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PloS One 2015Stuttering is a common childhood disorder. There is limited high quality evidence regarding options for best treatment. The aim of the study was to compare the... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Stuttering is a common childhood disorder. There is limited high quality evidence regarding options for best treatment. The aim of the study was to compare the effectiveness of direct treatment with indirect treatment in preschool children who stutter.
METHODS
In this multicenter randomized controlled trial with an 18 month follow-up, preschool children who stutter who were referred for treatment were randomized to direct treatment (Lidcombe Program; n = 99) or indirect treatment (RESTART-DCM treatment; n = 100). Main inclusion criteria were age 3-6 years, ≥3% syllables stuttered (%SS), and time since onset ≥6 months. The primary outcome was the percentage of non-stuttering children at 18 months. Secondary outcomes included stuttering frequency (%SS), stuttering severity ratings by the parents and therapist, severity rating by the child, health-related quality of life, emotional and behavioral problems, and speech attitude.
RESULTS
Percentage of non-stuttering children for direct treatment was 76.5% (65/85) versus 71.4% (65/91) for indirect treatment (Odds Ratio (OR), 0.6; 95% CI, 0.1-2.4, p = .42). At 3 months, children treated by direct treatment showed a greater decline in %SS (significant interaction time x therapy: β = -1.89; t(282.82) = -2.807, p = .005). At 18 months, stuttering frequency was 1.2% (SD 2.1) for direct treatment and 1.5% (SD 2.1) for indirect treatment. Direct treatment had slightly better scores on most other secondary outcome measures, but no differences between treatment approaches were significant.
CONCLUSIONS
Direct treatment decreased stuttering more quickly during the first three months of treatment. At 18 months, however, clinical outcomes for direct and indirect treatment were comparable. These results imply that at 18 months post treatment onset, both treatments are roughly equal in treating developmental stuttering in ways that surpass expectations of natural recovery. Follow-up data are needed to confirm these findings in the longer term.
TRIAL REGISTRATION
isrctn.org ISRCTN24362190.
Topics: Behavior Therapy; Child; Child, Preschool; Early Intervention, Educational; Female; Follow-Up Studies; Humans; Male; Quality of Life; Speech Production Measurement; Speech Therapy; Stuttering; Treatment Outcome
PubMed: 26218228
DOI: 10.1371/journal.pone.0133758 -
American Journal of Speech-language... Oct 2018To consider the rationale, methods, and potential benefits of nurturing the growth of resilience in school-aged children who stutter. Stuttering in childhood can have... (Review)
Review
PURPOSE
To consider the rationale, methods, and potential benefits of nurturing the growth of resilience in school-aged children who stutter. Stuttering in childhood can have negative psychological consequences for some, including the development of a negative attitude toward their speech from a young age (Vanryckeghem, Brutten, & Hernandez, 2005) and possible co-occurring psychopathology in adolescence and adulthood, in particular, anxiety disorders (Blood, Blood, Maloney, Meyer, & Qualls, 2007; Iverach & Rapee, 2014; McAllister, Kelman, & Millard, 2015). Children who stutter also frequently report teasing and bullying by their peers (Blood & Blood, 2007; Boyle, 2011; Langevin, Packman, & Onslow, 2009), which can have a significant impact on children's confidence and psychological well-being. However, the capacity of children who stutter to cope or "bounce back" from adversity is not routinely explored or incorporated in therapy for stuttering.
METHOD
This clinical focus article will explore the construct of resilience and consider why it may be important for children who stutter and their parents. A framework for understanding resilience in relation to stuttering is used, drawing from the Reaching In Reaching Out Resiliency Program (for children aged under 8 years and their parents) and the Penn Resiliency Program (for children aged 8 years and over).
CONCLUSIONS
The role of parents is key in modeling resilient responses to children and creating a resilience-rich environment. As children who stutter may be more vulnerable to adversity, some may benefit from targeted support to build their resilience, in order to enhance their ability to overcome challenges and thrive.
Topics: Adaptation, Psychological; Adolescent; Adolescent Behavior; Age Factors; Child; Child Behavior; Cost of Illness; Female; Humans; Male; Parent-Child Relations; Parenting; Quality of Life; Resilience, Psychological; Speech Acoustics; Speech Intelligibility; Stuttering; Voice Quality
PubMed: 30347057
DOI: 10.1044/2018_AJSLP-ODC11-17-0189 -
American Journal of Speech-language... Oct 2018The aim of this study was to describe a range of methods used in stuttering therapy for desensitizing parents of children who stutter (CWS). (Review)
Review
PURPOSE
The aim of this study was to describe a range of methods used in stuttering therapy for desensitizing parents of children who stutter (CWS).
METHOD
This clinical tutorial will first briefly explore the rationale and benefit of including parents of CWS of all ages in the therapy process. The construct of desensitization will be defined, and a description will be given of how traditionally it has been incorporated into therapy with adults who stutter and CWS. Research evidence will be presented about the impact of a child's stuttering on parents. The article will then focus on clinical methods for desensitizing parents of CWS using examples of activities conducted in group and individual therapy with parents at the Michael Palin Centre in London with reference to desired outcomes, how to measure them, and how to address potential pitfalls.
CONCLUSION
Desensitization activities can be implemented with parents of CWS to help them recognize and manage their emotional reactions to their child's stuttering, to support parents to feel knowledgeable and confident in managing their child's stuttering, and ultimately to enhance the child's progress in therapy.
Topics: Adolescent; Adolescent Behavior; Age Factors; Child; Child Behavior; Child, Preschool; Desensitization, Psychologic; Emotions; Female; Humans; Male; Parent-Child Relations; Parents; Speech Acoustics; Speech Intelligibility; Stuttering; Treatment Outcome; Voice Quality
PubMed: 30347058
DOI: 10.1044/2018_AJSLP-ODC11-17-0183 -
Journal of Communication Disorders 2022Stuttering 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... (Review)
Review
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.
Topics: Adolescent; Adult; Child; Child, Preschool; Employment; Humans; Quality of Life; Speech; Speech Therapy; Stuttering
PubMed: 35751980
DOI: 10.1016/j.jcomdis.2022.106242 -
Journal of Fluency Disorders Dec 2015This article presents a meta-analytic review of differences in communication attitudes between children who stutter (CWS) and children who do not stutter (CWNS). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This article presents a meta-analytic review of differences in communication attitudes between children who stutter (CWS) and children who do not stutter (CWNS).
METHOD
To be included in this review, the studies had to include a group of CWS and CWNS between the ages of 3-18 years and a measurement of communication attitudes. The journal articles were identified by using the key words stutter*, speech disfluenc*, fluency disorder*, and stammer* cross-referenced to awareness*, reaction*, attitude*, KiddyCAT, CAT, A-19 Scale, PASS and OASES.
RESULTS
A total of 18 studies met the inclusion criteria for this meta-analysis. The results showed that CWS exhibit more negative communication attitudes than CWNS from the preschool years. The differences between the groups increased with age, but were not influenced by gender.
CONCLUSION
The results indicate that negative communication attitudes can be an effect of stuttering. Key issues requiring further investigation are whether communication attitudes differ as a function of age at stuttering onset and whether communication attitudes influence the development of stuttering.
EDUCATIONAL OBJECTIVES
After reading this article, the reader will be able to: (a) summarise empirical findings with regard to the relationship between communication attitudes and childhood stuttering; (b) describe the different instruments used to measure communication attitudes; (c) discuss the relationship between communication attitudes, age and gender.
Topics: Attitude; Child; Child, Preschool; Communication; Female; Humans; Male; Neuropsychological Tests; Speech; Speech Production Measurement; Stuttering
PubMed: 26365773
DOI: 10.1016/j.jfludis.2015.08.001 -
Seminars in Speech and Language Sep 2018Stuttering anticipation is endorsed by many people who stutter as a core aspect of the stuttering experience. Anticipation is primarily a covert phenomenon and people... (Review)
Review
Stuttering anticipation is endorsed by many people who stutter as a core aspect of the stuttering experience. Anticipation is primarily a covert phenomenon and people who stutter respond to anticipation in a variety of ways. At the same time as anticipation occurs and develops internally, for many individuals the "knowing" or "feeling" that they are about to stutter is a primary contributor to the chronicity of the disorder. In this article, we offer a roadmap for both understanding the phenomenon of anticipation and its relevance to stuttering development. We introduce the (SAS)-a 25-item clinical tool that can be used to explore a client's internal experience of anticipation to drive goal development and clinical decision making. We ground this discussion in a hypothetical case study of "Ryan," a 14-year-old who stutters, to demonstrate how clinicians might use the SAS to address anticipation in therapy with young people who stutter.
Topics: Anticipation, Psychological; Female; Humans; Male; Psychological Tests; Stuttering
PubMed: 30142646
DOI: 10.1055/s-0038-1667164 -
American Journal of Speech-language... Oct 2018This clinical discussion paper will explore two aspects of attention in relation to young people who stutter and their parents: (a) what we attend to as human beings and... (Review)
Review
METHOD
This clinical discussion paper will explore two aspects of attention in relation to young people who stutter and their parents: (a) what we attend to as human beings and (b) how we attend. It will draw on research and clinical practice informed by CBT and MBIs. Specifically, information-processing theory in CBT explains psychological well-being partly in terms of what individuals focus their attention on, whereas MBIs focus on the relationship between how individuals attend to their internal experiences and their psychological well-being.
CONCLUSIONS
Although a nascent field, MBIs may be useful as a part of therapy for children and adolescents who stutter. The concepts highlighted by MBIs may also help to resolve some clinical issues.
Topics: Adolescent; Adolescent Behavior; Age Factors; Attention; Child; Child Behavior; Cognitive Behavioral Therapy; Female; Humans; Male; Mindfulness; Speech Acoustics; Speech Intelligibility; Stuttering; Treatment Outcome; Voice Quality
PubMed: 30347059
DOI: 10.1044/2018_AJSLP-ODC11-17-0196 -
Seminars in Speech and Language Mar 2022Avoidance Reduction Therapy for Stuttering (ARTS) is a behavioral therapy for children and adults that incorporates speech therapy and counseling to reduce learned...
Avoidance Reduction Therapy for Stuttering (ARTS) is a behavioral therapy for children and adults that incorporates speech therapy and counseling to reduce learned physical and socioemotional struggle that constitute the problem for the stutterer.a While stuttering is a neurodevelopmental difference, efforts to mask a stigmatized identity can contribute to avoidance, shame, and fear of speaking. This article provides theoretical foundations for therapy principles, describes the processes of self-acceptance and change, and outlines therapy goals and activities using child-friendly explanations and case study vignettes.
Topics: Adult; Behavior Therapy; Humans; Speech; Speech Therapy; Stuttering
PubMed: 35697036
DOI: 10.1055/s-0042-1742695 -
Language, Speech, and Hearing Services... Jan 2023School-age children and adolescents frequently have difficulty developing positive identities around their stuttering. Many students experience both physical and social...
PURPOSE
School-age children and adolescents frequently have difficulty developing positive identities around their stuttering. Many students experience both physical and social consequences from stuttering. The great lengths that speakers go to try to hide their stuttering and to speak fluently increase their difficulty. As long as school-age children who stutter try to identify as fluent speakers, they will have difficulty lessening the negative impact of stuttering on their lives. Fortunately, many people who stutter also report positive stuttering experiences. Speech-language pathologists can use these positive experiences to help school-age children grow more comfortable with stuttering. They can also help school-age children reduce some of the speaking effort and social stigma that leads them to try to conceal their stuttering in the first place. To accomplish both these goals, I propose a stutter-affirming therapy.
METHOD
This clinical focus article summarizes previous research about identity development in stuttering. I discuss a therapy approach I call stutter-affirming therapy. In elucidating this approach, I discuss practical ways that speech-language pathologists can use to help school-age children develop positive stuttering identities through easier speaking and stuttering. I ground these examples in a case study of a 12-year-old boy who stutters.
DISCUSSION
stutter-affirming therapy focuses on conditioning the speaker's reaction to stuttering in ways that move toward and embrace stuttering (stutterphilic reactions) rather than in ways that move away from and reject stuttering (stutterphobic reactions). Speech-language pathologists can help school-age children who stutter foster positive stuttering identities using the three priorities of stutter-affirming therapy. First, reject fluency by reducing stutterphobic and increasing stutterphilic reactions to stuttering. Second, value stuttering by discovering what speakers gain from it. Third, create an environment in which it is easier to stutter through education, advocacy, disclosure, and voluntary stuttering.
Topics: Male; Child; Adolescent; Humans; Stuttering; Speech Therapy; Social Stigma
PubMed: 36580565
DOI: 10.1044/2022_LSHSS-22-00038 -
Journal of Fluency Disorders Jun 2015The fact that some people who stutter have the ability to anticipate a stuttering moment is essential for several theories of stuttering and important for maximum... (Review)
Review
UNLABELLED
The fact that some people who stutter have the ability to anticipate a stuttering moment is essential for several theories of stuttering and important for maximum effectiveness of many currently used treatment techniques. The "anticipation effect," however, is poorly understood despite much investigation into this phenomenon. In the present paper, we combine (1) behavioral evidence from the stuttering-anticipation literature, (2) speech production models, and (3) models of error detection to propose a theoretical model of anticipation. Integrating evidence from theories such as Damasio's Somatic Marker Hypothesis, Levelt's Perceptual Monitoring Theory, Guenther's The Directions Into Velocities of Articulators (DIVA) model, Postma's Covert Repair Hypothesis, among others, our central thesis is that the anticipation of a stuttering moment occurs as an outcome of the interactions between previous learning experiences (i.e., learnt associations between stuttered utterances and any self-experienced or environmental consequence) and error monitoring. Possible neurological mechanisms involved in generating conscious anticipation are also discussed, along with directions for future research.
EDUCATIONAL OBJECTIVES
The reader will be able to: (a) describe historical theories that explain how PWS may learn to anticipate stuttering; (b) state some traditional sources of evidence of anticipation in stuttering; (c) describe how PWS may be sensitive to the detection of a stuttering; (d) state some of the neural correlates that may underlie anticipation in stuttering; and (e) describe some of the possible utilities of incorporating anticipation into stuttering interventions.
Topics: Humans; Models, Theoretical; Speech; Stuttering
PubMed: 25841698
DOI: 10.1016/j.jfludis.2015.03.002