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

Administering the Lidcombe Program to children who stutter with concomitant disorders: Insights from an exploratory retrospective chart review study

PURPOSE

Children who stutter (CWS) in clinical settings may present with concomitant disorders (CDs), which can complexify the delivery of the Lidcombe Program (LP). However, there is limited evidence on how CDs influence treatment outcomes in CWS, leaving clinicians with little guidance regarding best practices with these children. This exploratory study, conducted in partnership with a rehabilitation center's clinical team, aims to understand which CDs and suspected CDs speech-language pathologists document when treating CWS with the LP and their relationship to treatment characteristics and outcomes.

METHOD

A retrospective chart review was conducted on 47 children diagnosed with developmental stuttering who received the LP between 2016 and 2018.

RESULTS

38 CWS (80.9 %) had either at least one confirmed (59.6 %) or suspected (21.3 %) CD, of which 61.7 % were language-related and 27.6 % attention-related. CWS with diagnosed and suspected CDs had significantly higher stuttering severity rating (SR) scores post-treatment as compared to CWS without CDs (p =.001), although all groups significantly reduced their stuttering. There were high drop-out rates in all groups. CWS with diagnosed and suspected CDs who dropped out had significantly higher SR scores than CWS without CDs who progressed to Stage 2 (p =.011 and p =.014, respectively).

CONCLUSION

The LP is effective in improving fluency in both CWS with and without CDs. However, CWS with diagnosed or suspected CDs finished or dropped out of Stage 1 with significantly higher SR scores than CWS without CDs. Future research is needed to confirm these results and investigate the factors underlying the observed differences.

Perceptions and experiences of Australian speech-language pathologists who use the Lidcombe Program with children who stutter

Purpose: Speech-language pathologists (SLPs) have varying levels of training and experience working with children who stutter (CWS). They often work in contexts and populations that require clinical management to take them beyond the borders of translating clinical trial protocols and evidence-based practice (EBP). This study sought to investigate the clinical experiences of Australian SLPs working with CWS, including their Lidcombe Program confidence and practices. Method: A cross-sectional online survey was completed by 215 Australian SLPs during 2017-2020. They were recruited prior to attending one of 14 workshops hosted by Speech Pathology Australia (SPA). Result: Participants worked in a range of contexts and were from all states and territories. The majority assessed and/or treated up to five CWS annually. Six predictor variables were considered for self-reported clinical confidence. The quantitative analysis identified that an SLP's previous training, reading the SPA stuttering management clinical guideline, and the annual number of CWS treated were found to significantly impact self-reported clinical confidence. Themes included: (1) client, family, service, and context factors that influence clinical decision-making; (2) SLP areas of clinical strength and aspects of paediatric stuttering management requiring further development; and (3) factors that impact Lidcombe Program success and modifications. Conclusion: This study has found that Australian SLPs working with CWS identify a range of important factors that impact their practice.

Self-Perceived Communication Competence of Adults Who Stutter Following Communication-Centered Treatment

PURPOSE

The purpose of this study was to assess self-perceived communication competence of adults who stutter following participation in a non-ableist treatment for which one of the core components focuses on communication - with no direct or indirect goals designed to reduce or modify stuttered speech.

METHOD

Thirty-three adults who stutter completed the Self-Perceived Communication Competence scale (McCroskey & McCroskey, 1988) pre- and posttreatment.

RESULTS

Findings indicate significant gains in self-perceived communication competence posttreatment. Pre- to posttreatment changes in stuttering did not predict posttreatment gains in self-perceived communication competence.

CONCLUSION

The present study demonstrates that improvement in communication can be achieved independent of improvement in fluency, lending further support to the notion that stuttering and communication competence are distinct constructs.

Treatment for Stuttering in Preschool-Age Children: A Qualitative Document Analysis of Treatment Programs

PURPOSE

The purpose of this study was to identify commonalities and differences between content components in stuttering treatment programs for preschool-age children.

METHOD

In this document analysis, a thematic analysis of the content was conducted of handbooks and manuals describing Early Childhood Stuttering Therapy, the Lidcombe Program, Mini-KIDS, Palin Parent-Child Interaction Therapy, RESTART Demands and Capacities Model Method, and the Westmead Program. First, a theoretical framework defining a content component in treatment was developed. Second, we coded and categorized the data following the procedure of reflexive thematic analysis. In addition, the first authors of the treatment documents have reviewed the findings in this study, and their feedback has been analyzed and taken into consideration.

RESULTS

Sixty-one content components within the seven themes-interaction, coping, reactions, everyday life, information, language, and speech-were identified across the treatment programs. The content component SLP providing information about the child's stuttering was identified across all treatment programs. All programs are multithematic, and no treatment program has a single focus on speech, language, or parent-child interaction. A comparison of the programs with equal treatment goals highlighted more commonalities in content components across the programs. The differences between the treatment programs were evident in both the number of content components that varied from seven to 39 and the content included in each treatment program.

CONCLUSIONS

Only one common content component was identified across programs, and the number and types of components vary widely. The role that the common content component plays in treatment effects is discussed, alongside implications for research and clinical practice.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25457929.

Norwegian speech-language pathologists treatment practices for preschool children who stutter: An explorative study

PURPOSE

This study investigated the treatment practices of speech-language pathologists (SLPs) with preschool children who stutter to explore variations in service delivery and, consequently to better inform and support evidence-based practice.

METHOD

121 Norwegian SLPs completed an online survey about stuttering treatment for preschool children aged up to six years. They reported on treatment training, choices, setting, dosage, and outcomes. Data was analysed descriptively. Correlation analyses between years of clinical experience and clinician perceived outcomes were conducted.

RESULT

Sixty-eight percent of SLPs were trained in one or more stuttering treatment programs. The majority of SLPs (83 %) provided treatment in person in preschool centers; 59 % reported providing treatment once a week. Thirty-four percent of SLPs reported that they often or always delivered the whole treatment program. Treatment practice addressed various elements, including advising parents about language and communication strategies, supporting the child's self-image, and perceived outcomes. The SLPs reported their clinician perceived outcomes as 'always' or 'often' reduction of audible stuttering (70 %), reduced cognitive and emotional reactions (55 %), and improved communication skills (58 %). Factors influencing treatment choices were identified at the systemic level (e.g., work place regulations) and individual level (e.g., SLPs competency, child's best).

CONCLUSION

Stuttering treatment services in Norway differ from those reported in existing literature as treatment is given in preschool settings, only 34 % of SLPs deliver programs as intended whilst the majority use treatment elements only, and still experience positive changes. Provision is variable, and seems influenced by SLP training and competence.

Australian speech-language pathologists' experiences and perceptions of working with children who stutter: A qualitative study

PURPOSE

Effective early intervention is recommended to ameliorate the potential long term negative effects of stuttering. Efficacious treatments are available, but speech-language pathologists (SLPs) report finding implementation to be challenging due to a range of clinician, client and clinical context factors. Previous survey-based research has found that SLPs lack self-efficacy working with CWS, however the reasons contributing to this are not well understood. This study presents the first in-depth analysis of the current practices and perceptions of SLPs working with children who stutter (CWS).

METHODS

In this qualitative study 18 Australian SLPs who provide services to CWS were interviewed using a semi-structured interview approach. Data were analysed using reflexive thematic analysis.

RESULTS

The thematic analysis identified four themes: (1) A stronger sense of self-efficacy is needed in stuttering management compared to other areas of clinical practice; 2) SLPs' sense of self-efficacy in stuttering management is influenced by early career experiences, client factors and the practice context; 3) Professional development and collaboration strengthen self-efficacy; and 4) Parental involvement and engagement are crucial to treatment success.

CONCLUSION

SLP self-efficacy for working with CWS appears a critical factor in the provision of effective management for this population. This study provides an in-depth analysis of the role of SLP self-efficacy and the factors that influence it.