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"Packman, Ann"
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The History of Stuttering by 7 Years of Age: Follow-Up of a Prospective Community Cohort
Purpose: For a community cohort of children confirmed to have stuttered by the age of 4 years, we report (a) the recovery rate from stuttering, (b) predictors of recovery, and (c) comorbidities at the age of 7 years. Method: This study was nested in the Early Language in Victoria Study. Predictors of stuttering recovery included child, family, and environmental measures and first-degree relative history of stuttering. Comorbidities examined at 7 years included temperament, language, nonverbal cognition, and health-related quality of life. Results: The recovery rate by the age of 7 years was 65%. Girls with stronger communication skills at the age of 2 years had higher odds of recovery (adjusted OR = 7.1, 95% CI [1.3, 37.9], p = 0.02), but similar effects were not evident for boys (adjusted OR = 0.5, 95% CI [0.3, 1.1], p = 0.10). At the age of 7 years, children who had recovered from stuttering were more likely to have stronger language skills than children whose stuttering persisted (p = 0.05). No evident differences were identified on other outcomes including nonverbal cognition, temperament, and parent-reported quality of life. Conclusion: Overall, findings suggested that there may be associations between language ability and recovery from stuttering. Subsequent research is needed to explore the directionality of this relationship.
Journal Article
Peer Responses to Stuttering in the Preschool Setting
Contact author: Marilyn Langevin, who is now at the Institute for Stuttering Treatment & Research, Faculty of Rehabilitation Medicine, University of Alberta, 1500, 8215–112 Street, Edmonton, Alberta T6G 2C8, Canada. E-mail: marilyn.langevin{at}ualberta.ca .
Purpose: This study investigated peer responses to preschoolers' stuttering in preschool and sought to determine whether specific characteristics of participants' stuttering patterns elicited negative peer responses.
Method: Four outdoor free-play sessions of 4 preschoolers age 3–4 years who stutter were videotaped. Stutters were identified on transcripts of the play sessions. Peer responses to stuttered utterances were judged to be negative or neutral/positive. Thereafter, participants' stuttering behaviors, durations of stutters, and judgments of the meaningfulness of peer-directed stuttered utterances were analyzed.
Results: Between 71.4% and 100% of peer responses were judged to be neutral/positive. In the negative responses across 3 participants, peers were observed to react with confusion or to interrupt, mock, walk away from, or ignore the stuttered utterances. Utterances that elicited negative responses were typically meaningless and contained stutters that were behaviorally complex and/or of longer duration. Other social interaction difficulties also were observed—for example, difficulty leading peers in play, participating in pretend play, and resolving conflicts.
Conclusions: Results indicate that the majority of peer responses to stuttered utterances were neutral/positive; however, results also indicate that stuttering has the potential to elicit negative peer responses and affect other social interactions in preschool.
Key Words: stuttering, child, preschool, peer responses, interpersonal relations
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Journal Article
Measures of Psychological Impacts of Stuttering in Young School-Age Children: A Systematic Review
Purpose: Recent research has shown that some school-age children who stutter may have speech-related anxiety. Given this, speech-language pathologists require robust measures to assess the psychological effects of stuttering during the school-age years. Accordingly, this systematic review aimed to explore available measures for assessing the psychological impacts of stuttering in young school-age children and to examine their measurement properties. Method: The systematic search protocol was registered with PROSPERO (ID: 163181). Seven online databases, in addition to manual searching and screening of reference lists, were used to identify appropriate measures for the population of children who stutter aged 7-12 years. The first two authors independently assessed the measures using the quality appraisal tool described by Terwee et al. (2007). Results: Despite the comprehensive search strategy, only six measures were identified for quality appraisal. No assessment tool was found to possess adequate measurement properties for the eight assessed domains: content validity, internal consistency, construct validity, reproducibility, reliability, responsiveness, floor and ceiling effects, and interpretability. No measure had clear evidence of responsiveness to clinical change. Based on the criterion defined by the Terwee et al. (2007) appraisal tool, the Communication Attitude Test and the Overall Assessment of the Speaker's Experience of Stuttering for School-Age Children received the highest number of ratings in support of their measurement properties. Conclusions: The results highlight a lack of available measures in this domain and poor practices in developing and testing measurement instruments. To ensure that clinicians and researchers are equipped with sound measures to meet the mental health needs of this vulnerable population, further research to establish resources is needed.
Journal Article
Consensus Guidelines for the Assessments of Individuals Who Stutter Across the Lifespan
Purpose This project sought to develop consensus guidelines for clinically meaningful, comprehensive assessment procedures for people who stutter across the lifespan. Method Twelve expert clinicians and researchers who have written extensively about stuttering provided detailed descriptions of the type of data that they routinely collect during diagnostic evaluations of preschool children, school-age children, adolescents, and adults who stutter. Iterative content analysis, with repeated input from the respondents, was used to identify core areas that reflect common domains that these experts judge to be important for evaluating stuttering for varying age groups. Results Six core areas were identified as common components of a comprehensive evaluation of stuttering and people who stutter. These areas should be included to varying degrees depending upon the age and needs of the client or family. The core areas include the following: (a) stuttering-related background information; (b) speech, language, and temperament development (especially for younger clients); (c) speech fluency and stuttering behaviors; (d) reactions to stuttering by the speaker; (e) reactions to stuttering by people in the speaker's environment; and (f) adverse impact caused by stuttering. Discussion These consensus recommendations can help speech-language pathologists who are uncertain about appropriate stuttering assessment procedures to design and conduct more thorough evaluations, so that they will be better prepared to provide individualized and comprehensive treatment for people who stutter across the lifespan.
Journal Article
Safety Behaviors and Stuttering
Purpose: Those who are socially anxious may use safety behaviors during feared social interactions to prevent negative outcomes. Safety behaviors are associated with anxiety maintenance and poorer treatment outcomes because they prevent fear extinction. Social anxiety disorder is often comorbid with stuttering. Speech pathologists reported in a recent publication (Helgadottir, Menzies, Onslow, Packman, & O'Brian, 2014a) that they often recommended procedures for clients that could be safety behaviors. This study investigated the self-reported use of safety behaviors by adults who stutter. Method: Participants were 133 adults who stutter enrolled in an online cognitive-behavior therapy program. Participants completed a questionnaire about their use of potential safety behaviors when anxious during social encounters. Correlations were computed between safety behaviors and pretreatment scores on measures of fear of negative evaluation and negative cognitions. Results: Of 133 participants, 132 reported that they used safety behaviors. Many of the safety behaviors correlated with higher scores for fear of negative evaluation and negative cognitions. Conclusions: Adults who stutter report using safety behaviors, and their use is associated with pretreatment fear of negative evaluation and unhelpful thoughts about stuttering. These results suggest that the negative effects of safety behaviors may extend to those who stutter, and further research is needed.
Journal Article
An Experimental Clinical Trial of a Cognitive-Behavior Therapy Package for Chronic Stuttering
Tamsen St Clare
The University of Sydney and Westmead Hospital, Sydney, Australia
Susan Block
La Trobe University, Melbourne, Australia
Contact author: Mark Onslow, Australian Stuttering Research Centre, P.O. Box 170, Lidcombe NSW 1825, Australia. E-mail: m.onslow{at}usyd.edu.au .
Purpose: The aims of the present study were to (a) examine the rate of social phobia among adults who stutter, (b) study the effects of speech restructuring treatment on social anxiety, and (c) study the effects on anxiety and stuttering of a cognitive-behavior therapy (CBT) package for social anxiety.
Method: Thirty-two adults with chronic stuttering were randomly allocated to receive either speech restructuring following a CBT package for social anxiety or speech restructuring alone. Data were obtained on a variety of speech and psychological measures at pre-treatment, post-CBT, post–speech restructuring, and 12 months follow-up.
Results: Sixty percent of our cohort were diagnosed with social phobia. Speech restructuring treatment alone had no impact on the social phobia of our cohort at 12 months follow-up. At follow-up, participants who had received CBT showed no social phobia and greater improvements than control participants on a range of psychological measures of anxiety and avoidance. However, the CBT package made no difference to the speech outcomes of those with social phobia.
Conclusion: The CBT treatment was associated with significant and sustained improvements in psychological functioning but did not improve fluency.
KEY WORDS: stuttering, adults, anxiety, treatment, cognitive–behavior therapy (CBT)
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Journal Article
The Use of an Interactive Social Simulation Tool for Adults Who Stutter: A Pilot Study
This study reports a user evaluation of a DVD-based social simulator, developed for people who stutter to potentially gain confidence in using a learned fluency technique. The aim was to examine and evaluate the pilot of the DVD-based social simulator, Scenari-Aid, to inform the development of an online version of the program. Thirty-seven adults who were stuttering were recruited to the study from non-professional groups in Australia. The DVD comprised scenarios with actors in real-life settings that were designed to elicit verbal responses. Participants worked through the scenarios at their own rate and then completed an online survey. The survey comprised 29 statements requiring responses on a 5-point Likert scale and provided information about users’ perceptions of participating in the social simulations. There was high positive agreement among the participants on all statements, the most important being that they perceived the scenarios represented in everyday speaking situations and that they felt immersed in them. Participants also agreed that both their fluency and confidence increased in everyday speaking situations as a result of working through the DVD scenarios. The developers were satisfied that, despite the subjective nature of the findings, the study provided sufficient support for constructing the online version, which is now available to the public free of charge. Further research is needed to provide empirical evidence of the contribution it can make to the efficacy of speech programs for adults who stutter.
Journal Article
A Phase II Trial of Telehealth Delivery of the Lidcombe Program of Early Stuttering Intervention
Judy M. Simpson
The University of Sydney
Mark Jones
Queensland Clinical Trials Centre, University of Queensland, and Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
Contact author: Mark Onslow, Director, Australian Stuttering Research Centre, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, NSW 1825, Australia. E-mail: m.onslow{at}usyd.edu.au .
Purpose: The aims of this study were to evaluate the efficacy of telehealth delivery of the Lidcombe Program of Early Stuttering Intervention, compared with a control group, and to determine the number of children who could be regarded as \"responders.\"
Method: A speech-language pathologist provided telehealth delivery of the Lidcombe Program during telephone consultations with parents in their homes, remote from the clinic. The study design was an open plan, parallel group, randomized controlled trial with blinded outcome assessment. Children in the no-treatment control group who were still stuttering after 9 months then received the same treatment. The primary outcome measure was frequency of stuttering, gathered from audiotape recordings of participants' conversational speech in everyday, nontreatment situations, before and after treatment.
Results: Analysis of covariance showed a 73% decrease in frequency of stuttering at 9 months after randomization in the treatment group, as compared with the control group (95% confidence interval = 25%–90%, p = .02). Measures of treatment time showed that telehealth delivery of the Lidcombe Program requires around 3 times more resources than standard presentation.
Conclusions: Telehealth delivery of the Lidcombe Program is an efficacious treatment for preschool children who cannot receive the standard, clinic-based Lidcombe Program. Avenues for improving efficiency are considered.
Key Words: telehealth, Lidcombe Program, stuttering, early intervention
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Journal Article
Randomized Controlled Trial of Video Self-Modeling Following Speech Restructuring Treatment for Stuttering
Purpose: In this study, the authors investigated the efficacy of video self-modeling (VSM) following speech restructuring treatment to improve the maintenance of treatment effects. Method: The design was an open-plan, parallel-group, randomized controlled trial. Participants were 89 adults and adolescents who undertook intensive speech restructuring treatment. Post treatment, participants were randomly assigned to 2 trial arms: standard maintenance and standard maintenance plus VSM. Participants in the latter arm viewed stutter-free videos of themselves each day for 1 month. Results: The addition of VSM did not improve speech outcomes, as measured by percent syllables stuttered, at either 1 or 6 months postrandomization. However, at the latter assessment, self-rating of worst stuttering severity by the VSM group was 10% better than that of the control group, and satisfaction with speech fluency was 20% better. Quality of life was also better for the VSM group, which was mildly to moderately impaired compared with moderate impairment in the control group. Conclusions: VSM intervention after treatment was associated with improvements in self-reported outcomes. The clinical implications of this finding are discussed.
Journal Article