Meeting with the reference group

 
Around twice a year the EST-project group meets with its reference group. The group consists of representatives of institutions, organizations or groups of people that our research can be beneficial to. The EST project met with the reference group the 13th of December, for an update and discussion about our ongoing work

The meeting started off with an introduction to the latest publications from the EST project, as well as an overview of planned papers. As to the latest publications, you can read about some of them here, here, here and here. It’s been a productive year!

Further, we discussed the ongoing multiple single case (MSC) study, and aspects related to implementation of stuttering treatment that we have experienced in the study. This relates to parents conducting treatment at home, the dosage of treatment, the length of a clinic visit, and experiences with clinic visits online. The members of the reference group provided helpful insights to this matter.

This summer, two students at the master program in Psychology at the University of Oslo conducted interviews with parents in the MSC study before they started EST intervention. One of the students presented their work for the reference group. The interviews was included in their master thesis, which was just finished this fall. Hopefully the results will also be published in a scientific paper next year, the work is in progress from several of the EST team members. 

Finally, the upcoming RCT in the EST project was the topic of the discussion. Recruitment strategies and how to end a study was some of aspects we talked about.

The EST project would like to thank the reference group for helpful and motivating inputs to our work. Further, we would like to use the last blogpost of the year to wish all collaboration partners and readers a very Merry Christmas!

See you all in 2022!

On behalf of the EST-team,

Åse and Linn 

Implementasjonskvalitet i intervensjonsforskning – hva er det og hvorfor er det så viktig?

En intervensjonsstudie har til hensikt å undersøke om et tiltak eller et behandlingsprogram har effekt. Virker det - og i så fall, hvor godt virker det? For å undersøke dette kan det gjennomføres en randomisert kontrollert studie (RCT) eller en kvasi-eksperimentell studie. Begge disse forskningsdesignene kjennetegnes av at deltakerne kartlegges før intervensjon (pretest) og etter intervensjon (posttest), og så sammenlignes resultatene.  I et design som RCT (som vist i figuren her), så randomiseres utvalget til å få tiltaket eller ikke få det, og denne tilfeldige fordelingen gjør at vi kan sammenligne gruppene selv om det er ulike personer med i dem, og si noe om hvilken effekt tiltaket ser ut til å ha.

Imidlertid er det ikke bare forskningsdesign som har betydning for om vi kan si at tiltaket har effekt. Vi må også vite noe om hva som faktisk har skjedd i tiltaksgruppen, vi må undersøke hvordan intervensjonen har blitt implementert, altså iverksatt. Implementasjonskvalitet består av:

•  Intervensjonen selv (slik som protokoller/manual, opplæring)
• Støttesystemet rundt intervensjonen (slik som undersøkelse av fidelity (trofasthet til tiltaket) med overvåkning av kjerneelementer i intervensjonen for å sikre standard levering)

Dersom det ikke er gitt god opplæring eller laget en tydelig plan (manual) for hva som skal gjøres i tiltaket, gjør kanskje logopeder (eller andre som gjennomfører tiltaket) det slik de tror selv det er best. Da kan det bli svært ulik gjennomføring og vanskelig å si noe etterpå om hva som virket. Kanskje ble det planlagt 20 økter over 5 uker og så ble det bare gjennomført 10 økter – det kan ha betydning for om tiltaket har hatt effekt. 

Implementering er viktig. I verste fall kan det se ut til at intervensjonen ikke virker, men så er problemet at det ikke ble gjennomført lenge nok eller på den tiltenkte måten. I litteraturen kalles antall økter, varighet og frekvens for dose (etter medisinsk forskning). I språkforskning kan dose  også handle om antall ganger et ord blir repetert av barn eller voksen. Se en interessant artikkel av Frizelle og kollegaer (2021) for mer forskning om dose. For å få vite hva som faktisk har skjedd må vi følge nøye med på hva som skjer i intervensjonsgruppen – og i kontrollgruppen! Noen ganger kan kontrollgruppen bli for inspirert av å være med, slik at det skjer saker og ting i kontrollgruppen som gjør at effekten av intervensjonen ikke vises.

I EST-teamet har vi akkurat publisert en artikkel om implementasjonskvalitet i stammebehandling. Gjennom å undersøke tidligere forskning har vi funnet at intervensjonsforskningen på stammebehandlingsprogram for barn og ungdom er ganske gode på å beskrive ønsket dose og opplæring av foreldre, men at det er få studier som har undersøkt hva som faktisk har skjedd når foreldrene har gjennomført behandling. Det var også vanskelig å vite hva slags opplæring logopedene fikk før de gjennomførte de kliniske behandlingene. Det gjør at det kan være variasjon mellom hva som står i de ulike programmanualer og det som faktisk skjer i behandling. Da vet vi ikke hva som egentlig fører til økt taleflyt. Det betyr at vi trenger flere grundige studier for å få bedre kunnskap om stammebehandling.

Om du har tid nå i julestria, så les gjerne artikkelen vår her. Det er open access så alle kan lese gratis. Vil du ha mer kunnskap om implementasjon, så rett før vår artikkel kom ut, har Bergþórsdóttir og kollegaer på Island publisert en artikkel innen samme tema. Det er tydelig at dette er et særs aktuelt tema i forskningsverden nå! 

Ta vare på hverandre!  

New publication on the impact of stuttering on preschool aged children

It has been a busy year for the EST project this far. In several upcoming blogpost we will tell you about newly published studies from researchers in the project.

You can read post doc in the EST-project Linn Stokke Guttormsen and co-authors J. Scott Yaruss and Kari-Anne Bottegård Næss newest paper “Parents' Perceptions of the Overall Impact of Stuttering on Young Children” here: https://pubs.asha.org/doi/abs/10.1044/2021_AJSLP-20-00113

In their study, an adaptation of the Overall Assessment of the Speaker's Experience of Stuttering for School-Age Children was designed to ask parents about their perceptions of the impact of stuttering on their young children. Thirty-eight parents of young children who stutter participated. Results indicated that, on average, parents perceived that stuttering affected their children negatively; stuttering was perceived by some parents to affect the children’s mood, self-confidence, and social participation during stuttering moments or periods with stuttering. Furthermore, parent reports revealed that impact of stuttering can change with communication partners or situations. Parents' perceptions of impact are important for clinicians to consider when giving recommendations for therapy, as they can provide important insight into the family's needs. It is also important assess the perspective of the children if appropriate because present findings reveal that parents may not have insight into all aspects of impact, in particular, cognitive reactions to stuttering.

  

Stuttering awareness day 2021

This year, Åse and I (Linn) have participated in two different activities to raise awareness and knowledge of stuttering on the 22nd of October. In a webinar arranged by Statped, Åse brilliantly summarized what we know about stuttering treatment and participated in a panel debate. Hilda Sønsterud, Berit Løkken and Trude Beseth Nordeide also contributed with their insights, reflections and knowledge in the successful webinar with more than 350 participants. 

Katja Evjen asked me to be a guest in the podcast “Læring” in association with the International Stuttering Awareness day. Læring is made by journalist Monica Bjermeland and produced by Shane Colvin. The podcast touches upon many of the different interesting topics that is investigated at the Faculty of Educational Sciences at UiO. 

The other guest in the podcast was Elisabeth Egner, a young woman who has been stuttering since she was five years old. Elisabeth bravely shared her story in the studio, and listeners of the podcast gets an insight into how stuttering can be experienced during childhood and adolescence by hearing Elisabeth's story. When listening to Elisabeth describing her experiences with stuttering and associated thoughts and feelings I kept thinking about how important openness and knowledge about stuttering is. I therefore hope that many listen to this podcast and that it contributes to raising awareness of stuttering. You can find the podcast here. 

Speech fluency and language skills in children with Down syndrome

Following up our latest blog posts, we also have a new publication on speech fluency and language skills!

EST team members Kari-Anne B. Næss, Hilde Hofslundsengen alongside Egil Nygaard, and Scott Yaruss published about speech fluency and language skills, some months ago, in the Special Issue Down Syndrome: Neuropsychological Phenotype across the Lifespan. 

Participants were a national sample of children with Down syndrome aged six years. The results showed that parent reported much more difficulties with speech fluency in children with Down syndrome than in younger typically developed children (same non-verbal age level). Furthermore, better language skills among the children with Down syndrome were related to less fluency difficulties. The results suggest that speech fluency and language skills should be taken into consideration when planning treatment for children with Down syndrome, perhaps speech and language theraphy that simultaneously aims to improve language skills and fluency.

 

If you want to know more, the full paper can be read here (free): Brain Sciences | Free Full-Text | The Association between Difficulties with Speech Fluency and Language Skills in a National Age Cohort of Children with Down Syndrome (mdpi.com)  

Norsk publisering: Helsesykepleieres vurderinger rundt tidlig identifisering av barn som stammer

 

Et av EST-prosjektets formål er å se på tverrfaglig samarbeid rundt barnehagebarn som stammer. En viktig aktør er helsesykepleiere. Her kan du lese sammendraget av artikkelen "Tidlig identifisering av barn som stammer - en spørreundersøkelse av helsesykepleieres vurderinger" skrevet av EST-medlem Elisabeth Holm Hansen sammen med flere kolleger både i EST-gruppen og i det kliniske feltet.

Hele artikkelen er publisert i tidsskriftet Sykepleien og du finner den her.

Sammendrag

Bakgrunn: Utviklingsmessig kan stamming ha negative emosjonelle, atferds- og holdningsmessige konsekvenser. Derfor anbefales tidlig identifisering og igangsetting av logopedbehandling så raskt som mulig. Helsesykepleiere på helsestasjonen møter barn hver måned de seks første månedene, deretter ca hver annen måned fram til to- og fireårskontrollene. Ifølge de nasjonalfaglige retningslinjene har helsesykepleierne ansvaret for å undersøke barns språk for tidligst mulig å avdekke språkvansker og andre språkrelaterte vansker, deriblant stamming. Det er lite kunnskap om hvilke observasjoner og vurderinger som ligger til grunn for helsesykepleiernes praksis når de avdekker stamming.

Hensikt: Å få innsikt i helsesykepleieres praksis i første møte med foreldre til barn som stammer. Vi ønsket å evaluere praksis opp mot anbefalinger basert på nyere internasjonal forskning.

Metode: Studien er en deskriptiv tverrsnittstudie gjennomført via digitalt spørreskjema til helsesykepleiere som jobber ved helsestasjoner i sju av landets fylker. Dataene ble analysert ved deskriptiv statistikk, ordinal regresjonsanalyse og khikvadrattest.

Resultat: Nittifem helsesykepleiere besvarte spørreskjemaet. Helsesykepleiernes hyppigste fremgangsmåte i første møte med foreldre til barn som stammer, var å gi informasjon om stamming og lage nye avtaler med foreldrene. De rådene som ble gitt hyppigst, var knyttet til samspill og kommunikasjon samt å kontakte en fagperson. I vurderingen om videre oppfølging eller henvisning vektla helsesykepleierne barnets alder, barnets egen oppfatning av eller reaksjon på stamming og foreldrenes bekymring. Svært få hadde nedskrevne faglige retningslinjer for praksis og for når logoped skulle kontaktes.

Konklusjon: Helsesykepleiernes fremgangsmåter og råd i møte med foreldre til barn som stammer, er

hovedsakelig i tråd med nyere anbefalinger basert på internasjonal forskning. 

New publication from the EST team

Our Cochrane review “Non‐pharmacological interventions for stuttering in children six years and younger” has just been published! You can find the review here: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013489.pub2/full

The aim of this review was to investigate whether treatment for stuttering can improve speech fluency, children's communication attitudes and the impact on the child's quality of life, and potential harmful effects in children aged six years and younger, both in the short‐ and long‐term. We identified four eligible RCTs, all of which compared the Lidcombe Program to a wait‐list control group. In total, 151 children aged between two and six years participated in the four included studies. As we state in the review, there is a need for further studies from independent researchers to evaluate the effect of interventions for stuttering. While RCTs assessing other stuttering interventions than the Lidcombe Program have been published since the early to mid 2010s, these studies have investigated the comparative effectiveness of two or more interventions. However, we highlight the critical need for future research to rigorously investigate the effect of intervention programmes for stuttering compared to a no intervention control group to determine whether these interventions are more effective than natural recovery.

PhD candidate Åse Sjøstrand is first author on the review, with a great team of EST-members as co-authors. In addition, the Cochrane Developmental, Psychosocial and Learning Problems group has provided highly appreciated help and support during the process of conducting and writing up the review. This also includes support on use of the brand new RoB 2 tool for assessing Risk of Bias, developed by the Cochrane team. You can read about the tool here: https://methods.cochrane.org/risk-bias-2

EST-studien rekrutterer i disse dager deltakere til en liten behandlingsstudie

 

 

 
Målet med studien er å prøve ut en ny logopedisk behandling, som har til hensikt å redusere stammingen og dens eventuelle negative konsekvenser for barnet.
 
Etter en innledende kartleggingsfase, vil behandlingen gis ukentlig av logoped over Zoom. Barnet og en av dens foreldre vil i tillegg gjennomføre aktiviteter hjemme mellom timene.
 
Vi søker barn som:
 
·         er yngre enn seks år, og ikke skal begynne på skolen til høsten
 
·         ikke har mottatt strukturert behandling for stamming det siste halvåret. Med strukturert behandling mener vi regelmessig oppfølging av logoped. Sporadisk veiledning til foreldre eller barnehage inngår ikke som strukturert behandling
 
·         har språkkompetanse som muliggjør å følge behandlingsinstruksjoner på norsk
 
·         ikke har noen kjente diagnoser som påvirker kommunikasjon eller språklig utvikling
 
I tillegg vil frekvens stamming vurderes av logopeder i EST-teamet før eventuell inklusjon i studien.
 
Ved spørsmål eller interesse for studien kontakt delprosjektleder Åse Sjøstrand (47669992,  ase.sjostrand (ætt) isp.uio.no eller hovedprosjektleder i EST, Kari-Anne Bottegaard Næss, k.a.b.nass (ætt) isp.uio.no 

Oxford dysfluency conference going digital - reflections from the EST team

The European day for speech-language pathologist on March 6th focused on telepractice and digital technologies. Not only intervention and treatment are going online this days, conference are, too. In this blog post, we reflect about the Oxford dysfluency conference, which was held digitally in January this year.

The members of the EST group were presented with a variety of posters and talks, both of EST-project data, but also on other topics within stuttering such as Stuttering in an Age Cohort of Children with Down Syndrome by Kari-Anne Bottegaard Næss and colleagues.

Here we have sampled a few “snaps” and thoughts about the conference.

Ineke Samson presented a poster with the title Severity of overt stuttering in females and males, self-assessed and assessed by SLPs, in relation to associated symptoms. The poster accounts for a study where the aim is to investigate impact of stuttering on life quality in female and male teenagers and young adults who stutter, when controlled for overt stuttering severity. In an earlier study by Ineke and colleagues (Samson, Lindström, Sand, Herlitz, & Schalling, 2020) it was concluded that female teenagers who stutter report a larger impact of stuttering and more negative reactions to communication than their male peers. The present study aimed at extending the findings in that report, by adding measures that enable comparisons between overt stuttering severity (both self-rated and rated by SLPs) and the impact of stuttering on life quality. https://app.oxfordabstracts.com/submissions/191713/question/28472/download

Many interesting results and perspectives were reported and discussed during the conference. What Ineke found especially worth considering was researchers who suggested and argued that we should appreciate, rather than single out and separate, differences that exist in people. Why not describe stuttering as part of "neurological diversity" instead of a "neurological deficit” since diversity is part of the human experience? Many interesting presentations and discussions highlighted how stuttering in the (medical-) society is perceived as a problem that must be "fixed" by the person her- or himself. Instead, we may consider whether it is not society that needs to be reformed and "fixed", that everyone is included and can participate on equal terms.

Åse Sjøstrand presented a poster together with Linn Guttormsen and Marthe Vasvik Varpe about Caregivers ratings of concern for stuttering in young children. 

Linn related their poster to a presentation by Scott Yaruss about assessing stuttering severity with self-report. She commented, that attending this talk before our poster was a good preparation and stimulated thoughts concerning  what stuttering severity is if we only include the perspective of the listener and not the person who stutters. In our study, we assessed mothers', fathers' and kindergarten teachers' perceptions of stuttering severity and also their level concern. What we learned from this study was that we have to take into account the perspective of the person who is providing the information when conducting assessment. We were lucky to have engaged SLPs and researchers coming to our poster presentation, asking us questions and giving us new ideas. For instance, the study conducted by Millard, Zebrowski, and Kelman (2018) also revealed interesting mechanisms in relation to parental concern for stuttering.

Concerning specific EST-data, Melanie Kirmess presented a poster entitled Do early childhood professionals in Norway distinguish between stuttering and normal childhood dysfluencies?,

co-authored by Hilde Hofslundsengen, Linn S. Guttormsen, Elisabeth Holm Hansen and Kari-Anne Bottegaard Næss. This poster was based on some of the data from our multi-disciplinary survey for early childhood professionals. In Norway, we have historically used the term ”stotring” in addition to the more defined term stuttering. Hence, we wanted to know how professionals understand those two terms and not the least, if they use them to differentiate between stuttering and normal dysfluencies.  We were also curious if this topic concerning a small Norwegian feature would attract any other listeners at all, and yes – it did, and we had some nice discussions and feedback.

Missing out on meeting colleagues in Oxford, the EST group concluded the Oxford conference with a digital evening ”wine and talk” seminar for ourselves, having the time to discuss other presentations and impressions. The best thing with a digital conference like this is definitely the opportunity to watch presentations for some additional time after the formal conclusion of the conference.

 

MA-thesis about stuttering guidelines

 

The EST-team is very glad to welcome MA-student Trude Beseth Nordeide to the project. Trude is presenting her project here - and would really appreciate feedback from you concerning existing guidelines.

My name is Trude Beseth Nordeide. I’m a master’s degree student at the speech language therapist study at the University of Oslo. This spring I will write my master’s thesis, and I will write my thesis in collaboration with the EST project.

Through my time at the master program at UiO I’ve got an increased interest for stuttering in preschool children and children in school age. Therefore, I decided to take a closer look at existing national clinical guidelines in other countries for stuttering treatment for these client groups for my master’s thesis.

Through ECSFs (by Mark Pertijs) presentation “Evidence-based Clinical Guidelines in Stuttering Therapy” from 2014 I did find an overview over European countries with national guidelines, and I have chosen to take account for that list http://www.ecsf.eu/userfiles/files/PDF%20M.Pertijs%2020014-03-27.pdf, see page 41). 

However, I have not been able to find an updated list of countries with national guidelines. Therefore, I recently sent out emails to 13 countries with both consensus-based and evidence-based national guidelines (most of them were at that time evidence-based, and some in process of changing from consensus-based to evidence-based). Furthermore, I chose to contact ASHA and the Australian association as well, since both the USA and Australia have been influencing European SLTs practice with their research and guidelines.

Method and analysis 

I will use Appraisal Guidelines Research and Evaluation (AGREE) for analysing the guidelines. AGREE can contribute in evaluating the clinical guidelines through giving rates in the following six domains.

 

1 Scope and purpose	addresses the overall goal with the guideline, specific help questions and the target population.
2 Stakeholder involvement	focuses on the extent to which the guideline has been developed by the appropriate stakeholders, and whether it represents the views of its intended users.
3 Thoroughness in development	deals with the process of collecting and synthesizing the evidence, the methods for formulating the recommendations and updating them.
4 Clarity in the presentation	deals with the language, structure and format of the practice guidelines.
5 Usability	looks at the different variants and facilities, strategies for increasing uptake and source usability for the use of the practice guidelines.
6 Editorial independence	deals with the fact that the recommendations are not exclusively biased with a form of competing interest.

    

                  

The questions and domains in AGREE can contribute to receiving important information on how the guidelines relate to evidence collection and how well they are transferred to clinical implications for the SLTs. 

What is my goal with the project?

The purpose of my master’s project is to address information about the following elements in the guidelines: 

• How evidence-based national guidelines apply holistic implications for clinicians based on the underlying research (e.g., to which degree does the case that a treatment is evidence-based mean that it will be adequate for SLP clients in their environment?)
• If I receive both consensus-based and evidence-based guidelines it would be interesting to discuss the eventual differences.
• Do the authors of the guidelines have any relations with how the implications are presented? (E.g., Ratner et al. (2005) expressed lack of more independent stakeholders in the research of the different stuttering treatments.)
• Do the guidelines implications work as strict procedures or more “loose indicatives” to the clinician’s practice?

If you have any information relevant to my master project, or maybe have any updated information about countries in Europe who are not represented in the mentioned overview from 2014, who do have national guidelines today, I would be very happy hearing from you! You can contact me on this email: trudebno@student.uv.uio.no   

Thank you!  

Kindly, Trude Beseth Nordeide

Half way there- thoughts from a midway assessment

 

The PhD candidate in the EST project, Åse, marked being half way in her PhD this fall. In this blogpost she shares her thoughts from her midway assessment:

The midway assessment in a PhD is a milestone for a PhD candidate, although it is carried out differently across universities and departments. At the Faculty of Educational Sciences here at the University of Oslo, the mid way evaluation is a 90 minutes seminar, often held as part of a research seminars the PhDs candidates partake in. Participants are the candidate, opponent (a senior researcher within the research field), supervisor, coordinator of the organized research seminar and other PhD students.

I had my midway assessment in the end of September with professor Scott Yaruss as the opponent. The seminar begun with a presentation of my work. I talked about the three studies that will be included in my thesis, about the progress I have made, and about how I plan to work the next two years in order to finish the project on time. I also accounted for the courses I have taken and plan to take. Preparing for the seminar really felt like taking a step back and looking at my work from a distance. So much of working with the PhD feels like being on a high-speed rail, and it felt good to pause for a minute and get an overview of the road I have already traveled: The first study, a systematic review and meta- analyses, has been submitted, and the second study of my PhD is currently being drafted. I have finished all courses and the teaching proportion of the job. When did this even happen? It feels like I just started!

Also, preparing the presentation forced me to think ahead. Although I do have a progress plan and a time frame it is nice with a reason to reassess the plans, check in with deadlines and make changes accordingly. Two years is still a long way to go, but at least now, I know more about where I am going.  

The presentation was followed by a discussion about the work, between professor Yaruss and I. We discussed questions such as: what are the mechanisms leading to improvement in children`s stuttering? What are implications of the individuality of programs for treating stuttering in children? Discussing treatment for stuttering in preschool aged children, and the studies included in the EST project and my thesis especially, was very motivating. The discussion illuminated some parts of the projects that wasn’t clear for me, and presented me with many new insights. Thanks for the discussion, Scott!

-Åse