Temperament, anxiety, and depression in school-age children who stutter.

PURPOSE: The main aim of this study was to gain insight into whether temperament and/or stuttering severity were associated with anxiety and depression in children who stutter. Additionally, the study also provided an indication into the prevalence of anxiety and depression in children who stutter in a clinical cohort. METHOD: The participants were 132 English-speaking children (105 boys and 27 girls) between 9;0 and 14;11 years old (M = 11;8, SD = 1;10) and their mothers. At their first visit to a specialist center for children who stutter, mothers and children completed the relevant versions of the Early Adolescent Temperament Questionnaire-Revised (EATQ-R; Ellis & Rothbart, 2001) and a screening of children's anxiety and depression, using the Revised Children's Anxiety and Depression Scale (RCADS; Chorpita et al., 2000). Stuttering was evaluated using the Stuttering Severity Instrument Fourth Edition (SSI-4). Correlations were conducted between child and parent versions of the EATQ-R and RCADS; EATQ-R and RCADS; as well as the SSI-4 and RCADS. A comparison was made between those children who scored below the clinical threshold for anxiety and depression, and those who scored above. RESULTS: Significant correlations were found for all mother and child EATQ-R factors and RCADS scales (except for Obsessive Compulsive Disorder). Correlations were also found between the child- and mother-reported temperament factors of positive reactivity, negative reactivity, and self-regulation and anxiety and depression. Children who scored above the clinical threshold for any category of anxiety or depression had significantly lower positive reactivity and higher negative reactivity scores, compared to those who scored below the threshold. There were no differences between the two groups with regard to SSI-4 scores. CONCLUSIONS: This is the first study to evaluate associations between temperament and anxiety and depression in children who stutter. Higher negative reactivity scores and lower positive reactivity and self-regulation scores are associated with elevated levels of anxiety and depression in children who stutter. Further, those who score above the clinical threshold have significantly higher levels of negative reactivity and lower levels of positive reactivity compared to those scoring below the threshold. Findings suggest that levels of anxiety that reach clinical threshold are more prevalent in children who stutter than would be expected based on population data. Current findings have implications for both the assessment and therapy of children who stutter presenting at clinics for support.

Introduction to the Special Issue: The 11th Oxford Dysfluency Conference.

Purpose: The purpose of this introduction is to provide an overview of the articles in this special issue of AJSLP. These articles originated from the presentations at the 11th Oxford Dysfluency Conference in September 2017.

The Most Important Therapy Outcomes for School-Aged Children Who Stutter: An Exploratory Study.

Purpose: The aim of this article was to identify what school-aged children who stutter consider to be the most important outcomes from therapy. Method: A Delphi approach was employed for the study. Eighteen participants aged 9-13 years completed a survey, generating 90 statements that would constitute successful therapy outcomes. After categorization and reduction, 79 statements were sent to participants in a second survey to seek consensus on their importance. Fifteen participants aged 8-14 years completed this second survey. Statements with the highest median ratings and smallest standard deviations were retained. Results: Twenty-one statements were retained after analysis. These reflected hopes for affective and behavioral change in the young person and in other people after therapy. Important outcomes included, but are not limited to, increased fluency, greater independence, increased confidence at school, others knowing how to support the individual, and communication situations feeling easier. Conclusions: Participants identified a range of outcomes that were important to achieve as a result of speech and language therapy. The findings suggest a need for a more holistic view of what is meant by successful therapy, incorporating improvements in the ability to communicate and participate in daily situations. The findings suggest that an integrated or holistic approach to intervention would be required to achieve these goals and should include significant others from the child's environment. The important statements identified in this study could be used to inform the content of therapy and to evaluate change over time. Supplemental Material: https://doi.org/10.23641/asha.7144205.

Palin Parent-Child Interaction Therapy: The Bigger Picture.

Purpose: Palin Parent-Child Interaction therapy (Kelman & Nicholas, 2008) is an evidence-based intervention for young children who stutter. The evidence consists of multiple single-subject replicated studies, and this demonstrates that the intervention is effective. The aim of this study was to enhance the evidence base by exploring the effectiveness of the therapy with a large cohort of children who stutter. Method: Children and parents completed a range of assessments at 4 time points: start of therapy and then 3, 6, and 12 months later. The following variables were included: stuttering frequency, child's communication attitude, parents' perception of the impact of the stuttering on the child, the severity of stuttering and its impact on the parents, and their knowledge of stuttering and confidence in managing it. Hierarchical multiple regression analyses were conducted to explore whether the variables are predictive for the outcome "parent knowledge and confidence." In addition, we sought a preliminary view of factors associated with outcome level by separating children into 2 groups according to response to treatment (more successful and less successful). Results: The results demonstrated a significant improvement in all variables, and this improvement was maintained for 1 year posttreatment. Measures collected 3 months after the start of therapy showed significant improvement in child attitude to communication, parents' knowledge and confidence in how to manage stuttering, and mothers' ratings of stuttering severity and impact the child's stuttering has on the mothers. By 6 months after therapy onset, there was a significant reduction in stuttering frequency and fathers' perception of severity and their worry about it. Furthermore, these improvements were maintained 1 year posttherapy. Several variables predicted parents' knowledge and confidence 6 months after the start of therapy. Finally, those who made greater improvements had mothers who were more negative in their ratings of severity and worry, and had less knowledge and confidence at the start of therapy. There were no differences between the groups on a range of other variables. Conclusions: The results demonstrate that, over a year, children who attend a course of Palin Parent-Child Interaction show reduced stuttering frequency and a more positive attitude to speech. In addition, parents observe these improvements in the child, feel more confident in managing the stuttering, and are less worried about it. The different times at which specific variables significantly improved provides insight to a process of change over time. Results suggest that parents' ability to notice positive change in fluency and the impact that these observations have on both the child and the family are linked to their confidence in how to support the child. The preliminary findings with regard to response to treatment suggest that children can benefit from this program even with factors that might be predicted to reduce therapy success.

The Palin Parent Rating Scales: Parents' Perspectives of Childhood Stuttering and Its Impact.

Purpose: The goal of this study is to explore the psychometric properties of the Parent Rating Scales-V1 (S. K. Millard, S. Edwards, & F. M. Cook, 2009), an assessment tool for parents of children who stutter, and to refine the measure accordingly. Method: We included 259 scales completed prior to therapy. An exploratory factor analysis determined the test constructs and identified the items that had greatest loadings on those factors. Items that did not load on the factors were removed, and normative scores calculated. Results: The resulting 19-item questionnaire measures three factors: (a) the impact of stuttering on the child; (b) the severity of stuttering and its impact on the parents; and (c) the parents' knowledge about stuttering and confidence in managing it. Reliability was demonstrated, norms established, and an automated online version constructed. Conclusions: The Palin Parent Rating Scale is a valid and reliable tool, providing a method of exploring parents' perceptions of stuttering, the impact it has on the child and themselves, and the parents' knowledge of and confidence in managing the stuttering. This is an important addition to the existing range of assessments that may be used to evaluate stuttering in children up to age 14;6 (years;months) and allows the wider targets of parent-led therapy programs to be evaluated.

The Stammering Information Programme: a Delphi study.

PURPOSE: To find out what information children, parents and education staff feel would be important to know to support a child who stutters in the educational environment, in order to develop appropriate resources. METHOD: A Delphi study was carried out to seek the opinions of experts about the information to include. A structured six stage process was completed in order to gain consensus within four expert panels: children who stutter (CWS) aged 7-11 (n=25); young people who stutter aged 12-18 (n=27); parents of children and young people who stutter aged 2-18 (n=67); and members of the education workforce (n=35). RESULTS: In response to the questions, 538 statements were generated across the four expert panels, categorised and reduced to 276. Of the 154 rating questionnaires sent out, 99 were returned (64.2% response rate). The top 32 statements, which were those most highly rated and with the greatest consensus, were retained to inform the resources. CONCLUSIONS: This study demonstrates the value of including service users when devising materials aimed for the benefit of CWS. The methodology employed ensured that ideas, perceptions and needs were representative of a range of people who experience stuttering from different perspectives. The results indicated that each expert panel had different priorities of what should be included. The resulting resources may therefore be considered to have high content validity and would be predicted to meet the needs of those who require them. EDUCATIONAL OBJECTIVES: The reader will be able to (1) define the Delphi Approach (2) discuss the development of a user led resource for raising awareness about stuttering.

Working with young children who stutter: raising our game.

Several therapy programs have been demonstrated to be effective in supporting the development of fluency in preschool children who stutter. However, there is increasing evidence in allied fields suggesting that a positive therapy outcome cannot be entirely attributed to the therapy program itself, but also depends on what the therapist brings to the therapeutic context. This article seeks to discuss the therapist's skills and attributes that play a part in the development of the therapeutic alliance, which underpins therapy involving parents of young children who stutter. Using a model of clinical expertise development, the article discusses the attributes and skills that are necessary for the development of expertise, along with the behavioral and cognitive changes that evolve as a therapist becomes increasingly expert at using one particular program, Palin Parent-Child Interaction Therapy.

Is parent-child interaction therapy effective in reducing stuttering?

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.