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Sjøstrand Å, Næss KAB, Melle AH, Hoff K, Hansen EH, Guttormsen LS. Treatment for Stuttering in Preschool-Age Children: A Qualitative Document Analysis of Treatment Programs. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1020-1041. [PMID: 38557114 DOI: 10.1044/2024_jslhr-23-00463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE The purpose of this study was to identify commonalities and differences between content components in stuttering treatment programs for preschool-age children. METHOD In this document analysis, a thematic analysis of the content was conducted of handbooks and manuals describing Early Childhood Stuttering Therapy, the Lidcombe Program, Mini-KIDS, Palin Parent-Child Interaction Therapy, RESTART Demands and Capacities Model Method, and the Westmead Program. First, a theoretical framework defining a content component in treatment was developed. Second, we coded and categorized the data following the procedure of reflexive thematic analysis. In addition, the first authors of the treatment documents have reviewed the findings in this study, and their feedback has been analyzed and taken into consideration. RESULTS Sixty-one content components within the seven themes-interaction, coping, reactions, everyday life, information, language, and speech-were identified across the treatment programs. The content component SLP providing information about the child's stuttering was identified across all treatment programs. All programs are multithematic, and no treatment program has a single focus on speech, language, or parent-child interaction. A comparison of the programs with equal treatment goals highlighted more commonalities in content components across the programs. The differences between the treatment programs were evident in both the number of content components that varied from seven to 39 and the content included in each treatment program. CONCLUSIONS Only one common content component was identified across programs, and the number and types of components vary widely. The role that the common content component plays in treatment effects is discussed, alongside implications for research and clinical practice. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25457929.
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Affiliation(s)
- Åse Sjøstrand
- Department of Special Needs Education, University of Oslo, Norway
| | | | | | - Karoline Hoff
- The National Service for Special Needs Education, Oslo, Norway
| | - Elisabeth Holm Hansen
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Porsgrunn, Norway
| | - Linn Stokke Guttormsen
- Department of Special Needs Education, University of Oslo, Norway
- Department of Early Childhood Education, Oslo Metropolitan University, Norway
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Kirmess M, Guttormsen LS, Hofslundsengen H, Næss KAB, Kefalianos E. Norwegian speech-language pathologists treatment practices for preschool children who stutter: An explorative study. JOURNAL OF FLUENCY DISORDERS 2023; 77:105999. [PMID: 37562079 DOI: 10.1016/j.jfludis.2023.105999] [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: 03/31/2023] [Revised: 05/25/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE This study investigated the treatment practices of speech-language pathologists (SLPs) with preschool children who stutter to explore variations in service delivery and, consequently to better inform and support evidence-based practice. METHOD 121 Norwegian SLPs completed an online survey about stuttering treatment for preschool children aged up to six years. They reported on treatment training, choices, setting, dosage, and outcomes. Data was analysed descriptively. Correlation analyses between years of clinical experience and clinician perceived outcomes were conducted. RESULT Sixty-eight percent of SLPs were trained in one or more stuttering treatment programs. The majority of SLPs (83 %) provided treatment in person in preschool centers; 59 % reported providing treatment once a week. Thirty-four percent of SLPs reported that they often or always delivered the whole treatment program. Treatment practice addressed various elements, including advising parents about language and communication strategies, supporting the child's self-image, and perceived outcomes. The SLPs reported their clinician perceived outcomes as 'always' or 'often' reduction of audible stuttering (70 %), reduced cognitive and emotional reactions (55 %), and improved communication skills (58 %). Factors influencing treatment choices were identified at the systemic level (e.g., work place regulations) and individual level (e.g., SLPs competency, child's best). CONCLUSION Stuttering treatment services in Norway differ from those reported in existing literature as treatment is given in preschool settings, only 34 % of SLPs deliver programs as intended whilst the majority use treatment elements only, and still experience positive changes. Provision is variable, and seems influenced by SLP training and competence.
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Affiliation(s)
- Melanie Kirmess
- Department of Special Needs Education, University of Oslo, Oslo, Norway,.
| | - Linn Stokke Guttormsen
- Department of Special Needs Education, University of Oslo, Oslo, Norway,; Department of Early Childhood Education, Oslo Metropolitan University Oslo, Norway
| | - Hilde Hofslundsengen
- Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | | | - Elaina Kefalianos
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville, Australia
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Menjot P, Bettahi L, Leclercq AL, Durieux N, Remacle A. Interventions That Target or Affect Voice or Speech Production During Public Speaking: A Scoping Review. J Voice 2023:S0892-1997(23)00203-5. [PMID: 37487795 DOI: 10.1016/j.jvoice.2023.06.021] [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: 04/07/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES Public speaking (PS) is frequently necessary in many professional, educational, and personal settings. Mastering this communication skill is particularly important in today's society. Training techniques for PS have been described in the literature. Given that PS anxiety affects performance, especially voice characteristics and speech fluency, the purpose of this scoping review is to examine, map, and narratively summarize the available evidence on PS interventions that target or affect voice or speech. METHODS An extensive literature search was conducted in three bibliographic databases: Medline ALL/Ovid, PsycINFO/Ovid, and Eric/Ovid. Of the 850 studies identified, 22 met the eligibility criteria, and one was added from the reference lists of the included studies. RESULTS A total of 23 studies were included. The interventions identified aim to improve speaking skills either by explicitly targeting the voice or speech (direct intervention, n = 15) or by targeting the cognitive, behavioral, psychological, or physical environment impacting the speaker's production (indirect intervention, n = 8). CONCLUSIONS This scoping review provides the first published methodological summary of the characteristics of existing PS interventions that target or affect voice and speech. Heterogeneous characteristics were observed. Further studies are needed to determine which interventions are most effective.
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Affiliation(s)
- Pauline Menjot
- Research Unit for a Life-Course Perspective on Health and Education, Faculty of Psychology, Speech Therapy and Education Sciences, University of Liège, Liège, Belgium.
| | - Lamia Bettahi
- Research Unit for a Life-Course Perspective on Health and Education, Faculty of Psychology, Speech Therapy and Education Sciences, University of Liège, Liège, Belgium
| | - Anne-Lise Leclercq
- Research Unit for a Life-Course Perspective on Health and Education, Faculty of Psychology, Speech Therapy and Education Sciences, University of Liège, Liège, Belgium
| | - Nancy Durieux
- Research Unit for a Life-Course Perspective on Health and Education, Faculty of Psychology, Speech Therapy and Education Sciences, University of Liège, Liège, Belgium
| | - Angélique Remacle
- Research Unit for a Life-Course Perspective on Health and Education, Faculty of Psychology, Speech Therapy and Education Sciences, University of Liège, Liège, Belgium
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de Ávila NDSF, Juste F, Costa JB, de Andrade CRF. Treatment clinical trial - three types - for children with fluency disorders and stuttering. Codas 2021; 34:e20200264. [PMID: 34705998 PMCID: PMC9851192 DOI: 10.1590/2317-1782/20212020264] [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: 08/21/2020] [Accepted: 03/22/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To present a treatment clinical trial, involving three types of treatment for chronic developmental stuttering (CDS), to verify whether they present indicators and sufficient information to establish an effective and safe benefit-risk relationship. METHODS The study included 252 children between 2 and 12 years old, who underwent assessment and treatment for CDS. Among the selected children, 93 met the established inclusion criteria. After obtaining the scores for the risk of CDS (Protocol for the Risk of Developmental Stuttering), all children were assessed according to their fluency profile and the severity level of stuttering. The children underwent treatment for CDS Green, Yellow and Red Programs. The treatment chosen for each child was based on the analysis of the risk for CDS. RESULTS All therapeutic programs presented positive results in the post-treatment assessment considering the analyzed parameters, with the exception of word repetition, sound prolongation at the end of words, and intrusion of sounds/word segments. CONCLUSION The tested therapeutic programs - green, yellow, and red - were efficient for most of the participants. The direct intervention used in the Red Program was highly efficient in promoting fluent speech. This result suggests that for most of the patients with a higher risk of developing the chronic form of stuttering, the use of specific fluency promotion techniques is indicated.
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Affiliation(s)
- Nathalia dos Santos Fernandes de Ávila
- Programa de Pós-graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo – USP - São Paulo (SP), Brasil.
| | - Fabiola Juste
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo – USP - São Paulo (SP), Brasil.
| | - Julia Biancalana Costa
- Programa de Pós-graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo – USP - São Paulo (SP), Brasil.
| | - Claudia Regina Furquim de Andrade
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo – USP - São Paulo (SP), Brasil.
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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.
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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
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Singer CM, Hessling A, Kelly EM, Singer L, Jones RM. Clinical Characteristics Associated With Stuttering Persistence: A Meta-Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2995-3018. [PMID: 32772868 PMCID: PMC7890223 DOI: 10.1044/2020_jslhr-20-00096] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/01/2020] [Accepted: 06/03/2020] [Indexed: 05/07/2023]
Abstract
Purpose The purpose of this meta-analytic study was to identify clinical characteristics, defined as child factors that can be assessed by a speech-language pathologist as part of a routine speech-language evaluation that may differentiate children who persist in stuttering from children who eventually recover from stuttering. Clinical characteristics explored included sex, age at onset, family history of stuttering, stuttering frequency and severity, speech-language skills, and temperament. Method Studies were identified through electronic databases, journals, and reference lists of relevant reports (e.g., research articles). Eligible studies followed young children who stutter (i.e., under 6 years old) for at least 24 months, assessed a potential clinical marker at study entry, and determined talker group classification (i.e., persistent or recovered) at study completion. Sex and family history differences were estimated using risk ratios; all other differences were estimated using Hedges's g. Heterogeneity and methodological differences among studies were evaluated. Results Eleven studies (41 reports) met eligibility criteria. Persistent children were older at stuttering onset and exhibited higher frequencies of stuttering-like disfluencies, lower speech sound accuracy, and lower expressive and receptive language skills than recovered children. Males and children with a family history of stuttering were also more likely to persist. Conclusions Clinical characteristics were identified that are associated with increased risk for stuttering persistence. Future studies have the potential to translate these clinical characteristics into prognostic markers for stuttering persistence risk.
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Affiliation(s)
- Cara M. Singer
- Department of Communication Sciences and Disorders, Grand Valley State University, Grand Rapids, MI
| | - Alison Hessling
- Department of Communication Sciences and Disorders, Baylor University, Waco, TX
| | - Ellen M. Kelly
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Lisa Singer
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Robin M. Jones
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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Sjøstrand Å, Kefalianos E, Hofslundsengen H, Guttormsen LS, Kirmess M, Lervåg A, Hulme C, Naess KAB. Non-pharmacological interventions for stuttering in children aged between birth and six years. Hippokratia 2019. [DOI: 10.1002/14651858.cd013489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Åse Sjøstrand
- University of Oslo; Department of Special Needs Education; Mail box 1140 Blindern Oslo Norway 0318
| | - Elaina Kefalianos
- University of Melbourne; Department of Audiology and Speech Pathology; 550 Swanston Street Parkville Victoria Australia 3052
| | - Hilde Hofslundsengen
- Western Norway University of Applied Sciences; Faculty of Education, Arts and Sports; Pb. 133 Sogndal Norway 6856
| | - Linn S Guttormsen
- University of Oslo; Department of Special Needs Education; Mail box 1140 Blindern Oslo Norway 0318
| | - Melanie Kirmess
- University of Oslo; Department of Special Needs Education; Mail box 1140 Blindern Oslo Norway 0318
| | - Arne Lervåg
- University of Oslo; Department of Education; Mail box 1140 Blindern Sem Saelandsvei 7 Oslo Norway 0318
| | - Charles Hulme
- University of Oslo; Department of Special Needs Education; Mail box 1140 Blindern Oslo Norway 0318
- University of Oxford; Department of Education; 15 Norham Gardens Oxford UK OX2 6PY
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Nippold MA. Language development in children who stutter: A review of recent research. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:368-376. [PMID: 29642734 DOI: 10.1080/17549507.2018.1457721] [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: 10/09/2017] [Revised: 02/22/2018] [Accepted: 03/22/2018] [Indexed: 06/08/2023]
Abstract
Purpose: This article reviews recent studies that examined the controversial claim that children who stutter (CWS), as a group, have weaker language skills than children who do not stutter (CWNS). The article was an effort to address the conflicting conclusions of two previous reviews of the research in this area. Method: Studies published in research journals during the past 7 years (2011-2018) were located through a systematic review of the literature. Each study was analysed to determine how well it supported the claim that CWS, as a group, have weaker language skills than CWNS. Result: The evidence was not convincing to support this controversial claim. Rather, the review indicated that CWS performed as well as or better than CWNS on formal language tasks. Conclusion: The claim that language weaknesses are linked to children's stuttering is not well supported by recently published studies. Alternative interpretations of the literature are offered.
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Affiliation(s)
- Marilyn A Nippold
- Communication Disorders and Sciences Program, College of Education, University of Oregon , Eugene , OR , USA
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Leech KA, Bernstein Ratner N, Brown B, Weber CM. Language Growth Predicts Stuttering Persistence Over and Above Family History and Treatment Experience: Response to Marcotte. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1371-1372. [PMID: 31058570 PMCID: PMC6808319 DOI: 10.1044/2019_jslhr-s-18-0318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Purpose This response addresses comments made by Marcotte (2019) regarding our recent publication, "Preliminary Evidence That Growth in Productive Language Differentiates Childhood Stuttering Persistence and Recovery" ( Leech, Bernstein Ratner, Brown, & Weber, 2017 ). Marcotte calls into question our finding that language growth is a valid predictor of recovery from stuttering because we did not account for treatment and family history. Conclusions In response to her comments, we provide additional empirical analyses couched in a larger discussion of the difficulty of calibrating treatment and family history of stuttering. In short, we show that once treatment history and family history of stuttering are accounted for, the effect of language growth remains a significant predictor of stuttering persistence.
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Affiliation(s)
| | | | - Barbara Brown
- Purdue University, Department of Speech, Language, and Hearing Sciences, West Lafayette, IN
| | - Christine M. Weber
- Purdue University, Department of Speech, Language, and Hearing Sciences, West Lafayette, IN
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Byrd CT, Donaher J. Best Practice for Developmental Stuttering: Balancing Evidence and Expertise. Lang Speech Hear Serv Sch 2018; 49:1-3. [DOI: 10.1044/2017_lshss-17-0089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/18/2017] [Indexed: 11/09/2022] Open
Abstract
Purpose
Best practice for developmental stuttering remains a topic of debate. In the clinical forum following this introduction, four fluency experts balance the evidence and expertise to describe their approach to assessment and treatment.
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