From our experience, many parents and health care professionals are curious about what they can do when a child they care about starts to stutter. In their contact with a speech language pathologist, parents and professionals often wonder: What does stuttering treatment look like? Below are 8 facts about stuttering treatment that we view as important to highlight.
1. Stuttering treatment is behavioural in nature, and conducted (or supervised) by a speech and language therapist!
Research on efficacy of treatment effect for kindergarten children who stutter has focused on behavioural treatment. Behaviourally based interventions are interventions that involves teaching or facilitating changes in a child’s speech (Nye et al., 2013). The change in the child’s speech can involve a reduction of stuttering moments, a reduction of the duration of the stuttering moments, or both.
2. Parents normally play a crucial part in stuttering treatment!
In behavioural treatment interventions parent and child commonly meets a speech language pathologist on a regular basis (often weekly). Subsequently parents deliver the treatment on an even more regular basis (most commonly several times times a week). In the meetings with the clinician, parents are advised in how to carry out treatment at home until the next meeting with the clinician.
3. The aim of stuttering treatment varies between treatment programs!
Some intervention programs aim to reduce or eliminate stuttering, but not all. For instance, in some programs the parents and speech and language therapist agree on an acceptable level of stuttering severity that treatment should aim to establish. Some intervention programs also aim to increase the child’s quality of life and positive communication attitudes.
4. Stuttering treatment normally varies in length!
Stuttering treatment is different from most interventions for speech and language, in the way that the treatment does not last for a set amount of weeks. Rather, the total duration of the treatment will depend on how the child’s stuttering develops. Treatment will continue until the aim of that specific therapy program has been achieved.
5. The content of stuttering treatment varies between programs!
Treatment may involve making changes to the child’s communicative environment (Palin Parent-Child Interaction Therapy; (Millard, Edwards, & Cook, 2009, or Restart DCM; Franken & Putker-de Bruijn, 2007), changes in the child’s speech (Westmead program; Trajkovski et al., 2009), reinforcing specific speech behaviors (Lidcombe program; Onslow et al., 2017) or desensitization of stuttering and modification of stuttering moments (MiniKids; Waelkens, 2018). Importantly, there are differences in research investigating the effectiveness of the different treatment programs (see fact 8).
6. Treatment is fun!
The importance of the child having fun during treatment sessions is highlighted in many of the treatment programs. Treatment can involve different activities that the child likes, and it is up to the clinician to be creative when planning activities that treatment can be conducted within.
7. Behavioural stuttering treatment has been shown to be more efficacious than no treatment!
Studies where children who stutter have been randomized to either a treatment group or a no treatment control group have found stuttering to be more effective than no treatment. During the last 20 years, the evidence base for stuttering treatment has grown substantially. However, only few randomized controlled trials (RCTs) investigating treatment effect exists at the moment (see for instance de Sonneville-Koedoot, Stolk, Rietveld, & Franken, 2015; Harris, Onslow, Packman, Harrison, & Menzies, 2002; Jones et al., 2005; Lattermann, Euler, & Neumann, 2008).
8. The Lidcombe program and the RESTART DCM are the treatment programs that have the largest body of research!
It needs to be underscored that largest body of research does not necessarily mean best effect. Importantly, several of the less investigated programs may be effective in treating stuttering, however, this needs to be investigated in large RCTs.
Since stuttering treatment has shown to be effective in reducing or eliminating stuttering, we want to use the opportunity to highlight the importance of evidence based practice among speech language pathologists. Evidence based practice involves clinical decisions (for instance which treatment program to use) being informed by current research results, in addition to clinical competence and knowledge about the child and the family. We would also like to highlight the importance of parents seeking treatment from speech-language pathologists that offer evidence-based treatments. Unfortunately, parents can be misled by different professionals that are claiming to be able to “cure stuttering” without providing any documentation of this.
References
de Sonneville-Koedoot, C., Stolk, E., Rietveld, T., & Franken, M.-C. (2015). Direct versus Indirect Treatment for Preschool Children who Stutter: The RESTART Randomized Trial. PloS one, 10(7). doi:10.1371/journal.pone.0133758
Franken, M.-C., & Putker-de Bruijn, D. (2007). Restart-DCM Method. Treatment protocol developed within the scope of the ZonMW project Cost-effectiveness of the Demands and Capacities Model based treatment compared to the Lidcombe programme of early stuttering intervention: Randomised trial. http://www. nedverstottertherapie. nl.
Harris, V., Onslow, M., Packman, A., Harrison, E., & Menzies, R. (2002). An experimental investigation of the impact of the Lidcombe Program on early stuttering. Journal of fluency disorders, 27(3), 203-214. doi:https://doi.org/10.1016/S0094-730X(02)00127-4
Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, I., & Gebski, V. (2005). Randomised controlled trial of the Lidcombe programme of early stuttering intervention. bmj, 331(7518), 659. doi:https://doi.org/10.1136/bmj.38520.451840.E0
Lattermann, C., Euler, H. A., & Neumann, K. (2008). A randomized control trial to investigate the impact of the Lidcombe Program on early stuttering in German-speaking preschoolers. Journal of fluency disorders, 33(1), 52-65. doi:https://doi.org/10.1016/j.jfludis.2007.12.002
Millard, S. K., Edwards, S., & Cook, F. M. (2009). Parent-child interaction therapy: Adding to the evidence. International Journal of Speech-Language Pathology, 11(1), 61-76.
Nye, C., Vanryckeghem, M., Schwartz, J. B., Herder, C., Turner, H. M., & Howard, C. (2013). Behavioral stuttering interventions for children and adolescents: A systematic review and meta-analysis. Journal of Speech, Language, and Hearing Research, 56(3), 921-932. doi:10.1044/1092-4388(2012/12-0036)
Onslow, M., Webber, M., Harrison, E., Arnott, S., Bridgman, K., Carey, B., . . . Lloyd, W. (2017). The Lidcombe Program Treatment Guide.
Trajkovski, N., Andrews, C., Onslow, M., Packman, A., O’Brian, S., & Menzies, R. (2009). Using syllable-timed speech to treat preschool children who stutter: A multiple baseline experiment. Journal of fluency disorders, 34(1), 1-10. doi:https://doi.org/10.1016/j.jfludis.2009.01.001
Waelkens, V. (2018). Mini-Kids. Direct therapy for young children who stutter. Leuven
Ingen kommentarer:
Legg inn en kommentar