Research or studies of ‘fluent’ stutterers?

Hello experts!

There’s been a lot of work on the development of treatments for adult people who stutter to improve fluency, but even after treatment there is often an inexorable decline in fluency, leaving the person who stutters back at square one.

And yet, some people who stutter are able to find the right solution, whether that be support groups or other tools and processes, to make fluency work for them long term.

Has any research or studies been done with PWS who have gained significant long term fluency improvements?  If so, what were the outcomes?

 1,552 total views,  1 views today

Comments

Research or studies of ‘fluent’ stutterers? — 8 Comments

  1. ‘But I am a stutterer’ claimed a ‘very fluent’ client who stutters. He reminded me of this girl with anorexia looking at the mirror and perceiving herself to be fat. My reflections as a clinician was that I should have helped my client become more comfortable with the stuttering. in my clinical experience, the best results have been achieved wen there was a shift in attitude and perception towards stuttering. This was when stuttering is not seen as a monster but a condition which makes an individual unique and different. Using creativity one lives alongside the stuttering characteristics.
    So, bottom line, what is success in fluency intervention? Fluent speech or a more positive attitude towards communication and oneself?
    With regards to outcome measures, Barry Guitar and Rebecca McCauley’s book ‘Treatment of Stuttering- Established and Emerging Interventions’ discusses and outlines research outcomes of most current treatments for adults who stutter such as the Camperdown Programme, Fluency Plus Program and Application of SeechEasy to Stuttering Treatment etc.

  2. Hello Bruce, and thank you for your question. I’m not aware of any recent studies describing long-term fluency improvements for adults who stutter, but I do know that Patrick Finn of the University of Georgia has published a few studies of recovery of stuttering in adults. His studies focus on adults who have not been treated for stuttering, and he has conducted interviews with his participants to determine their attitudes about speaking and their own speech in general(Finn,Howard, & Kubala 2005, Journal of Fluency Disorders, pages 281-306). The 2005 study included 15 adults, half of whom had no evidence of stuttering in their speech, and half of whom still stuttered on occasion. In a 2004 book chapter (in Evidence-based treatment of stuttering, edited by Anne Bothe), he pointed out that the recovery process for adults can begin in adolescence. Some of the reasons participants gave for their recovery was a more conscious effort to change their habitual way of speaking and their attitudes about themselves and their speech.

    Outside of spontaneous recovery, Laura Plexico, Walt Manning, and Anthony DiLollo did in-depth interviews of seven adults who stutter who had reported successful management of stuttering, and whose severity was measured as no higher than “very mild” at the time of the interview. The study appeared in the Journal of Fluency Disorders (2005, pages 1-22). These adults were professionals who had devoted their lives to the treatment or study of stuttering, and were speech-language pathologists, leaders of support groups for people who stutter, or researchers of fluency disorders. Successful management was made possible through support from others, including family, therapy, and support groups, motivation to change, and cognitive change.

    Many current efficacy studies report fluency improvements 6 or 12 months after treatment, but to my knowledge, there aren’t too many reports of long-term improvements. Others on the panel may know of more.

    Kind regards,

    Jean

  3. Most of the studies of long term outcomes relate to treatments that fall into the category of speak more fluently. In the Journal of Speech Hearing Research 1996 there was study on prolonged speech outcomes. Onslow et al. from Australia. The speech of 12 clients was assessed. For 7 clients an assessment was made 3 years post treatment. Measures were percent syllables stuttered, syllables per minute, and speech naturalness. Results showed that 12 subjects who remained with the entire 2-3-year program achieved zero or near-zero stuttering. The majority of subjects did not show a regression trend in %SS or speech naturalness scores during the posttreatment period, either within or beyond the clinic.

    Another is one by Boberg and Deborah Kully. They did a study on the results of therapy at the Institute for Stuttering Treatment and Research Edmonton, Alberta. I’m not sure how long term the results were, but results from the phone call samples indicated that about 69% of the subjects maintained a satisfactory level of post-treatment fluency, with an additional 7% maintaining a level that was judged to be marginally satisfactory. There are other studies too as others have mentioned, but certainly not enough.

  4. Hello Bruce
    Based on clinical trials, and scientific research papers, long term retention was obtained with the following treatment protocol applications:
    1.Concentrated/Intensive treatment format with the length of treatment varying based on the level of severity.
    2.Treatment addressing stuttering from a neurophysiological perspective.
    3.Post-treatment maintenance and support program that is compatible with the original treatment method/program.

    Past and present studies have demonstrated that spaced therapy has the shortest retention level.

    As you stated, adults who stutters often times experience a RELAPSE in their fluency gain. This happens when these individuals do not have a maintenance program or do not conduct their maintenance training/exercises on a daily basis.

    Such computerized programs do exist with excellent long term retention. These programs are based on neuroscience.

  5. Hi Bruce

    In the interest of full disclosure, I am the Executive Director of the Institute of Stuttering Treatment and Research (ISTAR) at the University of Alberta. ISTAR maintains a fee-for-service stuttering treatment clinic that is not-for-profit but is supported by clinic fees that we charge. In addition to the fine works of Finn, Plexico and Manning mentioned above Marilyn Langevin and Deborah Kully and colleagues published a study of 5-year treatment outcomes of adults who stutter who participated in the Comprehensive Stuttering Treatment Program at ISTAR in Edmonton, Alberta. The abstract of the article, published in the Journal of Fluency Disorders in 2010 (prior to my arrival at ISTAR) neatly summarizes their findings:

    “Replicated evidence of satisfactory 1- and 2-year post-treatment outcomes has been reported for the Comprehensive Stuttering Program (CSP). However, little is known about longer term outcomes of the CSP. Yearly follow-up measures were obtained from 18 participants for 5 consecutive years. At 5-year follow-up, participants were maintaining clinically and statistically significant reductions in stuttering and increases in rates of speech relative to pre-treatment measures. Standardized effect sizes were large. There were no significant differences among the immediate post-treatment and five follow-up measures, indicating that speech gains achieved by the end of the treatment program were stable over the 5-year follow-up period. Insufficient return rates for self-report data for the third to fifth follow-up measurement occasions prohibited analyzing these data. However, non-significant differences among the immediate post-treatment and two follow-up measures indicated that improvements achieved by the end of treatment in speech-related confidence, and perceptions of struggle, avoidance, and expectancy to stutter were stable over the 2-year follow-up period. Significant differences among the speech-related communication attitudes scores indicated that improvements in attitudes made at the end of the treatment program were less stable. Taken together, these results provide further and longer term evidence of the effectiveness of the Comprehensive Stuttering Treatment Program.”

    • Allow me to add that a significant challenge to the collection of long-term treatment outcome data is the high attrition rate of participants. In today’s mobile society clients move frequently and do not always have as a priority the act of updating their addresses with the scientific researchers! In addition, the longer the term that you examine the greater the likelihood that participants who have moved have pursued alternate forms of fluency and attitude change maintenance to the original program under evaluation. We would love to learn of suggestions from the population of people who stutter of how outcomes research can overcome these challenges!

  6. Thanks everyone for your responses so far, happy to see more! My interest in this area was to find out if anyone has been able to identify any specific factors in people who have been able to achieve long term fluency improvement. I am encouraged to see some work in this area, but it does sound like more should be done.

    • Bruce, thank you for your question! Regarding how to identify the specific factors in people who have been able to achieve long term fluency improvement, I want to add the importance of combining qualitative and quantitative research, aiming for being more context-sensitive in research regarding treatment. Often research is to much focused on how a particular program is working more than what positive changes are observed in the person. I recommend the articles of Bothe and Richardson (2011) and Ingham and colleagues (2012) regarding integrating functional measures with treatment. Bothe introduced the word “peronally significant changes” in the research (in addition to statistical, practical and clinical evidence). This aspect I find very important. Maybe we more often can ask the person him/herself about which factors he or she thinks are of highest importance for his improvements.