Celebrating International Stuttering Awareness Day with a free collection of articles

Today, 22 October, Stuttering awareness day is marked around the world, and Norway is no exception. NIFS (the Norwegian interest organization for people with stuttering and cluttering) is informing about stuttering many places in the country today.

NIFS has a stand on Egertorget among other places, today. Their campaign is: "Speak with your own stuttering"

Statped is marking the day by launching a brand new, and free (!) publication consisting of 14 articles aimed for SLPs and SLP-students about assessment and treatment of stuttering in children, youth and adults. EST members Linn and Åse are proud to have contributed to the collection (prior to the ESTs projects start). Linn has been co-writing an article about treatment for stuttering in preschool aged children. Åse’s contribution is an article on assessment and treatment of bilingual people who stutter. She has also co-written a paper on how to work with teachers and the staff at school around children who stutter. In addition she was leading the project for some time, before starting her PhD in the EST project. In this week’s blogpost, we would like to tell you a little bit about the publication.

The new publication was put together by members of Nasjonalt Taleflytforum, a forum consisting of SLPs working with fluency disorders in Norway, lead by Statped. The network has previously worked with translations of assessment tools and preparation of information material. The idea of putting together a collection of articles for SLPs came in 2015. Since then an editorial board of four SLPs have worked with collecting articles from co-authors, commenting on them, and preparing them for publication. More than 10 SLPs have contributed to writing the articles.

The topic of the articles have been inspired by a survey the forum conducted among Norwegian SLP prior to starting the project. More than 50 suggestions to topics for articles came in. The need for new material on treatment in Norwegian was apparent! Up until now there has not really existed any practical handbooks or collections of articles in Norwegian about assessment and treatment of stuttering. With this collection SLPs in Norway will finally be able to access new and updated information about treatment, and best of all: it’s free online! (If you prefer to read from a printed hard copy, the publication can be purchased as print on demand here.)

Meeting with the EST reference group

In addition to the EST-project group, we have an advisory board and a reference group. The latter consists of representatives of institutions, organizations or groups of people that our research can be beneficial to. Importantly, an overall aim of reference groups is to involve the users of the research in the research projects and the research projects to benefit from the users experiences and knowledge about the topic under study. In the EST-project, collaboration with many of the representatives were established when drafting the grant proposal, however, we have also gotten some new representatives in the group throughout the two years that the project has been running.

The meeting this time focused on important design issues such as pre- and post-measures, inclusion criteria and collaboration in recruiting participants. The fruitful discussions with the reference group gave us new perspectives, possible solutions, but also some challenges to work further with.

I believe that I can say that I talk from everyone in the EST project group when I say that we are privileged to have such an engaged, knowledgeable and reflective reference group!

From the left: Elisabeth Holm Hansen (USN EST), Karoline Hoff (Statped), Martin Wright (NIFS), Ane Hestmann Melle (Statped), Melanie Kirmess (UiO EST), Kari-Anne Næss (UiO EST), Linn Stokke Guttormsen (UiO EST), Konstantinos Antypas and Hilde Hofslundsengen (HVL EST). Karianne Berg (Nord University) and Astrid-Tine Bjørvik (Statped midt, NTNU) joined on SKYPE.

An updste from the RCT-course

Then we arrived in Stavanger, the oil capital of Norway, on a day with a big jump in oil prices. However, no one in the RCT course was talking about oil. Everyone’s focus was on the research.

Nearly 20 researchers from different fields participated in the course, mostly PhD students but also others. Even an emeritus was among the participants. (I hope I will be as curious and eager to learn as him when I am his age.) However, it is not an everyday occurrence to have a visitor who is ranked among the world’s leading education economists.

It was a real pleasure to participate in Eric Bettinger’s lecture today. Different aspects were touched upon. They related to the components of an RCT (units, treatments, and outcome), mechanisms and counterfactuals (e.g. different outcomes from different dosages), selection bias (the one fulfilling the intervention differed from the one not fulfilling the intervention), the balance between the treatment and the control group for different non-manipulated variables (such as age, sex, etc.), the level of detail in the research question/generalization from the results (for a certain group of children at a certain age versus for all children) and the importance of theoretical justifications for a treatment for the advancement of the science.

Bettinger showed a great deal of enthusiasm through his pleasure, interest and engagement. He knows what he is talking about and gives a lot of examples from a variety of fields. Interaction was encouraged, and the lecture shifted between traditional teaching with well-designed PowerPoint slides (including nice references), training and discussions, which ensured variation and gave a feeling that the lecturing did not lasted too long, even if it was seven hours. Questions and comments were encouraged, and we were also given the opportunity to ask questions during the (approximately) 10-minute break. The language was clear, and the important points were stressed from different points of view. So Bettinger is not only a great economist but also a really great teacher and should we believe some of the existing research this may not be a too frequent combination.  A RCT-study from Netherland by Palali, van Elk, Bolhaar and Rud (2017) looked at the relationship between research quality and teaching quality and investigated if good researchers also are good teachers. They found that master students thought by teachers with high quality publications got higher grades. However, the student’s evaluation of the teaches did not fully reflected this since they were not ranked higher.

After today’s lectures, we took the bus back to Stavanger and went for a short walk to find our Airbnb house. After Indian takeaway food and some shopping (it is really cold here in Stavanger so I  had to buy a new jumper), we started our second task for today, namely to revise our questionnaire to the speech and language therapists, preschool teachers and health nurses. Finally, before we went to bed we did our homework.

I am looking forward to another course day tomorrow!

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Reference:

Palali, A., van Elk, R., Bolhaar, J., & Rud, I. (2017). Are good researchers also good teachers? The relationship between research quality and teaching quality. CPB Discussion Paper 347. Maastricht: CPB Netherlands Bureau for Economic Policy Analysis.

The detailed design process of a high-quality randomized controlled stuttering trial has started

Hilde, Linn, Åse and I are about to arrive in Stavanger to participate in a one-week course about randomized controlled trials (RCT) in social science at the University of Stavanger. The course is led by Eric Perry Bettinger from Standford School of Education, and we will actually be students for five days from 9:00 a.m. to 4:00 p.m. daily and have a reading list of seven pages full of references.

I am still a bit old fashioned when it comes to reading; I like paper versions of articles best so that I can make notes (e.g., inferences, comments, associations, questions) with a pen. I am aware of the latest technology, such as the Apple pencil that can be used to make comments by hand on the iPad, but I still prefer jotting down notes the old way. I do not know if it is because of my bad eyesight or the fact that it gives me a better overview of the text’s spatial landmarks and thereby reduces the cognitive load required to orient myself to the text. Or maybe it’s the depth of reading that is possible (e.g. effectively revisiting parts). It may simply be due to habit (reading rigidity). Luckily, the three others in the EST-team also prefer paper, so I am comforted by the feeling that I am not so outdated (read ‘old’) and it make me optimistic about my potential for learning the course materials. A systematic review of the research on the effects of reading media on reading comprehension by Delgadoa, Vargasb, Ackermanc and Salmeróna (2018) actually concluded that paper-based reading yields better comprehension outcomes than digital-based reading. So at least I could say that my preferred strategy is based on results from international research.

My thanks go to Linn and Åse for printing all the articles on the reading list and sending them to the Repro Central at the University for binding as books. They became no less than five “large books”, so then I knew what to do in the weekend. On Saturday, I opened the first book of articles and started to read enthusiastically Understanding and Misunderstanding Randomized Controlled Trials, by Deaton and Cartwright (2017). The content reminded me very much of the views on RCTs of a colleague at the University of Oslo, Tone Kvernbekk. She underlined RCTs pitfalls and the need for a combination of methods to determine what works and why.

On the one hand, the Deaton and Cartwright (2017) article critically highlights the pitfalls of the design of RCTs, such as potential confounders; on the other hand, it stresses the fact that other designs also have the same challenges in addition to their own. Therefore, RCT is still broadly considered to be the gold standard of designs. Neveertheless, the authors highlight the importance of having a realistic understanding of the strengths of RCT design and of its limitations and pointed to three common misunderstandings of it’s quality:

1)    Randomization ensures that the treatment and control groups differ only with regards to the treatment variable

2)    Randomization provides precise and unbiased estimates of average treatment effects

3)    Standard significant tests of RCTs are reliable

In addition, the athors underline the need for replication studies and complementary study designs to gain insights into the results of different samples and contexts and why the target intervention is effective and for whom (individual variations).

An update of our course experiences will follow shortly.

All the best,

Kari-Anne

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References:

Delgadoa, P., Vargasb, C., Ackermanc, R., & Salmeróna, L. (2018). Don't throw away your printed books: A meta-analysis on the effects of reading media on reading comprehension. Educational Research Review, 25, 23-38.

Deaton, A. & Cartwright, N. (2017). Understanding and misunderstanding randomized controlled trials. NBER working paper 22595. Cambridge: National bureau of economic research.

Norwegian speech pathologists’ treatment of young children who stutter

In June, Ane, Karoline and Kari-Anne and Linn published an article concerning Norwegian speech language pathologists’ (SLPs) treatment of young children (age 2-6) who stutter in the Norwegian journal Norsk tidsskrift for logopedi. Also, with the permission from the journal, the article was reprinted on the web page Utdanningsforskning.no. This blog post is a summary of the paper.

The majority of children who stutter will recover within school-age (Kefalianos et al., 2017; Månsson, 2000), however, few experience natural recovery within the first year after onset (Reilly m. fl., 2013). At present we are not able to predict who will experience natural recovery and who will persist to stutter and when natural recovery will occur (Clark, Tumanova, & Choi, 2017). Studies have shown treatment to be more efficacious in reducing stuttering in young children than no treatment (Harris, Onslow, Packman, Harrison, & Menzies, 2002; Lattermann, Euler, & Neumann, 2008). Given the abovementioned, treatment in young children is recommended. However, in Norway there are no national guidelines concerning stuttering treatment for young children.

Our study aimed at investigating how speech language pathologists in Norway treat young children who stutter. An electronic survey was carried out after approval by the Norwegian Centre for Research Data. Four main questions were asked in the survey. These concerned what kind of treatment approach SLPs used in treatment of young children who stutter (direct/ indirect/ a combination of direct and indirect/ other treatment), how often the different treatment approaches were given, the most often used indirect treatment (Palin PRS, Restart DCM, own developed of indirect direct strategies, other) and direct treatment (Westmead, Lidcombe program, fluency shaping techniques, stuttering modification techniques, other).

117 SLPs responded to the survey. The results indicate that the majority of SLPs use indirect treatment with young children who stutter. More specifically, the SLP’s own developed combination of different indirect strategies is used by most. Few report using indirect treatment programs such as Palin PCI (N=8) and Restart DCM (N=11) and direct treatment programs such as the Lidcombe program (N=2) and Westmead (N=0) most often. In summary, the results from our study highlight a discrepancy between the Norwegian SLPs practice and research evidence. Since there is no evidence for the treatment that is given most often by the majority of SLPs in the survey, future studies should target the effect of this treatment. Furthermore, to ensure efficacious treatment for young children who stutter in Norway, guidelines of stuttering treatment together with training in efficacious treatment programs should be implemented in Norwegian speech clinics.

References

Clark, C. E., Tumanova, V., & Choi, D. J. P. o. t. A. S. I. G. (2017). Evidence-Based Multifactorial Assessment of Preschool-Age Children Who Stutter. 2(4), 4-27.

Guttormsen, L.S., Melle, A.H., Hoff, K., & Næss, K-A.N (2019). Stammebehandling av barnehagebarn: norske logopeders praksis. Norsk tidsskrift for logopedi, 2, 6-13.

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

Kefalianos, E., Onslow, M., Packman, A., Vogel, A., Pezic, A., Mensah, F., . . . Reilly, S. (2017). The History of Stuttering by 7 Years of Age: Follow-Up of a Prospective Community Cohort. Journal of Speech, Language, and Hearing Research, 60(10), 2828-2839. doi:10.1044/2017_JSLHR-S-16-0205

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

Månsson, H. (2000). Childhood stuttering: Incidence and development. Journal of fluency disorders, 25(1), 47-57. doi:http://dx.doi.org/10.1016/S0094-730X(99)00023-6

Reilly, S., Onslow, M., Packman, A., Cini, E., Conway, L., Ukoumunne, O. C., . . . Block, S. (2013). Natural history of stuttering to 4 years of age: a prospective community-based study. Pediatrics, 132(3), 460-467. doi:http://dx.doi.org/10.1542/peds.2012-3067

Guest post: A research stay in Sogndal

As most members of the EST-project are having some well earned time of this summer, the EST blog will take a short break. As a last post before the holidays, we have asked Ria Bernard to be a guest on the blog! The PhD- student normally situated at the UCL have been working together with EST group member Hilde this spring. In this blog entrance she writes about her research and research stay. Thank you for sharing, Ria!

I first met Dr Hilde Hofslundsengen during her visit to University College London (UCL) in the autumn term 2018, when she was visiting my supervisor, Professor Courtenay Norbury’s, lab. Only a few months into my PhD, it was exciting to hear about the fantastic work Hilde was doing with the EST Project team and her passion for stuttering research.

My PhD is looking at whether there is an association between anxiety & depression and stuttering in children and young people. It is very much set in the context of preventative healthcare in terms of firstly identifying whether children who stammer are more likely to present with anxiety/depression relative to their non-stammering peers, and potentially identifying risk factors that could guide effective early intervention to offset later adverse mental health conditions in this population.

The first project in my PhD involves completing a systematic review of the literature that has explored anxiety and depression in young people who stammer. You can imagine how delighted I was when Hilde, with all her experiences within the EST project and beyond, agreed to co-author the review – and even more thrilled when she invited me to visit her at the Western Norway University of Applied Sciences to work on the review together!

In late May 2019, I arrived in the spectacular town of Sogndal. It was incredible to be surrounded by such breath-taking scenery while undertaking our research - and quite a change from the hustle and bustle of London. I was overwhelmed by everyone’s friendliness at the university and their ability to lapse effortlessly between Norwegian and English (amongst other languages!) over lunch in the staff canteen.

Following an initial literature search, we now settled down to the task of screening over 

13,000 articles. While overwhelming in the beginning, our persistence paid off and we managed to get down to just under 500 articles for the full text screening. With a week and a half to go, we worked hard to get through the second stage of the review process, each of us screening all 481 articles with a day to spare before I had to return to London. Exceeding the personal goals we had set for my four-week visit, I was very proud to be returning to UCL with 21 articles for the third coding stage of the review.

Alongside all the work on the review, I also managed to explore the stunning nature that Sogndal – and Norway – has to offer. From making the most of the long light evenings with mountain walks overlooking the Fjords to visiting Jostedalsbreen Glacier, nature offered a mesmerising solace from our computer screens. 

Hilde, making every effort to include me in the team, invited me to Bergen where I had an opportunity to be a tourist for a day, and to accompany her research team on their writing retreat in the most picturesque surroundings. Hilde’s colleagues were equally welcoming – inviting me to the cinema and to sample the cultural delights of the summer market in Lærdal. While we didn’t make it to Oslo, I was very pleased to meet Linn and Åse over a virtual coffee on Skype!

The last four weeks in Norway have been unforgettable and I want to say a big thank you to Hilde and her family for making me so incredibly welcome and giving me the chance to visit. Needless to say that having the opportunity to work side-by-side and systematically sift through decades of research literature had huge benefits not only for our project but also for me as a researcher learning from Hilde’s wealth of experience.

I hope one day I’ll have an opportunity to return!

Ria Bernard, UCL PhD student

My research is funded by ESRC UBEL DTP and Action for Stammering Children Charity

What I’ve learned in my first year as a PhD student in the EST-project

The summer holiday is about to start. That marks the end of my first year as a PhD-student in the EST project. During this year I have gotten to know the field of stuttering better through countless discussions in our group, writing, experiencing peer review, attending a symposium, and reading research. The research on treatment for preschool aged children who stutter is fast evolving. Just in the last year Millard, Zebrowski & Kelman (2018) Trajkovski, N., O'Brian, S., Onslow, M., Packman, A.,Lowe, R., Menzies, R., ... & Reilly, S. (2019) and Druker, Mazzucchelli & Beilby (2019) have added to the evidence. It is without doubt a truly interesting and exiting field to dig into.

However, being a PhD- student, I’ve discovered, also means classes to take, teaching to do and worries to have. I’ve spent this year trying to figure out how best to handle a #phdlife. Here are six things I’ve learned this year:

1) Planning is key!

The line “I don’t need to write that down, I’ll remember it” has never been true for me. With a lot to do at work, my short-term memory has definitely not approved. I use my calendar for all things I need to do, and I write “to do” lists on my phone, on stickers on my desk and in meetings. I’ve learned this keep me sane and helps me to worry less about things I need to remember.

To keep track of the longer run I keep a four-year plan that I often check in on and change accordingly. In addition I make a detailed plan for every week a couple of months ahead so that I can have a more simple plan to look at than my calendar to make sure I meet my small goals set for that time. This also helps me to see that I am actually getting things done! 

As for writing things down, I have also learned I should always write notes from meetings, classes as well as methodological reflections, references and thoughts I have for future papers. Along with other PhD-students at my department, I have tried writing every day. This has been a very interesting experience. Although I have not always succeeded, the post about ways to write more taught me that many activities are relevant in the writing process, not only writing on a blank page.

2) Imposter syndrome is real

Surely, I am not alone about feeling misplaced in academia at times. I’ve learned that worrying about being exposed as incompetent is not unusual. In fact, it has a name: Imposter syndrome. To manage the feeling in order to get things done, I have learned it is not always helpful to compare myself to others. Every PhD project is different, and every PhD student do things differently. Instead of worrying about my own process when hearing about what others manage, I try to be happy for them and notice when I am doing something right as well, which leads us to the next point:

3) No victory is too small to celebrate

Working long hours, and always having the feeling that I need to start on a new task, it is sometimes hard to slow down and notice that I am making progress. I’ve learned to notice and celebrate small milestone. That might be submitting a paper for a class, having that paper accepted, doing a presentation, or finishing a draft. Celebration might be finishing a little earlier, enjoying lunch outside or splurging on the good coffee. Paying attention to the small milestones along the way reminds me that I am in fact moving forward.

4) Teaching is fun!

Growing up with two teacher parents, I was determent never to become a teacher. So I became an SLP, started my PhD and found out I love to teach! 

Frankly- I have had a sneaky feeling I enjoyed it also prior to the PhD. Through my last job, I was able to teach at our department. Teaching student both in speech and language but also seminarian in special education motivates me and gives me a opportunity to look at the field from the outside. Also, meeting students and getting them excited about the world of stuttering is truly rewarding.

5) Doing a PhD is a learning experience

I often need to remind myself that the PhD position is not only a job, but also an education. I tell myself this when I have the feeling I know nothing on the first day of a lecture, or don’t understand anything of the first chapter of a new book. It takes some time to shake the feeling of being stupid. However, thinking about things that I didn’t know about when I first started a year ago really helps.  

6) It is a marathon, not a sprint!

I’ve learned that not all days are productive days. Some days I’ll only make it half way through my to do-list and feel like I am doing zero progress. Moreover, although days like that are unhelpful, I realize that my thesis does not break into a thousand pieces because of a day or two like that. Luckily!  Similarly, I have learned to take advantage of good days. To close the door to the office in order to not be disturbed when I feel like I’m in a good flow. Tick of all the boxes on the “to do” list, and perhaps, go back to point 3.

-Åse