Stuttering Treatment Outcomes Research Articles

A preliminary investigation of the mental health of parents of young children who stutter

IntroductionWhile research has shown that parents of preschool-aged children who stutter (CWS) may be negatively affected by their child's stuttering, few studies have investigated their mental health. If parents of CWS have poor mental health, this may impact stuttering treatment choices, the conduct of treatment, stuttering treatment outcomes, and the development of stuttering treatments. Methods82 parents (74 mothers and 8 fathers) of preschool-aged children who stutter (aged 1–5) were recruited upon application for an assessment for their child. A survey battery extracting quantitative and qualitative information about symptoms of potential depression, anxiety, stress, and psychological distress, as well as the emotional effect of stuttering on parents was administered and the results summarized. ResultsData from standardised measures revealed similar incidence as normative data for the presence of stress, anxiety or depression (1 in 6 parents) and distress (almost 1 in 5 parents). However, more than half of the participants reported experiencing a negative emotional effect due to their child's stuttering and a large proportion also reported that stuttering influenced their communication with their child. ConclusionsSpeech-language pathologists (SLPs) should broaden the scope of their duty of care to include the parents of CWS more fully. Parents should be provided with informational counselling or other support services that will help reduce worry and anxiety related to negative emotions.

Situational Embarrassment and Its Relationship to Social Anxiety in Adults Who Stutter.

Purpose Adults who stutter (AWS) have increased risk of comorbid social anxiety about speaking in social contexts. AWS also report experiencing embarrassment in different social situations; however, research has rarely been conducted on embarrassment and its relationship to social anxiety in AWS. Method AWS (N = 200) reported their level of embarrassment on four 10-point Likert items when speaking in four situational contexts: at home, to an individual important to them, in social groups, and at work. Participants were also assessed for sociodemographic, stuttering, and anxiety variables. Construct validity for the four embarrassment items was examined, the extent of embarrassment established in the four contexts as a function of age and sex, and the relationship of embarrassment to social anxiety evaluated. Results Evidence of acceptable construct validity and reliability is presented for the four embarrassment Likert items. Sixty-five percent of the sample experienced high levels of embarrassment when speaking in groups or at work, while 35.5% experienced high levels when speaking at home or to an individual important to them. Participants were significantly more embarrassed (p < .01) when speaking at work or when socializing in groups. Embarrassment was lowest when speaking in the home. Younger females were significantly more embarrassed when speaking at work or when socializing in groups. Those with high embarrassment scores on all four items were more likely to have elevated social anxiety scores (p < .001). Conclusion These preliminary results suggest that the assessment of situational embarrassment could be an important clinical measure that may help improve stuttering treatment outcomes that also target social anxiety.

An Evaluation of an Integrated Stuttering and Parent-Administered Self-Regulation Program for Early Developmental Stuttering Disorders.

Purpose This study reports findings from a clinical trial that implemented an early stuttering treatment program integrated with evidence-based parenting support (EBPS) to children who stutter (CWS) with concomitant self-regulation challenges manifested in elevated attention-deficit/hyperactivity disorder (eADHD) symptoms and compared those outcomes to CWS receiving stuttering treatment without EBPS. Method Participants were 76 preschool CWS and their parent(s). Thirty-six of these children presented with eADHD and were quasirandomized into two groups: stuttering treatment only (eADHDstandard) or stuttering treatment integrated with EBPS (eADHDintegrated). The remaining children did not meet criteria for eADHD symptoms and received stuttering treatment only (No-eADHDstandard). Pre, post, and 3-month follow-up measures of stuttering treatment outcomes as well as treatment effects on measures of child behavior difficulties and parenting practices were examined. Results Significant reduction in stuttering was found for all groups. However, the eADHDintegrated group showed a greater reduction in stuttering frequency than the eADHDstandard group, and at follow-up, stuttering frequencies in the eADHDintegrated group matched those of children in the No-eADHDstandard group, while stuttering in the eADHDstandard group remained significantly higher. Children with eADHD symptoms who received the integrated program also required significantly less stuttering intervention time than those children with eADHD symptoms who received stuttering treatment only. Families in the eADHDintegrated group reported large and significant improvements in child behavior and parenting practices. Conclusion This study provides support for an early treatment program for CWS. The integrated stuttering and self-regulation management program for CWS with eADHD symptoms proved successful for fluency and behavioral improvements, which were sustained at follow-up.

Therapist and individual experiences and perceptions of music therapy for adolescents who stutter: A qualitative exploration

ABSTRACT Introduction Affective reactions frequently reported by adolescents who stutter include embarrassment, frustration, and feelings of anxiety about further stuttering. It is possible that music therapy may enhance stuttering treatment outcomes; however, little is known about how individuals who stutter, and therapists working with this group, view such therapy. The purpose of this study was to explore individuals who stutter and therapist experiences with, and perceptions of, music and music therapy for stuttering. This work is part of a larger mixed-methods project to explore the effectiveness and potential benefit of music therapy with adolescents who stutter. Method Semi-structured interviews were conducted with six clinicians and three individuals who stutter. Interview data were analysed using qualitative content analysis. Results Four themes emerged from participants’ accounts: (a) the experience of living with stuttering, (b) the importance of music in everyday life, (c) the application of music therapy in stuttering, and (d) recommendations for music therapy in the continuum of support services for individuals who stutter. Discussion Participants in this study perceived music and music therapy to benefit individuals who experience stuttering, particularly within the context of mental health. There is agreement that song writing, improvisation and song singing are most useful when working with adolescents who experience stuttering.

Psychological counseling as an adjunct to stuttering treatment: Clients’ experiences and perceptions

PurposeStuttering can trigger anxiety and other psychological and emotional reactions, and limit participation in society. It is possible that psychological counseling could enhance stuttering treatment outcomes; however, little is known about how clients view such counseling. The purpose of this study was to gain an understanding of clients’ experiences with, and perceptions of, a psychological counseling service that was offered as an optional adjunct to speech therapy for stuttering. MethodNine individuals who stutter (13-38 years old) participated in semi-structured interviews. Six participants had taken part in psychological counseling; three participants did not do so. Interview data were analyzed using grounded theory as a guiding framework. ResultsFour thematic clusters emerged from participants’ accounts: insights into personal decision-making, why others may not participate in counseling, psychological counseling as a worthwhile part of therapy, and counseling as a necessary component in a stuttering treatment program. ConclusionIn addition to experiencing barriers and facilitators to help-seeking that are reported in related fields, participants accounts also revealed novel facilitators (i.e., a ‘why not’ mentality and the importance of having a pre-existing relationship with the clinician who offered the service) and barriers (i.e., viewing the service as a ‘limited resource,’ and, the overwhelming nature of intensive stuttering treatment programs). Findings suggest that clients value the option to access psychological counseling with trained mental health professionals to support the stuttering treatment provided by speech-language pathologists. Participants made recommendations for the integration of psychological counseling into stuttering treatment programs.

Stuttering treatment for a school-age child with Down syndrome: A descriptive case report

BackgroundLittle is known about optimal treatment approaches and stuttering treatment outcomes for children with Down syndrome. Aims and methodThe purpose of this study was to investigate outcomes for a child with Down syndrome who received a combination of fluency shaping therapy and parent delivered contingencies for normally fluent speech, prolonged speech, and stuttered speech. ResultsIn-clinic speech measures obtained at post-treatment and at 4 months follow-up reflected improvements in fluency of 89.0% and 98.6%, respectively. The participant's beyond-clinic follow-up sample reflected an improvement of 95.5%. Following treatment, the participant demonstrated improved self-confidence, self-esteem, and improved participation and functioning at school. ConclusionsFindings suggest that fluency shaping with parental contingencies may be a viable treatment approach to reduce stuttering in children with Down syndrome. Future research using an experimental research design is warranted.Educational objectives: Readers will be able to describe (a) prevalence estimates of stuttering in individuals with Down syndrome, (b) the main components of a fluency shaping program for a child with Down syndrome who stutters and has co-occurring speech and language delays, and (c) speech and parent-, teacher-, and self-report treatment outcomes.

Integrating Functional Measures With Treatment: A Tactic for Enhancing Personally Significant Change in the Treatment of Adults and Adolescents Who Stutter

It is proposed that stuttering treatment, particularly for adults and adolescents who stutter, may benefit from more inventive and extensive use of functional measurement-measures that are also treatment agents. Such measures can be tailored to produce more personally significant and evidence-based treatment benefits. They may be especially useful when employed in conjunction with partial self-management and performance-contingent procedures. Previous approaches to the definition of stuttering treatment goals and the measurement of stuttering treatment outcomes are critically reviewed. Suggestions for improvements are presented within the framework of an evidence-based and relatively standardized stuttering treatment. Results from a review of existing literature and from 2 case studies show that 2 specific personally significant problems, saying one's name and addressing large audiences, were improved by implementing these strategies in treatment. Functional measures directly connected to treatment, and partially self-managed performance-contingent schedules, merit further research as methodologies that are suitable for conducting personally significant and evidence-based treatments with adults and adolescents who stutter.

Australian normative data for the Overall Assessment of the Speaker's Experience of Stuttering

People who stutter often report negative impacts on their wellbeing as a result of their chronic fluency disorder. The need for a comprehensive assessment of the wellbeing and experience of stuttering should be a prime consideration when measuring treatment outcomes. One such measure designed to evaluate wellbeing and aspects of the individual's experience of his or her stuttering is the Overall Assessment of the Speaker's Experience of Stuttering (OASES). Normative data for the OASES Adult version (OASES-A; and hereafter referred to simply as the OASES) has begun to be collected over the past 10 years, though none are available for an Australian population. This paper presents Australian normative data for the OASES for 200 adult males and females who stutter, aged between 18 and 85 years. Additionally, the influence of age, sex, and frequency of stuttering on the Australian OASES scores are also presented. No significant relationships between OASES scores were found for sex and age, which is in keeping with the USA original dataset. However, those participants who had more severe stuttering were more likely to have higher negative impacts for ‘General Information’, Communication in Daily Situations,’ and for the overall OASES score. Implications for further research are discussed.Educational objectives: The reader will be able to: (i) describe the purpose of the Overall Experience of the Speaker's Experience of Stuttering for Adults (OASES), (ii) evaluate the relevance of the OASES to treatment planning and the evaluation of stuttering treatment outcomes in the adult population, and (iii) compare Australian normative dataset with the USA and Dutch normative datasets for the OASES.

Assessing quality of life in stuttering treatment outcomes research

Stuttering can affect many aspects of a person's life. People who stutter report that they experience negative reactions to stuttering, difficulty communicating in key situations, diminished satisfaction with life, and a reduced ability to achieve their goals in life. Unfortunately, most treatment outcomes studies have focused on changes in the observable characteristics of stuttering, with significantly fewer studies examining the broader consequences of stuttering. This paper proposes that evaluation of stuttering treatment outcomes can be enhanced through assessment of impact of stuttering on a speaker's quality of life. A means of assessing quality of life is described, based on the Overall Assessment of the Speaker's Experience of Stuttering (OASES; Yaruss & Quesal, 2006, 2008). The OASES is a multi-dimensional assessment instrument built upon the World Health Organization's International Classification of Functioning, Disability, and Health (ICF; WHO, 2001; see also Yaruss & Quesal, 2004). One section of the OASES is designed to assess specific aspects of quality of life in individuals who stutter. Preliminary data from two ongoing studies involving the OASES are briefly summarized in order to demonstrate: (a) that individuals who stutter do report an adverse impact on their quality of life as a result of stuttering and (b) that quality of life can improve following treatment for stuttering. It is recommended that future stuttering treatment outcomes studies directly examine the broader consequence of stuttering by focusing, in part, on quality of life. Educational objectives: After reading this article, the participant will be able to: (1) describe some of the adverse consequences of stuttering reported by individuals who stutter; (2) define quality of life as it relates to the study of the stuttering disorder; (3) explain the value of assessing quality of life in stuttering treatment outcomes research.

Stuttering Treatment Outcomes Measurement: Assessing Above and Below the Surface

Stuttering Treatment Outcomes Measurement: Assessing Above and Below the Surface

Treatment Outcomes Research: A Response to Ryan (2006)

Purpose This is a response to B. Ryan’s (2006) letter to the editor regarding “Intensive Stuttering Modification Therapy: A Multidimensional Assessment of Treatment Outcomes,” by M. Blomgren, N. Roy, T. Callister, and R. Merrill (2005). Issues discussed relate to (a) the goals of stuttering modification treatment, (b) appropriate “documentation” of stuttering treatment programs, and (c) dose–response relationships as they pertain to stuttering treatment. A brief tutorial and discussion concerning appropriate use of terminology associated with stuttering treatment outcomes research is provided.

Assessing Stuttering Treatment Without Assessing Stuttering? A Response to Reitzes and Snyder (2006)

Purpose This letter is a response to P. Reitzes and G. Snyder’s (2006) letter to the editor regarding “Intensive Stuttering Modification Therapy: A Multidimensional Assessment of Treatment Outcomes,” by M. Blomgren, N. Roy, T. Callister, and R. Merrill (2005). The focus of this letter is on issues related to (a) intended and unintended outcomes of stuttering modification treatment, (b) the rationale underlying specific stuttering treatment outcomes measures, and (c) “truth in advertising” of stuttering treatment programs. A secondary purpose is to provide a primer on vocabulary use in treatment research.

Connecting stuttering management and measurement: V. Deduction and induction in the development of stuttering treatment outcome measures and stuttering treatments

The development of evidence-based practice, which is increasingly popular in stuttering treatment, is closely linked to the development of outcome measures. Two approaches to the development of stuttering treatment outcome measures are outlined. The first is the deductive, top-down approach, where the development of specific outcome measures is guided by a priori general conceptualizations of the nature of the disorder. A competing approach to the development of stuttering treatment outcome measures is outlined. This is the inductive, or bottom up approach. This approach uses Baer's (1988, 1990) notion of specific complaints of clients as the starting point to develop inductive statements for use as general guidance for developing treatment outcome measures. It is argued that the deductive approach to development of outcome measures has limitations. It is overly prescriptive, generating numerous and increasingly complex outcome measures that are potentially confusing for clinicians. Further, it is arbitrary and fragile, being linked to conceptualizations and theories about stuttering, which, by necessity, are limited themselves. Further, the development of numerous outcome measures is not compatible with the conduct of randomized controlled trials, which allow a maximum of two primary outcome measures. In contrast, the inductive approach to the development of outcome measures has in its favour that it is empirically driven rather than arbitrary, and that it facilitates a yoking of the development of clinical outcomes and the clinical methods to attain those outcomes. The approach is unlikely to lead to the development of fruitless treatment methods. Further, the approach is parsimonious to the extent that it is likely to produce few guiding generalities for treatment outcome assessment -- perhaps as few as two in the case of adults and one in the case of preschoolers. This is well suited to the use of the randomized controlled trial as a source of evidence for treatment efficacy. One inductive statement that can be used to guide the development of outcome measures is that the ill effects of stuttered speech could be troubling for those who seek clinical help. The other is that those who seek clinical help are likely to experience speech-related anxiety. Together, these sources of information provide sound guidance for the development of outcome measures relating to stuttered speech and speech-related anxiety, and guidance for the development of treatments to offset those ill effects of the condition. Until another outcome measure can be derived from inductive processes, those treatment developments should serve all the needs of those who stutter and the clinicians who provide those needs.

Overall Assessment of the Speaker's Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment

This paper describes a new instrument for evaluating the experience of the stuttering disorder from the perspective of individuals who stutter. Based on the World Health Organization's International Classification of Functioning, Disability, and Health [World Health Organization (2001). The International Classification of Functioning, Disability, & Health. Geneva: World Health Organization], the Overall Assessment of the Speaker' s Experience of Stuttering (OASES) collects information about the totality of the stuttering disorder, including: (a) general perspectives about stuttering, (b) affective, behavioral, and cognitive reactions to stuttering, (c) functional communication difficulties, and (d) impact of stuttering on the speaker's quality of life. This paper summarizes scale development, reliability and validity assessment, and scoring procedures so clinicians and researchers can use the OASES to add to the available evidence about the outcomes of a variety of treatment approaches for adults who stutter. Educational objectives: As a result of this activity, participants will be able to: (1) identify key issues related to the documentation of treatment outcomes in stuttering; (2) discuss the components of the international classification of functioning, disability, and health as they relate to the documentation of stuttering treatment outcomes; (3) evaluate and use a new measurement instrument for assessing the outcomes of stuttering treatment from the perspective of the person who stutters.

Evidence-based treatment of stuttering: III. Evidence-based practice in a clinical setting

At the heart of evidence-based practice in stuttering treatment are four issues: (1) the collection of data to inform treatment; (2) the long standing concern with maintenance of treatment gains; (3) the need to demonstrate accountability to clients, payers and our profession as service providers; and (4) the desire to advance theoretical knowledge. This article addresses the first three of these issues from a practical point of view, illustrating how data collection for stuttering treatment outcome research in a clinical setting is intimately blended with that required for clinical purposes and providing an example of a process of evaluating data for clinical and research purposes. Educational objectives: The reader will learn about and be able to (1) differentiate between treatment outcome and treatment efficacy research, (2) describe models for integrating data collection for treatment outcome and clinical purposes, and (3) utilize guidelines for treatment efficacy that are applicable to outcome research to evaluate data for use in treatment outcome studies and to design outcome studies.

Searching for the neural basis of stuttering treatment outcome: recent neuroimaging studies

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Evaluating treatment outcomes for adults who stutter

The evaluation of stuttering treatment outcomes has traditionally focused primarily on changes in the production of speech disfluencies, even though many treatment approaches also address other aspects of the stuttering disorder, such as the speaker's reactions to stuttering and the overall effect of stuttering on the speaker's ability to communicate. One reason for the relative lack of outcomes data for many commonly recommended treatment programs is the fact that clinicians and researchers have not previously had access to a reliable means of assessing changes in the broader consequences of stuttering on a speaker's life. This paper describes an ongoing effort to develop a series of measurement instruments that can be used to evaluate the outcomes of a wide variety of stuttering treatment approaches by measuring changes in speakers' affective, behavioral, and cognitive reactions to stuttering; the effect of stuttering on speakers' functional communication abilities; and the impact of stuttering on speakers' overall quality of life.

Searching for the neural basis of stuttering treatment outcome: recent neuroimaging studies

Searching for the neural basis of stuttering treatment outcome: recent neuroimaging studies

The relationship between locus of control and long-term stuttering treatment outcome in adult stutterers

The present study was designed to investigate the extent to which adult stutterers' scores on the Locus of Control of Behaviour (LCB) scale are predictive of their ability to maintain speech fluency immediately following intensive treatment and approximately 2 years later. Twenty-one subjects participated in a 3-week intensive treatment program based on the Precision Fluency Shaping Program. Thirteen subjects could be contacted again 2 years later to participate in a follow-up evaluation. While most subjects showed a significant long-term improvement in fluency, no predictive relationship was found between scores on the LCB scale and the level of fluency, measured in percentage of words stuttered, post-treatment or at follow-up. However, LCB scores were found to be predictive of the subjects' fluency self-evaluation measured post-treatment and at follow-up. Overall, the present study suggests that while the LCB scale may contribute to the prediction of long-term treatment outcome, particularly as perceived by the client, other client and process variables will need to be considered as well.

Locus of control and client performance variables as predictors of stuttering treatment outcome

Locus of control and client performance variables as predictors of stuttering treatment outcome