training the children and their parents to use STS in conversation. Parents were also taught to use verbal contingencies in response to their child's stuttered and stutter-free speech and to praise their child's use of STS. Outcome assessments were conducted pre-treatment, at the completion of Stage 1 of the program and 6 months and 12 months after Stage 1 completion. RESULTS Outcomes are reported for the 19 children who completed Stage 1 of the program. The group mean percent stuttering reduction was 77% from pre-treatment to 12 months post-treatment, and 82% with the two least responsive participants removed. There was considerable variation in response to the treatment. Eleven of the children showed reduced avoidance of speaking situations and 18 were more satisfied with their fluency post-treatment. However, there was some suggestion that stuttering control was not sufficient to fully eliminate situation avoidance for the children. CONCLUSIONS The results of this trial are sufficiently encouraging to warrant further clinical trials of the method.
Collapse
Affiliation(s)
- Cheryl Andrews
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Sue O'Brian
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Mark Onslow
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Ann Packman
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Ross Menzies
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Robyn Lowe
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| |
Collapse
|
32
|
Swift MC, Jones M, O'Brian S, Onslow M, Packman A, Menzies R. Parent verbal contingencies during the Lidcombe Program: Observations and statistical modeling of the treatment process. JOURNAL OF FLUENCY DISORDERS 2016; 47:13-26. [PMID: 26897495 DOI: 10.1016/j.jfludis.2015.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/25/2015] [Accepted: 12/03/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE The purpose of this study was to document parent presentation of the Lidcombe Program verbal contingencies and model potential relationships between contingency provision and treatment duration. METHODS Forty parent-child pairs undertaking the Lidcombe Program participated, 26 of whom completed Stage 1. All participants were included in the analyses. Parents completed weekly audio-recordings of treatment during practice sessions and a diary of treatment during natural conversations. The number and types of contingencies provided during practice sessions were counted for 520 recordings. Accelerated failure time modeling was used to investigate associations between contingency provision during the first 4 weeks of treatment and duration of time to complete Stage 1. RESULTS During practice sessions 91% of contingencies were for stutter-free speech, 6.8% were for stuttering and 2.7% were incorrectly applied. Parents often combined several verbal contingencies into one. During natural conversations, the number of verbal contingencies reportedly provided across the day was low, an average of 8.5 (SD=7.82) contingencies for stutter-free speech and 1.7 (SD=2.43) for unambiguous stuttering. There was a positive, significant relationship between the number of verbal contingencies for stuttering provided during the first 4 weeks of treatment and time taken to complete Stage 1. CONCLUSION Parents mostly provided the expected types of contingencies but the number was lower than expected. An unexpected association was found between number of verbal contingencies for stuttering and treatment duration. Further research is required to explore the relation between rates of parent verbal contingencies, treatment process duration, and treatment outcome.
Collapse
Affiliation(s)
- Michelle C Swift
- The Australian Stuttering Research Centre, University of Sydney, Australia; Flinders University, Adelaide, Australia
| | - Mark Jones
- School of Population Health, The University of Queensland, Australia
| | - Sue O'Brian
- The Australian Stuttering Research Centre, University of Sydney, Australia
| | - Mark Onslow
- The Australian Stuttering Research Centre, University of Sydney, Australia.
| | - Ann Packman
- The Australian Stuttering Research Centre, University of Sydney, Australia
| | - Ross Menzies
- The Australian Stuttering Research Centre, University of Sydney, Australia
| |
Collapse
|
33
|
de Sonneville-Koedoot C, Bouwmans C, Franken MC, Stolk E. Economic evaluation of stuttering treatment in preschool children: The RESTART-study. JOURNAL OF COMMUNICATION DISORDERS 2015; 58:106-118. [PMID: 26524414 DOI: 10.1016/j.jcomdis.2015.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/15/2015] [Accepted: 10/21/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the incremental cost-effectiveness and cost-utility of the Lidcombe Program (LP) compared with treatment based on the Demands and Capacities Model (RESTART-DCM) for preschool children who stutter. METHOD A cost-effectiveness and cost-utility analysis were carried out alongside a Randomized Clinical Trial (the RESTART-study). In total, 199 children in 20 speech clinics participated. Outcome measures included the number needed to treat, based on the percentage of children who did not stutter at 18 months, and Health-related Quality of Life (EQ-VAS and HUI3) at 3, 6, 12 and 18 months. Health-related Quality of Life scores were used to calculate quality adjusted life years (V-QALYs for the EQ-VAS and U-QALYs for the HUI3). Direct and indirect costs were measured by cost questionnaires. Missing data were multiply imputed. Percentages of children who did not stutter in both groups were compared by a chi-square test. Between-group differences in mean QALYs and costs, as well as cost effectiveness and cost-utility ratios, were evaluated by applying bootstrapping techniques. RESULTS After 18 months, health outcomes were slightly better in the LP group, although only the difference in V-QALYs was statistical significant (0.018; 95% CI: 0.008 to 0.027) with a small effect size (Cohen's d=0.17). Mean costs for the LP group were significantly higher compared to the RESTART-DCM group (€3199 versus €3032), again with a small effect size (Cohen's d=0.14). The incremental cost-effectiveness ratio was €3360 for one additional child who did not stutter with the LP, and the estimated cost-utility ratios were €10,413 (extra cost per extra V-QALY) and €18,617 (extra cost per extra U-QALY). The results indicated a high probability that the LP is cost-effective compared to RESTART-DCM treatment given a threshold for willingness-to-pay of €20,000 per QALY. CONCLUSIONS Differences in effects and costs between the LP and RESTART-DCM treatment were small. Cost-effectiveness and cost-utility ratios were in favor of the LP. The LP is considered a good alternative to RESTART-DCM treatment in Dutch primary care.
Collapse
Affiliation(s)
- Caroline de Sonneville-Koedoot
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands; Erasmus University Medical Center, Sophia Children's Hospital, Department of Otorhinolaryngology, Speech and Hearing Centre, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
| | - Clazien Bouwmans
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Marie-Christine Franken
- Erasmus University Medical Center, Sophia Children's Hospital, Department of Otorhinolaryngology, Speech and Hearing Centre, PO Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Elly Stolk
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| |
Collapse
|
34
|
Donaghy M, Harrison E, O'Brian S, Menzies R, Onslow M, Packman A, Jones M. An investigation of the role of parental request for self-correction of stuttering in the Lidcombe Program. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 17:511-517. [PMID: 25763524 DOI: 10.3109/17549507.2015.1016110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE The Lidcombe Program is a behavioural treatment for stuttering in children younger than 6 years that is supported by evidence of efficacy and effectiveness. The treatment incorporates parent verbal contingencies for stutter-free speech and for stuttering. However, the contribution of those contingencies to reductions in stuttering in the program is unclear. METHOD Thirty-four parent-child dyads were randomized to two treatment groups. The control group received standard Lidcombe Program and the experimental group received Lidcombe Program without instruction to parents to use the verbal contingency request for self-correction. Treatment responsiveness was measured as time to 50% stuttering severity reduction. RESULT No differences were found between groups on primary outcome measures of the number of weeks and clinic visits to 50% reduction in stuttering severity. CONCLUSION This clinical experiment challenges the assumption that the verbal contingency request for self-correction contributes to treatment efficacy. Results suggest the need for further research to explore this issue.
Collapse
Affiliation(s)
- Michelle Donaghy
- Australian Stuttering Research Centre, The University of Sydney , Lidcombe, NSW , Australia
| | | | | | | | | | | | | |
Collapse
|