Contemporary clinical conversations about stuttering: Neurodiversity and ableism

Stuttering: Our Current Knowledge, Research Opportunities, and Ways to Address Critical Gaps

Our understanding of the neurobiological bases of stuttering remains limited, hampering development of effective treatments that are informed by basic science. Stuttering affects more than 5% of all preschool-age children and remains chronic in approximately 1% of adults worldwide. As a condition that affects a most fundamental human ability to engage in fluid and spontaneous verbal communication, stuttering can have substantial psychosocial, occupational, and educational impacts on those who are affected. This article summarizes invited talks and breakout sessions that were held in June 2023 as part of a 2-day workshop sponsored by the US National Institute on Deafness and Other Communication Disorders. The workshop encompassed topics including neurobiology, genetics, speech motor control, cognitive, social, and emotional impacts, and intervention. Updates on current research in these areas were summarized by each speaker, and critical gaps and priorities for future research were raised, and then discussed by participants. Research talks were followed by smaller, moderated breakout sessions intended to elicit diverse perspectives, including on the matter of defining therapeutic targets for stuttering. A major concern that emerged following participant discussion was whether priorities for treatment in older children and adults should focus on targeting core speech symptoms of stuttering, or on embracing effective communication regardless of whether the speaker exhibits overt stuttering. This article concludes with accumulated convergent points endorsed by most attendees on research and clinical priorities that may lead to breakthroughs with substantial potential to contribute to bettering the lives of those living with this complex speech disorder.

Contemporary clinical conversations about stuttering: What does brain imaging research mean to clinicians?

PURPOSE

To discuss among neuroscientists and community speech-language pathologists what brain imaging research means to clinicians.

METHOD

Two university neuroscientists and two speech-language pathologists in private practice discussed the matter. Written conversational turns in an exchange were limited to 100 words each. When that written dialogue was concluded, each participant provided 200 words of final reflection about the matter.

RESULT

For now, neuroscience treatments are not available for clinicians to use. But sometime in the future, a critical mass of neuroscientists will likely produce such treatments. The neuroscientists expressed diverse views about the methods that might be used for that to occur.

CONCLUSION

Neuroscience does have practical clinical application at present and, in a way, that does not exclude a concurrent influence of the social model of disability. As such, the current practices of clinicians are supported by basic neuroscience research.

Contemporary clinical conversations about stuttering: How to keep up with stuttering treatment research

PURPOSE

To discuss how speech-language pathologists can keep up with stuttering treatment research. To inform junior clinicians and students of speech-language pathology about this matter.

METHOD

The issue was discussed by two university researchers and two speech-language pathologists who provide clinical services. Written conversational turns in an exchange were limited to 100 words each.

RESULT

There was agreement among the group that keeping up to date with stuttering research is essential for speech-language pathologists, and to do so requires a basic understanding of research methods. For treatment research, there are several levels of evidence, and there was agreement that they are all relevant to clinical practice. All in the group agreed that basic research is essential to inform clinical practice, particularly in five domains. The volume of stuttering research is challenging for generalist clinicians to keep up with.

CONCLUSION

We make recommendations about how speech-language pathologists can keep up with stuttering treatment research in a time-efficient manner. This may be particularly useful for junior clinicians and students of speech-language pathology.

Neurodiversity in Saudi Arabia: Towards quality education and reduced inequalities

Traditional educational frameworks in Saudi Arabia have historically adopted a deficit-based approach to special education, potentially overlooking the benefits of neurodiversity. As global educational paradigms shift toward inclusive practices, examining the alignment of Saudi special education laws with neurodiversity principles becomes crucial. This content analysis study aimed to explore the existing literature on special education in Saudi Arabia to ascertain whether the laws and policies support or hinder the practice of neurodiversity, a concept that is gaining international recognition but remains nascent in Saudi Arabia. A systematic literature search was performed in Web of Science and Scopus, yielding 21 relevant studies after screening and application of inclusion criteria. A content analysis was conducted, focusing on the categorization of data relevant to special education laws and their implications for neurodiversity. The analysis identified seven key categories, including Implementation of Inclusive education and transition services, that reflect the current state of special education laws in relation to neurodiversity. A conceptual model was developed, illustrating the potential of special education laws to both support and impede neurodiversity in Saudi Arabia and potentially worldwide.

An annotated introductory reading list for neurodiversity

Since its inception, the concept of neurodiversity has been defined in a number of different ways, which can cause confusion among those hoping to educate themselves about the topic. Learning about neurodiversity can also be challenging because there is a lack of well-curated, appropriately contextualized information on the topic. To address such barriers, we present an annotated reading list that was developed collaboratively by a neurodiverse group of researchers. The nine themes covered in the reading list are: the history of neurodiversity; ways of thinking about neurodiversity; the importance of lived experience; a neurodiversity paradigm for autism science; beyond deficit views of ADHD; expanding the scope of neurodiversity; anti-ableism; the need for robust theory and methods; and integration with open and participatory work. We hope this resource can support readers in understanding some of the key ideas and topics within neurodiversity, and that it can further orient researchers towards more rigorous, destigmatizing, accessible, and inclusive scientific practices.

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.