Can supervise: YES
O'Brian, S, Heard, R, Onslow, M, Packman, A, Lowe, R & Menzies, RG 2020, 'Clinical Trials of Adult Stuttering Treatment: Comparison of Percentage Syllables Stuttered With Self-Reported Stuttering Severity as Primary Outcomes.', Journal of speech, language, and hearing research : JSLHR, vol. 63, no. 5, pp. 1387-1394.View/Download from: Publisher's site
Purpose In a companion paper, we found no statistical reason to favor percentage syllables stuttered (%SS) over parent-reported stuttering severity as a primary outcome measure for clinical trials of early stuttering. Hence, considering the logistical advantages of the latter measure, we recommended parent-reported stuttering severity for use as an outcome measure. The present report extends the prior analysis to a comparison of %SS with self-reported stuttering severity (SRSS) for use as an outcome measure in clinical trials of stuttering treatments for adults. Method We analyzed data from four randomized clinical trials for adults that incorporated %SS and SRSS data at prerandomization and at 6 months post randomization. We analyzed the distributions associated with the two measures, their agreement, and their estimates of effect sizes. Results The positively skewed distribution of %SS warrants much reservation about its value as a clinical trial outcome measure. This skew causes inherent instability because of spurious data associated with low scores, which occur commonly at the low end of such a distribution. This inherent instability is compounded by inherent problems with absolute reliability of %SS measures. These problems are reduced with the much more normal distribution of SRSS. Conclusions The logistical arguments in favor of SRSS apply similarly to adults as they do when parents report the stuttering severity of their children. However, there are statistical reasons to favor SRSS over %SS measures as a primary outcome of clinical trials with adult participants: SRSS has acceptable discriminant validity and a normal distribution, and it is less error prone than %SS. We recommend SRSS as a primary outcome for clinical trials of adults with stuttering.
Gunn, A, Menzies, RG, Onslow, M, O'Brian, S, Packman, A, Lowe, R, Helgadóttir, FD & Jones, M 2019, 'Phase I trial of a standalone internet social anxiety treatment for adolescents who stutter: iBroadway', International Journal of Language and Communication Disorders, vol. 54, no. 6, pp. 927-939.View/Download from: Publisher's site
© 2019 Royal College of Speech and Language Therapists Background: iGlebe is a fully automated internet treatment program for adults who stutter that has been shown, in some cases, to reduce anxiety and effectively manage social anxiety disorder for many participants. No such automated internet treatment program exists for adolescents who stutter. Aims: The present paper reports a Phase I trial of an adolescent version of the adult program: iBroadway. Methods & Procedures: Participants were 29 adolescents in the age range 12–17 years who were seeking cognitive–behaviour therapy (CBT) for anxiety associated with stuttering. The design was a non-randomized Phase I trial with outcome assessments at pre-treatment and immediately post-treatment after 5 months of access to the program. No contact by a clinical psychologist occurred during participant use of the program. Outcomes were a range of psychological, quality-of-life and stuttering severity measures. Outcomes & Results: The compliance rate for the seven iBroadway modules over 5 months was extremely favourable for internet CBT, at 52.4%. There was evidence of treatment effects for (1) the number of DSM-IV mental health diagnoses with the Diagnostic Interview Schedule for Children; (2) the Unhelpful Thoughts and Beliefs About Stuttering scale; (3) the Subjective Units of Distress Scale; and (4) parent-reported speech satisfaction. Conclusions & Implications: Further development of iBroadway, the adolescent version of iGlebe, with Phase II trialling is warranted.
Iverach, L, Jones, M, Lowe, R, O'Brian, S, Menzies, RG, Packman, A & Onslow, M 2019, 'Characteristics of adults who stutter by treatments sought.', Logopedics Phoniatrics Vocology, vol. 44, no. 3, pp. 134-142.View/Download from: Publisher's site
Several treatment approaches are available for adults who stutter, including speech treatment, cognitive behaviour therapy (CBT) treatment for anxiety, and a combination of both. It is useful to determine whether any differences exist between adults who stutter enrolled in different types of treatment. Therefore, the purpose of this study was to compare demographic, speech, and psychological characteristics of adults who stutter enrolled in speech, psychological, and combined treatment programs. Participants were 288 adults who stuttered (18-80 years) enrolled in one of three different treatment programs: Speech Treatment for stuttering (n = 134), Anxiety Treatment for anxiety about stuttering (n = 70), or Speech Treatment for Stuttering With or Without Anxiety Treatment (n = 84). Participants completed a range of demographic, speech, and psychological measures prior to the start of treatment. A significantly higher proportion of participants in the Anxiety Treatment group were in a personal relationship than the other treatment groups. The Anxiety Treatment group had higher average age than the other treatment groups. The Speech Treatment group also demonstrated significantly higher self-rated stuttering severity than the Anxiety Treatment group, even though there were no significant difference between groups for clinician-rated percentage of syllables stuttered. Although most characteristics of adults who stuttered did not vary by treatment type, the present findings suggest that adults who stutter enrolled in speech treatment perceived their stuttering as more severe, which may have prompted treatment seeking. Further research is needed regarding the supportive influence of personal relationship for those with the disorder.
Onslow, M & Lowe, R 2019, 'After the RESTART trial: six guidelines for clinical trials of early stuttering intervention', International Journal of Language and Communication Disorders, vol. 54, no. 4, pp. 517-528.View/Download from: Publisher's site
© 2019 Royal College of Speech and Language Therapists Background: The Rotterdam Evaluation Study of Stuttering Therapy randomized trial (RESTART) was seminal, comparing the Lidcombe Program with RESTART Demands and Capacities Model-based treatment (RESTART-DCM) for pre-school age children who stutter. Aims: To critique the methods of the RESTART trial to develop guidelines for its systematic replication and extension. Beyond that, to contribute to the refinement of existing methodological guidelines for early stuttering intervention. Method: The discussion is organized around methodological issues of primary outcomes, treatment completion, clinician allegiance, treatment fidelity, age exclusions and no-treatment control reasoning. Main Contribution: We recommend six methodological guidelines to guide future clinical trials comparing the Lidcombe Program with RESTART-DCM, which can be applied to clinical trials of other early stuttering intervention methods: (1) incorporate a continuous measure of primary outcome; (2) ensure that all children in clinical trials have completed treatment; (3) eliminate potential bias due to clinician allegiance; (4) establish treatment fidelity within and beyond the clinic; (5) include children younger than 3 years in clinical trials; and (6) establish an estimate of treatment effect size at some stage of treatment development. Conclusion: In addition to guiding future clinical research comparing RESTART-DCM and Lidcombe Program treatment, these recommendations may extend to influence positively other treatment developments for early stuttering.
Trajkovski, N, O'Brian, S, Onslow, M, Packman, A, Lowe, R, Menzies, R, Jones, M & Reilly, S 2019, 'A three-arm randomized controlled trial of Lidcombe Program and Westmead Program early stuttering interventions', JOURNAL OF FLUENCY DISORDERS, vol. 61.View/Download from: Publisher's site
Imeson, J, Lowe, R, Onslow, M, Munro, N, Heard, R, O'Brian, S & Arnott, S 2018, 'The Lidcombe Program and child language development: Long-term assessment.', Clinical linguistics & phonetics, vol. 32, no. 9, pp. 860-875.View/Download from: Publisher's site
This study was driven by the need to understand the mechanisms underlying Lidcombe Program treatment efficacy. The aim of the present study was to extend existing data exploring whether stuttering reductions observed when children successfully treated with the Lidcombe Program are associated with restricted language development. Audio recordings of 10-min parent-child conversations at home were transcribed verbatim for 11 pre-school-age children with various stuttering severities. Language samples from three assessments-pre-treatment, 9 and 18 months after beginning treatment-were analysed using SALT software for lexical diversity, utterance length and sentence complexity. At 18 months posttreatment commencement, the children had attained and maintained statistically significant stuttering reductions. During that period, there was no evidence that Lidcombe Program treatment was associated with restricted language development. The continued search for the mechanisms underlying this successful treatment needs to focus on other domains.
Iverach, L, Jones, M, Lowe, R, O'Brian, S, Menzies, RG, Packman, A & Onslow, M 2018, 'Comparison of adults who stutter with and without social anxiety disorder', Journal of Fluency Disorders, vol. 56, pp. 55-68.View/Download from: Publisher's site
© 2018 Purpose: Social anxiety disorder is a debilitating anxiety disorder associated with significant life impairment. The purpose of the present study is to evaluate overall functioning for adults who stutter with and without a diagnosis of social anxiety disorder. Method: Participants were 275 adults who stuttered (18–80 years), including 219 males (79.6%) and 56 females (20.4%), who were enrolled to commence speech treatment for stuttering. Comparisons were made between participants diagnosed with social anxiety disorder (n = 82, 29.8%) and those without that diagnosis (n = 193, 70.2%). Results: Although the socially anxious group was significantly younger than the non-socially anxious group, no other demographic differences were found. When compared to the non-socially anxious group, the socially anxious group did not demonstrate significantly higher self-reported stuttering severity or percentage of syllables stuttered. Yet the socially anxious group reported more speech dissatisfaction and avoidance of speaking situations, significantly more psychological problems, and a greater negative impact of stuttering. Conclusion: Significant differences in speech and psychological variables between groups suggest that, despite not demonstrating more severe stuttering, socially anxious adults who stutter demonstrate more psychological difficulties and have a more negative view of their speech. The present findings suggest that the demographic status of adults who stutter is not worse for those with social anxiety disorder. These findings pertain to a clinical sample, and cannot be generalized to the wider population of adults who stutter from the general community. Further research is needed to understand the longer-term impact of social anxiety disorder for those who stutter.
Onslow, M, Jones, M, O'Brian, S, Packman, A, Menzies, R, Lowe, R, Arnott, S, Bridgman, K, de Sonneville, C & Franken, MC 2018, 'Comparison of percentage of syllables stuttered with parent-reported severity ratings as a primary outcome measure in clinical trials of early stuttering treatment', Journal of Speech, Language, and Hearing Research, vol. 61, no. 4, pp. 811-819.View/Download from: Publisher's site
© 2018 American Speech-Language-Hearing Association. Purpose: This report investigates whether parent-reported stuttering severity ratings (SRs) provide similar estimates of effect size as percentage of syllables stuttered (%SS) for randomized trials of early stuttering treatment with preschool children. Method: Data sets from 3 randomized controlled trials of an early stuttering intervention were selected for analyses. Analyses included median changes and 95% confidence intervals per treatment group, Bland–Altman plots, analysis of covariance, and Spearman rho correlations. Results: Both SRs and %SS showed large effect sizes from pretreatment to follow-up, although correlations between the 2 measures were moderate at best. Absolute agreement between the 2 measures improved as percentage reduction of stuttering frequency and severity increased, probably due to innate measurement limitations for participants with low baseline severity. Analysis of covariance for the 3 trials showed consistent results. Conclusion: There is no statistical reason to favor %SS over parent-reported stuttering SRs as primary outcomes for clinical trials of early stuttering treatment. However, there are logistical reasons to favor parent-reported stuttering SRs. We conclude that parent-reported rating of the child's typical stuttering severity for the week or month prior to each assessment is a justifiable alternative to %SS as a primary outcome measure in clinical trials of early stuttering treatment.
Iverach, L, Lowe, R, Jones, M, O'Brian, S, Menzies, RG, Packman, A & Onslow, M 2017, 'A speech and psychological profile of treatment-seeking adolescents who stutter', Journal of Fluency Disorders, vol. 51, pp. 24-38.View/Download from: Publisher's site
© 2016 Purpose The purpose of this study was to evaluate the relationship between stuttering severity, psychological functioning, and overall impact of stuttering, in a large sample of adolescents who stutter. Method Participants were 102 adolescents (11–17 years) seeking speech treatment for stuttering, including 86 boys and 16 girls, classified into younger (11–14 years, n = 57) and older (15–17 years, n = 45) adolescents. Linear regression models were used to evaluate the relationship between speech and psychological variables and overall impact of stuttering. Results The impact of stuttering during adolescence is influenced by a complex interplay of speech and psychological variables. Anxiety and depression scores fell within normal limits. However, higher self-reported stuttering severity predicted higher anxiety and internalizing problems. Boys reported externalizing problems—aggression, rule-breaking—in the clinical range, and girls reported total problems in the borderline-clinical range. Overall, higher scores on measures of anxiety, stuttering severity, and speech dissatisfaction predicted a more negative overall impact of stuttering. Conclusion To our knowledge, this is the largest cohort study of adolescents who stutter. Higher stuttering severity, speech dissatisfaction, and anxiety predicted a more negative overall impact of stuttering, indicating the importance of carefully managing the speech and psychological needs of adolescents who stutter. Further research is needed to understand the relationship between stuttering and externalizing problems for adolescent boys who stutter.
Lowe, R, Helgadottir, F, Menzies, R, Heard, R, O'Brian, S, Packman, A & Onslow, M 2017, 'Safety behaviors and stuttering', Journal of Speech, Language, and Hearing Research, vol. 60, no. 5, pp. 1246-1253.View/Download from: Publisher's site
© 2017 American Speech-Language-Hearing Association. Purpose: Those who are socially anxious may use safety behaviors during feared social interactions to prevent negative outcomes. Safety behaviors are associated with anxiety maintenance and poorer treatment outcomes because they prevent fear extinction. Social anxiety disorder is often comorbid with stuttering. Speech pathologists reported in a recent publication (Helgadottir, Menzies, Onslow, Packman, & O'Brian, 2014a) that they often recommended procedures for clients that could be safety behaviors. This study investigated the self-reported use of safety behaviors by adults who stutter. Method: Participants were 133 adults who stutter enrolled in an online cognitive-behavior therapy program. Participants completed a questionnaire about their use of potential safety behaviors when anxious during social encounters. Correlations were computed between safety behaviors and pretreatment scores on measures of fear of negative evaluation and negative cognitions. Results: Of 133 participants, 132 reported that they used safety behaviors. Many of the safety behaviors correlated with higher scores for fear of negative evaluation and negative cognitions. Conclusions: Adults who stutter report using safety behaviors, and their use is associated with pretreatment fear of negative evaluation and unhelpful thoughts about stuttering. These results suggest that the negative effects of safety behaviors may extend to those who stutter, and further research is needed.
Iverach, L, Rapee, RM, Wong, QJJ & Lowe, R 2017, 'Maintenance of social anxiety in stuttering: A cognitive-behavioral model', American Journal of Speech-Language Pathology, vol. 26, no. 2, pp. 540-556.View/Download from: Publisher's site
© 2017 American Speech-Language-Hearing Association. Purpose: Stuttering is a speech disorder frequently accompanied by anxiety in social-evaluative situations. A growing body of research has confirmed a significant rate of social anxiety disorder among adults who stutter. Social anxiety disorder is a chronic and disabling anxiety disorder associated with substantial life impairment. Several influential models have described cognitive-behavioral factors that contribute to the maintenance of social anxiety in nonstuttering populations. The purpose of the present article is to apply these leading models to the experience of social anxiety for people who stutter. Method: Components from existing models were applied to stuttering in order to determine cognitive-behavioral processes that occur before, during, and after social-evaluative situations, which may increase the likelihood of stuttering-related social fears persisting. Results: Maintenance of social anxiety in stuttering may be influenced by a host of interrelated factors, including fear of negative evaluation, negative social-evaluative cognitions, attentional biases, self-focused attention, safety behaviors, and anticipatory and postevent processing. Conclusion: Given the chronic nature of social anxiety disorder, identifying factors that contribute to the persistence of stuttering-related social fears has the potential to inform clinical practice and the development of psychological treatment programs to address the speech and psychological needs of people who stutter with social anxiety.
Tran, V, Lam, MK, Amon, KL, Brunner, M, Hines, M, Penman, M, Lowe, R & Togher, L 2017, 'Interdisciplinary eHealth for the care of people living with traumatic brain injury: A systematic review.', Brain injury, vol. 31, no. 13-14, pp. 1701-1710.View/Download from: Publisher's site
To identify literature which discusses the barriers and enablers of eHealth technology and which evaluates its role in facilitating interdisciplinary team work for the care of people with a traumatic brain injury (TBI).Systematic review.Studies were identified by searching CINAHL, Embase, Medline, PsycINFO, Scopus, and Web of Science.Studies included in the review were required to feature an eHealth intervention which assisted interdisciplinary care for people with TBI.Descriptive data for each study described the eHealth intervention, interdisciplinary team, outcomes, and barriers and facilitators in implementing eHealth interventions.The search resulted in 1389 publications, of which 35 were retrieved and scanned in full. Six studies met all the inclusion criteria for the review. Four different eHealth interventions were identified: (i) an electronic goals systems, (ii) telerehabilitation, (iii) videoconferencing, and (iv) a point-of-care team-based information system. Various barriers and facilitators were identified in the use of eHealth.eHealth interventions have been reported to support interdisciplinary teams for the care of TBI. However, there is a substantial gap in existing literature regarding the barriers and enablers which characterize a successful interdisciplinary eHealth model for people with TBI.
Andrews, C, O'Brian, S, Onslow, M, Packman, A, Menzies, R & Lowe, R 2016, 'Phase II trial development of a syllable-timed speech treatment for school-age children who stutter', Journal of Fluency Disorders, vol. 48, pp. 44-55.View/Download from: Publisher's site
© 2016 Elsevier Inc. Purpose A recent clinical trial (Andrews et al., 2012) showed Syllable Timed Speech (STS) to be a potentially useful treatment agent for the reduction of stuttering for school-age children. The present trial investigated a modified version of this program that incorporated parent verbal contingencies. Methods Participants were 22 stuttering children aged 6–11 years. Treatment involved training the children and their parents to use STS in conversation. Parents were also taught to use verbal contingencies in response to their child's stuttered and stutter-free speech and to praise their child's use of STS. Outcome assessments were conducted pre-treatment, at the completion of Stage 1 of the program and 6 months and 12 months after Stage 1 completion. Results Outcomes are reported for the 19 children who completed Stage 1 of the program. The group mean percent stuttering reduction was 77% from pre-treatment to 12 months post-treatment, and 82% with the two least responsive participants removed. There was considerable variation in response to the treatment. Seventeen of the children showed reduced avoidance of speaking situations and 18 were more satisfied with their fluency post-treatment. However, there was some suggestion that stuttering control was not sufficient to fully eliminate situation avoidance for the children. Conclusions The results of this trial are sufficiently encouraging to warrant further clinical trials of the method. Educational objectives The reader will be able to: (a) discuss the reasons for investigating a new treatment for school-age children; (b) describe the main components of the STS treatment; (c) summarize the results of this clinical trial; (d) discuss the outcomes of this trial in relation to current theory
Iverach, L, Heard, R, Menzies, R, Lowe, R, O'Brian, S, Packman, A & Onslow, M 2016, 'A brief version of the unhelpful thoughts and beliefs about stuttering scales: The UTBAS-6', Journal of Speech, Language, and Hearing Research, vol. 59, no. 5, pp. 964-972.View/Download from: Publisher's site
© 2016 American Speech-Language-Hearing Association. Purpose: A significant proportion of adults who stutter experience anxiety in social and speaking situations. The Unhelpful Thoughts and Beliefs About Stuttering (UTBAS) scales provide a comprehensive measure of the unhelpful cognitions associated with social anxiety in stuttering. However, reducing the number of UTBAS items would make it ideal as a brief screening instrument. Therefore, the aim of the present study was to develop a brief version of the full UTBAS scales. Method: The 66-item UTBAS scales were completed by 337 adults who stutter. Item reduction was used to determine a smaller set of items that could adequately reproduce the total score for each full UTBAS scale. Results: Item reduction resulted in the inclusion of six items for the brief UTBAS-6 scales. Decile ranges for scores on the brief UTBAS-6 provide reliable estimates of the full UTBAS scores and valuable clinical information about whether a psychological assessment is warranted. Conclusions: The brief UTBAS-6 provides a reliable and efficient means of screening the unhelpful thoughts and beliefs associated with speech-related anxiety among adults who stutter. Referral for a psychological assessment is recommended in cases where the UTBAS total score falls in or above the fifth decile.
Lowe, R, Menzies, R, Packman, A, O'Brian, S, Jones, M & Onslow, M 2016, 'Assessing attentional biases with stuttering', International Journal of Language and Communication Disorders, vol. 51, no. 1, pp. 84-94.View/Download from: Publisher's site
© 2015 Royal College of Speech and Language Therapists. Background Many adults who stutter presenting for speech treatment experience social anxiety disorder. The presence of mental health disorders in adults who stutter has been implicated in a failure to maintain speech treatment benefits. Contemporary theories of social anxiety disorder propose that the condition is maintained by negative cognitions and information processing biases. Consistent with cognitive theories, the probe detection task has shown that social anxiety is associated with an attentional bias to avoid social information. This information processing bias is suggested to be involved in maintaining anxiety. Evidence is emerging for information processing biases being involved with stuttering. Aims This study investigated information processing in adults who stutter using the probe detection task. Information processing biases have been implicated in anxiety maintenance in social anxiety disorder and therefore may have implications for the assessment and treatment of stuttering. It was hypothesized that stuttering participants compared with control participants would display an attentional bias to avoid attending to social information. Methods & Procedures Twenty-three adults who stutter and 23 controls completed a probe detection task in which they were presented with pairs of photographs: a face displaying an emotional expression - positive, negative or neutral - and an everyday household object. All participants were subjected to a mild social threat induction being told they would speak to a small group of people on completion of the task. Outcomes & Results The stuttering group scored significantly higher than controls for trait anxiety, but did not differ from controls on measures of social anxiety. Non-socially anxious adults who stutter did not display an attentional bias to avoid looking at photographs of faces relative to everyday objects. Higher scores on trait anxiety were positively...
Menzies, R, O'Brian, S, Lowe, R, Packman, A & Onslow, M 2016, 'International Phase II clinical trial of CBTPsych: A standalone Internet social anxiety treatment for adults who stutter', Journal of Fluency Disorders, vol. 48, pp. 35-43.View/Download from: Publisher's site
© 2016 Elsevier Inc. Purpose CBTPsych is an individualized, fully automated, standalone Internet treatment program that requires no clinical contact or support. It is designed specifically for those who stutter. Two preliminary trials demonstrated that it may be efficacious for treating the social anxiety commonly associated with stuttering. However, both trials involved pre- and post-treatment assessment at a speech clinic. This contact may have increased compliance, commitment and adherence with the program. The present study sought to establish the effectiveness of CBTPsych in a large international trial with no contact of any kind from researchers or clinicians. Method Participants were 267 adults with a reported history of stuttering who were given a maximum of 5 months access to CBTPsych. Pre- and post-treatment functioning was assessed within the online program with a range of psychometric measures. Results Forty-nine participants (18.4%) completed all seven modules of CBTPsych and completed the post-treatment online assessments. That compliance rate was far superior to similar community trials of self-directed Internet mental health programs. Completion of the program was associated with large, statistically and clinically significant reductions for all measures. The reductions were similar to those obtained in earlier trials of CBTPsych, and those obtained in trials of in-clinic CBT with an expert clinician. Conclusions CBTPsych is a promising individualized treatment for social anxiety for a proportion of adults who stutter, which requires no health care costs in terms of clinician contact or support. Educational objectives The reader will be able to: (a) discuss the reasons for investigating CBTPsych without any clinical contact; (b) describe the main components of the CBTPsych treatment; (c) summarize the results of this clinical trial; (d) describe how the results might affect clinical practice, if at all.
Lam, MK, Hines, M, Lowe, R, Nagarajan, S, Keep, M, Penman, M & Power, E 2016, 'Preparedness for eHealth: Health Sciences Students' knowledge, skills and confidence', Journal of Information Technology Education : Research, vol. 15, pp. 305-334.
There is increasing recognition of the role eHealth will play in the effective and efficient delivery
of healthcare. This research challenges the assumption that students enter university as digital
natives, able to confidently and competently adapt their use of information and communication
technology (ICT) to new contexts. This study explored health sciences students' preparedness for
working, and leading change, in eHealth-enabled environments. Using a cross-sectional study
design, 420 undergraduate and postgraduate students participated in an online survey investigating
their understanding of and attitude towards eHealth, frequency of online activities and software
usage, confidence learning and using ICTs, and perceived learning needs. Although students
reported that they regularly engaged with a wide range of online activities and software and were
confident learning new ICT skills especially where they have sufficient time or support, their understanding
of eHealth was uncertain or limited. Poor understanding of and difficulty translating
skills learned in personal contexts to the professional context may impair graduates ability to confidently
engage in the eHealth-enabled workplace. These results suggest educators need to scaffold
the learning experience to ensure students build on their ICT knowledge to transfer this to
their future workplaces.
Lowe, R, Menzies, R, Packman, A, Obrian, S & Onslow, M 2015, 'Observer perspective imagery with stuttering', International Journal of Speech-Language Pathology, vol. 17, no. 5, pp. 481-488.View/Download from: Publisher's site
© 2015 The Speech Pathology Association of Australia Limited. Purpose: Adults who stutter are at risk of developing a range of psychological conditions. Social anxiety disorder is the most common anxiety disorder associated with stuttering. Observer perspective imagery is one cognitive process involved in the maintenance of some anxiety disorders. This involves viewing images as if looking at the self from the perspective of another. In contrast, the field perspective involves looking out from the self at the surrounding environment. The purpose of this study was to assess the presence of observer perspective imagery with stuttering.Method: The authors administered the Hackmann, Surawy and Clark (1998) semi-structured interview to 30 adults who stutter and 30 controls. Group images and impressions were compared for frequency, perspective recalled and emotional valence.Result: The stuttering group was significantly more likely than controls to recall images and impressions from an observer rather than a field perspective for anxious situations.Conclusion: It is possible the present results could reflect the same attentional processing bias that occurs with anxiety disorders in the non-stuttering population. These preliminary results provide an explanation for the persistence of conditions such as social anxiety disorder with stuttering. Clinical implications are discussed.
Obrian, S, Jones, M, Onslow, M, Packman, A, Menzies, R & Lowe, R 2015, 'Comparison of audio and audiovisual measures of adult stuttering: Implications for clinical trials', International Journal of Speech-Language Pathology, vol. 17, no. 6, pp. 589-593.View/Download from: Publisher's site
© 2015 © 2015 The Speech Pathology Association of Australia Limited. Purpose: This study investigated whether measures of percentage syllables stuttered (%SS) and stuttering severity ratings with a 9-point scale differ when made from audiovisual compared with audio-only recordings.Method: Four experienced speech-language pathologists measured %SS and assigned stuttering severity ratings to 10-minute audiovisual and audio-only recordings of 36 adults.Result: There was a mean 18% increase in %SS scores when samples were presented in audiovisual compared with audio-only mode. This result was consistent across both higher and lower %SS scores and was found to be directly attributable to counts of stuttered syllables rather than the total number of syllables. There was no significant difference between stuttering severity ratings made from the two modes.Conclusion: In clinical trials research, when using %SS as the primary outcome measure, audiovisual samples would be preferred as long as clear, good quality, front-on images can be easily captured. Alternatively, stuttering severity ratings may be a more valid measure to use as they correlate well with %SS and values are not influenced by the presentation mode.
Carey, B, O'Brian, S, Lowe, R & Onslow, M 2014, 'Webcam delivery of the camperdown program for adolescents who stutter: A phase II trial', Language, Speech, and Hearing Services in Schools, vol. 45, no. 4, pp. 314-324.View/Download from: Publisher's site
© American Speech-Language-Hearing Association. Purpose: This Phase II clinical trial examined stuttering adolescents' responsiveness to the Webcam-delivered Camperdown Program.Method: Sixteen adolescents were treated by Webcam with no clinic attendance. Primary outcome was percentage of syllables stuttered (%SS). Secondary outcomes were number of sessions, weeks and hours to maintenance, self-reported stuttering severity, speech satisfaction, speech naturalness, self-reported anxiety, self-reported situation avoidance, self-reported impact of stuttering, and satisfaction with Webcam treatment delivery. Data were collected before treatment and up to 12 months after entry into maintenance.Results: Fourteen participants completed the treatment. Group mean stuttering frequency was 6.1 %SS (range, 0.7–14.7) pretreatment and 2.8 %SS (range, 0–12.2) 12 months after entry into maintenance, with half the participants stuttering at 1.2 %SS or lower at this time. Treatment was completed in a mean of 25 sessions (15.5 hr). Self-reported stuttering severity ratings, self-reported stuttering impact, and speech satisfaction scores supported %SS outcomes. Minimal anxiety was evident either pre- or post-treatment. Individual responsiveness to the treatment varied, with half the participants showing little reduction in avoidance of speech situations.Conclusions: The Webcam service delivery model was appealing to participants, although it was efficacious and efficient for only half. Suggestions for future stuttering treatment development for adolescents are discussed.
Gunn, A, Menzies, RG, O'Brian, S, Onslow, M, Packman, A, Lowe, R, Iverach, L, Heard, R & Block, S 2014, 'Axis I anxiety and mental health disorders among stuttering adolescents', Journal of Fluency Disorders, vol. 40, pp. 58-68.View/Download from: Publisher's site
Purpose: The purpose of this study was to evaluate anxiety and psychological functioning among adolescents seeking speech therapy for stuttering using a structured, diagnostic interview and psychological questionnaires. This study also sought to determine whether any differences in psychological status were evident between younger and older adolescents. Method: Participants were 37 stuttering adolescents seeking stuttering treatment. We administered the Computerized Voice Version of the Diagnostic Interview Schedule for Children, and five psychometric tests. Participants were classified into younger (12-14 years; n=20) and older adolescents (15-17 years; n=17). Results: Thirty-eight percent of participants attained at least one diagnosis of a mental disorder, according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; APA, 2000), with the majority of these diagnoses involving anxiety. This figure is double current estimates for general adolescent populations, and is consistent with our finding of moderate and moderate-severe quality of life impairment. Although many of the scores on psychological measures fell within the normal range, older adolescents (15-17 years) reported significantly higher anxiety, depression, reactions to stuttering, and emotional/behavioral problems, than younger adolescents (12-14 years). There was scant evidence that self-reported stuttering severity is correlated with mental health issues. There are good reasons to believe these results are conservative because many participants gave socially desirable responses about their mental health status. Discussion: These results reveal a need for large-scale, statistically powerful assessments of anxiety and other mental disorders among stuttering adolescents with reference to control populations.Educational Objectives: The reader will be able to: (a) explain the clinical importance of assessing for mental health with stuttering ad...
Objective: Telehealth is the use of communication technology to provide health care services by means other than typical in-clinic attendance models. Telehealth is increasingly used for the management of speech, language and communication disorders. The aim of this article is to review telehealth applications to stuttering management. Methods: We conducted a search of peer-reviewed literature for the past 20 years using the Institute for Scientific Information Web of Science database, PubMed: The Bibliographic Database and a search for articles by hand. Results: Outcomes for telehealth stuttering treatment were generally positive, but there may be a compromise of treatment efficiency with telehealth treatment of young children. Our search found no studies dealing with stuttering assessment procedures using telehealth models. No economic analyses of this delivery model have been reported. Conclusion: This review highlights the need for continued research about telehealth for stuttering management. Evidence from research is needed to inform the efficacy of assessment procedures using telehealth methods as well as guide the development of improved treatment procedures. Clinical and technical guidelines are urgently needed to ensure that the evolving and continued use of telehealth to manage stuttering does not compromise the standards of care afforded with standard in-clinic models. © 2014 S. Karger AG, Basel.
Lam, MK, Nguyen, M, Lowe, R, Nagarajan, SV & Lincoln, M 2014, '"I can do it": Does confidence and perceived ability in learning new ICT skills predict pre-service health professionals' attitude towards engaging in e-healthcare?', Studies in Health Technology and Informatics, vol. 204, pp. 60-66.View/Download from: Publisher's site
© 2014 The authors and IOS Press. Background: There are many factors affecting health professionals' willingness to engage in e-health. One of these factors is whether health professionals perceive themselves to be able to learn new skills, and have the confidence in mastering these new Information and Communication Technology (ICT) skills. Objective: This study examined how health students' confidence and perceived ability for learning new ICT skills affect their attitude towards engaging in e-health. Methods: A survey was conducted to explore students' attitude towards using e-health and their perceived self-efficacy and confidence to learn new ICT skills. Multiple regression analysis was used to examine the relationship between confidence and self-efficacy, and attitude towards engaging in e-health controlling for participants' age, gender, and prior IT learning experience. Results: The three scales measuring attitude, confidence and self-efficacy showed good internal consistency with respective Cronbach's Alpha scores of 0.835, 0.761 and 0.762. Multiple regression analysis showed a significant relationship between confidence, self-efficacy and prior IT learning experiences with attitude towards e-health after adjusting for the effect of each other (F3,350=17.20,p<0.001). Conclusion: Self-efficacy and confidence in learning new ICT skills together with previous ICT training either at or outside their university studies are significant factors associated with students' attitude towards using e-health. Enhancing students' level of self-efficacy in learning new ICT skills may be the key to the success of implementation of e-health initiatives.
Lowe, R, Guastella, AJ, Chen, NTM, Menzies, RG, Packman, A, O'Brian, S & Onslow, M 2012, 'Avoidance of eye gaze by adults who stutter', Journal of Fluency Disorders, vol. 37, no. 4, pp. 263-274.View/Download from: Publisher's site
Purpose: Adults who stutter are at significant risk of developing social phobia. Cognitive theorists argue that a critical factor maintaining social anxiety is avoidance of social information. This avoidance may impair access to positive feedback from social encounters that could disconfirm fears and negative beliefs. Adults who stutter are known to engage in avoidance behaviours, and may neglect positive social information. This study investigated the gaze behaviour of adults who stutter whilst giving a speech. Method: 16 adults who stutter and 16 matched controls delivered a 3-min speech to a television display of a pre-recorded lecture theatre audience. Participants were told the audience was watching them live from another room. Audience members were trained to display positive, negative and neutral expressions. Participant eye movement was recorded with an eye-tracker. Results: There was a significant difference between the stuttering and control participants for fixation duration and fixation count towards an audience display. In particular, the stuttering participants, compared to controls, looked for shorter time at positive audience members than at negative and neutral audience members and the background. Conclusions: Adults who stutter may neglect positive social cues within social situations that could serve to disconfirm negative beliefs and fears.Educational objectives: The reader will be able to: (a) describe the nature of anxiety experienced by adults who stutter; (b) identify the most common anxiety condition among adults who stutter; (c) understand how information processing biases and the use of safety behaviours contribute to the maintenance of social anxiety; (d) describe how avoiding social information may contribute to the maintenance of social anxiety in people who stutter; and (e) describe the clinical implications of avoidance of social information in people who stutter. © 2012 Elsevier Inc.
St Clare, T, Menzies, RG, Onslow, M, Packman, A, Thompson, R & Block, S 2009, 'Unhelpful thoughts and beliefs linked to social anxiety in stuttering development of a measure', International Journal of Language and Communication Disorders, vol. 44, no. 3, pp. 338-351.View/Download from: Publisher's site
Background: Those who stutter have a proclivity to social anxiety. Yet, to date, there is no comprehensive measure of thoughts and beliefs about stuttering that represent the cognitions associated with that anxiety. Aims: The present paper describes the development of a measure to assess unhelpful thoughts and beliefs about stuttering. Methods & Procedures: The Unhelpful Thoughts and Beliefs about Stuttering UTBAS selfreport measure contains 66 items that assess the frequency of unhelpful thoughts and beliefs. Items were constructed from a comprehensive file audit of all stuttering cases seen in a cognitivebehavior therapy based treatment programme over a tenyear period. Outcomes & Results Preliminary investigations indicate that the UTBAS has high levels of testretest reliability r 0.89 and internal consistency Chronbach's alpha 0.98. It has good knowngroups validity, being able to discriminate between stuttering and nonstuttering participants on items that contain no reference to stuttering t38 8.06, p<0.0001, with a large effect size d 2.3. It has good convergent validity r 0.530.72 and discriminant validity r 0.240.27. The UTBAS sensitivity to change was supported by improvements in thoughts and beliefs related to social anxiety following cognitivebehavioural treatment for anxiety in stuttering t25 10.13, p<0.0001. The effect size was large d 2.5. Conclusions & Implications: Implications for the use of the UTBAS as an outcome measure and a clinical tool are discussed, along with the potential value of the UTBAS to explore the welldocumented social anxiety experienced by those who stutter.