Lidcombe Program telehealth treatment for children 6–12 years of age: A Phase II trial

Background: For children older than 6 years who stutter, there is a gap in clinical research. This is an issue for speech-language pathologists because the tractability of stuttering decreases and the risk of long-term psychological consequences increase with age. Purpose: To report a Phase II trial of a telehealth version of the Lidcombe Program with school-age children. Methods: Participants were 37 children who stuttered, 6–12 years of age, from Australia, New Zealand, Hong Kong, and Singapore. Parents were trained by video telehealth how to deliver the Lidcombe Program to their child. Primary and secondary outcomes were stuttering severity and psychosocial functioning measured pre-treatment and at 6 months and 12 months after starting treatment. Parents submitted two 10-minute recordings of their child speaking in conversation, and three measures of anxiety, impact of stuttering, and communication attitude. Results: Six months after starting treatment, seven children (18.9%) attained Lidcombe Program Stage 2 criteria, 25 children (67.6%) showed a partial response to treatment, and five children (13.5%) showed no response. By 12 months, 12 children (32.4%) had reached Stage 2 criteria. Psychosocial improvements were observed 6 and 12 months after starting treatment. Conclusions: The Lidcombe Program may eliminate or nearly eliminate stuttering for about one third of children 6–12 years of age. Randomized controlled trials with this age group involving the Lidcombe Program are warranted. In the interim, the Lidcombe Program is a clinical option clinicians can implement with this age group to reduce stuttering and its psychosocial impacts.</p

Early stuttering, temperament and anxiety

© 2012 Dr. Elaina KefalianosMany stuttering adults and adolescents experience speech-related anxiety. This relationship has not been examined in the preschool population. Given this, it is unknown whether stuttering preschool children also exhibit anxiety traits. Particular temperament traits have been identified as precursors of anxiety. Temperament refers to the way an individual reacts to or interacts with their environment. While the expression of temperament traits is largely genetically determined, it is also influenced by environmental factors. Variations in the expression of temperament traits between individuals are observed as personality traits. Two hypotheses regarding the relationship between temperament and early stuttering have been discussed in the literature. The first is that temperament is associated with the development of stuttering. Certain temperament traits are theorised to influence the onset, development and maintenance of the disorder. The second hypothesis is that temperament differences arise as an effect of stuttering. Stuttering preschool children can experience negative communication interactions. It is therefore possible that those negative interactions may influence the expression of temperament traits, particularly the precursors of anxiety. Further exploration of the relationship between temperament and early stuttering is crucial in order to ascertain which of the above hypotheses is true. Knowledge about the expression of temperament traits is required in order to determine whether stuttering children express temperament traits differently from non-stuttering children as well as to determine whether they have a heightened risk of developing anxiety. This doctoral study was embedded within the Early Language in Victoria Study (ELVS). ELVS has a prospective, longitudinal design. The overall aim of ELVS was to examine the epidemiology and evolution of communication impairments, including stuttering, from infancy through to 7 years. The aim of the present study was to investigate the expression of temperament traits, including the precursors of anxiety, among stuttering children in ELVS. Data were collected with a prospective, longitudinal cohort design. In total, 1444 children were recruited into this study. By 4 years, 173 children had been confirmed as stuttering and 1271 children were assigned to the non-stuttering group. Temperament data were collected using a parent-report scale which was included in annual parent completed questionnaires from 2-4 years. During this time, parents of stuttering participants also completed a stuttering questionnaire at 12 consecutive, monthly home visits, immediately post stuttering onset. At 6 and 7 years, temperament and stuttering behaviour data were collected from stuttering participants in annual parent completed questionnaires. The results from this study revealed little evidence of differences between stuttering and non-stuttering preschool children’s expression of temperament traits, including the precursors of anxiety, up to 4 years. There was little evidence of associations between various stuttering behaviours and the expression of temperament traits amongst stuttering participants. These findings suggest that within this study’s cohort, stuttering children were not at greater risk of developing anxiety compared to non-stuttering children and the range of stuttering characteristics exhibited by stuttering children did not influence the expression of their temperament traits, including the precursors of anxiety

Language development and stuttering preschool children

Language development Developing language skills is one of the most important tasks of early childhood; language is at the foundation of all of the skills that children need for life. When children have a language impairment, they can struggle to make and keep friends, negotiate new experiences and to self regulate. Long-term, children with a language impairment can have poorer mental health, poorer education and employment outcomes, and are more likely to engage in criminal activity and other anti-social behaviour. For some children, developing good language skills does not come easily or occur at the same rate as their age peers. For all children, progress towards developing language skills can have considerable natural variability. Connecting children who are experiencing communication problems with the right support and interventions can have a significant impact on their lives. However, the combination of variable natural development and lengthy waiting lists can make referring children and families for additional therapy and assessment complex. Stuttering preschool children Stuttering in the preschool years can be anxiety-provoking for parents, but does it necessarily indicate long-term social and emotional issues for the stuttering child? The Centre of Research Excellence in Child Language has examined stuttering in detail through the Early Language in Victoria (ELVS) study. The impacts of stuttering Stuttering is a well-known communication difficulty characterised by interruptions to speech. It can involve repeating sounds or words, prolonging sounds, ‘blocks’ or trouble making any sounds, as well as non-verbal signs of tension such as blinking or grimacing. A child who stutters may feel that their words ‘get stuck’. Stuttering usually starts in the preschool years. Stuttering that persists into adolescence or adulthood can affect psychological health through social phobias, educational underachievement and reduced social wellbeing. These articles have been adapted from two Centre of Research Excellence - Child Language Research Snapshots

Anxiety of children and adolescents who stutter : a review

Purpose: Adults who stutter have heightened rates of anxiety disorders, particularly social anxiety disorder, compared with non-stuttering controls. However, the timing of anxiety onset and its development in relation to stuttering is poorly understood. Identifying the typical age of anxiety onset in stuttering has significant clinical implications and is crucial for the management of both disorders across the lifespan. The present review aims to determine the scope of the research pertaining to this topic, identify trends in findings, and delineate timing of anxiety onset in stuttering. Methods: We examine putative risk factors of anxiety present for children and adolescents who stutter, and provide a review of the research evidence relating to anxiety for this population. Results: Young people who stutter can experience negative social consequences and negative attitudes towards communication, which is hypothesised to place them at increased risk of developing anxiety. The prevalence of anxiety of young people who stutter, and the timing of anxiety onset in stuttering could not be determined. This was due to methodological limitations in the reviewed research such as small participant numbers, and the use of measures that lack sensitivity to identify anxiety in the targeted population. Conclusions: In sum, the evidence suggests that anxiety in stuttering might increase over time until it exceeds normal limits in adolescence and adulthood. The clinical implications of these findings, and recommendations for future research, are discussed.Educational Objectives: The reader will be able to: (a) discuss contemporary thinking on the role of anxiety in stuttering and reasons for this view; (b) describe risk factors for the development of anxiety in stuttering, experienced by children and adolescents who stutter (c) outline trends in current research on anxiety and children and adolescents with stuttering; and (d) summarise rationales behind recommendations for future research in this area.13 page(s

Systematic review of implementation quality of non-pharmacological stuttering intervention trials for children and adolescents

Purpose: This narrative systematic review in line with PRISMA guidelines aims to investigate the implementation quality of previously published group comparison clinical trials of stuttering interventions for children and adolescents (under age 18 years). Methods: We searched for publications in the databases Eric, PsychInfo, PubMed and Web of Science using the search terms ‘stutt*’ or ‘stamm*’and ‘intervention’, ‘trial’ or ‘treatment’. We reviewed the implementation elements reported in studies and how these elements were used to report intervention outcomes. Results: 3,017 references published between 1974–2019 were identified. All references were screened for eligibility using predefined selection criteria resulting in 21 included studies. The implementation quality details reported varied between studies. Existing studies most commonly lacked details about the support system provided to SLPs administering the interventions and monitoring of treatment fidelity both in the clinical setting and in the home environment. Support systems for participant’s parents and treatment dosage were generally well reported. Dosage was the most common implementation quality element considered in analyses of treatment effect and within discussions of findings. Conclusion: Findings highlight the need for future clinical trials of stuttering interventions to closely adhere to systematic guidelines for reporting implementation quality to ensure reliability of trial outcomes. A checklist for reporting clinical trials of non-pharmacological stuttering interventions is proposed

Interventions for children and adolescence who stutter : A systematic review, meta-analysis, and evidence map

Purpose This systematic review critically appraises and maps the evidence for stuttering interventions in childhood and adolescence. We examine the effectiveness of speech-focused treatments, the efficacy of alternative treatment delivery methods and identify gaps in the research evidence. Methods Nine electronic databases and three clinical trial registries were searched for systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with children (2–18 years) who stutter. Pharmacological interventions were excluded. Primary outcomes were a measure of stuttering severity and quality assessments were conducted on all included studies. Results Eight RCTs met inclusion criteria and were analysed. Intervention approaches included direct (i.e. Lidcombe Program; LP) and indirect treatments (e.g. Demands and Capacities Model; DCM). All studies had moderate risk of bias. Treatment delivery methods included individual face-to-face, telehealth and group-based therapy. Both LP and DCM approaches were effective in reducing stuttering in preschool aged children. LP had the highest level of evidence (pooled effect size=-3.8, CI -7.3 to -0.3 for LP). There was no high-level evidence for interventions with school-aged children or adolescents. Alternative methods of delivery were as effective as individual face-to-face intervention. Conclusion The findings of this systematic review and evidence mapping are useful for clinicians, researchers and service providers seeking to understand the existing research to support the advancement of interventions for children and adolescence who stutter. Findings could be used to inform further research and support clinical decision-making

A systematic review of interventions for adults who stutter

Purpose To examine the effectiveness of (i) face to face interventions (ii) models of service delivery and (iii) psychological treatments combined with speech-focused interventions for adults who stutter. Methods Five electronic databases and three clinical trial registries were searched. Systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with adults who stutter were included. Pharmaceutical interventions were excluded. Primary outcomes included a measure of stuttering severity. Risk of bias assessment was conducted on included studies and overall quality of the evidence was graded. Results Five RCTS, four registered trials and three systematic reviews met inclusion criteria. Intervention approaches included speech restructuring programs (e.g. Camperdown Program) and transcranial direct current stimulation (tDCS). One study investigated cognitive behaviour therapy (CBT) alongside speech restructuring. Overall, studies were classified low risk of bias and good quality. Speech restructuring was included in all but one study (tDCS study) and had the most evidence i.e. supported by the greatest number of RCTs. On average, stuttering frequency was reduced by 50–57 % using speech restructuring approaches. No study reduced stuttering to the same level as community controls who don’t stutter. The study on tDCS reduced stuttering frequency by 22–27 %. Speech restructuring delivered via telehealth was non-inferior to face-to-face intervention. One study reported CBT was an effective adjunct to speech restructuring interventions. Conclusion Speech restructuring interventions were found to reduce stuttering in adults, however degree and maintenance of fluency varied. The body of evidence surrounding tDCS and psychological interventions is limited. Replication studies should be considered

Systematic review of implementation quality of non-pharmacological stuttering intervention trials for children and adolescents

Purpose This narrative systematic review in line with PRISMA guidelines aims to investigate the implementation quality of previously published group comparison clinical trials of stuttering interventions for children and adolescents (under age 18 years). Methods We searched for publications in the databases Eric, PsychInfo, PubMed and Web of Science using the search terms ‘stutt*’ or ‘stamm*’and ‘intervention’, ‘trial’ or ‘treatment’. We reviewed the implementation elements reported in studies and how these elements were used to report intervention outcomes. Results 3,017 references published between 1974–2019 were identified. All references were screened for eligibility using predefined selection criteria resulting in 21 included studies. The implementation quality details reported varied between studies. Existing studies most commonly lacked details about the support system provided to SLPs administering the interventions and monitoring of treatment fidelity both in the clinical setting and in the home environment. Support systems for participant’s parents and treatment dosage were generally well reported. Dosage was the most common implementation quality element considered in analyses of treatment effect and within discussions of findings. Conclusion Findings highlight the need for future clinical trials of stuttering interventions to closely adhere to systematic guidelines for reporting implementation quality to ensure reliability of trial outcomes. A checklist for reporting clinical trials of non-pharmacological stuttering interventions is proposed

Systematic review of implementation quality of non-pharmacological stuttering intervention trials for children and adolescents

Purpose: This narrative systematic review in line with PRISMA guidelines aims to investigate the implementation quality of previously published group comparison clinical trials of stuttering interventions for children and adolescents (under age 18 years). Methods: We searched for publications in the databases Eric, PsychInfo, PubMed and Web of Science using the search terms ‘stutt*’ or ‘stamm*’and ‘intervention’, ‘trial’ or ‘treatment’. We reviewed the implementation elements reported in studies and how these elements were used to report intervention outcomes. Results: 3,017 references published between 1974–2019 were identified. All references were screened for eligibility using predefined selection criteria resulting in 21 included studies. The implementation quality details reported varied between studies. Existing studies most commonly lacked details about the support system provided to SLPs administering the interventions and monitoring of treatment fidelity both in the clinical setting and in the home environment. Support systems for participant’s parents and treatment dosage were generally well reported. Dosage was the most common implementation quality element considered in analyses of treatment effect and within discussions of findings. Conclusion: Findings highlight the need for future clinical trials of stuttering interventions to closely adhere to systematic guidelines for reporting implementation quality to ensure reliability of trial outcomes. A checklist for reporting clinical trials of non-pharmacological stuttering in-terventions is proposed

Non-pharmacological interventions for stuttering in children aged between birth and six years

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Primary objective To assess the immediate and long‐term effects of non‐pharmacological interventions for stuttering on speech outcomes in children aged between birth and six years. Secondary objective To describe the relationship between intervention effects and participant characteristics (i.e. child age, child’s communication attitudes and the impact stuttering has on the child’s QoL)