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Johnson G, Onslow M, Carey B, Jones M, Kefalianos E. Lidcombe Program telehealth treatment for children 6-12 years of age: A Phase II trial. J Fluency Disord 2024; 80:106057. [PMID: 38613876 DOI: 10.1016/j.jfludis.2024.106057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 03/05/2024] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND For children older than 6 years who stutter, there is a gap in clinical research. This is an issue for speech-language pathologists because the tractability of stuttering decreases and the risk of long-term psychological consequences increase with age. PURPOSE To report a Phase II trial of a telehealth version of the Lidcombe Program with school-age children. METHODS Participants were 37 children who stuttered, 6-12 years of age, from Australia, New Zealand, Hong Kong, and Singapore. Parents were trained by video telehealth how to deliver the Lidcombe Program to their child. Primary and secondary outcomes were stuttering severity and psychosocial functioning measured pre-treatment and at 6 months and 12 months after starting treatment. Parents submitted two 10-minute recordings of their child speaking in conversation, and three measures of anxiety, impact of stuttering, and communication attitude. RESULTS Six months after starting treatment, seven children (18.9%) attained Lidcombe Program Stage 2 criteria, 25 children (67.6%) showed a partial response to treatment, and five children (13.5%) showed no response. By 12 months, 12 children (32.4%) had reached Stage 2 criteria. Psychosocial improvements were observed 6 and 12 months after starting treatment. CONCLUSIONS The Lidcombe Program may eliminate or nearly eliminate stuttering for about one third of children 6-12 years of age. Randomized controlled trials with this age group involving the Lidcombe Program are warranted. In the interim, the Lidcombe Program is a clinical option clinicians can implement with this age group to reduce stuttering and its psychosocial impacts.
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Affiliation(s)
- Georgina Johnson
- University of Melbourne, Department of Audiology & Speech Pathology, VIC, Australia.
| | - Mark Onslow
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | - Brenda Carey
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | - Mark Jones
- Bond University, Institute for Evidence-Based Healthcare, QLD, Australia
| | - Elaina Kefalianos
- University of Melbourne, Department of Audiology & Speech Pathology, VIC, Australia; Murdoch Children's Research Institute, Speech and Language Group, VIC, Australia
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Chang SE, Jackson ES, Santayana G, Zavos G, Onslow M. Contemporary clinical conversations about stuttering: What does brain imaging research mean to clinicians? Int J Speech Lang Pathol 2024:1-7. [PMID: 38530287 DOI: 10.1080/17549507.2024.2327472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE To discuss among neuroscientists and community speech-language pathologists what brain imaging research means to clinicians. METHOD Two university neuroscientists and two speech-language pathologists in private practice discussed the matter. Written conversational turns in an exchange were limited to 100 words each. When that written dialogue was concluded, each participant provided 200 words of final reflection about the matter. RESULT For now, neuroscience treatments are not available for clinicians to use. But sometime in the future, a critical mass of neuroscientists will likely produce such treatments. The neuroscientists expressed diverse views about the methods that might be used for that to occur. CONCLUSION Neuroscience does have practical clinical application at present and, in a way, that does not exclude a concurrent influence of the social model of disability. As such, the current practices of the clinicians are supported by basic neuroscience research.
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Affiliation(s)
- Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Communication Disorders, Ewha Womans University, Seoul, Korea
| | - Eric S Jackson
- Communicative Sciences and Disorders, New York University, New York, NY, USA
| | | | | | - Mark Onslow
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, Australia
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Onslow M. Ann Packman: Reflections on a career. J Fluency Disord 2024; 79:106034. [PMID: 38056155 DOI: 10.1016/j.jfludis.2023.106034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023]
Abstract
This is the fourth in a series of papers that provides an historical record in this journal of contributions made by the most influential figures in the field of stuttering. Ann Packman is an Australian researcher who will retire shortly. This paper reflects on her long and productive career, and her contributions to the field. With a background in literature, linguistics, philosophy, psychology, and the brain and language, she became well equipped to contribute to understanding stuttering causality. That work, and an accompanying collection of basic and applied clinical research, was constantly grounded with the thoughts and feelings of those who stutter in the community.
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Affiliation(s)
- Mark Onslow
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia.
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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. J Fluency Disord 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Amato Maguire M, Onslow M, Lowe R, O'Brian S, Menzies R. Searching for Lidcombe Program mechanisms of action: Inter-turn speaker latency. Clin Linguist Phon 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Onslow M, Lowe R, Jelčić Jakšić S, Packman A, Kelly E, MacMillan V, Hodes G. The Fifth Croatia Stuttering Symposium: Part II. Natural recovery from early stuttering. J Fluency Disord 2023; 78:106018. [PMID: 37898032 DOI: 10.1016/j.jfludis.2023.106018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/02/2023] [Accepted: 10/17/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE The Fifth Croatia Stuttering Symposium of 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 second of three Symposium modules. METHODS The module topic was that some children with early stuttering will recover naturally. A clinical situation was considered where a parent of a 3-year-old child asked if a clinician can predict whether their child will recover from stuttering without treatment. RESULTS A distinguished scholar presented a 5-minute video interpretation of research about this topic. Three master clinicians then each presented a 2-minute video demonstration of how that research 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.
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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
| | | | - Ann Packman
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | | | - Verity MacMillan
- South Western Sydney Local Health District, Australia; Ingham Institute for Applied Medical Research, Australia
| | - Gabrielle Hodes
- Gabrielle Hodes (Speech and Language Therapist), Private Practice, Bet Shemesh, Israel
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Shenker R, Rodgers N, Guitar B, Onslow M. Contemporary clinical conversations about stuttering: Neurodiversity and ableism. J Fluency Disord 2023; 78:106014. [PMID: 37769595 DOI: 10.1016/j.jfludis.2023.106014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/18/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE To discuss issues about neurodiversity and ableism, and how they pertain to clinical management of stuttering, with particular reference to early childhood stuttering. METHODS During a webinar this year, the issue emerged of how concepts of neurodiversity and ableism apply to early childhood stuttering during the pre-school years. It became apparent that this topic elicited disparate views and would be of particular interest to students of speech-language pathology. Consequently, the leaders of that webinar continued the conversation by written dialogue for the purpose of placing it on record. RESULTS The discussants reached agreement on many points, but there was some diversity of viewpoint about how neurodiversity and ableism should apply to clinical practice with children who have recently begun to stutter.
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Affiliation(s)
| | - Naomi Rodgers
- University of Iowa, Communication Sciences and Disorders, IA, USA
| | - Barry Guitar
- University of Vermont, Department of Communication Sciences and Disorders, Vermont, USA
| | - Mark Onslow
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia.
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Johnson G, Onslow M, Horton S, Kefalianos E. Reduced stuttering for school-age children: A systematic review. J Fluency Disord 2023; 78:106015. [PMID: 37776613 DOI: 10.1016/j.jfludis.2023.106015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/09/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Treatment of school-age children (6-12 years of age) who stutter is a public health priority. Their clinical needs include a psychosocial focus and stuttering reduction. For the latter clinical need, there is a critical window of opportunity for these children warranting research attention. PURPOSE The purpose of the review is to guide future clinical research by establishing (a) what interventions are associated with stuttering reduction for school-age children (b) the reported immediate and longer-term effects of those interventions, and (c) the level of evidence for these interventions in terms of study design. METHODS Fourteen databases and three conference proceedings were searched for interventions used to reduce stuttering in school-age children. Primary outcomes were mean stuttering reductions pre-treatment, immediately post-treatment, and any follow-up assessments. RESULTS Of the 4305 studies identified from the databases, 67 studies met inclusion criteria. Five different treatment approaches were reported in the literature that might reduce stuttering for a school-age child, but with varying effect sizes. These include (a) operant methods, (b) speech restructuring, (c) combined operant methods and speech restructuring, (d) machine-driven treatments, and (e) treatments with a cognitive behaviour therapy component. CONCLUSIONS Operant methods warrant investigation in future clinical trial research, as do variants of speech restructuring. Hybrid approaches showed encouraging results, including speech restructuring variants combined with operant methods or with cognitive behaviour therapy. However, evidence is preliminary only at Phase I and II trials. Several treatments with reported clinical promise have been overlooked for decades and require further investigation.
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Affiliation(s)
- Georgina Johnson
- University of Melbourne, Department of Audiology & Speech Pathology, VIC, Australia.
| | - Mark Onslow
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | - Sarah Horton
- University of Melbourne, Department of Audiology & Speech Pathology, VIC, Australia; Murdoch Children's Research Institute, Speech and Language Group, VIC, Australia
| | - Elaina Kefalianos
- University of Melbourne, Department of Audiology & Speech Pathology, VIC, Australia; Murdoch Children's Research Institute, Speech and Language Group, VIC, Australia
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Norman A, Lowe R, Onslow M, O'Brian S, Packman A, Menzies R, Schroeder L. Cost of Illness and Health-Related Quality of Life for Stuttering: Two Systematic Reviews. J Speech Lang Hear Res 2023; 66:4414-4431. [PMID: 37751681 DOI: 10.1044/2023_jslhr-23-00072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE For those who stutter, verbal communication is typically compromised in social situations. This may attract negative responses from listeners and stigmatization by society. These have the potential to impair health-related quality of life across a range of domains, including qualitative and quantitative impacts on speech output, mental health issues, and failure to attain educational and occupational potential. These systematic reviews were designed to explore this matter using traditional health economics perspectives of utility measures and cost of illness. METHOD Studies were included if they involved children, adolescents, or adults with stuttering as a primary diagnosis. The quality of life search strategy identified 2,607 reports, of which three were included in the quality of life analysis. The cost of illness search strategy identified 3,778 reports, of which 39 were included in the cost of illness analysis. RESULTS Two of the three studies included in the quality of life analysis had a high risk of bias. When measured using utility scores, quality of life for people who stutter was in the range of those reported for chronic health conditions such as diabetes mellitus, cardiovascular disease, and cancer. However, there is little such evidence of quality of life impairment during the preschool years. Studies included in the cost of illness analysis carried considerable risk of bias overall. CONCLUSIONS For people who stutter, there are substantive direct and indirect costs of illness. These include impairment, challenges, and distress across many domains throughout life, including income, education, employment, and social functioning. Evidence of quality of life impairment using utility measures is extremely limited. If this situation is not remedied, the lifetime impairment, challenges, and distress experienced by those who stutter cannot be documented in a form that can be used to influence health policy and health care spending. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24168201.
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Affiliation(s)
- Alicia Norman
- Macquarie University Centre for the Health Economy, Macquarie University Business School, North Ryde, New South Wales, Australia
- Australian Institute for Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Robyn Lowe
- 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
| | - Sue O'Brian
- Australian Stuttering Research Centre, University of Technology Sydney, New South Wales, Australia
| | - Ann Packman
- Australian Stuttering Research Centre, University of Technology Sydney, New South Wales, Australia
| | - Ross Menzies
- Australian Stuttering Research Centre, University of Technology Sydney, New South Wales, Australia
| | - Liz Schroeder
- Macquarie University Centre for the Health Economy, Macquarie University Business School, North Ryde, New South Wales, Australia
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
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Onslow M, Lowe R, Jakšić SJ, Franken MC, Hearne A, Uijterlinde I, Eggers K. The Fifth Croatia Stuttering Symposium: Part III. Mental health and early stuttering. J Fluency Disord 2023; 77:106000. [PMID: 37586168 DOI: 10.1016/j.jfludis.2023.106000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE The Fifth Croatia Stuttering Symposium of 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 third of three Symposium modules. METHODS The module topic was mental health and early stuttering, and that pre-schoolers who stutter are at risk of developing mental health issues. A clinical situation was considered where a parent of a 3-year-old child asked a clinician what the early signs of mental health issues might be for a child who stutters. RESULTS A distinguished scholar presented a 5-minute video interpretation of research about this topic. Three master clinicians then each presented a 2-minute video demonstration of how that research 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.
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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
| | | | | | - Anna Hearne
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | | | - Kurt Eggers
- Ghent University, Department of Rehabilitation Sciences, Belgium; Thomas More University College, Department of Speech-Language Pathology, Belgium; Turku University, Department of Psychology and Speech-Language Pathology, Finland
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Johnson G, Onslow M, Horton S, Kefalianos E. Psychosocial features of stuttering for school-age children: A systematic review. Int J Lang Commun Disord 2023; 58:1829-1845. [PMID: 37132231 DOI: 10.1111/1460-6984.12887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/03/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Contemporary clinical and empirical perspectives indicate that management of the psychosocial features of stuttering is fundamental for effective treatment. Interventions that improve psychosocial outcomes for school-age children who stutter are, therefore, needed. AIMS This systematic review identifies what psychosocial outcomes have been explored in existing school-age clinical research, the measures used and the potential treatment effects. This will provide guidance for developing interventions that reflect contemporary perspectives of stuttering management. METHODS & PROCEDURES A total of 14 databases and three conference proceedings were searched for clinical reports of psychosocial outcomes of children aged 6-12 years. The review did not include pharmacological interventions. Psychosocial measures and outcomes were analysed in each study based on data recorded pre-treatment, immediately post-treatment and for any follow-up assessments. MAIN CONTRIBUTIONS Of the 4051 studies identified from the databases, a total of 22 studies met criteria for inclusion in the review. From these 22 studies, the review identified four prominent psychosocial domains that have been explored in school-age clinical research to date: Impact of stuttering, communication attitude, anxiety and speech satisfaction. These domains vary in measurement and effect sizes. Two behavioural treatments were associated with anxiety reduction, even though they did not contain anxiolytic procedures. No evidence of potential treatment effects emerged for communication attitudes. Quality of life-an important psychosocial domain pertinent to health economics-did not feature in school-age clinical reports. CONCLUSIONS & IMPLICATIONS The psychosocial features of stuttering need to be managed during the school years. Three psychosocial domains-impact of stuttering, anxiety and speech satisfaction-show evidence of potential treatment effects. This review provides direction for future clinical research so that speech-language pathologists can effectively and holistically manage school-age children who stutter. WHAT THIS PAPER ADDS What is already known on the subject Elevated levels of anxiety are apparent for children and adolescents who stutter. Therefore, the need to assess and manage psychosocial features of stuttering are expertly regarded as clinical priorities. Clinical trials of such psychosocial features of stuttering for children aged 6-12 years are not well advanced and, therefore, do not reflect current best practice management of this disorder. What this study adds to existing knowledge This systematic review identifies four different psychosocial domains measured and reported in the literature for school-age stuttering management. For three psychosocial domains, some evidence of potential treatment effects emerged with participant numbers greater than 10: Impact of stuttering, anxiety and speech satisfaction. Though treatment effect sizes varied, there is a suggestion that cognitive behaviour therapy can improve anxiety of school-age children who stutter. There is also suggestion that two other behavioural treatments can improve anxiety of school-age children who stutter. What are the potential or actual clinical implications of this work? Given the essential need for school-age children who stutter to receive management of any speech-related anxiety they may experience, it would be productive to discover in future clinical research what interventions could contribute to that goal-behavioural or psychosocial, or both. This review reveals that cognitive behaviour therapy, and other behavioural treatments, are associated with anxiety reductions. Such approaches should be considered for future clinical trial research to help advance the evidence base for managing school-age stuttering.
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Affiliation(s)
- Georgina Johnson
- Department of Audiology & Speech Pathology, University of Melbourne, Melbourne, VIC, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, University of Technology Sydney, Sydney, NSW, Australia
| | - Sarah Horton
- Department of Audiology & Speech Pathology, University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Speech and Language Group, Melbourne, VIC, Australia
| | - Elaina Kefalianos
- Department of Audiology & Speech Pathology, University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Speech and Language Group, Melbourne, VIC, Australia
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Onslow M. Barry Guitar: Reflections on a career. J Fluency Disord 2023; 75:105956. [PMID: 36516526 DOI: 10.1016/j.jfludis.2022.105956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/21/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
This is the third in a series of papers that provides an historical record in this journal of contributions made by the most influential figures in the field of fluency disorders. The paper reflects on the long and productive career of Barry Guitar, documenting his outstanding achievements. The paper is based on interviews with him during 2022. Like no one else in our field, Barry Guitar has an understanding of the experience of stuttering and how to cope with it, and, throughout his career, he has used that understanding to inspire others to cope with it.
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Affiliation(s)
- Mark Onslow
- University of Technology Sydney, Australian Stuttering Research Centre, Building 1, 15 Broadway, Ultimo, NSW 2007, Australia.
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O'Brian S, Hayhow R, Jones M, Packman A, Iverach L, Onslow M, Menzies R. Lidcombe Program translation to community clinics in Australia and England. Int J Lang Commun Disord 2023; 58:295-309. [PMID: 36114801 PMCID: PMC10946954 DOI: 10.1111/1460-6984.12785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Early intervention is essential healthcare for stuttering, and the translation of research findings to community settings is a potential roadblock to it. AIMS This study was designed to replicate and extend the Lidcombe Program community translation findings of O'Brian et al. (2013) but with larger participant numbers, incorporating clinicians (speech pathologists/speech anlanguage therapists) and their clients from Australia and England. METHODS & PROCEDURES Participants were 51 clinicians working in public and private clinics across Australia (n = 36) and England (n = 15), and 121 of their young stuttering clients and their families. Outcome measures were percentage of syllables stuttered (%SS), parent severity ratings at 9 months post-recruitment, number of clinic visits to complete Stage 1 of the Lidcombe Program, and therapist drift. OUTCOMES & RESULTS Community clinicians in both countries achieved similar outcomes to those from randomized controlled trials. Therapist drift emerged as an issue with community translation. Speech and language therapists in England attained outcomes 1.0%SS above the speech pathologists in Australia, although their scores were within the range attained in randomized trials. CONCLUSIONS & IMPLICATIONS Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice. The long-term impact of therapist drift in community clinical practice with the Lidcombe Program has yet to be determined. WHAT THIS PAPER ADDS What is already known on the subject The Lidcombe Program is an efficacious early stuttering intervention. Translation to clinical communities has been studied with one Australian cohort. What this paper adds to existing knowledge A larger translation cohort is studied, comprising community clinicians and children in Australia and England. What are the potential or actual clinical implications of this work? Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice.
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Affiliation(s)
- Sue O'Brian
- Australian Stuttering Research CentreUniversity of Technology SydneyNSWAustralia
- Former location of Australian Stuttering Research Centre at University of SydneyNSWAustralia
| | - Rosemarie Hayhow
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS TrustBristolUK
| | | | - Ann Packman
- Australian Stuttering Research CentreUniversity of Technology SydneyNSWAustralia
- Former location of Australian Stuttering Research Centre at University of SydneyNSWAustralia
| | - Lisa Iverach
- Former location of Australian Stuttering Research Centre at University of SydneyNSWAustralia
- Present Address: University of SydneyNSWAustralia
| | - Mark Onslow
- Australian Stuttering Research CentreUniversity of Technology SydneyNSWAustralia
- Former location of Australian Stuttering Research Centre at University of SydneyNSWAustralia
| | - Ross Menzies
- Australian Stuttering Research CentreUniversity of Technology SydneyNSWAustralia
- Former location of Australian Stuttering Research Centre at University of SydneyNSWAustralia
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Darmody T, O'Brian S, Rogers K, Onslow M, Jacobs C, McEwen A, Lowe R, Packman A, Menzies R. Stuttering, family history and counselling: A contemporary database. J Fluency Disord 2022; 73:105925. [PMID: 35998418 DOI: 10.1016/j.jfludis.2022.105925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Information about genetic influence is useful to when counselling parents or caregivers who have infants and children at risk for stuttering. Yet, the most comprehensive family aggregate database to inform that counselling is nearly four decades old (Andrews et al., 1983). Consequently, the present study was designed to provide a contemporary exploration of the relationship between stuttering and family history. METHODS Data were sourced from the Australian Stuttering Research Centre, comprising 739 participants who presented for assessment, treatment, or investigation of stuttering. Reported family history data were acquired from pedigrees collected during assessment. We sought to establish the relation of the following variables to family history of stuttering: incidence, proband sex, parent sex, stuttering severity, age, reported age of stuttering onset, and impact of stuttering. Data were analysed with chi-square tests for independence, logistic and linear regression models. RESULTS Results were broadly consistent with existing data, but the following findings were novel. Males and females who stutter have the same increased odds of having a father who stutters relative to a mother who stutters. Males had later stuttering onset than females, with genetic involvement in this effect. There was a greater impact of stuttering for females than males with a family history of stuttering. CONCLUSION These findings have clinical applications. Speech-language pathologists may have infant or child clients known to them who are at risk of beginning to stutter. Information from the present study can be applied to counselling parents or caregivers of such children about stuttering and family history.
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Affiliation(s)
- Tara Darmody
- University of Technology Sydney, Graduate School of Health, NSW, Australia
| | - Sue O'Brian
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | - Kris Rogers
- University of Technology Sydney, Graduate School of Health, NSW, Australia
| | - Mark Onslow
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia.
| | - Chris Jacobs
- University of Technology Sydney, Graduate School of Health, NSW, Australia
| | - Alison McEwen
- University of Technology Sydney, Graduate School of Health, NSW, Australia
| | - Robyn Lowe
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | - Ann Packman
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | - Ross Menzies
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
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O'Brian S, Jones M, Packman A, Onslow M, Menzies R, Lowe R, Cream A, Hearne A, Hewat S, Harrison E, Block S, Briem A. The Complexity of Stuttering Behavior in Adults and Adolescents: Relationship to Age, Severity, Mental Health, Impact of Stuttering, and Behavioral Treatment Outcome. J Speech Lang Hear Res 2022; 65:2446-2458. [PMID: 35737907 DOI: 10.1044/2022_jslhr-21-00452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE This study investigated the complexity of stuttering behavior. It described and classified the complexity of stuttering behavior in relation to age, behavioral treatment outcomes, stuttering severity, anxiety-related mental health, impact of stuttering, and gender. METHOD For this study, a taxonomy was developed-LBDL-C7-which was based on the Lidcombe Behavioral Data Language of stuttering. It was used by five experienced judges to analyze the complexity of stuttering behavior for 84 adults and adolescents before and after speech restructuring treatment. Data were 3,100 stuttering moments, which were analyzed with nominal logistic regression. RESULTS The complexity of stuttering behavior appears not to change as a result of treatment, but it does appear to change with advancing age. Complexity of stuttering behavior was found to be independently associated with clinician stuttering severity scores but not with percentage of syllables stuttered or self-reported stuttering severity. Complexity of stuttering behavior was not associated with gender, anxiety, or impact of stuttering. CONCLUSION Clinical and research applications of these findings are discussed.
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Affiliation(s)
- Sue O'Brian
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Mark Jones
- Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia
| | - Ann Packman
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Ross Menzies
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Robyn Lowe
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Angela Cream
- Sir Charles Gairdner Osborne Park Health Care Group, Osborne Park Hospital, Stirling, Western Australia, Australia
| | | | - Sally Hewat
- School of Humanities and Social Science, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Elisabeth Harrison
- Department of Linguistics, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Susan Block
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Anne Briem
- LMU Klinikum, Ludwig Maximilian University of Munich, Germany
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16
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O'Brian S, Onslow M, Jones M, Lowe R, Packman A, Menzies R. Comparison of Stuttering Severity and Anxiety During Standard and Challenge Phone Calls. J Speech Lang Hear Res 2022; 65:982-990. [PMID: 35157508 DOI: 10.1044/2021_jslhr-21-00365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE This study was designed to answer three questions. (a) Does percentage of syllables stuttered (%SS) differ between standard and challenge phone calls. (b) Does anxiety differ between standard and challenge phone calls. (c) Is there a relationship between %SS and anxiety during standard and challenge phone calls? METHOD Participants were 230 adults diagnosed with stuttering, who were participants from five clinical trials. Each participant received two 10-min phone calls at pretreatment and a further two phone calls 6 months or 20 weeks postrandomization. One phone call was standard, and the other presented challenge: occasionally disagreeing with, interrupting, and talking over participants, or asking for clarification of their views. RESULTS Statistically significant, but clinically minor, increases of %SS and anxiety occurred during the challenge phone calls. There was a statistically significant association between %SS and anxiety. CONCLUSIONS Variable phone call procedures to assess stuttering severity in clinical trials are not likely to spuriously inflate or deflate treatment outcomes to a clinically important extent. Regardless, the present results suggest that there is statistical merit in controlling the nature of phone calls during clinical trials with the simple and replicable method developed in this report. Additionally, there is procedural merit in the challenge phone call procedure; it is a more valid representation of the challenges of everyday speech than the standard procedure. However, a disadvantage of the challenge phone call procedure is the practical issues associated with its use. The clinical and theoretical applications of the results are discussed.
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Affiliation(s)
- 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
| | - Mark Jones
- Bond University, Robina, Queensland, Australia
| | - Robyn Lowe
- Australian Stuttering Research Centre, University of Technology Sydney, New South Wales, Australia
| | - Ann Packman
- Australian Stuttering Research Centre, University of Technology Sydney, New South Wales, Australia
| | - Ross Menzies
- Australian Stuttering Research Centre, University of Technology Sydney, New South Wales, Australia
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17
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Brown L, Wilson L, Packman A, Halaki M, Andrews C, O'Brian S, Onslow M, Menzies RG. Conversational speech of school-age children after syllable-timed speech treatment for stuttering. Int J Speech Lang Pathol 2022; 24:42-52. [PMID: 34238105 DOI: 10.1080/17549507.2021.1946152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: The purpose of this laboratory study was to investigate whether rhythmic speech was primarily responsible for stuttering reductions in four school-aged children after the instatement stage of the Westmead Program of syllable-timed speech (STS) intervention. The study was designed to inform further development of the program. Reduction in variability of vowel duration is a marker of STS, and it was predicted that this would be present in the children's conversational speech after Stage 1 of the program if they were using STS. To strengthen such a finding, it was also predicted that there would be no reduction in articulation rate, sentence complexity, and utterance length after treatment, as there is evidence that reductions in these can reduce stuttering. Perceptual judgments of speech quality after treatment were also made by independent listeners.Method: Participants were four children, ages 8-11 years, who completed Stage 1 of an STS program and whose stuttering had reduced significantly. Pre-treatment (PRE) and post-treatment (POST) within-clinic audio-visual recordings of conversational speech were analysed for percentage of syllables stuttered, variability of vowel duration, articulation rate, and length and complexity of utterance. Four blinded listeners made perceptual judgments of speech quality in the POST recordings.Result: Recordings of all children showed that variability of vowel duration clearly reduced from the PRE to POST speech samples. Importantly, articulation rate and language use were not compromised. Some possible indicators of rhythmicity were identified in one child in the perceptual study.Conclusion: The findings suggest that STS was primarily responsible for the clinically significant reductions in stuttering after Stage 1 of the program. There is an urgent need for more evidence-based interventions for stuttering in this age group and further development of STS interventions is warranted.
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Affiliation(s)
- Lisa Brown
- School of Community Health, Charles Sturt University, Australia
| | - Linda Wilson
- School of Community Health, Charles Sturt University, Australia
| | - Ann Packman
- Australian Stuttering Research Centre, University of Technology Sydney, Australia
| | - Mark Halaki
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Australia
| | | | - Sue O'Brian
- Australian Stuttering Research Centre, University of Technology Sydney, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, University of Technology Sydney, Australia
| | - Ross G Menzies
- Australian Stuttering Research Centre, University of Technology Sydney, Australia
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18
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Lowe R, Jelčić Jakšić S, Onslow M, O'Brian S, Vanryckeghem M, Millard S, Kelman E, Block S, Franken MC, Van Eerdenbrugh S, Menzies R, Shenker R, Byrd C, Bosshardt HG, Del Gado F, Lim V. Contemporary issues with stuttering: The Fourth Croatia Stuttering Symposium. J Fluency Disord 2021; 70:105844. [PMID: 34049093 DOI: 10.1016/j.jfludis.2021.105844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE During the 2019 Fourth Croatia Clinical Symposium, speech-language pathologists (SLPs), scholars, and researchers from 29 countries discussed speech-language pathology and psychological practices for the management of early and persistent stuttering. This paper documents what those at the Symposium considered to be the key contemporary clinical issues for early and persistent stuttering. METHODS The authors prepared a written record of the discussion of Symposium topics, taking care to ensure that the content of the Symposium was faithfully reproduced in written form. RESULTS Seven contemporary issues for our field emerged from the Symposium. CONCLUSION Effective early intervention is fundamental to proper health care for the disorder. However, as yet, there is no consensus about the timing of early intervention and how it should be managed. Currently, clinical translation is a barrier to evidence-based practice with early stuttering, and proactive strategies were suggested for junior SLPs. Apprehension emerged among some discussants that treatment of early stuttering may cause anxiety. For persistent stuttering, assessment procedures were recommended, as were strategies for dealing with childhood bullying. There was agreement that SLPs are the ideal professionals to provide basic cognitive-behavior therapy for clients with persistent stuttering. Questions were raised about our discipline standards for basic professional preparation programs for stuttering management.
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Affiliation(s)
- Robyn Lowe
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | | | - Mark Onslow
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia.
| | - Sue O'Brian
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | - Martine Vanryckeghem
- University of Central Florida, School of Communication Sciences and Disorders, USA
| | | | | | - Susan Block
- La Trobe University, Discipline of Speech Pathology, College of Science, Health & Engineering, VIC, Australia
| | - Marie-Christine Franken
- Erasmus University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands
| | - Sabine Van Eerdenbrugh
- Thomas More College of Applied Sciences, Speech & Language Therapy & Audiology, Antwerp, Belgium
| | - Ross Menzies
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | | | - Courtney Byrd
- Michael and Tami Lang Stuttering Institute, The University of Texas at Austin, TX, USA
| | | | | | - Valerie Lim
- Speech and Language Therapy, Singapore Institute of Technology, Singapore
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19
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Park V, Onslow M, Lowe R, Jones M, O'Brian S, Packman A, Menzies RG, Block S, Wilson L, Harrison E, Hewat S. Psychological characteristics of early stuttering. Int J Speech Lang Pathol 2021; 23:622-631. [PMID: 33906547 DOI: 10.1080/17549507.2021.1912826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to use psychological measures of pre-schoolers who stutter and their parents to inform causal theory development and influence clinical practices. This was done using data from a substantive clinical cohort of children who received early stuttering treatment. METHOD The cohort (N = 427) comprised parents and their children who were treated with the Lidcombe Program, the Westmead Program, and the Oakville Program. The study incorporated demographic information, stuttering severity, and child and parent psychological measures prior to treatment. RESULT The cohort revealed nothing unusual about behavioural and emotional functioning, or the temperaments, of pre-school children that would influence treatment, be targeted during treatment, or influence causal theory development. However, a third of parents were experiencing moderate to high life stressors at the time of seeking treatment, and half the parents failed first-stage screening for Anankastic Personality Disorder. CONCLUSION The present results are consistent with a number of previous reports that showed that the population of pre-schoolers who stutter have no unusual psychological profiles. Hence, these results suggest that the association between mental health and stuttering later in life is a consequence of the disorder rather than being a part of its cause. The finding of the life stress of parents who seek stuttering treatment for pre-school children has potential clinical importance and warrants further investigation. Further psychological research is required about parents of pre-school children who stutter, because half the parents in the cohort failed the screener for Anankastic Personality Disorder. This is of interest because a previous study associated screening failure for another personality disorder (Impulsive Personality Disorder) with treatment dropout for early childhood stuttering.
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Affiliation(s)
- Veronica Park
- Australian Stuttering Research Centre, The University of Sydney, Sydney, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, The University of Sydney, Sydney, Australia
| | - Robyn Lowe
- Australian Stuttering Research Centre, The University of Sydney, Sydney, Australia
| | - Mark Jones
- School of Population Health, The University of Queensland, St Lucia, Australia
| | - Sue O'Brian
- Australian Stuttering Research Centre, The University of Sydney, Sydney, Australia
| | - Ann Packman
- Australian Stuttering Research Centre, The University of Sydney, Sydney, Australia
| | - Ross G Menzies
- Australian Stuttering Research Centre, The University of Sydney, Sydney, Australia
| | - Susan Block
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Linda Wilson
- School of Community Health, Charles Sturt University, Albury, Australia
| | | | - Sally Hewat
- School of Humanities and Social Science, The University of Newcastle, Callaghan, Australia
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20
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Jones ML, Menzies RG, Onslow M, Lowe R, O'Brian S, Packman A. Measures of Psychological Impacts of Stuttering in Young School-Age Children: A Systematic Review. J Speech Lang Hear Res 2021; 64:1918-1928. [PMID: 34019770 DOI: 10.1044/2021_jslhr-20-00455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Recent research has shown that some school-age children who stutter may have speech-related anxiety. Given this, speech-language pathologists require robust measures to assess the psychological effects of stuttering during the school-age years. Accordingly, this systematic review aimed to explore available measures for assessing the psychological impacts of stuttering in young school-age children and to examine their measurement properties. Method The systematic search protocol was registered with PROSPERO (ID: 163181). Seven online databases, in addition to manual searching and screening of reference lists, were used to identify appropriate measures for the population of children who stutter aged 7-12 years. The first two authors independently assessed the measures using the quality appraisal tool described by Terwee et al. (2007). Results Despite the comprehensive search strategy, only six measures were identified for quality appraisal. No assessment tool was found to possess adequate measurement properties for the eight assessed domains: content validity, internal consistency, construct validity, reproducibility, reliability, responsiveness, floor and ceiling effects, and interpretability. No measure had clear evidence of responsiveness to clinical change. Based on the criterion defined by the Terwee et al. (2007) appraisal tool, the Communication Attitude Test and the Overall Assessment of the Speaker's Experience of Stuttering for School-Age Children received the highest number of ratings in support of their measurement properties. Conclusions The results highlight a lack of available measures in this domain and poor practices in developing and testing measurement instruments. To ensure that clinicians and researchers are equipped with sound measures to meet the mental health needs of this vulnerable population, further research to establish resources is needed.
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Affiliation(s)
- Monique L Jones
- Australian Stuttering Research Centre, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Ross G Menzies
- Australian Stuttering Research Centre, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Robyn Lowe
- Australian Stuttering Research Centre, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Sue O'Brian
- Australian Stuttering Research Centre, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Ann Packman
- Australian Stuttering Research Centre, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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21
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Ilkhani Z, Karimi H, Farazi M, O'Brian S, Onslow M. Validity of telephone calls to assess percentage of syllables stuttered with adolescents in clinical research. J Commun Disord 2021; 91:106103. [PMID: 33873016 DOI: 10.1016/j.jcomdis.2021.106103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE Karimi, O'Brian, Onslow, and Jones (2013) reported, for adults, no systematic differences between percentage of syllables stuttered (%SS) scores during a 12-hour day and 10-minute phone calls. The present study replicated that finding with adolescents, using valid methods for the age group. The present study also extended that initial report by determining whether the gender of the caller influenced %SS scores. METHOD Participants were 17 adolescents with stuttering. Percentage of syllables stuttered scores were obtained from a 12-hour day of the adolescents' lives, and two 10-minute unscheduled phone calls made before and after that day. One phone call was from a male caller and the other from a female caller. RESULTS For adolescents, analysis of covariance (ANCOVA) and intraclass correlations (ICC) replicated the overall Karimi, O'Brian, Onslow, and Jones (2013) finding. No significant differences were found between the %SS scores of the three speech samples, and these %SS scores were found to be highly correlated. However, in contrast to the Karimi, O'Brian, Onslow, and Jones (2013) finding with adults, Bland-Altman plot results revealed a caveat to this finding when applied to individual adolescents. Additionally, there was no effect due to the gender of the caller. CONCLUSION A 10-minute phone call can be used confidently to assess group mean %SS scores during stuttering research with adolescents. However, a 10-minute phone call cannot be used confidently to assess %SS scores of individual adolescent participants. For the latter context, such as with data-based case studies and single-subject experimentation, we recommend supplementing %SS scores with self-reported severity scores.
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Affiliation(s)
- Zahra Ilkhani
- Student Research Committee, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Karimi
- College of Health and Human Sciences, Charles Darwin University, Australia
| | - Morteza Farazi
- University of Social Welfare and Rehabilitation Sciences, Iran
| | - Sue O'Brian
- Australian Stuttering Research Centre, University of Technology Sydney, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, University of Technology Sydney, Australia.
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22
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Karimi H, Onslow M, Jones M, O'Brian S, Packman A, Menzies R, Reilly S, Sommer M, Jelčić-Jakšić S. Corrigendum to "The Satisfaction with Communication in Everyday Speaking Situations (SCESS) scale: An overarching outcome measure of treatment effect" [J. Fluency Disord. (2018), 58, 77-85]. J Fluency Disord 2021; 67:105831. [PMID: 33674058 DOI: 10.1016/j.jfludis.2021.105831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Hamid Karimi
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, NSW, Australia
| | - Mark Onslow
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, NSW, Australia.
| | - Mark Jones
- School of Public Health, University of Queensland, QLD, Australia
| | - Sue O'Brian
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, NSW, Australia
| | - Ann Packman
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, NSW, Australia
| | - Ross Menzies
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, NSW, Australia
| | | | - Martin Sommer
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Germany
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Carey B, Onslow M, O'Brian S. Natural recovery from stuttering for a clinical cohort of pre-school children who received no treatment. Int J Speech Lang Pathol 2021; 23:48-56. [PMID: 32316786 DOI: 10.1080/17549507.2020.1746399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE The natural stuttering recovery rate by adulthood is high. Community cohort studies suggest a much lower rate during the first 18 months after onset, but this may be different for clinical cohorts of pre-school aged children. The present research and case presentations add to data reported by Franken et al. by investigating early natural recovery for a clinical cohort. METHOD Participants were 16 pre-school children presenting to a clinic with stuttering onset 1-15 months earlier. The children were studied for a mean of 19.4 months (84.3 weeks) using parent report and clinician identification of stuttering from recorded conversations. The children received no treatment during the study. Data were obtained for each participant and are presented graphically. RESULT Experienced speech-language pathologists detected stuttering in the recordings of 3 of 4 children identified as recovered by their parents. Only 1 of the 16 children (6.3%) was confirmed as recovered. CONCLUSION There is no reason to believe that the early natural recovery rate for clinically presenting children is different from community cohorts. Parent report of natural recovery during the pre-school years needs to be confirmed by clinician observation of the child's speech; otherwise, there is risk of harmful false negative identification. The present data support the Yairi et al. different recovery pathways for children who stutter.
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Affiliation(s)
- Brenda Carey
- Australian Stuttering Research Centre, The University of Sydney, NSW, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, The University of Sydney, NSW, Australia
| | - Sue O'Brian
- Australian Stuttering Research Centre, The University of Sydney, NSW, Australia
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24
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Lowe R, Menzies R, Onslow M, Packman A, O'Brian S. Speech and Anxiety Management With Persistent Stuttering: Current Status and Essential Research. J Speech Lang Hear Res 2021; 64:59-74. [PMID: 33400555 PMCID: PMC8608149 DOI: 10.1044/2020_jslhr-20-00144] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/16/2020] [Accepted: 10/22/2020] [Indexed: 06/12/2023]
Abstract
Purpose The purpose of this review article is to provide an overview of the current evidence base for the behavioral management of stuttering and associated social anxiety. Method We overview recent research about stuttering and social anxiety in the context of contemporary cognitive models of social anxiety disorder. That emerging evidence for self-focused attention and safety behavior use with those who stutter is considered in relation to current treatment approaches for stuttering: speech restructuring and social anxiety management. Results The emerging information about social anxiety and stuttering suggests a conflict between the two clinical approaches. For those clients who wish to control their stuttering and where speech restructuring is deemed the most suitable approach, it is possible that speech restructuring may (a) induce or increase self-focused attention, (b) promote the use of safety behaviors, and (c) become a safety behavior itself. This conflict needs to be explored further within clinical and research contexts. Conclusions The issues raised in this review article are complex. It appears that evidence-based speech treatment procedures are in conflict with current best-practice treatment procedures that deal with social anxiety. In this review article, we propose directions for future research to inform the development of improved treatments for those who stutter and recommendations for interim clinical management of stuttering.
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Affiliation(s)
- Robyn Lowe
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Ross Menzies
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Ann Packman
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Sue O'Brian
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
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25
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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. Int J Lang Commun Disord 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Donaghy M, O'Brian S, Onslow M, Lowe R, Jones M, Menzies RG. Verbal Contingencies in the Lidcombe Program: A Noninferiority Trial. J Speech Lang Hear Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Onslow M. Ehud Yairi: Reflections on a Career. J Fluency Disord 2020; 65:105779. [PMID: 32823252 DOI: 10.1016/j.jfludis.2020.105779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
This is the second in a series of papers that provides an historical record in this journal of contributions made by the most influential researchers in the field of fluency disorders. The present paper reflects on the long and productive career of Ehud Yairi, outlining his many contributions to the field of stuttering, and his outstanding achievements and accomplishments. The paper is based on interviews with him during 2020, after the conclusion of his research career. His visionary, lifetime work has advanced our understanding of the nature, origins, and epidemiology of this disorder.
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Affiliation(s)
- Mark Onslow
- Australian Stuttering Research Centre, University of Technology Sydney, Australia.
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Onslow M, Kelly EM. Temperament and early stuttering intervention: Two perspectives. J Fluency Disord 2020; 64:105765. [PMID: 32442826 DOI: 10.1016/j.jfludis.2020.105765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 02/26/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To discuss clinical applications of research findings about temperament and early stuttering. METHOD A "1000-bytes" format (Onslow & Millard, 2012) was used to provide readers with contemporaneous observation of a "conversation" between the authors. The conversation is proceeded by a prologue and followed by concluding statements from each author. RESULTS One author contended that comprehensive, multidimensional assessment of temperament domains is essential during clinical management of early stuttering, and the results of that assessment are best incorporated into a multifactorial treatment approach. The other author contested that view, arguing that such an approach is not empirically justifiable at present. CONCLUSIONS The authors agree about the salience of research on temperament and early stuttering but have different perspectives about the topic when applied to providing health care for early stuttering.
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Affiliation(s)
- Mark Onslow
- Australian Stuttering Research Centre, University of Technology Sydney, Australia.
| | - Ellen M Kelly
- Department of Hearing and Speech Sciences, Vanderbilt University, USA.
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O'Brian S, Heard R, Onslow M, Packman A, Lowe R, Menzies RG. Clinical Trials of Adult Stuttering Treatment: Comparison of Percentage Syllables Stuttered With Self-Reported Stuttering Severity as Primary Outcomes. J Speech Lang Hear Res 2020; 63:1387-1394. [PMID: 32392091 DOI: 10.1044/2020_jslhr-19-00142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose In a companion paper, we found no statistical reason to favor percentage syllables stuttered (%SS) over parent-reported stuttering severity as a primary outcome measure for clinical trials of early stuttering. Hence, considering the logistical advantages of the latter measure, we recommended parent-reported stuttering severity for use as an outcome measure. The present report extends the prior analysis to a comparison of %SS with self-reported stuttering severity (SRSS) for use as an outcome measure in clinical trials of stuttering treatments for adults. Method We analyzed data from four randomized clinical trials for adults that incorporated %SS and SRSS data at prerandomization and at 6 months post randomization. We analyzed the distributions associated with the two measures, their agreement, and their estimates of effect sizes. Results The positively skewed distribution of %SS warrants much reservation about its value as a clinical trial outcome measure. This skew causes inherent instability because of spurious data associated with low scores, which occur commonly at the low end of such a distribution. This inherent instability is compounded by inherent problems with absolute reliability of %SS measures. These problems are reduced with the much more normal distribution of SRSS. Conclusions The logistical arguments in favor of SRSS apply similarly to adults as they do when parents report the stuttering severity of their children. However, there are statistical reasons to favor SRSS over %SS measures as a primary outcome of clinical trials with adult participants: SRSS has acceptable discriminant validity and a normal distribution, and it is less error prone than %SS. We recommend SRSS as a primary outcome for clinical trials of adults with stuttering.
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Affiliation(s)
- Sue O'Brian
- Australian Stuttering Research Centre, The University of Technology Sydney, Australia
| | - Rob Heard
- Faculty of Health Sciences, The University of Sydney, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, The University of Technology Sydney, Australia
| | - Ann Packman
- Australian Stuttering Research Centre, The University of Technology Sydney, Australia
| | - Robyn Lowe
- Australian Stuttering Research Centre, The University of Technology Sydney, Australia
| | - Ross G Menzies
- Australian Stuttering Research Centre, The University of Technology Sydney, Australia
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Langevin M, Schneider P, Packman A, Onslow M. Exploring how preschoolers who stutter use spoken language during free play: A feasibility study. Int J Speech Lang Pathol 2019; 21:646-654. [PMID: 30348021 DOI: 10.1080/17549507.2018.1505949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 06/08/2023]
Abstract
Purpose: Play is critically important for the healthy development of children. This study explored the viability of a methodology to investigate how preschoolers who stutter use language in play with peers.Method: Transcripts of peer-directed utterances of four preschoolers who stutter and four matched non-stuttering children during free play were analysed for measures of verbal output (numbers of utterances and words), length and complexity of utterances (mean length of communication unit and syntactic complexity), and lexical diversity (number of different words, type token ratio and vocd).Result: Viable speech samples were obtained. Verbal output scores of two children who stutter were the same or higher than their matched controls whereas mean length of communication unit and syntactic complexity scores for three children who stutter were lower than their matched controls. In 22 of the 24 comparisons across number of different words, type token ratio, and vocd, scores of children who stutter were the same or higher than their matched controls.Conclusion: Interpretation of data is limited by the small sample size and lack of standardised testing. However, results indicate that the methodology has promise for future research into the way preschoolers who stutter use spoken language during play and the quality of their play.
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Affiliation(s)
- Marilyn Langevin
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada and
- Australian Stuttering Research Centre, University of Sydney, Lidcombe, Australia
| | - Phyllis Schneider
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada and
| | - Ann Packman
- Australian Stuttering Research Centre, University of Sydney, Lidcombe, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, University of Sydney, Lidcombe, Australia
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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. J Commun Disord 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
| | - Sally Hewat
- University of Newcastle, Newcastle, Australia.
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Gunn A, Menzies RG, Onslow M, O'Brian S, Packman A, Lowe R, Helgadóttir FD, Jones M. Phase I trial of a standalone internet social anxiety treatment for adolescents who stutter: iBroadway. Int J Lang Commun Disord 2019; 54:927-939. [PMID: 31364252 DOI: 10.1111/1460-6984.12496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/25/2019] [Accepted: 06/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND iGlebe is a fully automated internet treatment program for adults who stutter that has been shown, in some cases, to reduce anxiety and effectively manage social anxiety disorder for many participants. No such automated internet treatment program exists for adolescents who stutter. AIMS The present paper reports a Phase I trial of an adolescent version of the adult program: iBroadway. METHODS & PROCEDURES Participants were 29 adolescents in the age range 12-17 years who were seeking cognitive-behaviour therapy (CBT) for anxiety associated with stuttering. The design was a non-randomized Phase I trial with outcome assessments at pre-treatment and immediately post-treatment after 5 months of access to the program. No contact by a clinical psychologist occurred during participant use of the program. Outcomes were a range of psychological, quality-of-life and stuttering severity measures. OUTCOMES & RESULTS The compliance rate for the seven iBroadway modules over 5 months was extremely favourable for internet CBT, at 52.4%. There was evidence of treatment effects for (1) the number of DSM-IV mental health diagnoses with the Diagnostic Interview Schedule for Children; (2) the Unhelpful Thoughts and Beliefs About Stuttering scale; (3) the Subjective Units of Distress Scale; and (4) parent-reported speech satisfaction. CONCLUSIONS & IMPLICATIONS Further development of iBroadway, the adolescent version of iGlebe, with Phase II trialling is warranted.
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Affiliation(s)
- Anthony Gunn
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, Lidcombe, Sydney, NSW, Australia
| | - Ross G Menzies
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, Lidcombe, Sydney, NSW, Australia
| | - Mark Onslow
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, Lidcombe, Sydney, NSW, Australia
| | - Sue O'Brian
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, Lidcombe, Sydney, NSW, Australia
| | - Ann Packman
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, Lidcombe, Sydney, NSW, Australia
| | - Robyn Lowe
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, Lidcombe, Sydney, NSW, Australia
| | - Fjóla Dögg Helgadóttir
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, Lidcombe, Sydney, NSW, Australia
| | - Mark Jones
- School of Public Health, University of Queensland, Herston, QLD, Australia
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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. J Fluency Disord 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Onslow M, Lowe R. After the RESTART trial: six guidelines for clinical trials of early stuttering intervention. Int J Lang Commun Disord 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Menzies R, O'Brian S, Packman A, Jones M, Helgadóttir FD, Onslow M. Supplementing stuttering treatment with online cognitive behavior therapy: An experimental trial. J Commun Disord 2019; 80:81-91. [PMID: 31100535 DOI: 10.1016/j.jcomdis.2019.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/16/2019] [Accepted: 04/28/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE It is now well established that adults who present to speech clinics for help with stuttering will have an increased risk of having an anxiety disorder, particularly social anxiety disorder. Concomitant psychological problems are known to interfere with the maintenance of the benefits of behavioral speech treatments for stuttering. The current team has developed and trialed a cognitive behavior therapy (CBT) program designed specifically to reduce anxiety in adults who stutter, and trials have shown promise for both an in-clinic version and a standalone internet-based version. The aim of the present study is to determine whether iGlebe, the internet-based version of the team's internet CBT treatment (previously known as CBTPsych), enhances the benefits of behavioral stuttering treatment. METHOD Participants were 32 adults seeking treatment for stuttering. The design was a two-arm randomized experimental trial with blinded outcome assessments at 6 and 12 months post-randomization. Both arms received basic speech-restructuring training to reduce stuttering, without any anxiolytic (anxiety reducing) components. The experimental arm also received 5 months access to iGlebe. RESULTS There was evidence that, at 12 months post-randomization, iGlebe added clinically significant improvements to self-reported stuttering severity and quality of life. The present experimental trial provides the first evidence that the addition of CBT to speech restructuring improves speech outcomes. CONCLUSIONS The present results will be the basis for the development of a comprehensive, internet-based treatment program for anxiety associated with stuttering. Ultimately, it may be possible for such an economical, scalable, and translatable comprehensive treatment model to supplement standard speech-language pathology treatment practices for those who stutter.
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Affiliation(s)
- Ross Menzies
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Sue O'Brian
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Ann Packman
- Australian Stuttering Research Centre, The University of Sydney, Australia.
| | - Mark Jones
- School of Public Health, The University of Queensland, Australia.
| | | | - Mark Onslow
- Australian Stuttering Research Centre, The University of Sydney, Australia.
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Menzies RG, Packman A, Onslow M, O'Brian S, Jones M, Helgadóttir FD. In-Clinic and Standalone Internet Cognitive Behavior Therapy Treatment for Social Anxiety in Stuttering: A Randomized Trial of iGlebe. J Speech Lang Hear Res 2019; 62:1614-1624. [PMID: 31112442 DOI: 10.1044/2019_jslhr-s-18-0340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose iGlebe is an individualized, fully automated Internet cognitive behavior therapy (CBT) treatment program that requires no clinician contact. Phase I and II trials have demonstrated that it may be efficacious for treating the social anxiety commonly associated with stuttering. The present trial sought to establish whether the outcomes achieved by iGlebe are noninferior to those associated with in-clinic CBT from clinical psychologists. Method Fifty adults with stuttering were randomized to receive in-clinic CBT for anxiety or 5 months online access to iGlebe. The design was a noninferiority randomized controlled trial with outcomes assessed at prerandomization and at 6 and 12 months postrandomization. Primary outcomes were CIDI-Auto-2.1 diagnoses for anxiety and mood disorders and Brief Fear of Negative Evaluation scale scores ( Carleton, McCreary, Norton, & Asmundson, 2006 ). Secondary outcomes included speech, psychology, and quality-of-life measures. Results Outcomes consistently showed clinically significant improvements of around a medium effect size for the cohort as a whole from prerandomization to 6 months postrandomization, which were maintained at 12 months postrandomization. Comparisons between the 2 treatments showed little difference between iGlebe and in-clinic treatment for all primary and secondary outcomes, with last observation carried forward for missing data. Conclusions iGlebe is a promising individualized treatment for social anxiety for adults who stutter and offers a viable and inexpensive alternative to in-clinic CBT with clinical psychologists. An issue to emerge from this trial, which requires clarification during future clinical trials of iGlebe, is the posttreatment relation between percentage of syllables stuttered and self-reported stuttering severity ratings.
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Affiliation(s)
- Ross G Menzies
- Australian Stuttering Research Centre, The University of Sydney, New South Wales
| | - Ann Packman
- Australian Stuttering Research Centre, The University of Sydney, New South Wales
| | - Mark Onslow
- Australian Stuttering Research Centre, The University of Sydney, New South Wales
| | - Sue O'Brian
- Australian Stuttering Research Centre, The University of Sydney, New South Wales
| | - Mark Jones
- School of Public Health, The University of Queensland, Brisbane, Australia
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Kefalianos E, Onslow M, Packman A, Vogel A, Pezic A, Mensah F, Conway L, Bavin E, Block S, Reilly S. Response to the Letter to the Editor From Marcotte (2019) Regarding "The History of Stuttering by 7 Years: Follow-Up of a Prospective Community Cohort" by Kefalianos et al. (2017). J Speech Lang Hear Res 2019; 62:1369-1370. [PMID: 31058567 DOI: 10.1044/2019_jslhr-s-17-0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The purpose of this letter is to respond to Marcotte's (2019) letter to the editor, "The Influence of Treatment on Children's Recovery from Stuttering: Comments on Kefalianos et al. (2017) and Leech et al. (2017)," published by the Journal of Speech, Language, and Hearing Research.
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Affiliation(s)
- Elaina Kefalianos
- Department of Audiology and Speech Pathology, University of Melbourne, Australia
- Murdoch Children's Research Institute, Australia
- Centre for Neuroscience of Speech, The University of Melbourne, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, University of Technology Sydney, Australia
| | - Ann Packman
- Australian Stuttering Research Centre, University of Technology Sydney, Australia
| | - Adam Vogel
- Department of Audiology and Speech Pathology, University of Melbourne, Australia
- Centre for Neuroscience of Speech, The University of Melbourne, Australia
- Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Angela Pezic
- Murdoch Children's Research Institute, Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute, Australia
- Department of Paediatrics, University of Melbourne, Australia
- Royal Children's Hospital, Australia
| | - Laura Conway
- Murdoch Children's Research Institute, Australia
- Department of Paediatrics, University of Melbourne, Australia
| | - Edith Bavin
- School of Psychology and Public Health, La Trobe University, Australia
| | - Susan Block
- School of Human Communication Sciences, La Trobe University, Australia
| | - Sheena Reilly
- Murdoch Children's Research Institute, Australia
- Menzies Health Institute Queensland, Griffith University, Australia
- Department of Paediatrics, University of Melbourne, Australia
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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. J Fluency Disord 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Van Eerdenbrugh S, Packman A, O'Brian S, Onslow M. Challenges and Strategies for Speech-Language Pathologists Using the Lidcombe Program for Early Stuttering. Am J Speech Lang Pathol 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Abstract
Speaking rhythmically, also known as syllable-timed speech (STS), has been known for centuries to be a fluency-inducing condition for people who stutter. Cantonese is a tonal syllable-timed language and it has been shown that, of all languages, Cantonese is the most rhythmic (Mok, 2009). However, it is not known if STS reduces stuttering in Cantonese as it does in English. This is the first study to investigate the effects of STS on stuttering in a syllable-timed language. Nineteen native Cantonese-speaking adults who stutter were engaged in conversational tasks in Cantonese under two conditions: one in their usual speaking style and one using STS. The speakers' percentage syllables stuttered (%SS) and speech rhythmicity were rated. The rhythmicity ratings were used to estimate the extent to which speakers were using STS in the syllable-timed condition. Results revealed a statistically significant reduction in %SS in the STS condition; however, this reduction was not as large as in previous studies in other languages and the amount of stuttering reduction varied across speakers. The rhythmicity ratings showed that some speakers were perceived to be speaking more rhythmically than others and that the perceived rhythmicity correlated positively with reductions in stuttering. The findings were unexpected, as it was anticipated that speakers of a highly rhythmic language such as Cantonese would find STS easy to use and that the consequent reductions in stuttering would be great, even greater perhaps than in a stress-timed language such as English. The theoretical and clinical implications of the findings are discussed.
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Affiliation(s)
- Thomas Law
- a The Australian Stuttering Research Centre , The University of Sydney , Sydney , Australia
- b Department of Otorhinolaryngology, Head and Neck Surgery , The Chinese University of Hong Kong , NT , Hong Kong SAR
| | - Ann Packman
- a The Australian Stuttering Research Centre , The University of Sydney , Sydney , Australia
| | - Mark Onslow
- a The Australian Stuttering Research Centre , The University of Sydney , Sydney , Australia
| | - Carol K-S To
- c Division of Speech and Hearing Sciences , The University of Hong Kong , Pok Fu Lam , Hong Kong SAR
| | - Michael C-F Tong
- b Department of Otorhinolaryngology, Head and Neck Surgery , The Chinese University of Hong Kong , NT , Hong Kong SAR
| | - Kathy Y-S Lee
- b Department of Otorhinolaryngology, Head and Neck Surgery , The Chinese University of Hong Kong , NT , Hong Kong SAR
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Iverach L, Jones M, Lowe R, O'Brian S, Menzies RG, Packman A, Onslow M. Comparison of adults who stutter with and without social anxiety disorder. J Fluency Disord 2018; 56:55-68. [PMID: 29602052 DOI: 10.1016/j.jfludis.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 05/14/2023]
Abstract
PURPOSE Social anxiety disorder is a debilitating anxiety disorder associated with significant life impairment. The purpose of the present study is to evaluate overall functioning for adults who stutter with and without a diagnosis of social anxiety disorder. METHOD Participants were 275 adults who stuttered (18-80 years), including 219 males (79.6%) and 56 females (20.4%), who were enrolled to commence speech treatment for stuttering. Comparisons were made between participants diagnosed with social anxiety disorder (n = 82, 29.8%) and those without that diagnosis (n = 193, 70.2%). RESULTS Although the socially anxious group was significantly younger than the non-socially anxious group, no other demographic differences were found. When compared to the non-socially anxious group, the socially anxious group did not demonstrate significantly higher self-reported stuttering severity or percentage of syllables stuttered. Yet the socially anxious group reported more speech dissatisfaction and avoidance of speaking situations, significantly more psychological problems, and a greater negative impact of stuttering. CONCLUSION Significant differences in speech and psychological variables between groups suggest that, despite not demonstrating more severe stuttering, socially anxious adults who stutter demonstrate more psychological difficulties and have a more negative view of their speech. The present findings suggest that the demographic status of adults who stutter is not worse for those with social anxiety disorder. These findings pertain to a clinical sample, and cannot be generalized to the wider population of adults who stutter from the general community. Further research is needed to understand the longer-term impact of social anxiety disorder for those who stutter.
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Affiliation(s)
- Lisa Iverach
- 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.
| | - Robyn Lowe
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW 1825, Australia.
| | - Susan O'Brian
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW 1825, Australia.
| | - Ross G Menzies
- 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.
| | - Mark Onslow
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW 1825, Australia.
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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. J Speech Lang Hear Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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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. Int J Speech Lang Pathol 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Iverach L, Jones M, Lowe R, O'Brian S, Menzies RG, Packman A, Onslow M. Characteristics of adults who stutter by treatments sought. LOGOP PHONIATR VOCO 2018; 44:134-142. [PMID: 29569967 DOI: 10.1080/14015439.2018.1452976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Several treatment approaches are available for adults who stutter, including speech treatment, cognitive behaviour therapy (CBT) treatment for anxiety, and a combination of both. It is useful to determine whether any differences exist between adults who stutter enrolled in different types of treatment. Therefore, the purpose of this study was to compare demographic, speech, and psychological characteristics of adults who stutter enrolled in speech, psychological, and combined treatment programs. Participants were 288 adults who stuttered (18-80 years) enrolled in one of three different treatment programs: Speech Treatment for stuttering (n = 134), Anxiety Treatment for anxiety about stuttering (n = 70), or Speech Treatment for Stuttering With or Without Anxiety Treatment (n = 84). Participants completed a range of demographic, speech, and psychological measures prior to the start of treatment. A significantly higher proportion of participants in the Anxiety Treatment group were in a personal relationship than the other treatment groups. The Anxiety Treatment group had higher average age than the other treatment groups. The Speech Treatment group also demonstrated significantly higher self-rated stuttering severity than the Anxiety Treatment group, even though there were no significant difference between groups for clinician-rated percentage of syllables stuttered. Although most characteristics of adults who stuttered did not vary by treatment type, the present findings suggest that adults who stutter enrolled in speech treatment perceived their stuttering as more severe, which may have prompted treatment seeking. Further research is needed regarding the supportive influence of personal relationship for those with the disorder.
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Affiliation(s)
- Lisa Iverach
- a Australian Stuttering Research Centre , The University of Sydney , Lidcombe , Australia
| | - Mark Jones
- b School of Public Health , University of Queensland , Herston , Australia
| | - Robyn Lowe
- a Australian Stuttering Research Centre , The University of Sydney , Lidcombe , Australia
| | - Susan O'Brian
- a Australian Stuttering Research Centre , The University of Sydney , Lidcombe , Australia
| | - Ross G Menzies
- a Australian Stuttering Research Centre , The University of Sydney , Lidcombe , Australia
| | - Ann Packman
- a Australian Stuttering Research Centre , The University of Sydney , Lidcombe , Australia
| | - Mark Onslow
- a Australian Stuttering Research Centre , The University of Sydney , Lidcombe , Australia
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Law T, Packman A, Onslow M, To CKS, Tong MCF, Lee KYS. The Topography of Stuttering in Cantonese. Folia Phoniatr Logop 2018; 69:110-117. [PMID: 29462821 DOI: 10.1159/000481254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/03/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This is the first study to investigate the behavioral nature (topography) of stuttering in Cantonese. Cantonese, a Sino-Tibetan language, is both tonal and syllable-timed. Previous studies of stuttering topography have mainly been in Western languages, which are mainly stress-timed. METHODS Conversational speech samples were collected from 24 native Cantonese-speaking adults who stuttered. Six consecutive stuttering moments from each participant were analyzed using the Lidcombe behavioral data language (LBDL). A complexity analysis based on the LBDL was developed to indicate the proportion of multiple-behavior stuttering moments for each participant. RESULTS There was no significant difference in the frequency of the 7 LBDL behaviors. Almost half the stuttering moments across participants were reported as complex, containing more than 1 stuttering behavior, and stuttering complexity correlated significantly with stuttering severity. CONCLUSIONS These preliminary findings require replication because of their important theoretical and clinical implications. Differences in topography across languages have the potential to contribute to our understanding of the nature of stuttering. Clinically, the recognition of such differences may assist practitioners in identifying stuttering, for example when screening for early stuttering. The LBDL complexity score developed in this study has the potential to be used in other languages.
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Affiliation(s)
- Thomas Law
- Australian Stuttering Research Centre, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ann Packman
- Australian Stuttering Research Centre, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Carol K-S To
- Division of Speech and Hearing Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - Michael C-F Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Kathy Y-S Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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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. Int J Speech Lang Pathol 2017; 19:637. [PMID: 28358249 DOI: 10.1080/17549507.2017.1312781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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
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Kefalianos E, Onslow M, Packman A, Vogel A, Pezic A, Mensah F, Conway L, Bavin E, Block S, Reilly S. The History of Stuttering by 7 Years of Age: Follow-Up of a Prospective Community Cohort. J Speech Lang Hear Res 2017; 60:2828-2839. [PMID: 28979988 DOI: 10.1044/2017_jslhr-s-16-0205] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/01/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE For a community cohort of children confirmed to have stuttered by the age of 4 years, we report (a) the recovery rate from stuttering, (b) predictors of recovery, and (c) comorbidities at the age of 7 years. METHOD This study was nested in the Early Language in Victoria Study. Predictors of stuttering recovery included child, family, and environmental measures and first-degree relative history of stuttering. Comorbidities examined at 7 years included temperament, language, nonverbal cognition, and health-related quality of life. RESULTS The recovery rate by the age of 7 years was 65%. Girls with stronger communication skills at the age of 2 years had higher odds of recovery (adjusted OR = 7.1, 95% CI [1.3, 37.9], p = .02), but similar effects were not evident for boys (adjusted OR = 0.5, 95% CI [0.3, 1.1], p = .10). At the age of 7 years, children who had recovered from stuttering were more likely to have stronger language skills than children whose stuttering persisted (p = .05). No evident differences were identified on other outcomes including nonverbal cognition, temperament, and parent-reported quality of life. CONCLUSION Overall, findings suggested that there may be associations between language ability and recovery from stuttering. Subsequent research is needed to explore the directionality of this relationship.
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Affiliation(s)
- Elaina Kefalianos
- Department of Audiology and Speech Pathology, University of Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Centre for Neuroscience of Speech, The University of Melbourne, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, University of Sydney, Australia
| | - Ann Packman
- Australian Stuttering Research Centre, University of Sydney, Australia
| | - Adam Vogel
- Department of Audiology and Speech Pathology, University of Melbourne, Victoria, Australia
- Centre for Neuroscience of Speech, The University of Melbourne, Australia
- Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Angela Pezic
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Fiona Mensah
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Australia
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Laura Conway
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Australia
| | - Edith Bavin
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Susan Block
- School of Human Communication Sciences, La Trobe University, Bundoora, Victoria, Australia
| | - Sheena Reilly
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
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Law T, Packman A, Onslow M, To CKS, Tong MCF, Lee KYS. Lexical tone and stuttering in Cantonese. Clin Linguist Phon 2017; 32:285-297. [PMID: 28853955 DOI: 10.1080/02699206.2017.1359851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cantonese is a tone language, in which the variation of the fundamental frequency contour of a syllable can change meaning. There are six different lexical tones in Cantonese. While research with Western languages has shown an association between stuttering and syllabic stress, nothing is known about whether stuttering in Cantonese speakers is associated with one or more of the six lexical tones. Such an association has been reported in conversational speech in Mandarin, which is also a tone language, but which varies markedly from Cantonese. Twenty-four native Cantonese-speaking adults who stutter participated in this study, ranging in age from 18-33 years. There were 18 men and 6 women. Participants read aloud 13 Cantonese syllables, each of which was produced with six contrastive lexical tones. All 78 syllables were embedded in the same carrier sentence, to reduce the influence of suprasegmental or linguistic stress, and were presented in random order. No significant differences were found for stuttering moments across the six lexical tones. It is suggested that this is because lexical tones, at least in Cantonese, do not place the task demands on the speech motor system that typify varying syllabic stress in Western languages: variations not only in fundamental frequency, but also in duration and intensity. The findings of this study suggest that treatments for adults who stutter in Western languages, such as speech restructuring, can be used with Cantonese speakers without undue attention to lexical tone.
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Affiliation(s)
- Thomas Law
- a The Australian Stuttering Research Centre , The University of Sydney , Sydney , Australia
- b Department of Otorhinolaryngology, Head and Neck Surgery , The Chinese University of Hong Kong , NT , Hong Kong SAR
| | - Ann Packman
- a The Australian Stuttering Research Centre , The University of Sydney , Sydney , Australia
| | - Mark Onslow
- a The Australian Stuttering Research Centre , The University of Sydney , Sydney , Australia
| | - Carol K-S To
- c Division of Speech and Hearing Sciences , The University of Hong Kong , Pok Fu Lam , Hong Kong SAR
| | - Michael C-F Tong
- b Department of Otorhinolaryngology, Head and Neck Surgery , The Chinese University of Hong Kong , NT , Hong Kong SAR
| | - Kathy Y-S Lee
- b Department of Otorhinolaryngology, Head and Neck Surgery , The Chinese University of Hong Kong , NT , Hong Kong SAR
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Lowe R, Helgadottir F, Menzies R, Heard R, O'Brian S, Packman A, Onslow M. Safety Behaviors and Stuttering. J Speech Lang Hear Res 2017; 60:1246-1253. [PMID: 28525541 DOI: 10.1044/2016_jslhr-s-16-0055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 12/05/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE Those who are socially anxious may use safety behaviors during feared social interactions to prevent negative outcomes. Safety behaviors are associated with anxiety maintenance and poorer treatment outcomes because they prevent fear extinction. Social anxiety disorder is often comorbid with stuttering. Speech pathologists reported in a recent publication (Helgadottir, Menzies, Onslow, Packman, & O'Brian, 2014a) that they often recommended procedures for clients that could be safety behaviors. This study investigated the self-reported use of safety behaviors by adults who stutter. METHOD Participants were 133 adults who stutter enrolled in an online cognitive-behavior therapy program. Participants completed a questionnaire about their use of potential safety behaviors when anxious during social encounters. Correlations were computed between safety behaviors and pretreatment scores on measures of fear of negative evaluation and negative cognitions. RESULTS Of 133 participants, 132 reported that they used safety behaviors. Many of the safety behaviors correlated with higher scores for fear of negative evaluation and negative cognitions. CONCLUSIONS Adults who stutter report using safety behaviors, and their use is associated with pretreatment fear of negative evaluation and unhelpful thoughts about stuttering. These results suggest that the negative effects of safety behaviors may extend to those who stutter, and further research is needed.
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Kefalianos E, Onslow M, Ukoumunne OC, Block S, Reilly S. Temperament and Early Stuttering Development: Cross-Sectional Findings From a Community Cohort. J Speech Lang Hear Res 2017; 60:772-784. [PMID: 28359081 DOI: 10.1044/2016_jslhr-s-15-0196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/07/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of this study was to ascertain if there is an association between stuttering severity and behaviors and the expression of temperament characteristics, including precursors of anxiety. METHOD We studied temperament characteristics of a prospectively recruited community cohort of children who stutter (N = 173) at ages 3, 4, and 6 years using the Short Temperament Scale STS (Prior, Sanson, Smart & Oberklaid, 2000). RESULTS Six of 131 statistical tests of association between stuttering severity and behaviors and temperament traits were statistically significant at the 5% level, which was no more than expected by chance alone. CONCLUSIONS On the basis of parent responses to the STS, preschoolers who exhibited different levels of stuttering severity and behaviors did not generally express temperament traits differently from one another. Stuttering severity and stuttering behaviors were not associated with the precursors of anxiety. Overall, taking multiple tests into consideration, results show little evidence of association between stuttering severity and temperament up to 4 years of age or between stuttering behaviors and temperament up to 6 years of age.
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Affiliation(s)
- Elaina Kefalianos
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville, Victoria, AustraliaMurdoch Childrens Research Institute, Parkville, Victoria, AustraliaDepartment of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, University of Sydney, New South Wales, Australia
| | - Obioha C Ukoumunne
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, Devon, United Kingdom
| | - Susan Block
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Sheena Reilly
- Murdoch Childrens Research Institute, Parkville, Victoria, AustraliaDepartment of Paediatrics, University of Melbourne, Parkville, Victoria, AustraliaMenzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
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