Syllable timed speech treatment for school-age children who stutter

Abstract

Stuttering is most tractable, and therefore responsive to treatment, during the preschool years. It becomes more difficult to treat as children get older (Bothe, 2004; Bothe, Davidow, Bramlett & Ingham, 2006; Ingham, 1984; Ingham & Cordes, 1999; Onslow & Packman, 1997, 1999; Prins & Ingham, 1983). However, many children do not receive treatment for their stuttering during this period Increasing demands are placed on the communication of the school-age child (6 years through 11 years) both at school and with peers. The effects of stuttering in this age group result in bullying, negative perception by peers and rejection. The research into school-age treatments predominately investigates techniques developed for people who stutter in either the preschool age group or adolescent and adult age groups. This has resulted in a need to develop treatments for the school-age group, supported by rigorous evaluation. Consequently, the purpose of this thesis is to describe Phase I and Phase II trial evidence of a treatment designed specifically for school-age children who stutter. Syllable timed speech (STS) was taught to school-age children in conversational speech without programmed instruction. Parents participated in the treatment sessions and were taught to conduct therapy at home. This thesis is presented in three parts. Part One provides an overview of stuttering, a review of historical and current treatments available for school-age children, and a broad summary of how this age group learns and interacts with society. It finishes with a rationale for the two empirical studies that form the basis of the thesis. Part Two comprises two empirical studies using Syllable Timed Speech (STS) as the basis for treatment. In Part Three, the use of STS plus verbal contingencies is discussed in detail, with future directions and implications for speech pathologists treating this age group. The two empirical studies in Part Two were as follows: The first study investigated simply practising STS as a technique to reduce stuttering without any additional procedures. Ten children (aged 6 years to 11 years, 11 months) were treated in a prospective Phase I trial to determine if STS could stand alone as the treatment agent for this age group. The treatment for Study 1 consisted of two stages. Stage one was designed to treat the client and train the parent to conduct treatment at home. Stage 2 was reached when participants achieved pre-set goals in therapy. Percent syllables stuttered outcome measures were obtained through phone calls to each participant, taken before commencing treatment and 9 months into treatment. Secondary outcome measures were obtained for self-reported severity and satisfaction with the treatment, self-reported avoidance of speaking situations and the impact of stuttering. Speech naturalness was evaluated by presenting short samples of speech taken before treatment and entry into Stage 2. There was considerable individual variation in response to the treatment, with more than half of the participants’ stuttering decreasing by more than 50%. A paired-samples t-test taken pretreatment and 9 months after the beginning of treatment indicated clinically meaningful results. It was noted that the stuttering of 9 out of the 10 participants reduced significantly within the first 6 weeks of treatment. However, practising STS alone did not produce significant and extended reduction in stuttering for all the children. Only 3 out of the 10 participants reached Stage 2 before the 9-month follow-up. The first study showed the potential for STS as a treatment agent but the results, although promising, did not indicate adequate or sustained stuttering reduction. For the second study, therefore, the following modifications were made to address these issues: (1) contingencies were added to sustain and further augment the decrease in stuttering gained in the first few weeks of treatment and (2) STS was gradually withdrawn according to the individual needs of the child during Stage 1. Twenty-two children (aged 6 years to 11 years, 11 months) entered the treatment program and three children withdrew before reaching Stage 2. Four assessments were made at the times: (A1) entry into Stage 1, (A2) entry into Stage 2, (A3) 6 months and (A4) 12 months post entry into Stage 2. The same self-reported secondary outcomes were taken to evaluate participant satisfaction, avoidance, and impact of stuttering as in the first study. Naturalness was evaluated by five listeners evaluating samples taken pretreatment and at entry into Stage 2 on a rhythm scale developed for this study. The group mean percent syllables stuttered (%SS) at A1 was 8.4 and at A4 was 1.9 (SD=1.6), resulting in a mean reduction of stuttering of 78%. Group mean stuttering severity, situation avoidance, and speech satisfaction scores also improved significantly. Naturalness, as evaluated by the rhythm scale, was not compromised by using STS to control stuttering. These current studies, using STS as a stuttering treatment for school-aged children, are among a very few studies that specifically address stuttering treatment in the school-age population. Previous studies of school-aged children have focused on modifying treatments designed to deal with a different age group. Unlike previous treatments using STS, this treatment proceeds from simple STS practice to conversational speech practice without programmed instruction. Additionally, parents were taught to conduct the treatment at home which aided the generalization and maintenance of skills. Results confirm the STS treatment as an efficacious one that speech pathologists can consider using with their stuttering clients.