Department of Speech Pathology and Audiology, Faculty of Rehabilitation Medicine, University of Alberta, 8205-114 Street, Edmonton, Alberta, Canada T6G 2G4. teshima@telus.net

Abstract

The purposes of this study were to investigate naturalness of the post-treatment speech of Comprehensive Stuttering Program (CSP) clients and differences in naturalness ratings by three listener groups. Listeners were 21 student speech-language pathologists, 9 community members, and 15 listeners who stutter. Listeners rated perceptually fluent speech samples of CSP clients obtained immediately post-treatment (Post) and at 5 years follow-up (F5), and speech samples of matched typically fluent (TF) speakers. A 9-point interval rating scale was used. A 3 (listener group)x2 (time)x2 (speaker) mixed ANOVA was used to test for differences among mean ratings. The difference between CSP Post and F5 mean ratings was statistically significant. The F5 mean rating was within the range reported for typically fluent speakers. Student speech-language pathologists were found to be less critical than community members and listeners who stutter in rating naturalness; however, there were no significant differences in ratings made by community members and listeners who stutter. Results indicate that the naturalness of post-treatment speech of CSP clients improves in the post-treatment period and that it is possible for clients to achieve levels of naturalness that appear to be acceptable to adults who stutter and that are within the range of naturalness ratings given to typically fluent speakers. Educational objectives: Readers will be able to (a) summarize key findings of studies that have investigated naturalness ratings, and (b) interpret the naturalness ratings of Comprehensive Stuttering Program speaker samples and the ratings made by the three listener groups in this study.

The Lidcombe program of early stuttering intervention: mothers' experiences.

Australian Stuttering Research Centre, The University of Sydney, NSW 1825, Australia.

Abstract

The Lidcombe Program is a behavioral treatment for early stuttering which is implemented by parents, typically the mother. Despite this, there is limited detailed knowledge about mothers' experiences of administering the treatment. This article describes the findings of a qualitative study which explored the experiences of 16 mothers during their implementation of the Lidcombe Program. Information was collected using semi-structured, in-depth, face-to-face and telephone interviews. Participants were interviewed pre-treatment, and then regularly throughout the 6-month treatment period. Data were collected from nine interviews conducted with each participant. All interviews (n=140) were audio recorded and then transcribed verbatim. Thematic analysis was used to identify major issues and topics which emerged from the data. Practicalities of implementing the program are reported, including obstacles that mothers faced and solutions to address these. Positive aspects that mothers experienced through their involvement are discussed. The mothers' perceptions of the treatment are outlined and descriptions of the emotions mothers reported are also presented. Findings from the study will enable clinicians to better deliver the Lidcombe Program and will enable improved course instruction and clinical education about the procedure. EDUCATIONAL OBJECTIVES: The reader will be able to (1) describe the key components of the Lidcombe Program, (2) describe the rationale and methodology for this study, (3) outline the major findings regarding the mothers' experiences of the Lidcombe Program, (4) describe how the findings can be implemented in a clinical setting and (5) evaluate the strengths and limitations of a qualitative study.

December 2010

Follow-up of 6-10-year-old stuttering children after Lidcombe program treatment: a phase I trial.

Koushik S, Shenker R, Onslow M.

Montreal Fluency Centre, Canada; The University of Newcastle, Australia. sarita.koushik@gmail.com

Abstract

PURPOSE: This Phase I trial sought to establish (1) whether the Lidcombe Program is viable for school-age children, (2) whether there is any indication that it requires modification for school-age children, (3) whether treatment effects are durable, (4) how many treatment sessions appear to be required to significantly reduce stuttering frequency and (5) whether there is an association between follow-up period and relapse tendency. METHOD: Twelve children were treated, and one required an addition to the Lidcombe Program. The results for this child were excluded from group analysis, leaving a group of 6-10 year-olds. A retrospective method was used using routine pre-treatment clinic recordings. At follow-up, all children were telephoned and audio-recorded three times at random times during the day within a 7-10-day period. RESULTS: A blinded observer's mean percent syllables stuttered score pre-treatment was 9.2 and 1.9 at follow-up. No association was found between follow-up period and stuttering rates. The mean syllables per minute score pre-treatment was 145.8 and 179.3 at follow-up. These results were attained in a median of eight clinic visits with a range of 6-10 visits. CONCLUSIONS: Procedurally, the Lidcombe Program is viable for school-age children and parents report enjoyment in administering it. There appears to be a treatment effect that can be attained in a reasonable number of clinical hours. These results compel continued exploration with young school-aged children in subsequent Phase II and III studies. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) summarize the status of clinical trials for stuttering school-age children, (2) describe the phases of clinical trial development, (3) evaluate outcomes the Lidcombe Program for a school-age population in terms of stuttering reduction and treatment time, (4) evaluate the suitability of the Lidcombe Program with population of school-age stuttering children, and (5) provide an interpretation of the finding of no correlation between follow-up and post-treatment stuttering rates.

Randomized controlled trial of video self-modeling following speech restructuring treatment for stuttering.

Cream A, O'Brian S, Jones M, Block S, Harrison E, Lincoln M, Hewat S, Hearne A, Packman A, Menzies R, Onslow M.

Australian Stuttering Research Centre, The University of Sydney, Australia.

Abstract

PURPOSE: This study 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 two trial arms: standard maintenance and standard maintenance plus VSM. Participants in the latter arm viewed stutter-free videos of themselves each day for one month. RESULTS: The addition of VSM did not improve speech outcomes, as measured by percent syllables stuttered, at either one or six months post randomization. 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, being mild-moderately impaired compared to 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.

Randomized controlled non-inferiority trial of a telehealth treatment for chronic stuttering: the Camperdown Program.

Queensland Clinical Trials Centre, University of Queensland, Brisbane, QLD, Australia.

BACKGROUND: In the Lidcombe Program of Early Stuttering Intervention, parents present verbal contingencies for stutter-free and stuttered speech in everyday situations. A previous randomized controlled trial of the programme with preschool-age children from 2005, conducted in two public speech clinics in New Zealand, showed that the odds of attaining clinically minimal levels of stuttering 9 months after randomization were more than seven times greater for the treatment group than for the control group. AIMS: To follow up the children in the trial to determine extended long-term outcomes of the programme. METHODS & PROCEDURES: An experienced speech-language therapist who was not involved in the original trial talked with the children on the telephone, audio recording the conversations using a telephone recording jack. Parental reports were gathered in addition to the children's speech samples in order to obtain a balance of objective data and reports from a wide range of situations. OUTCOMES & RESULTS: At the time of this follow-up, the children were aged 7-12 years, with a mean of 5 years post-randomization in the 2005 trial. Twenty of the 29 children in the treatment arm and eight of the 25 children in the control (no treatment) arm were able to be contacted. Of the children in the treatment group, one (5%) failed to complete treatment and 19 had completed treatment successfully and had zero or near-zero frequency of stuttering. Three of the children (16%) who had completed treatment successfully had relapsed after 2 or more years of speech that was below 1% syllables stuttered. Meaningful comparison with the control group was not possible because an insufficient number of control children were located and some of them received treatment after completing the trial. CONCLUSIONS & IMPLICATIONS: The majority of preschool children are able to complete the Lidcombe Program successfully and remain below 1% syllables stuttered for a number of years. However, a minority of children do relapse and will require their parents to reinstate the treatment procedures.

Extended follow-up of a randomized controlled trial of the Lidcombe Program of Early Stuttering Intervention.

Queensland Clinical Trials Centre, University of Queensland, Brisbane, QLD, Australia.

Long-Term Outcome of the Lidcombe Program for Early Stuttering Intervention.

PURPOSE: To report long-term outcomes of the first 15 preschool children treated with the Lidcombe Program by speech-language pathologists (SLPs) who were inexperienced with the program and independent of the program developers. Research questions were: Would the treatment have a similar outcome with inexperienced SLPs compared to outcomes when implemented by the developers? Is treatment duration associated with pre-treatment measures? Is long-term treatment outcome affected by variables associated with natural recovery? METHOD: Fifteen preschool children who completed the Lidcombe Program were assessed prior to treatment and at least 12 months following treatment. Pre-treatment data were obtained from archived files; follow-up data were obtained from interviews and recordings completed after the study had been planned. RESULTS: Measures of stuttering indicated significant changes from pre-treatment to follow-up in percent syllables stuttered (%SS) and Stuttering Severity Instrument-3 (SSI-3) scores. Pre-treatment severity was significantly correlated with treatment time. Handedness was the only client characteristic that appeared to be related long-term treatment outcome. CONCLUSIONS: The treatment produced significant long-term changes in children's speech, even when administered by SLPs newly-trained in the Lidcombe Program. Treatment results appear to be influenced by pre-treatment stuttering severity.

Developing treatment for adolescents who stutter: a phase I trial of the Camperdown Program.

PURPOSE: To investigate in detail how adolescents who stutter perform during treatment, with the aim of informing treatment development for this age group. METHOD: The Camperdown Program was conducted with 3 adolescents who stutter. Their performance during treatment was recorded in detail, and outcome measures were collected before treatment and on 5 occasions after treatment. RESULTS: One participant responded extremely well to treatment, with percentage of syllables stuttered (%SS) scores at 12 months follow-up around 1%. In addition, his speech naturalness was within normal limits. Another participant withdrew from treatment during maintenance, yet he still approximately halved his pretreatment %SS scores and was also sounding natural after treatment. This participant was satisfied with his treatment outcome. A third participant did not reach maintenance and did not benefit from the treatment. CONCLUSION: The adolescent who succeeded in treatment presented with a high level of self-confidence and maturity. When examining the factors that seemed to impact on treatment outcome, an underlying theme of decreased parent influence and increased peer influence and self-direction was detected. These are fundamental during the journey through adolescence from childhood to adulthood. Future directions in developing treatments for adolescents are discussed.

What do people who stutter want - fluency or freedom?

PURPOSE: What proportion of adult PWS (persons who stutter) choose fluency and what proportion choose to be free from a need to be fluent in managing their stuttering, what demographic and stuttering-related variables influence their choice, and how consistent they are in their choice? METHOD: A survey instrument administered over the Internet was used to collect the data. RESULTS: Overall, 8% more of the 216 respondents opted for fluency than freedom. A larger proportion of male PWS and PWS under the age of 30 preferred fluency. Neither nationality nor language background influenced their preference. Those who received no therapy overwhelmingly chose fluency and a slight majority of those with less than five years of therapy preferred fluency. Those with greater than five years of therapy were evenly divided between the two choices. Those who preferred freedom were more consistent in their responses across items than those who opted for fluency. Based on the consistency of responses, 20 and 23 percent of the sample decisively opted for fluency and freedom respectively and 34% in the fluency group and 23% in the freedom group were ambivalent. CONCLUSION: A majority of PWS appear to benefit from flexible treatment programs with cafeteria style choices.

Is parent-child interaction therapy effective in reducing stuttering?

The Michael Palin Centre for Stammering Children, Finsbury Health Centre, Pine Street, London EC1R 0LP England. sharon.millard@islingtonpct.nhs.uk

PURPOSE: To investigate the efficacy of parent-child interaction therapy (PCIT) with young children who stutter. METHOD: This is a longitudinal, multiple single-subject study. The participants were 6 children aged 3;3-4;10 [years;months] who had been stuttering for longer than 12 months. Therapy consisted of 6 sessions of clinic-based therapy and 6 weeks of home consolidation. Speech samples were videorecorded during free play with parents at home and analyzed to obtain stuttering data for each child before therapy, during therapy, and up to 12 months posttherapy. RESULTS: Stuttering frequency data obtained during therapy and posttherapy were compared with the frequency and variability of stuttering in the baseline phase. Four of the 6 children significantly reduced stuttering with both parents by the end of the therapy phase. CONCLUSIONS: PCIT can reduce stuttering in preschool children with 6 sessions of clinic-based therapy and 6 weeks of parent-led, home-based therapy. The study highlights the individual response to therapy. Suggestions for future research directions are made.

May 2008

A phase II trial of telehealth delivery of the Lidcombe Program of Early Stuttering Intervention.

Australian Stuttering Research Centre, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW 1825, Australia.

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.

A randomized control trial to investigate the impact of the Lidcombe Program on early stuttering in German-speaking preschoolers.

In order to investigate whether the Lidcombe Program effects a short-term reduction of stuttered speech beyond natural recovery, 46 German preschool children were randomly assigned to a wait-contrast group or to an experimental group which received the Lidcombe Program for 16 weeks. The children were between 3;0 and 5;11 years old, their and both of their parents' native language was German, stuttering onset had been at least 6 months before, and their stuttering frequency was higher than 3% stuttered syllables. Spontaneous speech samples were recorded at home and in the clinic prior to treatment and after 4 months. Compared to the wait-contrast group, the treatment group showed a significantly higher decrease in stuttered syllables in home-measurements (6.9%SS vs. 1.6%SS) and clinic-measurements (6.8%SS vs. 3.6%SS), and the same increase in articulation rate. The program is considered an enrichment of currently applied early stuttering interventions in Germany. EDUCATIONAL OBJECTIVES: Readers will discuss and evaluate: (1) the short-term effects of the Lidcombe Program in comparison to natural recovery on stuttering; (2) the impact of the Lidcombe Program on early stuttering in German-speaking preschool children.

Telehealth delivery of the Camperdown Program for adults who stutter: a phase I trial.

Australian Stuttering Research Centre, The University of Sydney, P.O. Box 170, Lidcombe NSW 1825, Australia.

PURPOSE: This Phase I trial investigated the viability of telehealth delivery of the Camperdown Program with adults who stutter. This program involves speech restructuring. METHOD: All treatment was conducted remotely with participant-clinician contact occurring by telephone and e-mail. RESULTS: Ten adults completed the program. The group showed an 82% reduction in stuttering frequency immediately after treatment and a 74% reduction 6 months after treatment. However, there was significant individual variation in response to the program. CONCLUSION: These preliminary data suggest that telehealth Camperdown has the potential to provide efficacious treatment for clients who do not have access to traditional face-to-face treatment.

Stuttering and its treatment in adolescence: the perceptions of people who stutter.

Australian Stuttering Research Centre, The University of Sydney, Australia. anna@start.org.nz

Adolescence is a complicated phase of maturation during which a great deal of physical, neurological and social development occurs. Clinically this phase is thought to be the last chance to arrest the development of the disorder of stuttering before it becomes chronic in adulthood. However, little treatment development for this age group has occurred. Previous research on the impact of stuttering during adolescence presents a complex picture of apprehension about speaking which does not, however, appear to interfere with social life. The purpose of the present study was to investigate further the experiences of adolescents who stutter with respect to: (1) their experience of stuttering during the adolescent years, (2) reasons for seeking or not seeking therapy during the adolescent years, (3) barriers to seeking therapy during the adolescent years, (4) their experience of therapy during the adolescent years, and finally (5) suggested improvements to therapy for adolescents. Two focus groups and seven individual interviews were conducted with 13 adolescents and young adults. The major finding was a perceived lack of awareness about stuttering by teachers and parents, as well as other adolescents. In addition it appeared that having a stutter was, in itself, not enough reason to seek treatment. However when adolescents did seek treatment, for reasons such as joining the workforce, group therapy was well liked. Educational objectives: The reader will summarize key features that characterize: (1) the complex developmental phase of adolescence, (2) evaluate the experience of stuttering during the adolescent years, (3) discuss the experience of stuttering therapy during the adolescent years, (4) list adolescents' reported barriers to seeking therapy during the adolescent years, and (5) suggest possible ways to improve management of stuttering in adolescence.

Post-treatment speech naturalness of comprehensive stuttering program clients and differences in ratings among listener groups.

Abstract

The Lidcombe program of early stuttering intervention: mothers' experiences.

Abstract

Follow-up of 6-10-year-old stuttering children after Lidcombe program treatment: a phase I trial.

Abstract

Randomized controlled trial of video self-modeling following speech restructuring treatment for stuttering.

Abstract

Randomized controlled non-inferiority trial of a telehealth treatment for chronic stuttering: the Camperdown Program.

Extended follow-up of a randomized controlled trial of the Lidcombe Program of Early Stuttering Intervention.

Long-Term Outcome of the Lidcombe Program for Early Stuttering Intervention.

Developing treatment for adolescents who stutter: a phase I trial of the Camperdown Program.

What do people who stutter want - fluency or freedom?

Is parent-child interaction therapy effective in reducing stuttering?

May 2008

A phase II trial of telehealth delivery of the Lidcombe Program of Early Stuttering Intervention.

A randomized control trial to investigate the impact of the Lidcombe Program on early stuttering in German-speaking preschoolers.

Telehealth delivery of the Camperdown Program for adults who stutter: a phase I trial.

Stuttering and its treatment in adolescence: the perceptions of people who stutter.