LPV Forum - Letter to Editor

Abstract

I have read with interest the growing awareness in Sweden of the importance of treatment efficacy research in the area of stuttering. Recently two articles by Swedish researcher/clinicians have warranted some comment. Helltoft-Nilsen and Ramberg (3) have reported data evaluating a program for stuttering adolescents. They describe an intensive speech therapy program based on principles of non-avoidance and facilitation of communication and social skills. They point out clearly that stuttering can be viewed within the World Health Organization’s model, and proceed to attempt to develop instruments that purport to measure changes in the stuttering problem as a result of treatment. The measures reported include primarily subjective ratings carried out by independent listeners, the therapists providing the treatment and the youth leaders working with the subjects. The only standardized measure employed was the Locus of Control of Behaviour scale (Craig et al ., 1984 (1)). The authors are to be commended for providing a detailed description of the stuttering treatment program and for attempting to provide data that reflect the ‘disability’ and ‘handicap’ aspects of the stuttering problem. Indeed, those of us working with people who stutter know very well the devastation that is often caused by stuttering and we should continually seek to refine our methods for collecting data that accurately reflect this part of the problem. From a research standpoint, however, this paper presents two very major concerns. First, there is an obvious lack of data pertaining to the actual fluency counts demonstrated by the subjects. While I am in total agreement with supplementing fluency scores with additional perceptual data, I cannot accept a paper that fails to provide any fluency count data at all. It seems that the authors could have very easily supplied the reader with a Table or Appendix containing raw data reflecting the actual number of words or syllables stuttered before and after treatment. A second major concern deals with the issue of experimenter bias. The fact that the clinicians and youth workers who provided the treatment also performed the pre and post evaluations is again totally unacceptable. The authors would have done better to rely only on the independent listener’s perceptual evaluations. Forne-Wastlund (2) reported on a pilot study designed to investigate a newly developed Swedish Comprehensive Stuttering Program. There is no doubt that this program, based on the principles of fluency shaping is radically different both in form and in substance from the non-avoidance approach, and one can engage in pages of academic and clinical debate regarding the merits of these two approaches. My intention however, is to comment on the design of the studies from a research perspective and to leave the philosophical debate for another time. To her credit, Forne-Wastlund reports data based on the Stuttering Severity Instrument (Riley, 1994 (4)) one of the few standardized instruments that we have to measure stuttering frequency and concomitant behaviors. Although the paper does not present the raw data, the author summarizes the SSI scores for each subject in individual profile histories and treatment results. A second strength of this paper is the inclusion of follow-up data at intervals of five months and one year following treatment. Clinical experience has demonstrated time and again that it is not that difficult to obtain significant gains immediately following intensive treatment. The challenge rests with the maintenance period and Forne-Wastland should be congratulated for her attempts at following her subjects over a twelve month period. In summary, it is gratifying in many ways to see the efforts being made to document and quantify treatment outcomes for stuttering. As more clinician/researchers embark on this voyage we would all be advised to review our knowledge base pertaining to appropriate empirical procedures and design.