Stuttering generalization self-measure: preliminary development of a self-measuring tool

Objectives: The reader will become knowledgeable about 1) the relationship between stuttering severity and speech-anxiety level, and 2) the importance of assessing the generalization effect in different social speaking situations. Additionally, the reader will understand the processes of validating the Stuttering Generalization Self-Measure. Abstract Introduction: Generalization of treatment is considered a difficult task for clinicians and people who stutter (PWS), and can constitute a barrier to long-term treatment success. To our knowledge, there are no standardized tests that collect measurement of the behavioral and cognitive aspects alongside the client’s self-perception in real-life speaking situations. Purpose: This paper describes the development of a Stuttering Generalization Self-Measure (SGSM). The purpose of SGSM is to assess 1) stuttering severity and 2) speech-anxiety level during real-life situations as perceived by PWS. Additionally, this measurement aims to 3) investigate correlations between stuttering severity and speech-anxiety level within the same real-life situation. Method: The SGSM includes speaking situations that are developed to cover a variety of frequent speaking situations. These items were created according to five listener categories (family and close friends, acquaintances, strangers, persons of authority, and giving a short speech to small audience). Forty-three participants (22 PWS, and 21 control) aged 18 to 53 years were asked to complete the assessment in real-life situations. Results: Preliminary analyses indicated that test-retest reliability was high for both groups. Discriminant validity was also achieved as the SGSM scores significantly differed between the two groups for stuttering and speech-anxiety. Convergent validity was confirmed by significant correlations between the SGSM and other speech-related anxiety measures

The use of email as a component of adult stammering therapy : a preliminary report

In West Glasgow email has evolved from a rapid means of arranging therapy appointments with adults who stammer into a medium for exchange of therapeutic messages with some clients. Since 2004, sixteen clients have used email to communicate as part of their therapy programme. The benefits include improving access to services, supporting speech change, facilitating lasting personal growth, improving clinical decision-making, equalizing the therapist-client relationship and enhancing caseload management. Although this experience suggests that email is appropriate for stammering therapy, the effectiveness and ethics of, and the rationale for, clinical practice that includes email need careful consideration. Further research is required to formally evaluate the client experience

Voice and speech functions (B310-B340)

The International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) domain ‘voice and speech functions’ (b3) includes production and quality of voice (b310), articulation functions (b320), fluency and rhythm of speech (b330) and alternative vocalizations (b340, such as making musical sounds and crying, which are not reviewed here)

Day-to-day Variability of Stuttering

Variability has long been known to be a primary feature of the disorder of stuttering (Bloodstein & Bernstein Ratner, 2008; Costello & Ingham, 1984; Yaruss, 1997a, 1997b). Many factors that affect variability have been investigated (Brown, 1937; Johnson & Brown, 1935; Quarrington, Conway, & Siegel, 1962) yet the typical range of variability experienced by speakers remains unknown. This study will examine the speech of six adult speakers in three spontaneous speaking situations and two reading tasks. The frequency, duration, and types of stuttered events that occur on the tasks will be compared within and between speakers. The focus will be on describing variability in stuttering frequency and duration within speakers and attempting to detect consistent patterns between speakers

Bridging the gap in internet treatments for mental health: A fully automated online cognitive behaviour therapy for social anxiety for those who stutter.

Introduction: CBTpsych.com is a fully functional intervention that aims at bridging the gap between Eliza (Weizenbaum, 1966) and modern internet treatments for anxiety disorders (Helgadottir, Menzies, Onslow, Packman & O‟Brien, 2009a). A Phase I trial demonstrated that two participants no longer met the diagnosis of social phobia on the DSM-IV and ICD-10 after being treated by CBTpsych.com. The quality of the interaction appeared to be similar to face-to-face therapy. The automated techniques were successful in engaging the participants and in encouraging them to log on regularly and complete the treatment (Helgadottir, Menzies, Onslow, Packman & O‟Brien, 2009b). The current study is a phase II trial targeting social anxiety in stuttering. Method: File audit data were gathered from 10 years of experience in the psychological management of social anxiety and stuttering (St Clare et al., 2008). This data was used to create a fully automated human-like intervention using algorithms alone. CBTpsych.com creates cognitive restructuring exercises, behavioural experiments, and negative thoughts checklists for the automated treatment program. Furthermore, other features such as imagery rescripting were incorporated to adhere to the Clark D. M. and Wells (1995) model of social anxiety treatment. 18 participants presenting for treatment of stuttering with social anxiety at the Australian Stuttering Research Centre (ASRC) were offered 5 months access to the “computer psychologist”. 16 participants started using the computer program. The treatment did not involve any contact with clinical psychologists at the ASRC. Results: Post-treatment analysis revealed that of the 16 participants who started using the program, 78% no longer met the criteria for social phobia. Furthermore, none of the 10 participants who completed all 7 sections of the computer program within 5 months had social phobia diagnosis at post-treatment. Consequently, in this study the “computer psychologist” was able to identify the specific problem areas participants reported and to design individualized formulations and tailored treatment components with corrective feedback. Furthermore, participants were able to engage in highly specific cognitive restructuring exercises, and with the help of the computer psychologist managed to build behavioural experiments to test out unhelpful cognitions. Data from this Phase II trial suggest that the computerised treatment protocol can lead to substantial reductions in anxiety and avoidance, and improve mood and quality of life as measured by the FNE, SPAI, BDI-II, UTBAS, SASS and OASES. Conclusions: The computer psychologist motivated people both to log on regularly (with use of an automated email process) and to complete the program. It engaged clients in detailed cognitive restructuring work, creating successful behavioural experiments for exposure, and producing promising preliminary results. However, these results need to be tested in a randomized controlled trial to establish efficacy. A RCT is currently under way. The preliminary findings presented here suggest that it would be viable to develop this type of treatment intervention for other anxiety disorders. Limitations of this approach and suggestions for future research are discussed

The state of the art in non-pharmacological interventions for developmental stuttering. Part 2: qualitative evidence synthesis of views and experiences.

BACKGROUND: A range of interventions have been developed to treat stuttering in recent years. The effectiveness of these interventions has largely been assessed in studies focusing on the impact of specific types of therapy on patient outcomes. Relatively little is known about the factors that influence how the delivery and impact of different types of intervention may be experienced from the perspective of both people who deliver as well as those who receive interventions. AIMS: To synthesize the available evidence in relation to factors that might enhance or mitigate against successful outcomes following interventions for stuttering by identifying and synthesizing relevant qualitative research that explored the experiences of people delivering and receiving interventions that aim to improve fluency. METHODS & PROCEDURES: We carried out a systematic review including research that had used in-depth interviews and focus groups and conducted a substantive qualitative analysis of the data collected. Included study populations were either adults or children affected by a diagnosed stutter and/or providers of therapy for stuttering. An iterative approach was used to search for published qualitative evidence in relevant databases from 1990 to 2014. Retrieved citations were sifted for relevance and the data from articles that met the inclusion criteria were extracted. Each included paper was assessed for quality and a thematic analysis and synthesis of findings was carried out. MAIN CONTRIBUTION: Synthesized qualitative evidence highlights the changing experiences for people who stutter both historically and, for individuals, over the life course. Barriers and facilitators to the implementation of interventions for stuttering are encountered at the individual, intervention, interpersonal and social levels. Interventions may be particularly pertinent at certain transition points in the life course. Attention to emotional as well as practical aspects of stuttering is valued by people receiving therapy. The client-therapist relationship and support from others are also key factors in achieving successful outcomes. CONCLUSIONS & IMPLICATIONS: A synthesis of qualitative findings from published papers has added to the effectiveness data reported in an accompanying paper in understanding how stuttering impacts on people across the life course. Evidence suggests that a client-centred and individually tailored approach enhances the likelihood of successful intervention outcomes through attention to emotional, situational and practical needs

The state of the art in non-pharmacological interventions for developmental stuttering. Part 1: a systematic review of effectiveness

Background The growing range of available treatment options for people who stutter presents a challenge for clinicians, service managers and commissioners, who need to have access to the best available treatment evidence to guide them in providing the most appropriate interventions. While a number of reviews of interventions for specific populations or a specific type of intervention have been carried out, a broad-based systematic review across all forms of intervention for adults and children was needed to provide evidence to underpin future guidelines, inform the implementation of effective treatments and identify future research priorities. Aims To identify and synthesize the published research evidence on the clinical effectiveness of the broad range of non-pharmacological interventions for the management of developmental stuttering. Methods & Procedures A systematic review of the literature reporting interventions for developmental stuttering was carried out between August 2013 and April 2014. Searches were not limited by language or location, but were restricted by date to studies published from 1990 onwards. Methods for the identification of relevant studies included electronic database searching, reference list checking, citation searching and hand searching of key journals. Appraisal of study quality was performed using a tool based on established criteria for considering risk of bias. Due to heterogeneity in intervention content and outcomes, a narrative synthesis was completed. Main Contribution The review included all available types of intervention and found that most may be of benefit to at least some people who stutter. There was evidence, however, of considerable individual variation in response to these interventions. The review indicated that effects could be maintained following all types of interventions (although this was weakest with regard to feedback and technology interventions). Conclusions This review highlights a need for greater consensus with regard to the key outcomes used to evaluate stuttering interventions, and also a need for enhanced understanding of the process whereby interventions effect change. Further analysis of the variation in effectiveness for different individuals or groups is needed in order to identify who may benefit most from which intervention

Life Partner Perceptions of the Emotional Impact of Stuttering

The aim of the present study is to investigate the extent to which life partners understand the emotional impact stuttering has on their loved one who stutters. This was accomplished by administering the Speech Situation Checklist - Emotional Reaction (SSC-ER), a subtest of the Behavior Assessment Battery (BAB; Vanryckeghem & Brutten, 2018) via Qualtrics, an online survey software, to the participants who stutter and a modified version of the SSC-ER to their life partner. No significant differences and a positive correlation were observed between groups (people who stutter (PWS) and their life partner (LP) as it relates to total score on the SSC-ER. Gender, age, and duration of relationship, overall, were not confounding variables that affected the total score. Internal reliability was high across both the SSC-ER and its modified version. All items on the test correlated significantly with the total score with the exception of items 8 and 13 for PWS and items 6, 13, and 36 for LPs. Between-group item analysis revealed that the majority of test items did not differ significantly with the exception of six items: 3, 4, 13, 19, 26, and 27. The aforementioned items follow the construct pertaining to fixed sounds and/or words. The findings in this investigation provide evidence that LPs have a general understanding of the anxiety levels their partner who stutters experiences as it relates to communication situations

Webcam Delivery of the Lidcombe Program for Preschool Children Who Stutter: A Randomised Controlled Trial

Early intervention provides children who stutter with the best opportunity to avoid the lifelong complications associated with stuttering. Access to effective treatment, in particular, the Lidcombe Program, provides preschool children with the best chance to overcome their stuttering. Currently many children are unable to access such efficacious treatment due to distance and lifestyle factors. One solution to this problem is to deliver the treatment via webcam over the internet. This service delivery model was designed to increase access to timely, best-practice intervention for those who are currently unable to access treatment. That model was thought to be able to produce efficiency rates similar to those of traditional clinic treatment. Further, it provides a method of service delivery that: (1) improves access to evidence-based best-practice stuttering treatment for children, (2) improves access to specialist speech pathologists and quality services, (3) reduces costs and resources involved with outreach service provision, (4) provides more convenient home-based treatment for young children, and (5) ensures more equitable service delivery for rural and remote preschool children and their families. A Phase I study showed that webcam delivery of the Lidcombe Program was a viable treatment delivery model (O’Brian, Smith & Onslow, 2012). This thesis further investigates delivery of the Lidcombe Program for preschool children using the internet and a webcam. The modification in this project, compared to previous, low-tech telehealth (phone and mail) trials of the Lidcombe Program, allowed the principles of standard delivery of the Lidcombe Program to remain relatively unchanged. This was due primarily to the use of a webcam and live videoconferencing. The speech pathologist-parent-child triad was preserved, with all parties having clinic contact. Real-time measurements, observation and education for parent implementation of the program were also achieved through this medium. Thus, treatment could be delivered mostly in accordance with the program treatment guide (Packman et al., 2011, p. 1). The design for this project was a parallel, open plan, Phase III noninferiority randomised controlled trial (RCT). The control group received standard delivery of the Lidcombe Program (Packman, et al., 2011) in a traditional clinic setting. The experimental group received the Lidcombe Program within their homes using a computer, a webcam, the internet and a live video calling program (Skype). The primary outcome measures – the number of consultations and speech pathologist hours to attain entry into Stage 2 – evaluated treatment efficiency. The secondary outcomes – stuttering reduction as measured by parent evaluated severity ratings, investigated treatment efficacy, as did quantitative and qualitative data obtained from parent questionnaires. The number of weeks to attain Stage 2 entry was also measured. Initially, 66 children were assessed for this trial. Eleven were ineligible and six withdrew during the assessment process, with 49 participants being randomised. Of these, 24 were assigned to the control arm and 25 to the experimental arm. Due to time restrictions associated with the student’s candidature, not all 18-month data were collected in time for inclusion in this thesis. Pretreatment data are reported for all 49 participants. Data for all 43 participants active in the trial 9 months postrandomisation are also reported. Stage 2 entry data are available for the 35 participants (71% of the total cohort) who reached Stage 2 by December 31st 2012. Results for both groups showed no significant difference between the number of consultations and the number of weeks to Stage 2. Efficacy measures showed no significant difference between the groups in stuttering reduction. A further secondary outcome measure was parent responses to a questionnaire at entry into Stage 2. Similarly, there was no significant difference between the two groups when asked about speech pathologist-child rapport, speech pathologist-parent rapport, ease of learning treatment, severity ratings and ability to adapt treatment. Further, two-thirds of clinic families said they would choose webcam treatment in the future. Webcam parents reported no difficulty in seeking out their own resources and did not feel treatment within their home was invasive. Webcam families listed convenience and comfort as the main advantages of webcam treatment, with technical difficulties as the main disadvantage. All webcam families would choose this same method for future stuttering treatment. The thesis concludes with a discussion of the speech pathologist’s role, consultation logistics and additional qualitative observations from the webcam group. These include convenience, treatment readiness, defining clinical space, trends in clinical transfer, clinical application, limitations and future directions. Overall, this thesis demonstrates that the findings from a Phase III RCT investigating the efficiency and efficacy of stuttering treatment for preschool support the use of webcam and internet to increase access to timely and appropriate stuttering intervention. The potential for community translation of these findings is considerable; children as young as 3 years of age can receive the same stuttering treatment within their homes as they would within a clinic; they can expect no difference in outcomes or experience. This is significant given that children as young as 2 years of age can be negatively affected by their stuttering. No longer do children who stutter need to be disadvantaged by where they live or by the skills of the closest speech pathologist. They can now access evidence-based treatment within their homes

Webcam Delivery of the Lidcombe Program for Preschool Children Who Stutter: A Randomised Controlled Trial

Early intervention provides children who stutter with the best opportunity to avoid the lifelong complications associated with stuttering. Access to effective treatment, in particular, the Lidcombe Program, provides preschool children with the best chance to overcome their stuttering. Currently many children are unable to access such efficacious treatment due to distance and lifestyle factors. One solution to this problem is to deliver the treatment via webcam over the internet. This service delivery model was designed to increase access to timely, best-practice intervention for those who are currently unable to access treatment. That model was thought to be able to produce efficiency rates similar to those of traditional clinic treatment. Further, it provides a method of service delivery that: (1) improves access to evidence-based best-practice stuttering treatment for children, (2) improves access to specialist speech pathologists and quality services, (3) reduces costs and resources involved with outreach service provision, (4) provides more convenient home-based treatment for young children, and (5) ensures more equitable service delivery for rural and remote preschool children and their families. A Phase I study showed that webcam delivery of the Lidcombe Program was a viable treatment delivery model (O’Brian, Smith & Onslow, 2012). This thesis further investigates delivery of the Lidcombe Program for preschool children using the internet and a webcam. The modification in this project, compared to previous, low-tech telehealth (phone and mail) trials of the Lidcombe Program, allowed the principles of standard delivery of the Lidcombe Program to remain relatively unchanged. This was due primarily to the use of a webcam and live videoconferencing. The speech pathologist-parent-child triad was preserved, with all parties having clinic contact. Real-time measurements, observation and education for parent implementation of the program were also achieved through this medium. Thus, treatment could be delivered mostly in accordance with the program treatment guide (Packman et al., 2011, p. 1). The design for this project was a parallel, open plan, Phase III noninferiority randomised controlled trial (RCT). The control group received standard delivery of the Lidcombe Program (Packman, et al., 2011) in a traditional clinic setting. The experimental group received the Lidcombe Program within their homes using a computer, a webcam, the internet and a live video calling program (Skype). The primary outcome measures – the number of consultations and speech pathologist hours to attain entry into Stage 2 – evaluated treatment efficiency. The secondary outcomes – stuttering reduction as measured by parent evaluated severity ratings, investigated treatment efficacy, as did quantitative and qualitative data obtained from parent questionnaires. The number of weeks to attain Stage 2 entry was also measured. Initially, 66 children were assessed for this trial. Eleven were ineligible and six withdrew during the assessment process, with 49 participants being randomised. Of these, 24 were assigned to the control arm and 25 to the experimental arm. Due to time restrictions associated with the student’s candidature, not all 18-month data were collected in time for inclusion in this thesis. Pretreatment data are reported for all 49 participants. Data for all 43 participants active in the trial 9 months postrandomisation are also reported. Stage 2 entry data are available for the 35 participants (71% of the total cohort) who reached Stage 2 by December 31st 2012. Results for both groups showed no significant difference between the number of consultations and the number of weeks to Stage 2. Efficacy measures showed no significant difference between the groups in stuttering reduction. A further secondary outcome measure was parent responses to a questionnaire at entry into Stage 2. Similarly, there was no significant difference between the two groups when asked about speech pathologist-child rapport, speech pathologist-parent rapport, ease of learning treatment, severity ratings and ability to adapt treatment. Further, two-thirds of clinic families said they would choose webcam treatment in the future. Webcam parents reported no difficulty in seeking out their own resources and did not feel treatment within their home was invasive. Webcam families listed convenience and comfort as the main advantages of webcam treatment, with technical difficulties as the main disadvantage. All webcam families would choose this same method for future stuttering treatment. The thesis concludes with a discussion of the speech pathologist’s role, consultation logistics and additional qualitative observations from the webcam group. These include convenience, treatment readiness, defining clinical space, trends in clinical transfer, clinical application, limitations and future directions. Overall, this thesis demonstrates that the findings from a Phase III RCT investigating the efficiency and efficacy of stuttering treatment for preschool support the use of webcam and internet to increase access to timely and appropriate stuttering intervention. The potential for community translation of these findings is considerable; children as young as 3 years of age can receive the same stuttering treatment within their homes as they would within a clinic; they can expect no difference in outcomes or experience. This is significant given that children as young as 2 years of age can be negatively affected by their stuttering. No longer do children who stutter need to be disadvantaged by where they live or by the skills of the closest speech pathologist. They can now access evidence-based treatment within their homes