Studies being done on developmental appropriateness?

Dear Experts – thank you for taking part.  I am the mother of a 17-year old who stutters, author of “Voice Unearthed: Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter” and of this forum’s submission “The Right Time to Break Out the Stickers.”

I am always concerned when I see therapy recommendations for school-aged children lumped in with teens and adults.    These kids are experiencing distinctly different developmental stages than older teens and adults (see my ISAD submission).  Are you aware of any research or studies being done regarding the developmental appropriateness of stuttering modification therapy for this age group?

Thank you for your consideration and I look forward to your insights…

Best,

Dori Lenz Holte

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Comments

Studies being done on developmental appropriateness? — 6 Comments

  1. Hi Dori, I share your concern whenever I see the treatment implication that “one size fits all.” I know from your work that you too are sensitive to the importance of tailoring the treatment experience on the basis of the many skills and interests of the individual person being served. While there are commonalities in our daily lives and communication experiences, I have found that “success” often relates directly to the extent to which we clinicians can see through the eyes of the person who stutters and come to understand his/her place in that world. Keep up your good work. You have an important message. Kind regards, David

    • Thank you David for your thoughtful reply. I agree that we must do the best we can to understand a child’s place in the world and respond in a way that is nurturing and productive. We also must be cognitive of what falls outside of commonality between children’s and adults’ abilities to communicate. This is pretty vast considering brain development and world experience.

      Adults (parents, therapists, teachers) on a daily, even hourly, basis lend their eyes and world experience to interpreting and reacting to children’s behavior. For instance, if a child is reticent or refuses to use speech tools outside of the clinic setting, it is the adult’s responsibility to interpret and react to this behavior. The adults might believe that the child is being stubborn or lazy (which is exactly what I believed for years) or they may decide that expecting a child to use these tools is developmentally inappropriate (what I wish I would have believed much sooner). Each reaction will have an array of outcomes that will significantly impact the child’s world. It seems that an increased understanding of the cognitive differences between adults (even teens) and children as it relates to therapy for stuttering needs to be further explored and reported on by professionals within the field. How do we make that happen? Thanks as always for your support of my message.

      Children’s words and behaviors are continually interpreted and reacted to through the eyes of the adults who have substantial control of their world. The impact of these reactions is tremendous. hopefully react in a way that is nurturing and productive to the child as children most often do not have the emotional or intellectual maturity to accurately express what they are experiencing.

    • oops, that last paragraph had not made the final cut, but got in there anyway…maybe the moderators can remove it? No big deal…

  2. Dori, you might be interested in the following article which “summarizes the literature regarding different stuttering intervention approaches that have been used with preschool-age and early school-age children.” Sidavi and Fabus, (2010) A Review of Stuttering Intervention Approaches for Preschool-Age and Elementary School-Age Children. Contemporary Issues in Communication Science and Disorders, Volume 37, 14-26 (http://www.asha.org/uploadedFiles/asha/publications/cicsd/2010SAReviewofStutteringInterventionApproaches.pdf). You will see there are many approaches. Just as with treating stuttering in adults, in my opinion one size does not fit all. Some approaches are have more research since they focus more on behaviors which can be more easily counted. There is even some research that shows that the relationship between the client and the clinician is more important than the treatment protocol. I am very glad you found the right match for you and your son with Jerry.

    • Hi Judy, thanks for your response and for the article. The second paragraph in the article is exactly what I wish parents fully understood…”Stuttering treatment is a contentious issue for speech language pathologists (SLPs) and has posed a pressing challenge in the field of speech-language pathology for decades….There are many treatments for stuttering, however, there is little agreement as to which should be used and when treatment should begin.”

      The support organizations continually assure parents that they should get their child to therapy ASAP and that a speech therapist can help their child to “manage their speech.” They convey little if any of the contentiousness, uncertainty, and lack of agreement around treatment for children. These organizations do a lot of good as far as connecting families and lending support to coping with the challenge, but as long as therapy results and outcome measures focus primarily on disfluency counts, we risk doing harm.

      The article also acknowledges (p 17) that it is difficult to obtain outcome measures and quantify efficacy when the focus is on desensitization and reducing the individual’s anxiety. They go on to say “it is not sufficient to count the number of disfluencies or the frequency of stuttering moments…because the overt aspects of stuttering account for only 10% of the problem.” But it’s that 10% that’s easiest to measure, and it’s only natural that that aspect becomes the primary focus in therapy. Wouldn’t it be far more productive to focus our energy on the aspects that account for 90% of the problem and will not lead to withdrawal and silence – a far greater handicap than the stuttering?

      You know that my mission in life is to affect change in the treatment for children who stutter. I do not, by any means, have all the answers on how best to do that… I hope and pray every day that the leaders in this field will embrace this mission and we can work together to come up with an approach that does not carry the risks of the current therapies for school-aged children. Thanks again for taking the time to respond.
      Best,
      Dori

  3. Dori poses a very important question, that is often made more confusing by professionals in our field. I just finished reading the review article that was referenced in another reply (Sidavi and Fabus, (2010) A Review of Stuttering Intervention Approaches for Preschool-Age and Elementary School-Age Children. Contemporary Issues in Communication Science and Disorders, Volume 37, 14-26). I chose one section of the article (research on regulated breathing) and pulled up two of the articles that were referenced – I did not have access to the third article. Andrews & Tanner (1982) studied subjects with an average age of 26 years. Ladauceur et al. (1982) studied 12 subjects with an age range of 17 – 74 years. Both studies found this approach disappointing and NEITHER USED CHILDREN. Why was this section in the paper. I can only assume that other studies mentioned (possibly most) included adult subjects. One can also assume that most of the studies that were done with children had small sample sizes and were not replicated- something the authors themselves point out as important.

    I am unaware of any replicated research with adequate sample size that demonstrates that stuttering modification or fluency shaping is an effective treatment for pre-school or young school-age children who stutter. NOTE: The research of the Lidcombe program has been completed on children with adequate sample size and some replication, but it isn’t really fluency shaping or stuttering modification since the child is not told how to modify their speech in this program.