Contemporary clinical conversations about stuttering: Neurodiversity and ableism.

PURPOSE: To discuss issues about neurodiversity and ableism, and how they pertain to clinical management of stuttering, with particular reference to early childhood stuttering. METHODS: During a webinar this year, the issue emerged of how concepts of neurodiversity and ableism apply to early childhood stuttering during the pre-school years. It became apparent that this topic elicited disparate views and would be of particular interest to students of speech-language pathology. Consequently, the leaders of that webinar continued the conversation by written dialogue for the purpose of placing it on record. RESULTS: The discussants reached agreement on many points, but there was some diversity of viewpoint about how neurodiversity and ableism should apply to clinical practice with children who have recently begun to stutter.

No other choice: Speech-Language Pathologists' attitudes toward using telepractice to administer the Lidcombe Program during a pandemic.

PURPOSE: Telepractice has been shown to be a viable modality for the delivery of stuttering treatment. Since the advent of COVID-19, speech-language pathologists must adapt in-clinic treatments for online presentation. This research aimed to gather information from speech-language pathologists on their experiences of telepractice to deliver the Lidcombe Program to treat stuttering in young children. METHODS: This paper presents the findings of an online survey that polled the clinical experiences of 106 speech-language pathologists who were delivering the Lidcombe Program via telepractice during COVID-19. RESULTS: The majority of respondents were experienced clinicians from the United States and Canada who had attended a Lidcombe Program workshop. Prior to COVID-19, 80 % had provided some clinical services online (up to 10 % of the time), and at the start of COVID-19 public lockdown orders, 77 % viewed telepractice as both a necessity and an opportunity. Three months after the public lockdown orders, the large majority, 94 %, said that they would continue to use both telepractice and in-clinic treatment in the future. Technology issues, concerns about establishing the clinical relationship, and identification of mild stuttering featured as challenges of telepractice service delivery, while benefits included time efficiency, flexibility of scheduling, and improved clinical processes. CONCLUSION: Respondents reported that the Lidcombe Program was easily translatable to telepractice and the majority intend to continue telepractice in the future.

Contemporary issues with stuttering: The Fourth Croatia Stuttering Symposium.

PURPOSE: During the 2019 Fourth Croatia Clinical Symposium, speech-language pathologists (SLPs), scholars, and researchers from 29 countries discussed speech-language pathology and psychological practices for the management of early and persistent stuttering. This paper documents what those at the Symposium considered to be the key contemporary clinical issues for early and persistent stuttering. METHODS: The authors prepared a written record of the discussion of Symposium topics, taking care to ensure that the content of the Symposium was faithfully reproduced in written form. RESULTS: Seven contemporary issues for our field emerged from the Symposium. CONCLUSION: Effective early intervention is fundamental to proper health care for the disorder. However, as yet, there is no consensus about the timing of early intervention and how it should be managed. Currently, clinical translation is a barrier to evidence-based practice with early stuttering, and proactive strategies were suggested for junior SLPs. Apprehension emerged among some discussants that treatment of early stuttering may cause anxiety. For persistent stuttering, assessment procedures were recommended, as were strategies for dealing with childhood bullying. There was agreement that SLPs are the ideal professionals to provide basic cognitive-behavior therapy for clients with persistent stuttering. Questions were raised about our discipline standards for basic professional preparation programs for stuttering management.

Three Lidcombe program clinic visit options: a phase II trial.

PURPOSE: Weekly clinic visits are recommended in the Lidcombe Program Treatment Guide (Packman et al., 2015). That specification is based on traditional speech-language pathology practices rather than empirical research, and two studies have suggested that such a format does not always occur in clinical communities. This research was conducted to determine the relative efficacy of different Lidcombe Program models of clinic visits. METHOD: Thirty-one children were randomized to three different service delivery models: twice-weekly, weekly and fortnightly (once every two weeks) clinic visits. All children were treated with the Lidcombe Program following manualised procedures. Measures of percentage syllables stuttered were obtained from beyond clinic audio recordings pre- and post-randomization. RESULTS: Results showed that the twice-weekly and fortnightly treatment formats were not suitable for all families. However, the fortnightly outcomes at 9 months post-randomization were comparable with those attained during weekly clinic visits. CONCLUSIONS: These results justify further, large-scale clinical trialling to compare weekly Lidcombe Program clinic visits with schedules involving less frequent clinic visits.

What Are the Options for the Treatment of Stuttering in Preschool Children?

Treatment of stuttering during the preschool years is considered to be the best prevention of persistent chronic stuttering; however, many clinicians do not feel comfortable treating stuttering and may be confused about choosing an intervention. This article summarizes the history of direct and indirect methodology for treatment of stuttering in preschool children. It provides an update of contemporary treatments and discusses issues related to the timing of treatment. Guidelines for choosing a level of treatment based on the risk of a preschool child continuing to stutter are discussed, with examples of which children would be most appropriate for which level of intervention.

Multilingual children who stutter: clinical issues.

UNLABELLED: Stuttering occurs across all languages and cultures. However, the impact of speaking more than one language on assessment and treatment of young children who stutter is not well documented. This paper discusses some of the challenges related to clinical issues pertaining to this population including (a) identifying stuttering in an unfamiliar language, (b) the influence of language proficiency, and (c) treatment of multilingual young children who stutter. The paper is written from the perspective of the author's experience treating multilingual children who stutter within the context of the linguistic and cultural diversity of Canada, notably in the French speaking Province of Quebec where many children grow up speaking two or more languages in everyday life. Clinical examples will be taken from the evidence-based literature as well as the author's clinical experience. EDUCATIONAL OBJECTIVES: After reading this paper, the learner will be able to (1) summarize the literature regarding assessment and treatment of stuttering in young children speaking more than one language, (2) summarize some of the challenges related to this issue and (3) describe some of the findings associated with treatment of bilingual children who stutter and (4) be prepared to apply some of these suggestions in the treatment of bilingual children who stutter.

North-American Lidcombe Program file audit: replication and meta-analysis.

Thousands of North American clinicians have trained for the Lidcombe Program of Early Stuttering Intervention, yet there are no benchmark data for that continent. This retrospective file audit includes logistical regression of variables from files of 134 children younger than 6 years who completed Stage 1 of the Lidcombe Program. Benchmarking data for clinic visits to Stage 2 is available for these files. Meta-analysis supplements worldwide Lidcombe Program benchmark data. The median number of clinic visits to Stage 2 was 11. High pre-treatment stuttering severity predicted more clinic visits than low severity. A trend toward statistical significance was found for the frequency of clinic visits. Frequent attendance of mean less than 11 days was associated with longer treatment times than infrequent attendance of mean 11 days or more. Results for North America were consistent with benchmark data from the UK and Australia. The mean attendance trend is clinically important and requires further investigation because of its potential clinical significance.

Follow-up of 6-10-year-old stuttering children after Lidcombe program treatment: a phase I trial.

PURPOSE: This Phase I trial sought to establish (1) whether the Lidcombe Program is viable for school-age children, (2) whether there is any indication that it requires modification for school-age children, (3) whether treatment effects are durable, (4) how many treatment sessions appear to be required to significantly reduce stuttering frequency and (5) whether there is an association between follow-up period and relapse tendency. METHOD: Twelve children were treated, and one required an addition to the Lidcombe Program. The results for this child were excluded from group analysis, leaving a group of 6-10 year-olds. A retrospective method was used using routine pre-treatment clinic recordings. At follow-up, all children were telephoned and audio-recorded three times at random times during the day within a 7-10-day period. RESULTS: A blinded observer's mean percent syllables stuttered score pre-treatment was 9.2 and 1.9 at follow-up. No association was found between follow-up period and stuttering rates. The mean syllables per minute score pre-treatment was 145.8 and 179.3 at follow-up. These results were attained in a median of eight clinic visits with a range of 6-10 visits. CONCLUSIONS: Procedurally, the Lidcombe Program is viable for school-age children and parents report enjoyment in administering it. There appears to be a treatment effect that can be attained in a reasonable number of clinical hours. These results compel continued exploration with young school-aged children in subsequent Phase II and III studies. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) summarize the status of clinical trials for stuttering school-age children, (2) describe the phases of clinical trial development, (3) evaluate outcomes the Lidcombe Program for a school-age population in terms of stuttering reduction and treatment time, (4) evaluate the suitability of the Lidcombe Program with population of school-age stuttering children, and (5) provide an interpretation of the finding of no correlation between follow-up and post-treatment stuttering rates.

Connecting stuttering management and measurement: I. Core speech measures of clinical process and outcome.

BACKGROUND: There will always be a place for stuttering treatments designed to eliminate or reduce stuttered speech. When those treatments are required, direct speech measures of treatment process and outcome are needed in clinical practice. AIMS: Based on the contents of published clinical trials of such treatments, three 'core' measures of treatment outcome are presented for consideration by clinicians: measures of stuttering rate, speech rate and speech naturaleness. MAIN CONTRIBUTION: In contrast to clinical trials, however, clinicians are at liberty to have as many outcome measures as thought necessary, and to design non-standard ones to suit their needs and those of their clients. In that context, the merits of severity ratings of stuttering are considered. It is argued that the prime source of guidance of suitable measures of treatment process are the manuals of the treatments that have figured in clinical trials. CONCLUSIONS: Although there are independent data sources that contradict the axiom that treatment outcomes should be measured beyond the clinic, it is argued that it is premature to dispense with beyond-clinic process outcome measures for clinical practice. It is argued that for clinicians who conduct treatments in non-research contexts, one pretreatment outcome measurement occasion is sufficient, along with post-treatment measures at each maintenance visit. More than anything else, the numerous advantages of severity ratings of stuttering facilitate clinical measurement of treatment outcome and treatment process in several settings and on several occasions.

Progression of language complexity during treatment with the Lidcombe Program for early stuttering intervention.

The Lidcombe Program is an operant treatment for early stuttering. Outcomes indicate that the program is effective; however, the underlying mechanisms leading to a successful reduction of stuttering remain unknown. The purpose of this study was to determine whether fluency achieved with the Lidcombe Program was accompanied by concomitant reduction of utterance length and decreases in linguistic complexity. Standardized language tests were administered pretreatment to 4 male preschool children. Spontaneous language samples were taken 2 weeks prior to treatment, at Weeks 1, 4, 8, and 12 during treatment, and 6 months after the onset of treatment. Samples were analyzed for mean length of utterance (MLU), percentage of simple and complex sentences, number of different words (NDW), and percentage of syllables stuttered. Analysis revealed that all participants presented with language skills in the average and above average range. The children achieved an increase in stutter-free speech accompanied by increases in MLU, percentage of complex sentences, and NDW. For these preschool children who stutter, improved stutter-free speech during treatment with the program appeared to be achieved without a decrease in linguistic complexity. Theoretical and clinical implications are discussed.