Designing a Module on Stuttering and Cluttering: A Guide for Speech-Language Pathology Educators

PURPOSE

Due to the scope of practice of speech-language pathology (SLP) expanding considerably in recent times, there is reduced emphasis on certain communication conditions within the curricula of SLP university programs. Stuttering and cluttering are neglected components of such curricula, despite the complex clinical skill set required to work with these client groups. Evaluation of the content and quality of modules on stuttering and cluttering is warranted to ensure that SLP students are graduating with adequate competence and confidence for supporting people with these conditions. This tutorial, based on a review of the literature, aims to provide guidance to educators who are designing or revising such modules.

METHOD

The All Ireland Society for Higher Education (AISHE) model for module design provides a practical and theoretically underpinned guide to educators in higher education on the design of a new module or the review of an existing one. The model's seven key components are discussed, and their application to a module on stuttering and cluttering is outlined.

RESULTS

The AISHE model provides a systematic and user-friendly approach to module design in SLP university programs. It supports educators who are designing a new module or revising a module currently being taught on stuttering and cluttering.

CONCLUSIONS

Educators are encouraged to familiarize themselves with the seven components of the AISHE model and to use it as a tool to design or revise modules on stuttering and cluttering. This will ensure that SLP students are graduating with increased competence and confidence in working with these client groups.

Treatment for Stuttering in Preschool-Age Children: A Qualitative Document Analysis of Treatment Programs

PURPOSE

The purpose of this study was to identify commonalities and differences between content components in stuttering treatment programs for preschool-age children.

METHOD

In this document analysis, a thematic analysis of the content was conducted of handbooks and manuals describing Early Childhood Stuttering Therapy, the Lidcombe Program, Mini-KIDS, Palin Parent-Child Interaction Therapy, RESTART Demands and Capacities Model Method, and the Westmead Program. First, a theoretical framework defining a content component in treatment was developed. Second, we coded and categorized the data following the procedure of reflexive thematic analysis. In addition, the first authors of the treatment documents have reviewed the findings in this study, and their feedback has been analyzed and taken into consideration.

RESULTS

Sixty-one content components within the seven themes-interaction, coping, reactions, everyday life, information, language, and speech-were identified across the treatment programs. The content component SLP providing information about the child's stuttering was identified across all treatment programs. All programs are multithematic, and no treatment program has a single focus on speech, language, or parent-child interaction. A comparison of the programs with equal treatment goals highlighted more commonalities in content components across the programs. The differences between the treatment programs were evident in both the number of content components that varied from seven to 39 and the content included in each treatment program.

CONCLUSIONS

Only one common content component was identified across programs, and the number and types of components vary widely. The role that the common content component plays in treatment effects is discussed, alongside implications for research and clinical practice.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25457929.

Evaluation of an Integrated Fluency and Acceptance and Commitment Therapy Intervention for Adolescents and Adults Who Stutter

PURPOSE

Developmental stuttering is a complex and multifaceted neurodevelopmental disorder that may cause pervasive negative consequences for adults who stutter (AWS). Historically, intervention for AWS has primarily addressed speech fluency, with less focus on the covert psychosocial aspects of the disorder. The purpose of this article is to report on a feasibility trial evaluating a novel integrated intervention that combines traditional stuttering management techniques with Acceptance and Commitment Therapy (ACT) for AWS.

METHOD

Twenty-nine AWS participated in the feasibility trial. All participants successfully completed a combined fluency and ACT intervention, titled the fluency and Acceptance and Commitment Therapy for Stuttering (fACTS) Program. As this was a feasibility study, no control group was included. Intervention was administered by two certified practicing speech-language pathologists, over eight 60- to 90-min sessions.

RESULTS

Generalized linear mixed modeling was used to determine change from pre- to post-intervention and follow-up. Significant pre- and post-intervention improvements in self-efficacy, psychosocial functioning, and psychological flexibility were observed, along with significant reductions in observable stuttering behaviors (i.e., stuttered speech frequency). Intervention gains for all variables of interest were maintained 3 and 6 months post-intervention.

CONCLUSIONS

The fACTS Program was created to be a holistic and flexible intervention to promote self-efficacy beliefs and address stuttering-related psychosocial impacts and speech fluency goals of AWS. Preliminary results indicated positive improvement in all psychosocial outcomes (i.e., self-efficacy, psychosocial impact, and psychological flexibility) and observable speech fluency following completion of the program. Future clinical trials of the fACTS Program with an included control group will further investigate the mechanisms of change for the positive effects observed.

Communicative practices and perceptions towards stuttering people in South Africa

BACKGROUND

 A few studies have explored the life experiences of people who stutter. Research has shown that stuttering affects a significant number of people in the population.

OBJECTIVES

 The study was designed to explore the experiences of people who stutter and the perception of stuttering in South Africa.

METHOD

 Four people who identified as South Africans who stutter participated in this study. The primary investigator conducted semi-structured interviews with each of the participants. In addition, a questionnaire was administered to 20 acquaintances of all the participants. Transcriptions of interviews and results of questionnaires were analysed for major and minor themes.

RESULTS

 Results of this study suggest different perceptions by those who stutter and those acquainted with them. The findings of the study show that people who stutter experience communication barriers, so they adopt certain strategies to manage and cope with their speech disorder. The findings showed that stuttering has a pervasive impact on the lives of people who stutter and how they view themselves, considering negative societal views.

CONCLUSION

 Evaluation of the results from the study reveals that although stuttering is a common speech disorder, many people who are less informed about it harbour various stereotypes and myths that stigmatise stuttering. This study concludes by outlining recommendations for creating awareness of stuttering. It suggests vigorous campaigns aiming at promoting a multilevel approach that extends beyond the mere social and professional understanding of stuttering but addresses the inherent perceptions, myths, and stereotypes around stuttering.Contribution: Experiences of people who stutter and perceptions towards stuttering can help to better understand the speech disorder and overcome myths and stereotyping of stuttering.

The Fifth Croatia Stuttering Symposium: Part I. Treatments for early stuttering

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.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Effectiveness of speech therapy in treating vocal blocking tics in children with Tourette syndrome: Two case reports

Tourette syndrome is characterized by at least two motor tics and one vocal tic, which persist for over a year. Infrequently, tics can manifest as blocking tics in speech when they prevent a person from starting to speak or interrupt their speech flow. Vocal blocking tics (VBTs) resemble stuttering, and they can be difficult to differentiate from each other. A previous report described two patients with severe VBTs who did not benefit from stuttering-therapy-based speech therapy and were treated effectively with cannabis-based medicine. Here, we present the cases of two patients, seven- and nine-year-old boys, who benefited from speech therapy in which stuttering therapy techniques were used. Detailed descriptions of the interventions are included. Further research is needed to test the effectiveness of speech therapy in treating VBTs in a larger group of children with Tourette syndrome.

Searching for Lidcombe Program mechanisms of action: Inter-turn speaker latency

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.

The Fifth Croatia Stuttering Symposium: Part II. Natural recovery from early stuttering

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.

Stuttering on Instagram: What is the focus of stuttering-related Instagram posts and how do users engage with them?

PURPOSE

Instagram has become a popular platform for sharing and seeking health-related information, including stuttering. However, concerns have been raised about the accuracy, confidentiality, and potential negative impact of such information. This study aims to examine how stuttering is defined and understood on Instagram, and how users engage with related content.

METHODS

We analyzed highly engaged Instagram posts with the hashtag "#Stuttering" published within a year and their corresponding comments using thematic analysis.

RESULTS

The results revealed four main themes and nine sub-themes that highlighted different understandings of stuttering on Instagram, including the need for intervention, emotional impact on people who stutter, positive meanings, and mental health implications. User engagement varied based on the nature of the post, with users showing appreciation, objections, seeking advice, celebrating success stories, mocking, or advocating for people who stutter.

CONCLUSION

Although Instagram can serve as a means of normalizing stuttering and highlighting success stories, it raises concerns about the promotion of non-evidence-based treatments and the use of stuttering for political or entertainment purposes. This study emphasizes the need to critically evaluate health-related information presented on social media platforms. To provide reliable information to PWS and their families who seek information on social media, it is recommended to promote evidence-based information on stuttering through trustworthy organizations such as the National Stuttering Association or the Stuttering Foundation, particularly on special occasions like International Stuttering Awareness Day.

Contemporary clinical conversations about stuttering: Neurodiversity and ableism

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.

Reduced stuttering for school-age children: A systematic review

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.

Effectiveness of Stuttering Modification Treatment in School-Age Children Who Stutter: A Randomized Clinical Trial

PURPOSE

This study investigated the effectiveness of the stuttering modification intervention Kinder Dürfen Stottern (KIDS) in school-age children who stutter.

METHOD

Seventy-three children who stutter were included in this multicenter, two-group parallel, randomized, wait-list controlled trial with a follow-up of 12 months. Children aged 7-11 years were recruited from 34 centers for speech therapy and randomized to either the immediate-treatment group or the 3 months delayed-treatment group. KIDS was provided by 26 clinicians who followed a treatment manual. Although the primary outcome measure was the impact of stuttering (Overall Assessment of the Speaker's Experience of Stuttering-School-Age [OASES-S]), the secondary outcomes included objective and subjective data on stuttering severity.

RESULTS

At 3 months postrandomization, the mean score changes of the OASES-S differed significantly between the experimental (n = 33) and control group (n = 29; p = .026). Furthermore, treatment outcomes up to 12 months were analyzed (n = 59), indicating large effects of time on the OASES-S score (p < .001, partial η2 = .324). This was paralleled by significant improvements in parental ratings and objective ratings (stuttering severity, frequency, and physical concomitants).

CONCLUSIONS

The significant short-term treatment effects in the OASES-S are in line with the (initial) focus of KIDS on cognitive and affective aspects of stuttering. Over 12 months, these changes were maintained and accompanied by behavioral improvements. The results suggest that individual treatment with KIDS is an adequate treatment option for this age group.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24207864.

Solution-Focused Brief Therapy for Stuttering in the Public Schools: Children Solve Their Own Stuttering Problems in This Case Study

PURPOSE

This clinical focus article follows the case studies of three school-age children who stutter in solution-focused brief therapy (SFBT), highlighting treatment features and demonstrating positive outcomes. Empowerment and self-agency are emphasized as desired characteristics. Children searched within themselves and acted to influence therapy results. Techniques such as self-disclosure and fluency shaping were incorporated into this approach.

METHOD

In a public school district, participants with moderate-to-severe stuttering used the Clinical Use of Self-Reports to measure their perceived stuttering severity across various contexts and audiences. The speech-language pathologist (SLP) provided verbal feedback/contingencies including personalized questions, supportive statements, and positive gestures/comments. The students identified a stuttering problem, implemented the suggested techniques in clinic and in their natural environments, and shared pertinent feedback during the following therapy sessions.

RESULTS

Participants solved stuttering problems and took charge of their own treatment. After 5 weeks of SFBT, the 18-year-old demonstrated sufficient problem-solving skills to agree to be discharged from the program. The remaining two students exhibited growth toward their individualized goals. They showed curiosity about their own stuttering situations and applied innovative strategies, in the outside world, that had been practiced and formulated in their therapy sessions.

CONCLUSIONS

The participants engaged in conversations with the SLP, teachers, peers, and family members. They documented conversations, reflections, performance scales, and personal goals in their journals. During therapy sessions, the children clarified real-life goals and tried out techniques for managing their stuttering difficulties. In addition, they completed the Clinical Use of Self-Reports to assess their communication values, successes, and challenges.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23706363.

Australian pre-service primary teachers' knowledge, attitudes, and skills regarding stuttering

Purpose: Exploring Australian pre-service primary teachers' knowledge, attitudes, and classroom strategies regarding stuttering provides speech-language pathologists (SLPs) with information that can facilitate enhanced outcomes for school-aged children who stutter.Method: In this exploratory descriptive cross-sectional study, 51 final-year Bachelor of Education (Primary) students enrolled at an Australian university completed an online survey about stuttering.Result: Responses demonstrated positive and negative beliefs. Seventy-four per cent of pre-service teachers believed that stuttering has a psychological aetiology and that students who stutter are more likely to be shy or anxious. Participants agreed that their reactions and support offered would largely be based on their assumptions rather than knowledge.Conclusion: Pre-service primary teachers share similar misconceptions and unhelpful attitudes towards stuttering with previously evaluated populations. Implications for SLPs are discussed.

Internet searches conducted by people who stutter: association with speech-language therapy and severity of stuttering

Stuttering is a fluency disorder that is multidimensional because it involves more than speech difficulties. People who stutter can use the Internet to find out more about their condition and connect with other people in the same position, yet in Croatia, there are not nearly as many online sources on stuttering or as many possibilities to connect with other people who stutter as in the USA or Great Britain. If one does not speak English well, a lot of information about stuttering will simply be denied to them, especially to those who have never received speech therapy. The present study, the first of its kind in Croatia, was conducted in order to understand how often and for what reasons people who stutter search for Internet resources related to their condition. The study also assessed whether Internet use depended on age, experience with speech-language therapy, self-reported satisfaction with such therapy, and self-assessed severity of stuttering. An online questionnaire integrating the 9-Point Stuttering Severity Scale was developed for this study and administered to 51 individuals aged 18 years and older in Croatia. All collected data and findings on the internet searches come from the questionnaire. Age did not significantly affect the frequency or purpose of Internet searches. Individuals who were not attending speech therapy were more likely to search online sources about stuttering than those who received it before. People who rated their stuttering as severe were more likely to search online sources for stuttering than those who rated their condition as mild. These results suggest that there is a need for more useful, high-quality online content and materials in Croatian for people who stutter. Such resources would offer people who stutter a new world of support, mutual understanding, shared experiences and knowledge, and ways for them to help themselves.

Understanding the Broader Impact of Stuttering: Suicidal Ideation

PURPOSE

Suicide and suicidal ideation are topics that have a long but limited history in stuttering research. Clinicians and clinical researchers have discussed personal and therapeutic experiences with clients who have attempted suicide, died by suicide, or struggled with suicidal thoughts. This study sought to (a) explore the occurrence of suicidal ideation in a sample of adults who stutter; (b) evaluate the relationship between adverse impact related to stuttering and suicidal ideation; and (c) document respondents' thoughts related to suicide, stuttering, and their intersection.

METHOD

One hundred forty adults who stutter completed the Suicide Behavior Questionnaire-Revised (SBQ-R). Of these, 70 participants completed the Perseverative Thinking Questionnaire (PTQ), and 67 completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES). Participants who indicated at least some tendency for suicidal thoughts on the SBQ-R (n = 95) were then asked a set of follow-up questions to explore their experiences of suicidal ideation related to stuttering.

RESULTS

Quantitative data indicated that the majority of adults who reported experiencing suicidal ideation associated these experiences with stuttering (61.2%, n = 59). Individuals with higher Total Scores on the PTQ and OASES were predicted to experience significantly higher rates of suicidal ideation and, in particular, a higher likelihood of having more frequent suicidal ideation in the past year. Qualitative analyses revealed that suicidal ideation intersects meaningfully with the experience of stuttering.

CONCLUSIONS

Data from this study highlight the importance of considering broader life consequences of stuttering that some adults may experience, including suicidal ideation. By being cognizant that clients may develop such thoughts, speech-language pathologists can play a valuable role in identifying and providing necessary support for at-risk individuals.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23699688.

"I Just Want People to Think I'm Normal": An Interview Study of Young Swedish Women With Covert Stuttering

PURPOSE

Research indicates that there is a tendency for females who stutter, more often than males, to use coping strategies that involve covering their stutter, for example, by avoiding situations that require verbal participation. The aim of the study is to increase knowledge about how covert stuttering develops and its impact on self-image and quality of life for women who stutter.

METHOD

Eleven young women who stutter covertly were interviewed, and data were subjected to qualitative content analysis. Background information was obtained from the self-report instruments measuring the impact of stuttering on different aspects of life (Overall Assessment of the Speaker's Experiences of Stuttering) and degree of perceived social anxiety (Liebowitz Social Anxiety Scale, Self-Report).

RESULTS

Three main themes were identified: (a) managing stuttering, (b) personal aspects, and (c) stuttering as a phenomenon. Shame and a desire to fit in emerged as distinct motives for covering stuttering. The women described that stuttering controlled both life choices and everyday life. Development of self-image had been strongly negatively affected, resulting in social anxiety. The women expressed a particular vulnerability of being a woman who stutters, due to societal norms of female behavior and a lack of female role models who stutter.

CONCLUSIONS

The choice of coping strategy was motivated by a desire to "be normal." As a result, stuttering had come to dominate life and affect self-image and life choices. The study highlights the importance for clinicians to be alert to and aware of the fact that the experiences of women who stutter can lead them to develop coping strategies that have far-reaching negative consequences.

A novel non-word speech preparation task to increase stuttering frequency in experimental settings for longitudinal research

PURPOSE

The variable and intermittent nature of stuttering makes it difficult to consistently elicit a sufficient number of stuttered trials for longitudinal experimental research. This study tests the efficacy of using non-word pairs that phonetically mimic English words with no associated meaning, to reliably elicit balanced numbers of stuttering and fluent trials over multiple sessions. The study also evaluated the effect of non-word length on stuttering frequency, the consistency of stuttering frequency across sessions, and potential carry-over effects of increased stuttering frequency in the experimental task to conversational and reading speech after the task.

METHODS

Twelve adults who stutter completed multiple sessions (mean of 4.8 sessions) where they were video-recorded during pre-task reading and conversation, followed by an experimental task where they read 400 non-word pairs randomized for each session, and then a post-task reading and conversation sample.

RESULTS

On average, across sessions and participants, non-word pairs consistently yielded a balanced distribution of fluent (60.7%) and stuttered (39.3%) trials over five sessions. Non-word length had a positive effect on stuttering frequency. No carryover effects from experimental to post-task conversation and reading were found.

CONCLUSIONS

Non-word pairs effectively and consistently elicited balanced proportions of stuttered and fluent trials. This approach can be used to gather longitudinal data to better understand the neurophysiological and behavioral correlates of stuttering.

Norwegian speech-language pathologists treatment practices for preschool children who stutter: An explorative study

PURPOSE

This study investigated the treatment practices of speech-language pathologists (SLPs) with preschool children who stutter to explore variations in service delivery and, consequently to better inform and support evidence-based practice.

METHOD

121 Norwegian SLPs completed an online survey about stuttering treatment for preschool children aged up to six years. They reported on treatment training, choices, setting, dosage, and outcomes. Data was analysed descriptively. Correlation analyses between years of clinical experience and clinician perceived outcomes were conducted.

RESULT

Sixty-eight percent of SLPs were trained in one or more stuttering treatment programs. The majority of SLPs (83 %) provided treatment in person in preschool centers; 59 % reported providing treatment once a week. Thirty-four percent of SLPs reported that they often or always delivered the whole treatment program. Treatment practice addressed various elements, including advising parents about language and communication strategies, supporting the child's self-image, and perceived outcomes. The SLPs reported their clinician perceived outcomes as 'always' or 'often' reduction of audible stuttering (70 %), reduced cognitive and emotional reactions (55 %), and improved communication skills (58 %). Factors influencing treatment choices were identified at the systemic level (e.g., work place regulations) and individual level (e.g., SLPs competency, child's best).

CONCLUSION

Stuttering treatment services in Norway differ from those reported in existing literature as treatment is given in preschool settings, only 34 % of SLPs deliver programs as intended whilst the majority use treatment elements only, and still experience positive changes. Provision is variable, and seems influenced by SLP training and competence.

The Fifth Croatia Stuttering Symposium: Part III. Mental health and early stuttering

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.

Psychosocial features of stuttering for school-age children: A systematic review

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.

Eye movement as a simple, cost-effective tool for people who stutter: A case study

BACKGROUND

 Access to services remains the biggest barrier to helping the most vulnerable in the South African Stuttering Community. This novel stuttering therapy, harnessing an unconscious link between eye and tongue movement, may provide a new therapeutic approach, easily communicated and deliverable online.

OBJECTIVES

 This study provides both objective and subjective assessments of the feasibility of this intervention. Assessment tools holistically address all components of stuttering in line with comprehensive treatment approaches: core behaviours, secondary behaviours, anticipation and reactions.

METHOD

 On receipt of ethical approval, this single-subject case design recruited one adult (21-year-old) male with a developmental stutter (DS). The participant gave informed consent and completed four scheduled assessments: baseline, after 5-week training, 3 months post-intervention and 24 months post-completion. The study used objective assessment tools: Stuttering Severity Instrument-4 (SSI-4); Subjective-assessment tools: SSI-4 clinical use self-report tool (CUSR); Overall Assessment of Speaker's Experience of Stuttering (OASES-A); Premonitory Awareness in Stuttering (PAiS) and Self-Report Stuttering Severity* (SRSS) (*final assessment).

RESULTS

 The participant's scores improved across all assessment measures, which may reflect a holistic improvement. The participant reported that the tool was very useful. There were no negative consequences.

CONCLUSION

 This case report indicates that this innovative treatment may be feasible. No adverse effects were experienced, and the treatment only benefited the participant. The results justify the design of a pilot randomised feasibility clinical trial.Contribution: The results indicate that this is a needed breakthrough in stuttering therapy as the instructions can be easily translated into any language. It can also be delivered remotely reducing accessibility barriers.

Why do people who stutter attend stuttering support groups?

BACKGROUND

 Stuttering support groups (SSGs) have been a long-standing invaluable resource for people who stutter (PWS) but research into SSGs is only emerging. Speech-language therapists (SLTs) need further insight to successfully facilitate SSGs.

OBJECTIVES

 To determine PWS' perspectives regarding why they attend SSGs in South Africa.

METHOD

 Thirteen PWS who attend SSGs, between 20 and 58 years old, were a part of this qualitative study. Purposive sampling was utilised. Semi-structured telephonic interviews were used and data was analysed thematically.

RESULTS

 Four themes, namely, 'altered perceptions', 'increased sense of community', 'support group reciprocity', and 'support group environment, participants and topics', were identified. The results yielded clinical implications which included SLTs encouraging: (1) improved perceptions of being a PWS through education and self-empowerment, (2) PWS' connections between meetings to increase the sense of community, (3) reciprocity in meetings, (4) sharing personal stories to promote learning and general self-management and (5) support, praise and education to empower and encourage PWS. This study's findings show that SSGs helped PWS accept their stutter and gain confidence. This study showcased how SSGs can help PWS manage their fluency and gain confidence. Additionally, this study supports current research which suggests that dysfluency and social-emotional well-being should be equally addressed.

CONCLUSION

 Recommendations were generated from PWS' perspectives and included focusing discussions on fluency, emotions and sharing personal stories. Insights from PWS helped better inform SLTs of their role within SSGs including guiding and facilitating conversations.Contribution: People who stutters' perspectives can be used in clinical practice to help SLTs meet the needs of PWS and guide best practice when facilitating SSGs.

[Stuttering in Children: Review and Referral Criteria]

Stuttering is a speech fluency disorder, in which people know perfectly well the message they want to convey, even though their speech is characterized by changes in rhythm, repetitions, prolongations, pauses and blocks, and may also be associated with states of anxiety or emotional tension. Up to one in every six children, typically between two and five years old, experience a period of transitory speech disfluency, with usual spontaneous recovery before reaching school age, with a prevalence rate of stuttering of up to 1% of the adult population, and a higher incidence rate in males (4:1). In Portugal, it is estimated that stuttering affects around 100 thousand people, acquiring importance due to its frequency and association with lower self-esteem, anxiety and social isolation, with negative impact on people's ability to communicate and on their well-being and social interactions. The aim of this article is to highlight the complexity of the diagnostic and therapeutic approach of stuttering in pediatrics, with a particular focus on differentiating between normal speech disfluencies and childhood-onset fluency disorder (stuttering) and referral criteria, in order to raise awareness and facilitate early detection of these cases.

Intensive speech-language pathology therapy with adults who stutter: preliminary study

PURPOSE

To compare the results of fluency and self-perception of the impact of stuttering on the lives of adults who stutter, before and after undergoing intensive speech-language pathology therapy.

METHODS

This is a descriptive and longitudinal study with data collection before and after intensive therapy in four patients who stutter. The intensive care program consisted of thirty one-hour sessions held in five individual sessions a week. Speech samples collected before and after therapy were analyzed by two fluency experts. Descriptive data analysis was performed through the frequency distribution of categorical variables and analysis of measures of central tendency and dispersion of continuous variables. The verification of agreement between the evaluations carried out by the two judges was performed using the intraclass correlation coefficient (ICC). Correlation analysis was also performed using Spearman's rank correlation coefficient between the variables in the speech sample and the OASES-A scores.

RESULTS

There was a reduction of the percentage of stuttering disfluencies, increasing the flow of words per minute of the participants. The descriptive analysis of the OASES-A showed a decrease in the degree of impact of stuttering on the participants' lives in all parts of the questionnaire.

CONCLUSION

There was an improvement in all variables analyzed after intensive care, including an improvement in speech fluency and a reduction in the impact of stuttering on the participants' lives, which suggests the relevance of the intensive speech therapy proposal for stuttering.

Can Stoicism inspire stuttering intervention? The clinical usefulness of an ancient philosophy

BACKGROUND

A range of psychotherapies are effective in managing an individual's personal reactions to stuttering and reducing the impact stuttering has on their lives. Many of these therapies, such as cognitive behavioural therapy, have their origins in Stoicism, an ancient Greek philosophy founded in 301 bce. Stoicism remains a relatively unexplored topic in the psychotherapy and speech and language therapy literatures.

AIMS

This paper aims to highlight the potential benefits of integrating Stoic principles and techniques into stuttering intervention.

METHODS

This aim is achieved through a discussion on Stoic philosophy and the range of techniques that have informed modern evidence-based psychotherapies that are effective with the stuttering population.

MAIN CONTRIBUTION

This paper initiates an important conversation on the usefulness of Stoicism to the field of stuttering. Key recommendations are provided for the integration of Stoic philosophy into future clinical and research practice related to stuttering.

CONCLUSIONS

Stoicism offers philosophical guidance for the art of living, but also provides a range of strategies and practical techniques that have potential to expand the clinical toolkit of modern psychotherapy and speech and language therapy. Scientific validation of the clinical application of Stoicism is recommended to exploit its effectiveness with the stuttering population.

WHAT THIS PAPER ADDS

What is already known on the subject Stoicism is an ancient philosophy that has informed modern-day psychotherapies including cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT). Such therapies are recommended for use with individuals who stutter to target their personal reactions to stuttering and reduce any adverse impacts on their lives. What this paper adds to existing knowledge This paper discusses the principles and techniques of Stoicism with reference to how they align with modern psychotherapeutic approaches and speech and language therapy interventions used with individuals who stutter. Clinical implications and directions for future research are also presented. What are the potential or actual clinical implications of this work? Speech and language therapists (SLTs) are recommended to continue their use of psychotherapies such as CBT and ACT with individuals who stutter. In addition, SLTs are advised to explore Stoicism and its range of techniques to better understand the philosophical underpinnings of evidence-based psychotherapies and to expand their clinical toolkit.

Australian speech-language pathologists' experiences and perceptions of working with children who stutter: A qualitative study

PURPOSE

Effective early intervention is recommended to ameliorate the potential long term negative effects of stuttering. Efficacious treatments are available, but speech-language pathologists (SLPs) report finding implementation to be challenging due to a range of clinician, client and clinical context factors. Previous survey-based research has found that SLPs lack self-efficacy working with CWS, however the reasons contributing to this are not well understood. This study presents the first in-depth analysis of the current practices and perceptions of SLPs working with children who stutter (CWS).

METHODS

In this qualitative study 18 Australian SLPs who provide services to CWS were interviewed using a semi-structured interview approach. Data were analysed using reflexive thematic analysis.

RESULTS

The thematic analysis identified four themes: (1) A stronger sense of self-efficacy is needed in stuttering management compared to other areas of clinical practice; 2) SLPs' sense of self-efficacy in stuttering management is influenced by early career experiences, client factors and the practice context; 3) Professional development and collaboration strengthen self-efficacy; and 4) Parental involvement and engagement are crucial to treatment success.

CONCLUSION

SLP self-efficacy for working with CWS appears a critical factor in the provision of effective management for this population. This study provides an in-depth analysis of the role of SLP self-efficacy and the factors that influence it.

The effect of manual movements on stuttering in individuals with down syndrome

PURPOSE

Stuttering may disrupt the speech of individuals with Down syndrome (DS), but standard stuttering therapies may be less adapted to these clients' needs. This study examined if their strength in gesture use can lead to the development of a new stuttering therapy.

METHOD

Eighteen individuals with DS who stutter participated in an experimental task. During this task, they produced sentences in three different conditions: once without the ability to use gestures, once while moving the mouth of a hand puppet synchronous with their speech, and once while making beat gestures along their speech. Stuttering frequency was measured and compared between conditions while controlling for the effect of articulation rate.

RESULTS

The experimental hand puppet and beat condition did not affect the stuttering frequency, but the covariate articulation rate did. An exploratory posthoc analysis showed that the articulation rate decreased during the experimental hand puppet and beat condition. Manual movements in the present task might only induce fluency through articulation rate reduction. However, analyses at individual level show significant interindividual variability.

CONCLUSION

Individual analyses show that effect on stuttering frequency cannot be attributed entirely to articulation rate reduction and that beat gestures might still play a role. However, at this point, there is not enough direct evidence to implement beat gestures in current stuttering therapy.

Lidcombe Program translation to community clinics in Australia and England

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.

The Effects of Different Sources and Modalities of Stuttering Disclosure on Listeners' Perceptions of a Child Who Stutters

INTRODUCTION

Research reveals the clinical efficacy of both verbal and written stuttering disclosure statements provided by a child who stutters (CWS) and his advocates (i.e., mother or teacher) [Lang Speech Hear Serv Sch. 2020 Jul;51(3):745-60 and Lang Speech Hear Serv Sch. 2021 Aug;52(4):1031-1048]. Although existing data reveal that both the source (i.e., self- vs. advocate disclosure) and modality (i.e., verbal or written) of stuttering disclosure yields significant improvements in the perceptions of speech skills and personality characteristics of CWS, there is a paucity of research directly comparing the modality (verbal vs. written) and source (self, mother, teacher) of disclosure statements. Accordingly, this study analyzes listeners' perceptions of a 12-year-old male CWS' speech skills and personal characteristics, as a function of both the source and modality of factual stuttering disclosure statements [Lang Speech Hear Serv Sch. 2020 Jul;51(3):745-60 and Lang Speech Hear Serv Sch. 2021 Aug;52(4):1031-1048].

METHODS

A total of 641 college-aged adults participated in this analysis; study participants reported their perceptions of speech skills and personality characteristics of a 12-year-old CWS as a function of stuttering disclosure. Participants were randomly assigned to view one video containing one of two disclosure modalities (verbal or written), one of three stuttering disclosure source conditions (self-disclosure, mother disclosure, and teacher disclosure), or a no-disclosure control condition. Participants in the control group viewed a brief video of a 12-year-old CWS reciting a short reading passage; participants in the experimental groups viewed their assigned disclosure statement followed by the same video used in the control condition. Immediately following the video, all participants completed a survey quantifying their perceptions of the CWSs relative to his speech skills and personal characteristics.

RESULTS

Results reveal optimal results via verbal self-disclosure and verbal teacher disclosure. A limited number of nominally positive perceptual differences were noted within the written mother disclosure group, while written CWS self-disclosure yielded significantly negative perceptions of the CWS. Overall, verbal disclosures yield far more significant and desirable perceptions of CWS' speech skills and personal characteristics when compared to written stuttering disclosure.

DISCUSSION

Results of this analysis reveal that verbal stuttering disclosure is significantly more effective in improving listeners' perceptions of a CWS, when compared to written stuttering disclosures. Despite the widespread adoption of written communication over digital media (e.g., email and text messages), these data support the notion that face-to-face or video verbal stuttering disclosure provides the most desirable perceptual benefits for CWS. Within verbal stuttering disclosure, verbal self-disclosure appears to be the single best overall disclosure methodology relative to clinical application.

Auditory feedback control in adults who stutter during metronome-paced speech II. Formant Perturbation

PURPOSE

Prior work has shown that Adults who stutter (AWS) have reduced and delayed responses to auditory feedback perturbations. This study aimed to determine whether external timing cues, which increase fluency, resolve auditory feedback processing disruptions.

METHODS

Fifteen AWS and sixteen adults who do not stutter (ANS) read aloud a multisyllabic sentence either with natural stress and timing or with each syllable paced at the rate of a metronome. On random trials, an auditory feedback formant perturbation was applied, and formant responses were compared between groups and pacing conditions.

RESULTS

During normally paced speech, ANS showed a significant compensatory response to the perturbation by the end of the perturbed vowel, while AWS did not. In the metronome-paced condition, which significantly reduced the disfluency rate, the opposite was true: AWS showed a significant response by the end of the vowel, while ANS did not.

CONCLUSION

These findings indicate a potential link between the reduction in stuttering found during metronome-paced speech and changes in auditory motor integration in AWS.

Attributes that affect the choice of treatment for preschool age children who stutter: an observational study

Introduction: Little is known about the clinical decision-making process that speech-language pathologists( (SLPs) make when they decide which treatment approach they will use with Preschool age Children who Stutter (PCWS). Frequently used approaches are the Lidcombe Program, RESTART-DCM, Mini-KIDS, the Palin Parent-Child Interaction program and the Social-Cognitive Behaviour Therapy. In this study, we explored which attributes play a role in the complex process that precedes this clinical decision. We also explored if SLPs from the Netherlands, who are expected to follow the recommendations formulated in the Dutch professional stuttering guidelines, use different treatment approaches than SLPs from Belgium, who do not have specific guidelines to follow. Finally, we explored whether the number of years of experience of SLPs had an impact on the choice for treatment. Methods: This study used an observational design in which 36 SLPs, additionally qualified in the treatment of stuttering, completed a questionnaire. The SLPs spoke Dutch, resided in the Netherlands or Belgium and used more than one treatment approach for PCWS in their standard practice. Results: The following attributes affected the choice for treatment approach of most SLPs: (1) the child’s reactions to the stuttering, (2) the child’s language (and speech) skills, (3) the child’s age, (4) the family’s lifestyle, (5) the parent’s ease to understand a treatment approach as judged by the SLPs and (6) the amount and quality of published research-based evidence. The decision-making of experienced SLPs is significantly more affected by the child’s stuttering severity and time since onset compared to less experienced SLPs (both U = 90, p = .05). Dutch SLPs did not take other attributes into account than Belgian SLPs. Discussion/Conclusion: This study was a first attempt to explore which attributes affect the decision for a specific treatment. Further prospective research is needed.

Improving Clinical Competence Through Simulated Training in Evidence-Based Practice for Stuttering: A Pilot Study

PURPOSE

The purpose of this pilot study was to determine the effectiveness and acceptability of an initial module (1.1; active listening skills) of the Simulated Training in Evidence-Based Practice for Stuttering (STEPS) program, a theory-driven, multimodule, content and learning platform designed to advance knowledge and skills in working with culturally and linguistically diverse persons who stutter of all ages.

METHOD

Fifteen preservice speech-language pathologists (SLPs) were randomly assigned to complete either the STEPS 1.1 module or a control module. In both conditions, all participants engaged in pre- and post-clinical interviews with a standardized patient portraying a parent of a child who stutters. Prior to participation, all participants provided self-ratings on the Jefferson Scale of Physician Empathy-Health Profession Student. Post participation, trained observers rated all participants' active listening behaviors using the Active Listening Observation Scale-Modified. Post participation, the STEPS 1.1 participants also completed an intervention acceptability questionnaire.

RESULTS

No differences between groups were found in self-perceived clinical empathy prior to participation. Participants who completed the STEPS 1.1 condition utilized paraphrasing and client-directed eye gaze significantly more frequently at posttest than at pretest and significantly more than the control group at posttest. Quantitative and qualitative responses from the participants who completed STEPS 1.1 indicated high acceptability of its content, structure, duration, and perceived impact.

CONCLUSION

Preliminary data from the present pilot study support use of the STEPS 1.1 module to improve preservice SLPs' use of skills that have been shown to predict perceived clinical empathy and increase assessment and treatment effectiveness.

Examining the understandings of young adult South African men who stutter: The question of disability

BACKGROUND

A disability studies approach seeks to understand and address political and social issues that affect disabled individuals. Disability studies scholars employ various models of disability to address and oppose the oppression and discrimination of disabled individuals. A disability studies approach, however, has largely been absent in studies that have investigated the lived experiences of people who stutter.

AIM

To examine the understandings young adult South African men who stutter hold of whether, and in what way, stuttering may be considered to be a disability.

METHODS & PROCEDURES

A total of 15 men who stutter, aged 20-39 years, participated in the study. Semi-structured interviews and two focus groups discussions were conducted to collect data for the study. The data were analysed according to a phenomenological approach and the affective turn in social research.

OUTCOMES & RESULTS

The results indicated that some men in this study understood stuttering as a speech disorder that can be controlled, while other men constructed stuttering as a disability, subjectively positioning themselves either as disabled or non-disabled men.

CONCLUSIONS & IMPLICATIONS

This article emphasizes the importance of adopting a disability studies approach when examining the lived experiences of people who stutter and enhancing intervention strategies to adequately address the disabled needs of such individuals.

WHAT THIS PAPER ADDS

What is already known on the subject? The past few decades have seen researchers investigating the personal and social experiences of people who stutter. However, empirical studies exploring the disabling experiences of people who stutter have been absent from the existing body of knowledge. What this paper adds to existing knowledge? This research aimed to provide comprehensive insight into the disabling experiences of people who stutter. The results gave an insight into the oppression and disablism experienced by people who stutter. More specifically, the findings demonstrated how individuals who stutter are disabled by oppressive communication practices that dominate spaces of education and employment. What are the potential or actual clinical implications of this work? Several men in this study attended speech therapy to gain control over their stuttering. For a number of participants, speech therapy proved a valuable experience, while others saw speech therapy as being out of touch with their lived reality of stuttering. Speech and language therapists are encouraged to employ a disability studies approach in order to enhance intervention strategies to adequately address the disabling needs of people who stutter.

Implementation fidelity in parent-implemented interventions for stuttering

Knowledge of the fidelity with which interventions are delivered in research studies is crucial to meaningful examination of intervention impact. This paper presents a review of fidelity implementation (FOI) measurements in interventions jointly delivered by speech-language pathologists (SLP) and parents in research for preschool-aged children who stutter (CWS). Four key FOI components were examined: dosage, adherence, quality, responsiveness. Thirty-six studies met the inclusion criteria for this study. Articles were published between 1990 and 2020 described nine different interventions and examined CWS aged 2-6 years. No study reported all FOI components in both the clinical and the home setting and five did not report on any FOI component in either setting. The number of FOI components reported ranged from 0 to 4 in both clinical (M = 1.5) and home (M = 1.0) settings. Across studies, dosage was most often reported (n = 27, 75.0%) and responsiveness was least often reported (n = 16, 44.4%). The number of FOI components reported in articles did not increase over time, although a trend towards greater reporting in recent years was observed. Poor reporting of FOI in intervention research presents a serious methodological concern that impacts the ability of clinicians and researchers to interpret the findings of these studies. Rigorous measurement and reporting of FOI in future intervention studies is required in order to better inform evidence-based practices for interventions with CWS.

Self-Disclosure Experiences of Adults Who Stutter: An Interpretative Phenomenological Analysis

PURPOSE

Self-disclosure describes the act of revealing personal information to another person. To date, researchers in the area of stuttering have primarily demonstrated the utility of self-disclosure through analysis of listener perceptions. This study explores the utility of informative self-disclosure use from the perspectives of adults who stutter with experience using this strategy over time and across contexts.

METHOD

Twelve adults who stutter discussed their self-disclosure experiences in semistructured interviews. Interview transcripts were analyzed using interpretative phenomenological analysis to produce themes reflecting the most salient aspects of self-disclosure experiences. Credibility was achieved through bracketing, investigator triangulation, and member checking.

RESULTS

Four superordinate themes reflecting experiences shared by all 12 participants were generated. Each superordinate theme contained two to three corresponding subthemes. The superordinate themes included cognitive relief, self-empowerment, social connection, and personalization. These findings reflect the positive impact of informative self-disclosure use on communication and quality of life.

CONCLUSIONS

Adults who stutter perceive informative self-disclosure to be an effective strategy that provides various benefits to the speaker, in addition to facilitating positive listener perceptions. Clinicians should encourage clients to self-disclose in an informative and personalized manner, provide opportunities for practice, and support clients in determining when and where it is most beneficial for them to implement this strategy.

What Is the Role of Questioning in Young Children's Fluency?

PURPOSE

Most therapy programs for young children who stutter (CWS) involve caregiver counseling and adjustment of caregiver behavior to maximize opportunities for the child to be more fluent. One component sometimes included as a recommended adjustment is a reduction in caregiver question asking, as question asking is hypothesized to increase language formulation demands on the child. However, there is limited research to guide clinician advisement to caregivers that has controlled for numerous potential confounding factors, including utterance length and grammaticality, that may impact potential stressors on children. Our aim was to assess whether there was an empirical basis for such recommendations by comparing disfluency profiles of answers to questions and nonanswer utterances produced by children during spontaneous play with parents and examiners.

METHOD

We analyzed fluency and structural properties as well as pragmatic function of 15,782 utterances from language samples produced by 32 CWS and 32 children who do not stutter (CWNS) who were between 28 and 50 months of age. CWS and CWNS were matched on gender and age within 4 months and were matched as closely as possible on maternal education.

RESULTS

For utterances produced by CWS, answers to adult questions were significantly less likely to contain stuttering-like disfluencies than other utterance types, and this was still true after controlling for utterance length and grammaticality. In contrast, for utterances produced by CWNS, answers to questions were significantly more likely to be disfluent than other utterance types after controlling for length and grammaticality.

CONCLUSION

Given the current findings, some prior research, and the documented potential benefits in language development for adult question asking of children, we do not believe that clinicians need to recommend changes to typical question-asking behavior by caregivers of CWS.

Stuttering interventions for children, adolescents, and adults: a systematic review as a part of clinical guidelines

INTRODUCTION

Stuttering may have a holistic effect on the quality of life of a person who stutters by limiting participation in social situations, resulting in feelings of isolation and frustration, leading to difficulties in education and employment and increasing the likelihood of mental health problems. Even young children who stutter may have negative experiences of speaking. Therefore, it is important to treat stuttering behavior effectively in both children and adults. The purpose of this paper was to systematically review group and case studies about the effectiveness of behavioral stuttering interventions to provide evidence-based guidelines for clinicians.

METHODS

Systematic data retrieval was conducted in four electronic databases (PsycINFO, CINAHL, PubMed, Cochrane). The assessment of search results was conducted according to predetermined inclusion and exclusion criteria by two independent judges. The methodological quality of each paper was assessed using strict criteria to include only high-quality research.

RESULTS

The search revealed 2293 results, and 38 papers (systematic reviews N=3, group design studies N=21 and case studies N=14) with acceptable methodological quality were included. The data show that there is most evidence about the treatment of early childhood stuttering, very little evidence about school-aged children and some evidence about adults. The most convincing evidence is about the Lidcombe Program in the treatment of young children who stutter, but also other methods have promising evidence. Our data imply that in the treatment of adults who stutter, holistic treatments may influence speech fluency and overall experience of stuttering behavior. Speech restructuring treatments may have a positive effect on overt characteristics of stuttering, but not on covert stuttering behavior.

CONCLUSIONS

The results of this review agree with earlier reviews about the treatment of young children. However, due to different inclusion criteria, this review also shows the benefits of holistic treatment approaches with adults and adolescents.

The good, the bad, and the ugly: Unpacking the pros and cons associated with change for adults who stutter

PURPOSE

The purpose of the current study was to document the pros and cons that adults who stutter may consider when deciding to change how they live with stuttering.

METHODS

Semi-structured interviews were conducted with 11 adults who stutter and 12 speech-language pathologists who specialize in stuttering therapy. Participants were asked to identify and discuss the advantages and disadvantages of making a change to how they live with stuttering. Reflexive thematic analysis was used to generate multilevel themes.

RESULTS

Meaningful units were extracted from interview transcripts to develop 37 discrete pros and 15 discrete cons. The pros of change clustered into five organizing themes: enriching one's social relationships, feeling better in social interactions, developing a healthier sense of self, gaining autonomy, and communicating easier. The cons of change clustered into three organizing themes: experiencing discomfort, expending resources, and recognizing that some things may not change.

CONCLUSION

This study documented why adults who stutter may or may not seek change. Identifying the pros and cons of behavior change is an important step in understanding why some clients who stutter are ambivalent about, or resistant to, the therapeutic process.

Stuttering, family history and counselling: A contemporary database

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.

Telepractice application for the overt stuttering assessment of children aged 6-15 years old

BACKGROUND

Despite the importance of delivering speech and language therapy services to children who stutter (CWS), there are barriers to accessing speech and language therapy. One way to improve access for those who may otherwise be deprived of speech and language therapy services, including CWS, is through telepractice (TP). However, there is currently no evidence as to the viability of TP stuttering assessments for CWS.

AIM

To investigate the validity and reliability, and acceptability of using a TP application to assess overt stuttering behaviour children aged 6-15 years.

METHODS & PROCEDURE

A total of 30 CWS, aged between 6 and 15 years, were recruited from a speech therapy clinic in King Abdulaziz University Hospital in Riyadh, Saudi Arabia. Children were divided into two testing conditions, either face-to-face (f2f)-led or TP-led testing, and the Stuttering Severity Instrument (SSI-IV) was administered, percentage of syllables stuttered (%SS) was calculated, and severity ratings (SR) assigned, either via f2f or via TP using two laptops with webcams, video conference software and a broadband internet connection. Agreement and reliability of scoring in the two testing conditions were reported in addition to findings from questionnaires exploring children's and their caregivers' perceptions both before and immediately after the TP assessment was carried out.

OUTCOME & RESULTS

A total of 30 sessions were successfully carried out, with results revealing unsatisfactory levels of agreement when applying the Bland and Altman method. However, when discrepancies were found, these were comparable with those from traditional f2f studies. Generally, parents and children exhibited high levels of satisfaction and held a positive view regarding TP pre- and post-assessment.

CONCLUSIONS & IMPLICATIONS

The results of the study suggest that conducting an overt stuttering assessment via TP for 6-15-year-olds CWS is reliable and valid. Although the TP model posed some (mainly technical) challenges for executing the assessment, high levels of satisfaction were recorded by parents and children alike. The TP system and equipment chosen in this study has provided a basis for the delivery of TP overt stuttering assessment in a clinical setting, thus addressing the barriers to access that are present for CWS. These results are preliminary, but they can be seen as a building block for future research in TP assessment studies for CWS.

WHAT THIS PAPER ADDS

What is already known on the subject Stuttering treatment via TP has been proven to be feasible and successful across a variety of treatment programs (e.g., Lidcombe, Camperdown). However, the viability of assessing stuttering via videoconferencing has never been explored in children. What this paper adds to existing knowledge Preliminary support for the assessment of overt stuttering in CWS aged 6-15 years via video conferencing. The results justify larger scale studies of this service delivery method. What are the potential or actual clinical implications of this work? The TP system and equipment chosen in this study has provided a basis for the delivery of TP overt stuttering assessment in a clinical setting, thus addressing the barriers to access that are present for CWS aged 6-15 years.

The Complexity of Stuttering Behavior in Adults and Adolescents: Relationship to Age, Severity, Mental Health, Impact of Stuttering, and Behavioral Treatment Outcome

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.

"Knowledge Without Action Means Nothing": Stakeholder Insights on the Behaviors That Constitute Positive Change for Adults Who Stutter

PURPOSE

The aim of this study was to document the behaviors that adults who stutter (AWS) may engage in to make positive changes to living with stuttering.

METHOD

We interviewed 23 key stakeholders, including 11 AWS and 12 speech-language pathologists who specialize in stuttering therapy. The semi-structured interviews began with the primary question, "If an adult who stutters was making positive changes to living with stuttering, what would they be doing?" Follow-up probing questions focused the interviews on identifying actionable behaviors that would suggest positive changes. The interviews were transcribed and qualitatively analyzed using applied and reflexive thematic analyses to develop multilevel themes.

RESULTS

Meaningful units extracted from the interviews contributed to three high-order global themes: (a) noticing and adjusting physical behaviors involved in speaking, to the extent that it is personally important to do so; (b) developing neutral or positive thoughts and feelings about stuttering; and (c) participating more fully in social and professional activities, even if the person stutters or thinks they might stutter. We developed 35 low-order basic themes, which we grouped into 11 mid-order organizing themes, to richly illustrate the three global themes.

CONCLUSIONS

These findings extend the ongoing discussion regarding best practices for therapy targets in stuttering intervention. We identified measurable, multidimensional actions that clinicians can integrate in their therapy plans with AWS. While these actions represent a holistic approach to making positive changes, it grants clients and clinicians space to develop individualized intentions and outcomes.

Investigation of the effect of delayed auditory feedback and transcranial direct current stimulation (DAF-tDCS) treatment for the enhancement of speech fluency in adults who stutter: A randomized controlled trial

BACKGROUND

Stuttering is a disorder that begins in childhood and can persist into adulthood. In the present study, it was hypothesized that the combined intervention of transcranial direct current stimulation (tDCS) and Delayed Auditory Feedback (DAF) would cause greater improvement in speech fluency in comparison to the intervention with DAF alone.

METHODS

A randomized, double-blind, sham-controlled clinical trial was conducted to investigate the effects of the combined intervention. Fifty adults with moderate to severe stuttering (25 females, 25 males, Mean age=26.92, SD=6.23) were randomly allocated to the anodal or sham tDCS group. In the anodal tDCS group, participants received DAF combined with anodal tDCS (1 mA), while the sham tDCS group was exposed to sham tDCS simultaneously with DAF. In this study, a 60-ms delay was used for DAF intervention, and tDCS was applied over the left superior temporal gyrus. Each individual participated in six 20-minute intervention sessions (held on six consecutive days). Speech fluency was assessed before and after the intervention.

RESULTS

In the anodal tDCS group, the scores of the Stuttering Severity Instrument, Overall Assessment of the Speaker's Experience of Stuttering questionnaire, and the percentage of stuttered syllable reduced significantly (from average baseline rates of 8.45%, across three tasks, to 5.36% at the follow-up assessment) after the intervention.

CONCLUSION

The results of this study suggest that delivery of anodal tDCS when combined with DAF may enhance stuttering reduction effects for six weeks following the intervention.

Temperament, anxiety, and depression in school-age children who stutter

PURPOSE

The main aim of this study was to gain insight into whether temperament and/or stuttering severity were associated with anxiety and depression in children who stutter. Additionally, the study also provided an indication into the prevalence of anxiety and depression in children who stutter in a clinical cohort.

METHOD

The participants were 132 English-speaking children (105 boys and 27 girls) between 9;0 and 14;11 years old (M = 11;8, SD = 1;10) and their mothers. At their first visit to a specialist center for children who stutter, mothers and children completed the relevant versions of the Early Adolescent Temperament Questionnaire-Revised (EATQ-R; Ellis & Rothbart, 2001) and a screening of children's anxiety and depression, using the Revised Children's Anxiety and Depression Scale (RCADS; Chorpita et al., 2000). Stuttering was evaluated using the Stuttering Severity Instrument Fourth Edition (SSI-4). Correlations were conducted between child and parent versions of the EATQ-R and RCADS; EATQ-R and RCADS; as well as the SSI-4 and RCADS. A comparison was made between those children who scored below the clinical threshold for anxiety and depression, and those who scored above.

RESULTS

Significant correlations were found for all mother and child EATQ-R factors and RCADS scales (except for Obsessive Compulsive Disorder). Correlations were also found between the child- and mother-reported temperament factors of positive reactivity, negative reactivity, and self-regulation and anxiety and depression. Children who scored above the clinical threshold for any category of anxiety or depression had significantly lower positive reactivity and higher negative reactivity scores, compared to those who scored below the threshold. There were no differences between the two groups with regard to SSI-4 scores.

CONCLUSIONS

This is the first study to evaluate associations between temperament and anxiety and depression in children who stutter. Higher negative reactivity scores and lower positive reactivity and self-regulation scores are associated with elevated levels of anxiety and depression in children who stutter. Further, those who score above the clinical threshold have significantly higher levels of negative reactivity and lower levels of positive reactivity compared to those scoring below the threshold. Findings suggest that levels of anxiety that reach clinical threshold are more prevalent in children who stutter than would be expected based on population data. Current findings have implications for both the assessment and therapy of children who stutter presenting at clinics for support.

Palin parent-child interaction therapy with children with autism spectrum disorder and stuttering

INTRODUCTION

It is estimated that 8% of children who stutter (CWS) have autism spectrum disorder (ASD) Briley & Ellis (2018). There is evidence that interventions for CWS and interventions for children with ASD can be effective, but there is little evidence to guide clinical decision making when working with CWS with a co-existing diagnosis of ASD. Palin Parent-Child Interaction (PCI) therapy Kelman & Nicholas (2020) is an evidence-based intervention for CWS, with the authors suggesting that the approach may be beneficial for CWS with ASD. The aim of this study was to examine outcomes for three CWS with ASD who received Palin PCI at a specialist centre for stuttering in London.

METHOD

The participants were three CWS with ASD aged 4;5, 6;7 and 7;7. Assessments were administered before therapy, and then at three, six and twelve months after therapy began. Outcome measures included stuttering frequency, child's communication attitude, parents' perception of the impact of stuttering on the child, the severity of stuttering and its impact on the parents, and parents' knowledge and confidence in managing stuttering.

RESULTS

All three children showed improvement in three or more variables. Four out of five parents reported reduced impact of stuttering on the child and themselves following therapy, and change was maintained one year post-therapy. All five parents reported increased knowledge of stuttering and confidence in managing it after therapy, and four parents maintained these changes for a year.

CONCLUSIONS

Over a one year period, these CWS with ASD who received Palin PCI showed change across multiple variables. The observed increases in parent knowledge and confidence were comparable to previously published data. These preliminary findings suggest that CWS with ASD and their parents can benefit from Palin PCI therapy and that further experimental evaluation of this approach with this client group is indicated.

Risk Factors for the Development of Persistent Stuttering: What Every Pediatrician Should Know

Early identification and adequate treatment of children who stutter is important, since it has an impact on speech development. Considering the importance of aiding pediatricians to recognize children at risk for developing persistent stuttering, the aim of the present study was to correlate speech fluency characteristics of children, whose parents reported stuttering behaviors, to the risk factors of persistent stuttering. The participants were 419 children aged 2:0 to 11:11 years, who were divided into two groups: children with stuttering complaints (CSC), composed of children whose parents reported the presence of stuttering behaviors; and children with no stuttering complaint (CNSCs), composed of children with no stuttering behaviors. Risk variables were gathered based on a questionnaire answered by parents involving the following variables: sex, presence of family history of stuttering, whether stuttering behaviors were observed for more than 12 months, whether stuttering behaviors began before 5 years of age, increased effort to speak (i.e., syllable and sound repetitions and fixed articulatory positions), negative family attitude towards the child’s speech, and negative attitude towards the child’s own speech. The diagnosis of stuttering was determined by a formal speech assessment by a pathologist (SLP). The risk analysis indicated that increased effort to speak, negative family attitude towards the child’s speech, and complaints of stuttering for more than 12 months were associated with a higher risk of stuttering in children. Therefore, when pediatricians are faced with complaints about the presence of stuttering behaviors and these factors are present, they should immediately refer the patient to an SLP for specific assessment.

Uncertainty and Perceived Control as Predictors of Communicative Participation and Mental Health in Adults Who Stutter

PURPOSE

This study examined the role of uncertainty and perceived control in predicting the communicative participation and mental health of adults who stutter.

METHOD

Two hundred sixty-nine adults who stutter completed measures of uncertainty about stuttering, perceived control of stuttering, communicative participation, and global mental health. In addition, participants self-reported on a variety of demographic and speech-related measures. Correlational analyses and hierarchical regression were performed to determine associations between variables of interest.

RESULTS

Uncertainty accounted for significant variance in communicative participation and global mental health after statistically controlling for the effects of demographic and speech-related variables. Perceived control accounted for significant variance in communicative participation over and above what was accounted for by demographic variables, speech-related variables, and uncertainty.

CONCLUSIONS

The findings suggest that uncertainty about stuttering and perceived control of stuttering should be accounted for during assessment and intervention with adults who stutter. Interventions that specifically target uncertainty and perceived control may be useful in improving therapeutic outcomes for individuals who stutter.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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