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: UTS OPUS or 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.
Koushik, S, Hewat, S, Onslow, M, Shenker, R, Jones, M, O'Brian, S, Packman, A, Menzies, R, Harrison, E & Wilson, L 2019, 'Three Lidcombe program clinic visit options: a phase II trial.', Journal of communication disorders, vol. 82.View/Download from: UTS OPUS or Publisher's site
PURPOSE:Weekly clinic visits are recommended in the Lidcombe Program Treatment Guide (Packman et al., 2015). That specification is based on traditional speech-language pathology practices rather than empirical research, and two studies have suggested that such a format does not always occur in clinical communities. This research was conducted to determine the relative efficacy of different Lidcombe Program models of clinic visits. METHOD:Thirty-one children were randomized to three different service delivery models: twice-weekly, weekly and fortnightly (once every two weeks) clinic visits. All children were treated with the Lidcombe Program following manualised procedures. Measures of percentage syllables stuttered were obtained from beyond clinic audio recordings pre- and post-randomization. RESULTS:Results showed that the twice-weekly and fortnightly treatment formats were not suitable for all families. However, the fortnightly outcomes at 9 months post-randomization were comparable with those attained during weekly clinic visits. CONCLUSIONS:These results justify further, large-scale clinical trialling to compare weekly Lidcombe Program clinic visits with schedules involving less frequent clinic visits.
Menzies, R, O'Brian, S, Packman, A, Jones, M, Helgadóttir, FD & Onslow, M 2019, 'Supplementing stuttering treatment with online cognitive behavior therapy: An experimental trial.', Journal of communication disorders, vol. 80, pp. 81-91.View/Download from: UTS OPUS or Publisher's site
PURPOSE:It is now well established that adults who present to speech clinics for help with stuttering will have an increased risk of having an anxiety disorder, particularly social anxiety disorder. Concomitant psychological problems are known to interfere with the maintenance of the benefits of behavioral speech treatments for stuttering. The current team has developed and trialed a cognitive behavior therapy (CBT) program designed specifically to reduce anxiety in adults who stutter, and trials have shown promise for both an in-clinic version and a standalone internet-based version. The aim of the present study is to determine whether iGlebe, the internet-based version of the team's internet CBT treatment (previously known as CBTPsych), enhances the benefits of behavioral stuttering treatment. METHOD:Participants were 32 adults seeking treatment for stuttering. The design was a two-arm randomized experimental trial with blinded outcome assessments at 6 and 12 months post-randomization. Both arms received basic speech-restructuring training to reduce stuttering, without any anxiolytic (anxiety reducing) components. The experimental arm also received 5 months access to iGlebe. RESULTS:There was evidence that, at 12 months post-randomization, iGlebe added clinically significant improvements to self-reported stuttering severity and quality of life. The present experimental trial provides the first evidence that the addition of CBT to speech restructuring improves speech outcomes. CONCLUSIONS:The present results will be the basis for the development of a comprehensive, internet-based treatment program for anxiety associated with stuttering. Ultimately, it may be possible for such an economical, scalable, and translatable comprehensive treatment model to supplement standard speech-language pathology treatment practices for those who stutter.
Menzies, RG, Packman, A, Onslow, M, O'Brian, S, Jones, M & Helgadóttir, FD 2019, 'In-Clinic and Standalone Internet Cognitive Behavior Therapy Treatment for Social Anxiety in Stuttering: A Randomized Trial of iGlebe.', Journal of speech, language, and hearing research : JSLHR, vol. 62, no. 6, pp. 1614-1624.View/Download from: UTS OPUS or Publisher's site
Purpose iGlebe is an individualized, fully automated Internet cognitive behavior therapy (CBT) treatment program that requires no clinician contact. Phase I and II trials have demonstrated that it may be efficacious for treating the social anxiety commonly associated with stuttering. The present trial sought to establish whether the outcomes achieved by iGlebe are noninferior to those associated with in-clinic CBT from clinical psychologists. Method Fifty adults with stuttering were randomized to receive in-clinic CBT for anxiety or 5 months online access to iGlebe. The design was a noninferiority randomized controlled trial with outcomes assessed at prerandomization and at 6 and 12 months postrandomization. Primary outcomes were CIDI-Auto-2.1 diagnoses for anxiety and mood disorders and Brief Fear of Negative Evaluation scale scores ( Carleton, McCreary, Norton, & Asmundson, 2006 ). Secondary outcomes included speech, psychology, and quality-of-life measures. Results Outcomes consistently showed clinically significant improvements of around a medium effect size for the cohort as a whole from prerandomization to 6 months postrandomization, which were maintained at 12 months postrandomization. Comparisons between the 2 treatments showed little difference between iGlebe and in-clinic treatment for all primary and secondary outcomes, with last observation carried forward for missing data. Conclusions iGlebe is a promising individualized treatment for social anxiety for adults who stutter and offers a viable and inexpensive alternative to in-clinic CBT with clinical psychologists. An issue to emerge from this trial, which requires clarification during future clinical trials of iGlebe, is the posttreatment relation between percentage of syllables stuttered and self-reported stuttering severity ratings.
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: UTS OPUS or 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: UTS OPUS or 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: UTS OPUS or 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.
Karimi, H, Onslow, M, Jones, M, O'Brian, S, Packman, A, Menzies, R, Reilly, S, Sommer, M & Jelčić-Jakšić, S 2018, 'The Satisfaction with Communication in Everyday Speaking Situations (SCESS) scale: An overarching outcome measure of treatment effect.', Journal of fluency disorders, vol. 58, pp. 77-85.View/Download from: UTS OPUS or Publisher's site
PURPOSE:The Consolidated Standards of Reporting Trials (CONSORT) statement strongly suggests one primary outcome for clinical trials, yet the outcomes of stuttering treatments span numerous behavioral and psychosocial domains. That presents a roadblock to eventual meta-analysis of clinical trials for adults who stutter. METHOD:We propose a simple and convenient outcome measure for clinical trials of stuttering treatment for adults that spans whatever behavioral and psychosocial factors might impel clients to seek treatment: a nine-point scale of Satisfaction with Communication in Everyday Speaking Situations (SCESS). The scale consists of one question which is simple, brief, easy to administer, cost-free, and translatable into many languages. The present report develops the SCESS scale by determining its reliability, content validity, and construct validity. RESULTS:Reliability, content validity, and construct validity of the SCESS were confirmed with statistically significant and substantive correlations with speech-related and anxiety-related measures. However, the SCESS did not correlate well with percentage syllables stuttered. Three behavioral and psychosocial measures had the highest correlation with the SCESS: total Overall Assessment of the Speaker's Experience of Stuttering, self-reported stuttering severity, and Unhelpful Thoughts and Beliefs about Stuttering. CONCLUSION:The SCESS measure has potential to be applied as an overarching clinical trial outcome measure of stuttering treatment effect. This study provides some preliminary evidence for including it as a primary or secondary outcome in clinical trials of adult stuttering treatments. However, further studies are needed to establish the SCESS responsiveness to different stuttering treatments.
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: UTS OPUS or 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.
Van Eerdenbrugh, S, Packman, A, O'Brian, S & Onslow, M 2018, 'Challenges and Strategies for Speech-Language Pathologists Using the Lidcombe Program for Early Stuttering', American Journal of Speech-Language Pathology, vol. 27, no. 3S, pp. 1259-1272.View/Download from: UTS OPUS or Publisher's site
Purpose: The Lidcombe program is a treatment for
preschool-age children who stutter. Studies indicate that
its implementation is not always straightforward. In this study,
challenges that parents and speech-language pathologists
(SLPs) encounter when implementing the Lidcombe program
were identified, and strategies to address them were sought.
Method: In Part 1, Lidcombe program treatment challenges
were determined from 4 sources. In Part 2, 7 SLPs with
15 to 23 years of Lidcombe program experience were
interviewed to develop strategies to respond to the identified
Result: A template of the themes and a report with possible
strategies are the outcomes of this study. A total of 124 themes
were identified, mostly related to the implementation of
Lidcombe program procedures. Strategies to deal with these
challenges were formulated.
Conclusions: This study provides treatment challenges
that parents or SLPs may encounter during the
Lidcombe program. It also provides strategies that
SLPs can suggest to address them. An added contribution
of the findings is that SLPs in the clinic can now
anticipate the sort of treatment challenges that parents
may face. A summary of the findings will be made
available on the Australian Stuttering Research Centre
website and through the Lidcombe Program Trainers
Van Eerdenbrugh, S, Packman, A, Onslow, M, O'brian, S & Menzies, R 2018, 'Development of an internet version of the Lidcombe Program of early stuttering intervention: A trial of Part 1.', International journal of speech-language pathology, vol. 20, no. 2, pp. 216-225.View/Download from: UTS OPUS or Publisher's site
PURPOSE:There is evidence that access to treatment for early stuttering is not available for all who need it. An internet version of the Lidcombe Program for early stuttering (Internet-LP) has been developed to deal with this shortfall. The LP is suitable for such development because it is delivered by parents in the child's everyday environment, with training by a speech-language pathologist. A Phase I trial of Internet-LP Part 1, comprising parent training, is reported here. METHOD:Eight parents of pre-schoolers who stutter were recruited and six completed the trial. RESULT:Post-trial assessment indicated that the parents scored well for identifying and measuring stuttering and for knowledge about conducting practice sessions, including how to present verbal contingencies during practice sessions. CONCLUSION:The results prompted minor adjustments to Part 1 and guided the construction of Part 2, which instructs parents during the remainder of the treatment process.
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.
Van Eerdenbrugh, S, Packman, A, Onslow, M, O'brian, S & Menzies, R 2017, 'Erratum to: Development of an internet version of the Lidcombe Program of early stuttering intervention: A trial of Part 1 (International Journal of Speech-Language Pathology, (2016), (1-10), 10.1080/17549507.2016.1257653)', International Journal of Speech-Language Pathology, vol. 19, no. 6, p. 637.View/Download from: Publisher's site
© 2017 The Speech Pathology Association of Australia Limited Published by Informa UK Limited, trading as Taylor & Francis Group. The keywords to this paper have been amended since original publication online (from: Stuttering, stepped care, model to: treatment, pre-school, Lidcombe Program).
Smith, KA, Iverach, L, O'Brian, S, Mensah, F, Kefalianos, E, Hearne, A & Reilly, S 2017, 'Anxiety in 11-year-old children who stutter: Findings from a prospective longitudinal community sample', Journal of Speech, Language, and Hearing Research, vol. 60, no. 5, pp. 1211-1222.View/Download from: Publisher's site
© 2017 American Speech-Language-Hearing Association. Purpose: To examine if a community sample of 11-year-old children with persistent stuttering have higher anxiety than children who have recovered from stuttering and nonstuttering controls. Method: Participants in a community cohort study were categorized into 3 groups: (a) those with persistent stuttering, (b) those with recovered stuttering, and (c) nonstuttering controls. Linear regression modeling compared outcomes on measures of child anxiety and emotional and behavioral functioning for the 3 groups. Results: Without adjustment for covariates (unadjusted analyses), the group with persistent stuttering showed significantly increased anxiety compared with the recovered stuttering group and nonstuttering controls. The group with persistent stuttering had a higher number of children with autism spectrum disorder and/or learning difficulties. Once these variables were included as covariates in subsequent analysis, there was no difference in anxiety, emotional and behavioral functioning, or temperament among groups. Conclusion: Although recognized to be associated with stuttering in clinical samples, anxiety was not higher in school-age children who stutter in a community cohort. It may be that anxiety develops later or is less marked in community cohorts compared with clinical samples. We did, however, observe higher anxiety scores in those children who stuttered and had autism spectrum disorder or learning difficulties. Implications and recommendations for research are discussed.
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
Bridgman, K, Onslow, M, O'Brian, S, Jones, M & Block, S 2016, 'Lidcombe program webcam treatment for early stuttering: A randomized controlled trial', Journal of Speech, Language, and Hearing Research, vol. 59, no. 5, pp. 932-939.View/Download from: Publisher's site
© 2016 American Speech-Language-Hearing Association. Purpose: Webcam treatment is potentially useful for health care in cases of early stuttering in which clients are isolated from specialized treatment services for geographic and other reasons. The purpose of the present trial was to compare outcomes of clinic and webcam deliveries of the Lidcombe Program treatment (Packman et al., 2015) for early stuttering. Method: The design was a parallel, open plan, noninferiority randomized controlled trial of the standard Lidcombe Program treatment and the experimental webcam Lidcombe Program treatment. Participants were 49 children aged 3 years 0 months to 5 years 11 months at the start of treatment. Primary outcomes were the percentage of syllables stuttered at 9 months postrandomization and the number of consultations to complete Stage 1 of the Lidcombe Program. Results: There was insufficient evidence of a posttreatment difference of the percentage of syllables stuttered between the standard and webcam Lidcombe Program treatments. There was insufficient evidence of a difference between the groups for typical stuttering severity measured by parents or the reported clinical relationship with the treating speech-language pathologist. Conclusions: This trial confirmed the viability of the webcam Lidcombe Program intervention. It appears to be as efficacious and economically viable as the standard, clinic Lidcombe Program treatment.
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.
Swift, MC, Jones, M, O'Brian, S, Onslow, M, Packman, A & Menzies, R 2016, 'Parent verbal contingencies during the Lidcombe Program: Observations and statistical modeling of the treatment process', Journal of Fluency Disorders, vol. 47, pp. 13-26.View/Download from: Publisher's site
© 2016 Elsevier Inc. Purpose: The purpose of this study was to document parent presentation of the Lidcombe Program verbal contingencies and model potential relationships between contingency provision and treatment duration. Methods: Forty parent-child pairs undertaking the Lidcombe Program participated, 26 of whom completed Stage 1. All participants were included in the analyses. Parents completed weekly audio-recordings of treatment during practice sessions and a diary of treatment during natural conversations. The number and types of contingencies provided during practice sessions were counted for 520 recordings. Accelerated failure time modeling was used to investigate associations between contingency provision during the first 4 weeks of treatment and duration of time to complete Stage 1. Results: During practice sessions 91% of contingencies were for stutter-free speech, 6.8% were for stuttering and 2.7% were incorrectly applied. Parents often combined several verbal contingencies into one. During natural conversations, the number of verbal contingencies reportedly provided across the day was low, an average of 8.5 (SD = 7.82) contingencies for stutter-free speech and 1.7 (SD = 2.43) for unambiguous stuttering. There was a positive, significant relationship between the number of verbal contingencies for stuttering provided during the first 4 weeks of treatment and time taken to complete Stage 1. Conclusion: Parents mostly provided the expected types of contingencies but the number was lower than expected. An unexpected association was found between number of verbal contingencies for stuttering and treatment duration. Further research is required to explore the relation between rates of parent verbal contingencies, treatment process duration, and treatment outcome.
Donaghy, M, Harrison, E, Obrian, S, Menzies, R, Onslow, M, Packman, A & Jones, M 2015, 'An investigation of the role of parental request for self-correction of stuttering in the Lidcombe Program', International Journal of Speech-Language Pathology, vol. 17, no. 5, pp. 511-517.View/Download from: Publisher's site
© 2015 The Speech Pathology Association of Australia Limited. Purpose: The Lidcombe Program is a behavioural treatment for stuttering in children younger than 6 years that is supported by evidence of efficacy and effectiveness. The treatment incorporates parent verbal contingencies for stutter-free speech and for stuttering. However, the contribution of those contingencies to reductions in stuttering in the program is unclear.Method: Thirty-four parent-child dyads were randomized to two treatment groups. The control group received standard Lidcombe Program and the experimental group received Lidcombe Program without instruction to parents to use the verbal contingency request for self-correction. Treatment responsiveness was measured as time to 50% stuttering severity reduction.Result: No differences were found between groups on primary outcome measures of the number of weeks and clinic visits to 50% reduction in stuttering severity.Conclusion: This clinical experiment challenges the assumption that the verbal contingency request for self-correction contributes to treatment efficacy. Results suggest the need for further research to explore this issue.
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.
Messenger, M, Packman, A, Onslow, M, Menzies, R & O'Brian, S 2015, 'Children and adolescents who stutter: Further investigation of anxiety', Journal of Fluency Disorders, vol. 46, pp. 15-23.View/Download from: Publisher's site
© 2015 Elsevier Inc.. Purpose: Despite the greatly increased risk of social anxiety disorder in adults who stutter, there is no clear indication of the time of onset of this disorder in childhood and adolescence. The purpose of this study was to explore this issue further using the Revised Children's Manifest Anxiety Scale (RCMAS), so that appropriate interventions can be developed prior to adulthood. This is the first time the RCMAS has been completed by children younger than 11 years. Using the same test for both school-age children and adolescents can potentially identify when anxiety starts to develop from age 6 years through to adulthood. Methods: The RCMAS was administered to 18 school-age boys, five school-age girls, 41 adolescent boys and nine adolescent girls who were seeking treatment for their stuttering. Participants also rated the severity of their own stuttering. Results: All mean scaled scores on the four RCMAS subscales and Total Anxiety scores were within normal limits. However, for both groups of boys, scores on the Lie Scale were significantly higher than scores on the other three subscales. Conclusions: Experts suggest high scores on the RCMAS Lie Scale are indicative of participants attempting to present themselves in a positive light and so cast doubt on the veracity of their other responses on the test. One interpretation, then, is that the boys were concealing true levels of anxiety about their stuttering. The results suggest why findings of anxiety studies in children and adolescents to date are equivocal. Clinical implications are discussed.Educational objectives: The reader will be able to: (a) discuss why understanding when anxiety starts in people who stutter is important, (b) describe the function of the RCMAS Lie sub scale and (c) summarize the possible implications of the RCMAS findings in this study.
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.
Arnott, S, Onslow, M, O'Brian, S, Packman, A, Jones, M & Block, S 2014, 'Group Lidcombe Program treatment for early stuttering: A randomized controlled trial', Journal of Speech, Language, and Hearing Research, vol. 57, no. 5, pp. 1606-1618.View/Download from: Publisher's site
© American Speech-Language-Hearing Association. Purpose: This study adds to the Lidcombe Program evidence base by comparing individual and group treatment of preschoolers who stutter.Method: A randomized controlled trial of 54 preschoolers was designed to establish whether group delivery outcomes were not inferior to the individual model. The group arm used a rolling group model, in which a new member entered an existing group each time a vacancy became available. Assessments were conducted prerandomization and 9 months and 18 months postrandomization.Results: There was no evidence of a difference between treatment arms for measures of weeks or clinic visits required, percent syllables stuttered, or parent severity ratings. However, children in the group arm consumed around half the number of speech-language pathologist hours compared with children treated individually. In addition, children in the group progressed more quickly after the treating speech-language pathologist became more practiced with the group model, suggesting the group results are conservative estimates.Conclusions: Group delivery of the Lidcombe Program is an efficacious alternative to the individual model. Parents responded favorably to the group model, and the treating speech-language pathologists found group treatment to be more taxing but clinically gratifying.
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...
Helgadottir, FD, Menzies, RG, Onslow, M, Packman, A & O'Brian, S 2014, 'Safety behaviors and speech treatment for adults who stutter', Journal of Speech, Language, and Hearing Research, vol. 57, no. 4, pp. 1308-1313.View/Download from: Publisher's site
Purpose: Those with anxiety use safety behaviors when attempting to prevent negative outcomes. There is evidence that these behaviors contribute to the persistence of anxiety disorders. Safety behaviors have been prominent in the cognitive behavior therapy literature during the last decade, particularly with social phobia management. However, nothing is known of safety behavior use by those who stutter. This is surprising given the high prevalence of social phobia in the stuttering population who seek clinical help. Method: Clinical psychologists and speech-language pa-thologists (SLPs) created a list of safety behaviors that might be used by adults during treatment for stuttering. Participants were 160 SLPs who were asked whether they advised adults who stutter to use any of these safety behaviors. Results: SLPs commonly recommend safety behaviors during stuttering management. Factor structures were found for the following 5 safety behavior categories: (a) general safety behaviors, (b) practice and rehearsal, (c) general avoidance, (d) choosing safe and easy people, and (e) control-related safety behaviors. Conclusions: There is a need to determine the frequency with which adults who receive stuttering treatment follow these clinician recommendations. In addition, there is a need to experimentally determine whether following such recommendations prevents fear extinction at long-term follow-up. © American Speech-Language-Hearing Association.
Helgadóttir, FD, Menzies, RG, Onslow, M, Packman, A & O'Brian, S 2014, 'A standalone Internet cognitive behavior therapy treatment for social anxiety in adults who stutter: CBTpsych', Journal of Fluency Disorders, vol. 41, no. C, pp. 47-54.View/Download from: Publisher's site
© 2014 Elsevier Inc. Purpose: Social anxiety is common for those who stutter and efficacious cognitive behavior therapy (CBT) for them appears viable. However, there are difficulties with provision of CBT services for anxiety among those who stutter. Standalone Internet CBT treatment is a potential solution to those problems. CBTpsych is a fully automated, online social anxiety intervention for those who stutter. This report is a Phase I trial of CBTpsych. Method: Fourteen participants were allowed 5 months to complete seven sections of CBTpsych. Pre-treatment and post-treatment assessments tested for social anxiety, common unhelpful thoughts related to stuttering, quality of life and stuttering frequency. Results: Significant post-treatment improvements in social anxiety, unhelpful thoughts, and quality of life were reported. Five of seven participants diagnosed with social anxiety lost those diagnoses at post-treatment. The two participants who did not lose social anxiety diagnoses did not complete all the CBTpsych modules. CBTpsych did not improve stuttering frequency. Eleven of the fourteen participants who began treatment completed Section 4 or more of the CBTpsych intervention. Conclusions: CBTpsych provides a potential means to provide CBT treatment for social anxiety associated with stuttering, to any client without cost, regardless of location. Further clinical trials are warranted.Educational objectives: At the end of this activity the reader will be able to: (a) describe that social anxiety is common in those who stutter; (b) discuss the origin of social anxiety and the associated link with bullying; (c) summarize the problems in provision of effective evidence based cognitive behavior therapy for adults who stutter; (d) describe a scalable computerized treatment designed to tackle the service provision gap; (e) describe the unhelpful thoughts associated with stuttering that this fully automated computer program was able to tackle; (f) list the positiv...
Karimi, H, Jones, M, O'Brian, S & Onslow, M 2014, 'Clinician percent syllables stuttered, clinician severity ratings and speaker severity ratings: Are they interchangeable?', International Journal of Language and Communication Disorders, vol. 49, no. 3, pp. 364-368.View/Download from: Publisher's site
Background At present, percent syllables stuttered (%SS) is the gold standard outcome measure for behavioural stuttering treatment research. However, ordinal severity rating (SR) procedures have some inherent advantages over that method. Aims To establish the relationship between Clinician %SS, Clinician SR and self-reported Speaker SR. To investigate whether Clinician SRs and Speaker SRs can be used interchangeably. Method & Procedures Participants were three experienced speech-language pathologist (SLP) judges and 87 adults who stuttered. Adults who stuttered received a 10-min unscheduled telephone call at the conclusion of which they self-reported a SR using a nine-point scale. The SLPs measured the stuttering for these conversations with %SS and also with the SR scale. The mean scores for Clinician %SS and Clinician SR were compared with Speaker SR using appropriate indices of relative and absolute reliability. Relative reliability indices deal with the rank order of participants in a sample and whether they can be distinguished from each other. However, absolute reliability indices are related to the closeness of the measurement scores to each other and to a hypothetical true score. Outcomes & Results Strong correlations were found between Clinician %SS and Clinician SR, and also between Clinician %SS and Speaker SR, although with higher values in the former case. Additionally, very high correlations showed acceptable relative reliability between Clinician SR and Speaker SR. However, absolute reliability in terms of standard error of measurement and limits of agreement was poor for Clinician SR and Speaker SR. Conclusions & Implications The results suggest that Clinician SR and Speaker SR cannot be used interchangeably to measure temporal stuttering severity changes for an individual client. However, researchers might use these two measures interchangeably in research contexts, such as clinical trials, where changes of the entire group are of interest to det...
Karimi, H, O'Brian, S, Onslow, M & Jones, M 2014, 'Absolute and relative reliability of percentage of syllables stuttered and severity rating scales', Journal of Speech, Language, and Hearing Research, vol. 57, no. 4, pp. 1284-1295.View/Download from: Publisher's site
Purpose: Percentage of syllables stuttered (%SS) and severity rating (SR) scales are measures in common use to quantify stuttering severity and its changes during basic and clinical research conditions. However, their reliability has not been assessed with indices measuring both relative and absolute reliability. This study was designed to provide such information. Relative reliability deals with the rank order of participants in a sample, whereas absolute reliability measures the closeness of scores to one other and to a hypothetical true score. Method: Eighty-seven adult participants who stutter received a 10-min unscheduled telephone call. Three experienced judges measured %SS and also used a 9-point SR scale to measure stuttering severity from recordings of the telephone calls. Results: Relative intrajudge and interjudge reliability were satisfactory for both scales. However, absolute intrajudge and interjudge reliability were not satisfactory. Results showed that paired-judge SR and %SS procedures improved absolute reliability compared with single-judge measures. Additionally, the paired-judge procedure improved relative reliability from high to very high levels. Conclusion: Measurement of group changes of stuttering severity can be done in research contexts using either %SS or SR. However, for detecting changes within individuals using such measures, a paired-judge procedure is a more reliable method. © American Speech-Language-Hearing Association.
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.
O'Brian, S, Smith, K & Onslow, M 2014, 'Webcam delivery of the lidcombe program for early stuttering: A phase I clinical trial', Journal of Speech, Language, and Hearing Research, vol. 57, no. 3, pp. 825-830.View/Download from: Publisher's site
Purpose: The Lidcombe Program is an operant treatment for early stuttering shown with meta-analysis to have a favorable odds ratio. However, many clients are unable to access the treatment because of distance and lifestyle factors. In this Phase I trial, we explored the potential efficacy, practicality, and viability of an Internet webcam Lidcombe Program service delivery model. Method: Participants were 3 preschool children who stuttered and their parents, all of whom received assessment and treatment using webcam in their homes with no clinic attendance. Results: At 6 months post-Stage 1 completion, all children were stuttering below 1.0% syllables stuttered. The webcam intervention was acceptable to the parents and appeared to be practical and viable, with only occasional audiovisual problems. At present, there is no reason to doubt that a webcam-delivered Lidcombe Program will be shown with clinical trials to have comparable efficacy with the clinic version. Conclusion: Webcam-delivered Lidcombe Program intervention is potentially efficacious, is practical and viable, and requires further exploration with comparative clinical trials and a qualitative study of parent and caregiver experiences. © American Speech-Language-Hearing Association.
Smith, KA, Iverach, L, O'Brian, S, Kefalianos, E & Reilly, S 2014, 'Anxiety of children and adolescents who stutter: A review', Journal of Fluency Disorders, vol. 40, pp. 22-34.View/Download from: Publisher's site
Purpose: Adults who stutter have heightened rates of anxiety disorders, particularly social anxiety disorder, compared with non-stuttering controls. However, the timing of anxiety onset and its development in relation to stuttering is poorly understood. Identifying the typical age of anxiety onset in stuttering has significant clinical implications and is crucial for the management of both disorders across the lifespan. The present review aims to determine the scope of the research pertaining to this topic, identify trends in findings, and delineate timing of anxiety onset in stuttering. Methods: We examine putative risk factors of anxiety present for children and adolescents who stutter, and provide a review of the research evidence relating to anxiety for this population. Results: Young people who stutter can experience negative social consequences and negative attitudes towards communication, which is hypothesised to place them at increased risk of developing anxiety. The prevalence of anxiety of young people who stutter, and the timing of anxiety onset in stuttering could not be determined. This was due to methodological limitations in the reviewed research such as small participant numbers, and the use of measures that lack sensitivity to identify anxiety in the targeted population. Conclusions: In sum, the evidence suggests that anxiety in stuttering might increase over time until it exceeds normal limits in adolescence and adulthood. The clinical implications of these findings, and recommendations for future research, are discussed.Educational Objectives: The reader will be able to: (a) discuss contemporary thinking on the role of anxiety in stuttering and reasons for this view; (b) describe risk factors for the development of anxiety in stuttering, experienced by children and adolescents who stutter (c) outline trends in current research on anxiety and children and adolescents with stuttering; and (d) summarise rationales behind recommendations for future...
Karimi, H, O'Brian, S, Onslow, M, Jones, M, Menzies, R & Packman, A 2013, 'Unscheduled telephone calls to measure percent syllables stuttered during clinical trials', Journal of Speech, Language, and Hearing Research, vol. 56, no. 5, pp. 1455-1461.View/Download from: Publisher's site
Purpose: Researchers have used unscheduled telephone calls for many years during clinical trials to measure adult stuttering severity before and after treatment. Because variability is a hallmark of stuttering severity with adults, it is questionable whether an unscheduled telephone call is truly representative of their everyday speech. Method: The authors studied the speech of 9 men and 1 woman for a 12-hr day during different speaking activities. On that day and 1 week prior to that day, participants received an unscheduled 10-min telephone call from a person unknown to them. The authors compared the percent syllables stuttered (%SS) for the unscheduled telephone call on the day to the %SS of the unsch eduled telephone call 1 week prior to the day and to the %SS during the entire day. Results: No significant differences were found, and all confidence intervals with t tests included 0. The concordance correlation test also showed a strong positive correlation between %SS scores for the entire day and for the unscheduled 10-min telephone call. Conclusion: The authors conclude that there is no reason to doubt that 10-min unscheduled telephone calls are a representative speech sample for %SS during clinical trials of stuttering treatments. © American Speech-Language-Hearing Association.
Karimi, H, O'Brian, S, Onslow, M, Jones, M, Menzies, R & Packman, A 2013, 'Using statistical process control charts to study stuttering frequency variability during a single day', Journal of Speech, Language, and Hearing Research, vol. 56, no. 6, pp. 1789-1799.View/Download from: Publisher's site
Purpose: Stuttering varies between and within speaking situations. In this study, the authors used statistical process control charts with 10 case studies to investigate variability of stuttering frequency. Method: Participants were 10 adults who stutter. The authors counted the percentage of syllables stuttered (%SS) for segments of their speech during different speaking activities over a 12-hr day. Results for each participant were plotted on control charts. Results: All participants showed marked variation around mean stuttering frequency. However, there was no pattern of that variation consistent across the 10 participants. According to control charts, the %SS scores of half the participants were indicative of unpredictable, out-of-control systems, and the %SS scores of the other half of the participants were not. Self-rated stuttering severity and communication satisfaction correlated significantly and intuitively with the number of times participants exceeded their upper control chart limits. Conclusions: Control charts are a useful method to study how %SS scores might be applied to the study of stuttering variability during research and clinical practice. However, the method presents some practical problems, and the authors discuss how those problems can be solved. Solving those problems would enable researchers and clinicians to better plan, conduct, and evaluate stuttering treatments. © American Speech-Language-Hearing Association.
O'Brian, S, Iverach, L, Jones, M, Onslow, M, Packman, A & Menzies, R 2013, 'Effectiveness of the Lidcombe Program for early stuttering in Australian community clinics', International Journal of Speech-Language Pathology, vol. 15, no. 6, pp. 593-603.View/Download from: Publisher's site
This study explored the effectiveness of the Lidcombe Program for early stuttering in community clinics. Participants were 31 speech-language pathologists (SLPs) using the Lidcombe Program in clinics across Australia, and 57 of their young stuttering clients. Percentage of syllables stuttered (%SS) was collected 9 months after beginning treatment along with information about variables likely to influence outcomes. The mean %SS for the 57 children 9 months after starting treatment was 1.7. The most significant predictor of outcome was Lidcombe Program Trainers Consortium (LPTC) training. The children of trained SLPs (n = 19), compared to the children of untrained SLPs, took 76% more sessions to complete stage 1, but achieved 54% lower %SS scores, 9 months after starting treatment. Results suggest that outcomes for the Lidcombe Program in the general community may be comparable to those obtained in clinical trials when SLPs receive formal training and support. © 2013 The Speech Pathology Association of Australia Limited.
O'Brian, S, Jones, M, Lincoln, M, Harrison, E, Packman, A, Menzies, R & Onslow, M 2013, 'Validity of real-time measures of stuttering frequency', Speech, Language and Hearing, vol. 16, no. 2, pp. 107-116.View/Download from: Publisher's site
© W. S. Maney & Son Ltd 2013. Purpose: This study investigated the validity of real-time measurement of percent syllables stuttered (%SS), and whether slowing down the rate of presentation of recorded speech samples, or independent measurement of the number of stutters and the number of syllables improved this validity. Method: Eight speech-language pathologists (SLPs) measured %SS from 16×3-minute audio samples of stuttered speech, presented in the following ways: (1) concurrently counting stutters and syllables at original speed, (2) concurrently counting stutters and syllables with the speed of presentation slowed by about a third, (3) independently counting stutters and syllables at original speed, or (4) independently counting stutters and syllables at reduced speed. All measures were compared with previously determined 'expert consensus' values. SLPs also rated each method for ease of use. Results: Results showed no significant difference between the expert consensus measures and any of the measurement methods in terms of validity or reliability, despite SLPs generally finding the modified methods easier to use. Conclusions: Neither slowing down the rate of presentation nor counting stutters and syllables independently improved the validity or reliability of real-time measurement of %SS by SLPs.
Stuttering is a speech disorder that begins during the first years of life and is among the most prevalent of developmental disorders. It appears to be a problem with neural processing of speech involving genetics. Onset typically occurs during the first years of life, shortly after language development begins. Clinical presentation during childhood is interrupted and effortful speech production, often with rapid onset. If not corrected during early childhood, it becomes intractable and can cause psychological, social, educational and occupational problems. There is evidence from replicated clinical trials to support early intervention during the pre-school years. Meta-analysis of studies indicates that children who receive early intervention during the pre-school years are 7.7 times more likely to have resolution of their stuttering. Early intervention is recommended with a speech pathologist. Some children who begin to stutter will recover without such intervention. However, the number of such recoveries is currently not known, and it is not possible to predict which children are likely to recover naturally. Consequently, the current best practice is for speech pathologists to monitor children for signs of natural recovery for up to 1 year before beginning treatment. © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
Andrews, C, O'Brian, S, Harrison, E, Onslow, M, Packman, A & Menzies, R 2012, 'Syllable-timed speech treatment for school-age children who stutter: A phase I trial', Language, Speech, and Hearing Services in Schools, vol. 43, no. 3, pp. 359-369.View/Download from: Publisher's site
Purpose: This clinical trial determined the outcomes of a simple syllable-timed speech (STS) treatment for school-age children who stutter. Method: Participants were 10 children, ages 6-11 years, who stutter. Treatment involved training the children and their parents to use STS at near normal speech rates. The technique was practiced in the clinic and at home with the parents during everyday conversations. Results: Nine months after commencing treatment, stuttering had decreased by >50% for half of the children, with 2 children attaining 81% and 87% reduction. Intention-to-treat analysis showed a clinically and statistically significant reduction in stuttering for the group even when a withdrawn participant was included. These results were mostly confirmed by self-reported stuttering severity ratings and were supported by improved situation avoidance and quality-of-life scores. There was considerable individual variation in response to the treatment. Conclusion: STS shows promise as a treatment for some schoolage children who stutter. As a fluency technique, it is simple to learn and simple to teach, and the children in this study appeared to enjoy the treatment. The efficacy of the treatment could likely be improved with modifications. © American Speech-Language-Hearing Association.
Carey, B, O'Brian, S, Onslow, M, Packman, A & Menzies, R 2012, 'Webcam delivery of the camperdown program for adolescents who stutter: A phase I trial', Language, Speech, and Hearing Services in Schools, vol. 43, no. 3, pp. 370-380.View/Download from: Publisher's site
Purpose: This Phase I clinical trial explored the viability of webcam Internet delivery of the Camperdown Program for adolescents who stutter. Method and Procedure: Participants were 3 adolescents ages 13, 15, and 16 years, with moderate-severe stuttering. Each was treated with the Camperdown Program delivered by webcam with no clinic attendance. Primary outcome measures were percentage of syllables stuttered and number of treatment sessions to maintenance. Secondary outcome measures were speech naturalness, situation avoidance, self-reported stuttering severity, and parent and adolescent satisfaction. Data were collected pre treatment and at 1 day, 6 months, and 12 months post entry to maintenance. Results: Participants entered maintenance after means of 18 sessions and 11 clinician hours. Group mean reduction of stuttering from pre treatment to entry to maintenance was 83%, from pre treatment to 6 months post entry to maintenance was 93%, and from pre treatment to 12 months post entry to maintenance was 74%. Self-reported stuttering severity ratings confirmed these results. Post entry to maintenance speech naturalness for participants fell within the range of that of 3 matched controls. However, avoidance of speech situations showed no corresponding improvements for 2 of the participants. Conclusion: The service delivery model was efficacious and efficient. All of the participants and their parents also found it appealing. Results justify a Phase II trial of the delivery model. © American Speech-Language-Hearing Association.
Cocomazzo, N, Block, S, Carey, B, O'Brian, S, Onslow, M, Packman, A & Iverach, L 2012, 'Camperdown Program for adults who stutter: A student training clinic Phase i trial', International Journal of Language and Communication Disorders, vol. 47, no. 4, pp. 365-372.View/Download from: Publisher's site
Objectives: During speech pathology professional preparation there is a need for adequate student instruction with speech-restructuring treatments for adults. An important part of that clinical educational experience is to participate in a clinical setting that produces outcomes equivalent to those attained during clinical trials. A previous report showed that this is possible with a traditional, intensive speech-restructuring treatment. Considering the treatment process advantages and time efficiency of the Camperdown Program, it is arguably a compelling prospect for clinician education. Therefore, the present study is a Phase I trial of the treatment at a student university clinic, with a similar design to a previous report. Background: During speech pathology professional preparation there is a need for adequate student instruction with speech-restructuring treatments for adults. An important part of that clinical educational experience is to participate in a clinical setting that produces outcomes equivalent to those attained during clinical trials. A previous report showed that this is possible with a traditional, intensive speech-restructuring treatment. Considering the treatment process advantages and time efficiency of the Camperdown Program, it is arguably a compelling prospect for clinician education. Aims: The present study is a Phase I trial of the treatment at a student university clinic, with a similar design to a previous report. Methods & Procedures: The design was a non-randomized Phase I clinical trial with 12 adult participants. Primary outcomes were per cent syllables stuttered (%SS) within and beyond the clinic, and speech naturalness scores from pre- and post-treatment stutter-free speech samples. Outcomes & Results: Pooled %SS scores pre-treatment were 5.7, at immediate post-treatment were 1.0, and at 12 months post-treatment were 2.4. The group speech naturalness scores post-treatment did not increase to a clinically significant extent. Co...
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.
O'Brian, S, Packman, A, Onslow, M & Menzies, R 2012, 'Measuring outcomes following the camperdown program for stuttering: A response to Dr. Ingham', Journal of Speech, Language, and Hearing Research, vol. 55, no. 1, pp. 310-312.View/Download from: Publisher's site
Purpose: To respond to Dr. Ingham's letter to the editor, "Comments on Recent Developments in Stuttering Treatment Maintenance Research Using the Camperdown Program,"which appears in this issue of the Journal of Speech, Language, and Hearing Research. Method: When a treatment program has a performancecontingent maintenance schedule, as the Camperdown Program has, participants vary greatly in the time taken to complete this schedule-up to 2 years or more, in some cases. We reject Dr. Ingham's position that outcomes be measured a year after individual participants conclude their maintenance for the very reasons he has argued many times in the literature. Conclusion: We will continue to measure the outcomes of our clinical trials after a clinically meaningful period and at the same time for all participants. © American Speech-Language-Hearing Association.
Carr Swift, M, O'Brian, S, Hewat, S, Onslow, M, Packman, A & Menzies, R 2011, 'Investigating parent delivery of the Lidcombe Program', International Journal of Speech-Language Pathology, vol. 13, no. 4, pp. 308-316.View/Download from: Publisher's site
The Lidcombe Program is an early childhood stuttering treatment delivered by parents in the child's everyday environment, under the guidance of a speech-language pathologist (SLP). Given the parents' central role in the treatment delivery, the way it is implemented away from the clinic and away from the SLP's input is very important. And yet, to date there has been very little investigation into this process. This study investigated to what extent parents deliver contingencies for stuttering and stutter-free speech, in structured and unstructured conversations, as directed in the treatment manual. Participants were three mothers and their children who were receiving the Lidcombe Program. They recorded two treatment sessions each week and completed a daily treatment diary. The recordings were analysed for the use of parent verbal contingencies (PVCs). This method detected differences in PVC delivery by the mothers both across and within cases over time. The results show that valuable information can be gained from analysing home treatment sessions in this way and with a few modifications this methodology would be useful in larger scale studies. The strengths and limitations of this methodology are discussed with future larger studies of this type recommended. © 2011 The Speech Pathology Association of Australia Limited.
Iverach, L, Jones, M, Menzies, RG, O'Brian, S, Packman, A & Onslow, M 2011, 'Response to Walter Manning and J. Gayle Beck: Comments concerning Iverach, Jones et al. (2009a)', Journal of Fluency Disorders, vol. 36, no. 1, pp. 66-71.View/Download from: Publisher's site
Iverach, L, Menzies, R, Jones, M, O'Brian, S, Packman, A & Onslow, M 2011, 'Further development and validation of the Unhelpful Thoughts and Beliefs about Stuttering (UTBAS) scales: Relationship to anxiety and social phobia among adults who stutter', International Journal of Language and Communication Disorders, vol. 46, no. 3, pp. 286-299.View/Download from: Publisher's site
Background: In an initial validation study, the Unhelpful Thoughts and Beliefs About Stuttering (UTBAS I) scale, demonstrated excellent psychometric properties as a self-report measure of the frequency of unhelpful cognitions associated with social anxiety for adults who stutter. Aims: The aim was to further validate the original UTBAS I scale, and to develop two additional scales to assess beliefs (UTBAS II) and anxiety (UTBAS III) associated with negative thoughts. Methods & Procedures: A total of 140 adults seeking speech-restructuring treatment for stuttering completed the original UTBAS I scale, the newly developed UTBAS II and III scales, and self-report measures of psychological functioning. Participants also completed a first-stage screener for the presence of anxious personality disorder, and a diagnostic assessment to evaluate the presence of social phobia, according to criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the International Classification of Diseases (ICD-10). Outcomes & Results: The mean UTBAS I score for the present sample did not differ significantly from the mean score reported in the original UTBAS I validation study. Convergent validity was confirmed by significant correlations between the UTBAS Total score and all anxiety-related measures. Discriminant validity was established by the absence of strong correlations between the UTBAS Total score and some of the self-report measures of unrelated constructs, although it was found to tap into the negative cognitions associated with depression and life problems. Approximately one-quarter of participants met criteria for a diagnosis of DSM-IV or ICD-10 social phobia (23.5% and 27.2% respectively), and nearly one-third met first-stage screening criteria for anxious personality disorder (30%). The mean UTBAS scores for participants who met criteria for these disorders were significantly higher than scores for participants who did not, confirming known-groups v...
Iverach, L, Menzies, RG, O'Brian, S, Packman, A & Onslow, M 2011, 'Anxiety and stuttering: Continuing to explore a complex relationship', American Journal of Speech-Language Pathology, vol. 20, no. 3, pp. 221-232.View/Download from: Publisher's site
Purpose: The relationship between anxiety and stuttering has been widely studied. However, a review conducted more than 10 years ago (Menzies, Onslow, & Packman, 1999) identified 5 methodological issues thought to preclude consistent research findings regarding the nature of this relationship. The purpose of the present review was to determine whether methodological improvements have occurred since the Menzies et al. (1999) review. Method: Literature published since the Menzies et al. review was evaluated with regard to the 5 methodological issues identified in that review: (a) the construct of anxiety, (b) trait anxiety measures, (c) participant numbers, (d) treatment status of participants, and (e) speaking tasks. Results: Despite some remaining ambiguous findings, research published since the Menzies et al. review has provided far stronger evidence of a relationship between stuttering and anxiety, and has focused more on social anxiety, expectancies of social harm, and fear of negative evaluation. Conclusion: The aims of future research should be to improve research design, increase statistical power, employ multidimensional measures of anxiety, and further develop anxiolytic treatment options for people who stutter. © American Speech-Language-Hearing Association.
Metten, C, Bosshardt, HG, Jones, M, Eisenhuth, J, Block, S, Carey, B, O'Brian, S, Packman, A, Onslow, M & Menzies, R 2011, 'Dual tasking and stuttering: From the laboratory to the clinic', Disability and Rehabilitation, vol. 33, no. 11, pp. 933-944.View/Download from: Publisher's site
Purpose: The aim of the three studies in this article was to develop a way to include dual tasking in speech restructuring treatment for persons who stutter (PWS). It is thought that this may help clients maintain the benefits of treatment in the real world, where attentional resources are frequently diverted away from controlling fluency by the demands of other tasks. Method. In Part 1, 17 PWS performed a story-telling task and a computer semantic task simultaneously. Part 2 reports the incorporation of the Part 1 protocol into a handy device for use in a clinical setting (the Dual Task and Stuttering Device, DAS-D). Part 3 is a proof of concept study in which three PWS reported on their experiences of using the device during treatment. Results. In Part 1, stuttering frequency and errors on the computer task both increased under dual task conditions, indicating that the protocol would be appropriate for use in a clinical setting. All three participants in Part 3 reported positively on their experiences using the DAS-D. Conclusions. Dual tasking during treatment using the DAS-D appears to be a viable clinical procedure. Further research is required to establish effectiveness. © 2011 Informa UK, Ltd.
O'Brian, S, Jones, M, Packman, A, Menzies, R & Onslow, M 2011, 'Stuttering severity and educational attainment', Journal of Fluency Disorders, vol. 36, no. 2, pp. 86-92.View/Download from: Publisher's site
Purpose: This study investigated the relationship between self-reported stuttering severity ratings and educational attainment. Method: Participants were 147 adults seeking treatment for stuttering. At pretreatment assessment, each participant reported the highest educational level they had attained and rated their typical and worst stuttering severity on a 9-point scale for a range of speaking situations. These included: (1) talking with a family member, (2) talking with a familiar person, not a family member, (3) talking in a group of people, (4) talking with a stranger, (5) talking with an authority figure such as a work manager or teacher, (6) talking on the telephone, (7) ordering food or drink, and (8) giving their name and address. Results: There was a significant negative relationship between highest educational achievement and mean self-reported stuttering severity rating for the eight situations. Conclusions: Future research is needed to investigate how this result should be addressed in educational institutions.Educational objectives: The reader will be able to: (1) describe the negative effects of stuttering through childhood to adulthood; (2) identify some of the negative consequences associated with stuttering on peer and teacher relationships, and academic performance at school; and (3) summarise the relationship between stuttering severity and educational attainment. © 2011 Elsevier Inc.
Jones, M, Dobson, A & O'brian, S 2011, 'A graphical method for assessing agreement with the mean between multiple observers using continuous measures', International Journal of Epidemiology, vol. 40, no. 5, pp. 1308-1313.View/Download from: Publisher's site
Background: Currently, we are not aware of a method to assess graphically on one simple plot agreement between more than two observers making continuous measurements on the same subjects. Methods: We aimed to develop a simple graphical method to assess agreement between multiple observers using continuous measurements. The Bland-Altman graphical method for assessing agreement between two observers using continuous measures was modified and extended to accommodate multiple observers. Mathematical formulae are derived and real data examples used to illustrate the proposed method. Results: The examples show that the proposed graphical method of assessing agreement provides clinically useful information. This information includes estimates of the limits of agreement with the mean and a visual means for determining these limits over the range of measurements. In a data example that included five readers' measurements of 40 lung lesions, the intra-class correlation (ICC) was 0.84 indicating readers can reliably measure the lesions. However, the estimated limits of agreement with the mean were -1.1 to 1.1 cm implying that the readers' measurements can plausibly differ from the mean estimated tumour size by more than 1 cm. This is a clinically significant difference according to the study authors. In addition, a plot of the limits of agreement with the mean by mean tumour size shows heterogeneous agreement presumably due to the varying degrees of definition at the edge of the lesions. Conclusions The proposed graphical method of assessing agreement can be used alongside other measures such as ICC for reporting on reproducibility in studies of multiple observers making continuous measurements. © The Author 2011; all rights reserved.
Trajkovski, N, Andrews, C, Onslow, M, O'Brian, S, Packman, A & Menzies, R 2011, 'A phase II trial of the Westmead Program: Syllable-timed speech treatment for pre-school children who stutter', INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY, vol. 13, no. 6, pp. 500-509.View/Download from: Publisher's site
Carey, B, O'Brian, S, Onslow, M, Block, S, Jones, M & Packman, A 2010, 'Randomized controlled non-inferiority trial of a telehealth treatment for chronic stuttering: The Camperdown Program', International Journal of Language and Communication Disorders, vol. 45, no. 1, pp. 108-120.View/Download from: Publisher's site
Background: Although there are treatments that can alleviate stuttering in adults for clinically significant periods, in Australia there are barriers to the accessibility and availability of best-practice treatment.Aims: This parallel group, non-inferiority randomized controlled trial with multiple blinded outcome assessments investigated whether telehealth delivery of the Camperdown Program provides a non-inferior alternative to face-to-face treatment for adults who stutter.Methods & Procedures: Forty participants who presented to a university speech clinic were randomized: 20 to the telehealth arm and 20 to the face-to-face arm. Exclusion criteria were age younger than 18 years, frequency of stuttering less than 2% of syllables stuttered and previous speech-restructuring treatment within the past 12 months. The Camperdown Program for adults who stutter was the intervention. Primary outcome measures were frequency of stuttering measured in per cent syllables stuttered (%SS) before treatment and at 9 months post-randomization and efficiency, measured by counting the number of speech pathologist contact hours used by each participant. Intention to treat analysis was conducted using last observation carried forward. Secondary outcome measures were speech naturalness, self-reported stuttering severity, and treatment satisfaction.Outcomes & Results: There was no statistically or clinically significant difference in %SS between the two groups at 9 months post-randomization. Analysis of covariance adjusting for baseline %SS showed telehealth had 0.8% absolute lower per cent syllables stuttered than face-to-face. There were also no differences in %SS between groups immediately post-treatment, or at 6 months and 12 months post-treatment (p 0.9). In the second primary outcome measure, the telehealth group used statistically less contact time (221 min) on average than the face-to-face group (95% confidence interval - 387 to - 56 min, p 0.01).Conclusions & Implications: The...
Cream, A, O'Brian, S, Jones, M, Block, S, Harrison, E, Lincoln, M, Hewat, S, Packman, A, Menzies, R & Onslow, M 2010, 'Randomized controlled trial of video self-modeling following speech restructuring treatment for stuttering', Journal of Speech, Language, and Hearing Research, vol. 53, no. 4, pp. 887-897.View/Download from: Publisher's site
Purpose: In this study, the authors investigated the efficacy of video self-modeling (VSM) following speech restructuring treatment to improve the maintenance of treatment effects. Method: The design was an open-plan, parallel-group, randomized controlled trial. Participants were 89 adults and adolescents who undertook intensive speech restructuring treatment. Post treatment, participants were randomly assigned to 2 trial arms: standard maintenance and standard maintenance plus VSM. Participants in the latter arm viewed stutter-free videos of themselves each day for 1 month. Results: The addition of VSM did not improve speech outcomes, as measured by percent syllables stuttered, at either 1 or 6 months postrandomization. However, at the latter assessment, self-rating of worst stuttering severity by the VSM group was 10% better than that of the control group, and satisfaction with speech fluency was 20% better. Quality of life was also better for the VSM group, which was mildly to moderately impaired compared with moderate impairment in the control group. Conclusions: VSM intervention after treatment was associated with improvements in self-reported outcomes. The clinical implications of this finding are discussed. © American Speech-Language-Hearing Association.
Goodhue, R, Onslow, M, Quine, S, O'Brian, S & Hearne, A 2010, 'The Lidcombe Program of early stuttering intervention: mothers' experiences', Journal of Fluency Disorders, vol. 35, no. 1, pp. 70-84.View/Download from: Publisher's site
The Lidcombe Program is a behavioral treatment for early stuttering which is implemented by parents, typically the mother. Despite this, there is limited detailed knowledge about mothers' experiences of administering the treatment. This article describes the findings of a qualitative study which explored the experiences of 16 mothers during their implementation of the Lidcombe Program. Information was collected using semi-structured, in-depth, face-to-face and telephone interviews. Participants were interviewed pre-treatment, and then regularly throughout the 6-month treatment period. Data were collected from nine interviews conducted with each participant. All interviews (n=140) were audio recorded and then transcribed verbatim. Thematic analysis was used to identify major issues and topics which emerged from the data.Practicalities of implementing the program are reported, including obstacles that mothers faced and solutions to address these. Positive aspects that mothers experienced through their involvement are discussed. The mothers' perceptions of the treatment are outlined and descriptions of the emotions mothers reported are also presented. Findings from the study will enable clinicians to better deliver the Lidcombe Program and will enable improved course instruction and clinical education about the procedure. Educational objectives: The reader will be able to (1) describe the key components of the Lidcombe Program, (2) describe the rationale and methodology for this study, (3) outline the major findings regarding the mothers' experiences of the Lidcombe Program, (4) describe how the findings can be implemented in a clinical setting and (5) evaluate the strengths and limitations of a qualitative study. © 2010 Elsevier Inc.
Iverach, L, Jones, M, O'Brian, S, Block, S, Lincoln, M, Harrison, E, Hewat, S, Menzies, RG, Packman, A & Onslow, M 2010, 'Mood and substance use disorders among adults seeking speech treatment for stuttering', Journal of Speech, Language, and Hearing Research, vol. 53, no. 5, pp. 1178-1190.View/Download from: Publisher's site
Objectives: Stuttering has been associated with a range of anxiety disorders, including social phobia. In the general community, anxiety disorders are frequently associated with increased rates of mood and substance use disorders. Therefore, in the present study, the authors sought to determine the rate of mood and substance use disorders among adults who stutter. Method: The study employed a matched case-control design. Participants included 92 adults seeking treatment for stuttering and 920 age-and gender-matched controls. Mental health assessments were conducted via a computerized psychiatric diagnostic interview. Conditional logistic regression models were used to estimate odds ratios for the prevalence of mood and substance use disorders in both groups. Results: When compared with matched controls, adults seeking treatment for stuttering had twofold increased odds of meeting criteria for a 12-month diagnosis of any mood disorder but were not found to report significantly higher lifetime prevalence rates for any substance use disorder. Conclusions: Although adults who stutter in the present study were characterized by significantly higher rates of mood disorders than matched controls, they do not appear to self-medicate with substances such as alcohol. Results are discussed in terms of treatment implications and possible reasons why adults who stutter may avoid alcohol. © American Speech-Language-Hearing Association.
Iverach, L, O'Brian, S, Jones, M, Block, S, Lincoln, M, Harrison, E, Hewat, S, Menzies, RG, Packman, A & Onslow, M 2010, 'The Five Factor Model of personality applied to adults who stutter', Journal of Communication Disorders, vol. 43, no. 2, pp. 120-132.View/Download from: Publisher's site
Previous research has not explored the Five Factor Model of personality among adults who stutter. Therefore, the present study investigated the five personality domains of Neuroticism, Extraversion, Openness, Agreeableness and Conscientiousness, as measured by the NEO Five Factor Inventory (NEO-FFI), in a sample of 93 adults seeking speech treatment for stuttering, and compared these scores with normative data from an Australian and a United States sample. Results revealed that NEO-FFI scores for the stuttering group were within the 'average' range for all five personality domains. However, adults who stutter were characterized by significantly higher Neuroticism, and significantly lower Agreeableness and Conscientiousness, than normative samples. No significant differences were found between groups on the dimensions of Extraversion and Openness. These results are discussed with reference to the relationship between personality factors among adults who stutter, their directionality, and implications for predicting treatment outcome. Learning outcomes: The reader will be able to: (1) describe the Five Factor Model of personality, including the NEO-FFI personality domains of Extraversion, Neuroticism, Openness, Agreeableness, and Conscientiousness, and (2) discuss differences in NEO-FFI domain scores between adults who stutter and normative samples, and (3) understand the clinical implications of personality profiles in terms of treatment process and outcome for adults who stutter. © 2009 Elsevier Inc.
O'Brian, S, Jones, M, Pilowsky, R, Onslow, M, Packman, A & Menzies, R 2010, 'A new method to sample stuttering in preschool children', International Journal of Speech-Language Pathology, vol. 12, no. 3, pp. 173-177.View/Download from: Publisher's site
This study reports a new method for sampling the speech of preschool stuttering children outside the clinic environment. Twenty parents engaged their stuttering children in an everyday play activity in the home with a telephone handset nearby. A remotely located researcher telephoned the parent and recorded the play session with a phone-recording jack attached to a digital audio recorder at the remote location. The parent placed an audio recorder near the child for comparison purposes. Children as young as 2 years complied with the remote method of speech sampling. The quality of the remote recordings was superior to that of the in-home recordings. There was no difference in means or reliability of stutter-count measures made from the remote recordings compared with those made in-home. Advantages of the new method include: (1) cost efficiency of real-time measurement of percent syllables stuttered in naturalistic situations, (2) reduction of bias associated with parent-selected timing of home recordings, (3) standardization of speech sampling procedures, (4) improved parent compliance with sampling procedures, (5) clinician or researcher on-line control of the acoustic and linguistic quality of recordings, and (6) elimination of the need to lend equipment to parents for speech sampling. © 2010 The Speech Pathology Association of Australia Limited.
Cream, A, O'Brian, S, Onslow, M, Packman, A & Menzies, R 2009, 'Selfmodelling as a relapse intervention following speechrestructuring treatment for stuttering', International Journal of Language and Communication Disorders, vol. 44, no. 5, pp. 587-599.View/Download from: Publisher's site
Background Speech restructuring is an efficacious method for the alleviation of stuttered speech. However, posttreatment relapse is common. Aims To investigate whether the use of video selfmodelling using restructured stutterfree speech reduces stuttering in adults who had learnt a speechrestructuring technique and subsequently relapsed. Methods & Procedures Participants were twelve adults who had previously had speechrestructuring treatment for stuttering and relapsed. They were video recorded for 1 hour within the clinic, practising their speechrestructuring technique. The videos were then edited to remove all observable stuttering. Participants then viewed the resulting video of themselves using restructured stutterfree speech each day for 1 month and were instructed to speak as they did on the video. Beyondclinic speech samples and selfreport severity data were collected before and after the intervention. Outcomes & Results Very large effect sizes were found. The mean per cent syllables stuttered was 7.7 preintervention and 2.3 postintervention. For all but one participant there was a reduction in stuttering from preintervention to postintervention. These results were verified with selfreport data. Speech naturalness was not compromised by the video selfmodelling procedure. Conclusion & Implications Video selfmodelling as a relapse management tool does not involve excessive time expenditure by the clinician or the client. The study indicates video selfmodelling is potentially useful for managing relapse after speechrestructuring treatment for stuttering, and in some cases may be a standalone procedure to manage relapse. Phase II and III trials are warranted to determine the size and duration of the effect. It is suggested video selfmodelling could also be included in a relapse management plan. © 2009 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.
Helgadóttir, FD, Menzies, RG, Onslow, M, Packman, A & O'Brian, S 2009, 'Online CBT I: Bridging the gap between Eliza and modern online CBT treatment packages', Behaviour Change, vol. 26, no. 4, pp. 245-253.View/Download from: Publisher's site
Reviews have demonstrated large effect sizes when using computerised cognitive behaviour therapy (CBT) protocols for treating anxiety, depression and health related concerns. However, the amount of therapist contact per user seems to be the most significant prognostic indicator. Thus, in some ways current online interventions can be viewed primarily as an extension of one-on-one therapy. The present article provides guidelines for targeting this limitation of online psychological interventions. The goal is to mimic the therapeutic relationship using a computer, without having any therapist involved. Consequently, thousands of users would be able to receive treatment simultaneously, reaching a wider audience, which was the initial goal of the online model. The development of a treatment program using file audit data is suggested as an alternative to having an individual therapist for each user. This is done by allowing the 'computer psychologist' to tailor individualised treatments for each user based on their psychological profile. The user is provided with individualised corrective feedback based on a set of prewritten responses to common faulty thoughts. A new paradigm is proposed for online treatment delivery.
Helgadóttir, FD, Menzies, RG, Onslow, M, Packman, A & O'Brian, S 2009, 'Online CBT II: A phase I trial of a standalone, online CBT treatment program for social anxiety in stuttering', Behaviour Change, vol. 26, no. 4, pp. 254-270.View/Download from: Publisher's site
This paper introduces a novel approach to internet treatment for social anxiety. The goal of this treatment was to address key limitations of current standalone treatments (Helgadottir, Menzies, Onslow, Packman, & O'Brian, 2009). The 'computer psychologist' designed for this study used fully automated, prewritten individualised sample answers in order to simulate a human-human interaction through a human-computer interface. Two males who sought treatment for stuttering and met the diagnosis for social phobia according to the DSM-IV and ICD-10 criteria were selected for this study. After receiving the treatment, both users no longer met criteria for social phobia. Also, significant improvements were observed on other psychometric tests, including measures of unhelpful cognitions, behavioural avoidance, quality of life, and low mood. The quality of the interaction appeared to be similar to face-to-face therapy, indicating that the 'computer psychologist' established an effective therapeutic relationship, and the automated techniques used were sufficiently engaging to prompt users to log on regularly and complete the treatment program.
Iverach, L, Jones, M, O'Brian, S, Block, S, Lincoln, M, Harrison, E, Hewat, S, Cream, A, Menzies, RG, Packman, A & Onslow, M 2009, 'Corrigendum to "The relationship between mental health disorders and treatment outcomes among adults who stutter" [J. Fluency Disorders 34 (2009) 29-43] (DOI:10.1016/j.jfludis.2009.02.002)', Journal of Fluency Disorders, vol. 34, no. 4, p. 301.View/Download from: Publisher's site
Iverach, L, Jones, M, O'Brian, S, Block, S, Lincoln, M, Harrison, E, Hewat, S, Cream, A, Menzies, RG, Packman, A & Onslow, M 2009, 'The relationship between mental health disorders and treatment outcomes among adults who stutter', Journal of Fluency Disorders, vol. 34, no. 1, pp. 29-43.View/Download from: Publisher's site
The ability to reduce stuttering in everyday speaking situations is the core component of the management plan of many who stutter. However, the ability to maintain the benefits of speech-restructuring treatment is known to be compromised, with only around a third of clients achieving this [Craig, A. R., & Hancock, K. (1995). Self-reported factors related to relapse following treatment for stuttering. Australian Journal of Human Communication Disorders, 23, 48-60; Martin, R. (1981). Introduction and perspective: Review of published research. In E. Boberg (Ed.), Maintenance of fluency. New York: Elsevier]. The aim of this study was to determine whether the presence of mental health disorders contributes to this failure to maintain fluency after treatment. Assessments for mental health disorders were conducted with 64 adults seeking speech-restructuring treatment for their stuttering. Stuttering frequency, self-rated stuttering severity and self-reported avoidance were measured before treatment, immediately after treatment and 6 months after treatment. Stuttering frequency and situation avoidance were significantly worse for those participants who had been identified as having mental health disorders. The only subgroup that maintained the benefits of the treatment for 6 months was the third of the participants without a mental health disorder. These results suggest that prognosis for the ability to maintain fluency after speech restructuring should be guarded for clients with mental health disorders. Further research is needed to determine the benefits of treating such disorders prior to, or in combination with, speech-restructuring. Educational objectives: The reader will (1) evaluate the impact of one or more mental health disorders on medium-term outcomes from speech-restructuring treatment for stuttering, (2) describe how this finding affects prognosis for certain groups of stuttering clients, (3) evaluate how these finding are consistent with estimates of post-...
Iverach, L, Jones, M, O'Brian, S, Block, S, Lincoln, M, Harrison, E, Hewat, S, Menzies, RG, Packman, A & Onslow, M 2009, 'Screening for personality disorders among adults seeking speech treatment for stuttering', Journal of Fluency Disorders, vol. 34, no. 3, pp. 173-186.View/Download from: Publisher's site
Stuttering is frequently associated with negative consequences which typically begin in early childhood. Despite this, no previous studies have investigated the presence of personality disorders among adults who stutter. Therefore, the aims of the present study were to screen for personality disorders among adults who stutter, and to compare these screening estimates with matched controls from a national population sample. Using a matched case-control design, participants were 94 adults seeking treatment for stuttering, 92 of whom completed the International Personality Disorders Examination Questionnaire (IPDEQ) as a first-stage screener, and 920 age- and gender-matched controls from the Australian National Survey of Mental Health and Well-Being (ANSMHWB). A conditional logistic regression model was used to estimate odds ratios for the primary outcome: first-stage presence of any personality disorder; as well as specific personality disorders. Based on first-stage screening, the presence of any personality disorder was significantly higher for adults in the stuttering group than matched controls, demonstrating almost threefold increased odds. This difference between groups remained significant for all specific personality disorders, with four- to sevenfold increased odds found for Dissocial, Anxious, Borderline, Dependent and Paranoid personality disorders, and two- to threefold increased odds found for Histrionic, Impulsive, Schizoid and Anankastic personality disorders. In conclusion, stuttering appears to be associated with a heightened risk for the development of personality disorders. These results highlight the need for research regarding the assessment and treatment of personality disorders among adults who stutter. Educational objectives: The reader will be able to: (1) describe the nature of personality disorders, including factors thought to contribute to their development; (2) identify some of the negative consequences associated with stuttering which...
Iverach, L, O'Brian, S, Jones, M, Block, S, Lincoln, M, Harrison, E, Hewat, S, Menzies, RG, Packman, A & Onslow, M 2009, 'Prevalence of anxiety disorders among adults seeking speech therapy for stuttering', Journal of Anxiety Disorders, vol. 23, no. 7, pp. 928-934.View/Download from: Publisher's site
The present study explored the prevalence of anxiety disorders among adults seeking speech therapy for stuttering. Employing a matched case-control design, participants included 92 adults seeking treatment for stuttering, and 920 age- and gender-matched controls from the Australian National Survey of Mental Health and Well-being. A conditional logistic regression model was used to estimate odds ratios for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and International Classification of Diseases (ICD-10) anxiety disorders. Compared with matched controls, the stuttering group had six- to seven-fold increased odds of meeting a 12-month diagnosis of any DSM-IV or ICD-10 anxiety disorder. In terms of 12-month prevalence, they also had 16- to 34-fold increased odds of meeting criteria for DSM-IV or ICD-10 social phobia, four-fold increased odds of meeting criteria for DSM-IV generalized anxiety disorder, and six-fold increased odds of meeting criteria for ICD-10 panic disorder. Overall, stuttering appears to be associated with a dramatically heightened risk of a range of anxiety disorders. © 2009.
Menzies, RG, Onslow, M, Packman, A & O'Brian, S 2009, 'Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists', Journal of Fluency Disorders, vol. 34, no. 3, pp. 187-200.View/Download from: Publisher's site
This paper explores the relationships between anxiety and stuttering and provides an overview of cognitive-behavior therapy (CBT) strategies that can be applied by speech-language pathologists. There is much support for the idea that adults who stutter (AWS) may need CBT. First, approximately 50% of AWS may be suffering from social anxiety disorder. A difficult developmental history marked by problematic peer relationships and bullying may contribute to this. Stereotypes in the general community lead AWS to have occasional experiences that confirm their fears of negative evaluation. This can leave AWS with significant social and occupational avoidance and can impact on their quality of life. Second, in a recent large study of behavioral treatment for AWS, participants who had a mental health disorder, including social anxiety, failed to maintain the benefits of treatment. Available evidence supports the contention that CBT can effectively decrease anxiety and social avoidance, and increase engagement in everyday speaking situations for AWS. The components of CBT presented here are drawn from a model widely used in clinical psychology, and existing supportive data reviewed. Worksheets for speech-language pathologists undertaking CBT in this population are provided. CBT procedures, in their essentials, are straightforward to implement. Hence, the present authors suggest that speech-language pathologists who have had training in conducting CBT should be able to apply the techniques described in this paper. Educational objectives: The reader will be able to explain: (1) the relation between stuttering and anxiety; (2) the nature of Social Anxiety Disorder; (3) why those who stutter are often diagnosed with Social Anxiety Disorder; (4) the four components of cognitive behavior therapy; (5) how cognitive behavior therapy is adapted for the management of speech-related anxiety in those who stutter. © 2009 Elsevier Inc. All rights reserved.
Trajkovski, N, Andrews, C, Onslow, M, Packman, A, O'Brian, S & Menzies, R 2009, 'Using syllable-timed speech to treat preschool children who stutter: A multiple baseline experiment', JOURNAL OF FLUENCY DISORDERS, vol. 34, no. 1, pp. 1-10.View/Download from: Publisher's site
Hearne, A, Packman, A, Onslow, M & O'Brian, S 2008, 'Developing treatment for adolescents who stutter: A phase I trial of the camperdown program', Language, Speech, and Hearing Services in Schools, vol. 39, no. 4, pp. 487-497.View/Download from: Publisher's site
Purpose: To investigate in detail how adolescents who stutter perform during treatment, with the aim of informing treatment development for this age group. Method: The Camperdown Program was conducted with 3 adolescents who stutter. Their performance during treatment was recorded in detail, and outcome measures were collected before treatment and on 5 occasions after treatment. Results: One participant responded extremely well to treatment, with percentage of syllables stuttered (%SS) scores at 12 months follow-up around 1%. In addition, his speech naturalness was within normal limits. Another participant withdrew from treatment duringmaintenance, yet he still approximately halved his pretreatment %SS scores and was also sounding natural after treatment. This participant was satisfied with his treatment outcome. A third participant did not reach maintenance and did not benefit from the treatment. Conclusion: The adolescent who succeeded in treatment presented with a high level of self-confidence and maturity. When examining the factors that seemed to impact on treatment outcome, an underlying theme of decreased parent influence and increased peer influence and self-direction was detected. These are fundamental during the journey through adolescence from childhood to adulthood. Future directions in developing treatments for adolescents are discussed. © American Speech-Language-Hearing Association.
Jones, M, Onslow, M, Packman, A, O'Brian, S, Hearne, A, Williams, S, Ormond, T & Schwarz, I 2008, 'Extended follow-up of a randomized controlled trial of the Lidcombe program of early stuttering intervention', International Journal of Language and Communication Disorders, vol. 43, no. 6, pp. 649-661.View/Download from: Publisher's site
Background: In the Lidcombe Program of Early Stuttering Intervention, parents present verbal contingencies for stutter-free and stuttered speech in everyday situations. A previous randomized controlled trial of the programme with preschool-age children from 2005, conducted in two public speech clinics in New Zealand, showed that the odds of attaining clinically minimal levels of stuttering 9 months after randomization were more than seven times greater for the treatment group than for the control group. Aims: To follow up the children in the trial to determine extended long-term outcomes of the programme. Methods & Procedures: An experienced speech-language therapist who was not involved in the original trial talked with the children on the telephone, audio recording the conversations using a telephone recording jack. Parental reports were gathered in addition to the children's speech samples in order to obtain a balance of objective data and reports from a wide range of situations. Outcomes & Results: At the time of this follow-up, the children were aged 7-12 years, with a mean of 5 years post-randomization in the 2005 trial. Twenty of the 29 children in the treatment arm and eight of the 25 children in the control (no treatment) arm were able to be contacted. Of the children in the treatment group, one (5%) failed to complete treatment and 19 had completed treatment successfully and had zero or near-zero frequency of stuttering. Three of the children (16%) who had completed treatment successfully had relapsed after 2 or more years of speech that was below 1% syllables stuttered. Meaningful comparison with the control group was not possible because an insufficient number of control children were located and some of them received treatment after completing the trial. Conclusions & Implications: The majority of preschool children are able to complete the Lidcombe Program successfully and remain below 1% syllables stuttered for a number of years. However, a minorit...
Menzies, RG, O'Brian, S, Onslow, M, Packman, A, St. Clare, T & Block, S 2008, 'An experimental clinical trial of a cognitive-behavior therapy package for chronic stuttering', Journal of Speech, Language, and Hearing Research, vol. 51, no. 6, pp. 1451-1464.View/Download from: Publisher's site
Purpose: The aims of the present study were to (a) examine the rate of social phobia among adults who stutter, (b) study the effects of speech restructuring treatment on social anxiety, and (c) study the effects on anxiety and stuttering of a cognitive-behavior therapy (CBT) package for social anxiety. Method: Thirty-two adults with chronic stuttering were randomly allocated to receive either speech restructuring following a CBT package for social anxiety or speech restructuring alone. Data were obtained on a variety of speech and psychological measures at pre-treatment, post-CBT, post-speech restructuring, and 12 months follow-up. Results: Sixty percent of our cohort were diagnosed with social phobia. Speech restructuring treatment alone had no impact on the social phobia of our cohort at 12 months follow-up. At follow-up, participants who had received CBT showed no social phobia and greater improvements than control participants on a range of psychological measures of anxiety and avoidance. However, the CBT package made no difference to the speech outcomes of those with social phobia. Conclusion: The CBT treatment was associated with significant and sustained improvements in psychological functioning but did not improve fluency. © American Speech-Language-Hearing Association.
O'Brian, S, Packman, A & Onslow, M 2008, 'Telehealth delivery of the camperdown program for adults who stutter: A Phase I trial', Journal of Speech, Language, and Hearing Research, vol. 51, no. 1, pp. 184-195.View/Download from: Publisher's site
Purpose: This Phase I trial investigated the viability of telehealth delivery of the Camperdown Programwith adultswho stutter. This program involves speech restructuring. Method: All treatment was conducted remotely with participant-clinician contact occurring by telephone and e-mail. Results: Ten adults completed the program. The group showed an 82% reduction in stuttering frequency immediately after treatment and a 74% reduction 6 months after treatment. However, there was significant individual variation in response to the program. Conclusion: These preliminary data suggest that telehealth Camperdown has the potential to provide efficacious treatment for clients who do not have access to traditional face-toface treatment. © American Speech-Language-Hearing Association.
Onslow, M, Jones, M, O'Brian, S, Menzies, R & Packman, A 2008, 'Defining, identifying, and evaluating clinical trials of stuttering treatments: A tutorial for clinicians', American Journal of Speech-Language Pathology, vol. 17, no. 4, pp. 401-415.View/Download from: Publisher's site
Purpose: To develop a method for clinicians to evaluate stuttering treatment efficacy research with very little burden of work. Method: The clinical trial is the most fundamental, clinically interpretable, and useful output unit of stuttering treatment research. We define a clinical trial of a stuttering treatment and specify 3 levels of clinical trials evidence. We use this taxonomy to identify and evaluate clinical trials of stuttering treatment. Our taxonomy draws on 2 fundamental principles of clinical trials used to evaluate health care: randomization and effect size. Results: Published clinical trials of stuttering treatments were identified and allocated to 1 of 3 levels of evidence. Conclusions: We outline a 3-step, semi-automated, Internet-based method to identify the publication of a report of stuttering treatment efficacy. For a report identified as such, a 10-item checklist is applied to verify its status as a clinical trial and to allocate it to 1 of 3 levels of clinical trials evidence. The present taxonomy reduces the burden of work of a 136-item checklist in an existing taxonomy. © American Speech-Language-Hearing Association.
Hewat, S, Onslow, M, Packman, A & O'Brian, S 2006, 'A phase II clinical trial of self-imposed time-out treatment for stuttering in adults and adolescents', Disability and Rehabilitation, vol. 28, no. 1, pp. 33-42.View/Download from: Publisher's site
Purpose. This study reports the development and clinical trial of a new treatment program for persistent developmental stuttering in adolescents and adults. The treatment is based on the operant procedure of self-imposed time-out. This involves the person stopping speaking for a short period after each stutter. Method. Twenty-two participants completed Stage 1 (Instatement and Generalisation) of the program and 18 completed Stage 2 (Maintenance) of the program. Stuttering outcome was measured from independent audio and video recordings made outside and inside the clinic, before and after treatment. Speech naturalness was measured at the end of Stage 1. Secondary analyses were conducted to investigate whether responsiveness to the program was related to stuttering severity or age. Participants completed an extensive self-report inventory at the end of treatment. Results. There was a range of responsiveness to the treatment, with more than half the participants reducing their stuttering by more than 50%. Participants with more severe types of stuttering appeared to respond better but no other predictors of responsiveness were identified. Speech sounded reasonably natural after treatment. Participants' perceptions of the treatment were for the most part positive with the majority reporting that the treatment was easier to use and more effective than treatment based on prolonged-speech. Conclusions. The self-imposed time-out treatment program reported here is clearly effective for a significant number of adolescents and adults who stutter. Given that it does not require speech restructuring and the constant attention to speech that this involves, this could be a treatment of choice for those who are likely to respond. Consequently, further research is needed to determine which clients seeking behavioural treatment for their stuttering will benefit most from this program. Further research is also needed to determine the extent to which the effectiveness of time-out is...
Trajkovski, N, Andrews, C, O'Brian, S, Onslow, M & Packman, A 2006, 'Treating stuttering in a preschool child with syllable timed speech: A case report', BEHAVIOUR CHANGE, vol. 23, no. 4, pp. 270-277.View/Download from: Publisher's site
O'Brian, S, Onslow, M, Cream, A & Packman, A 2005, 'Reviewing the literature? A response to Prins and Ingham (2005) ', Journal of Speech, Language, and Hearing Research, vol. 48, no. 5, pp. 1029-1032.View/Download from: Publisher's site
O'Brian, S, Packman, A & Onslow, M 2004, 'Self-rating of stuttering severity as a clinical tool', American Journal of Speech-Language Pathology, vol. 13, no. 3, pp. 219-226.View/Download from: Publisher's site
Scaling is a convenient and equipment-free means for speech-language pathologists (SLPs) and clients to evaluate stuttering severity in everyday situations. This study investigated the extent to which the severity ratings of 10 adult stuttering speakers, made immediately after speaking and again from recordings 6 months later, agreed with ratings made by an SLP. For 9 of the 10 speakers, there was good agreement between their initial ratings and those of the SLP. For 8 of the 10 speakers, there was also good agreement between their initial ratings and those made from recordings 6 months later, indicating that the severity ratings made at the time of speaking were reliable. These findings support the use of the 9-point scale as a clinical measurement procedure.
O'Brian, S, Packman, A, Onslow, M & O'Brian, N 2004, 'Measurement of stuttering in adults: Comparison of stuttering-rate and severity-scaling methods', Journal of Speech, Language, and Hearing Research, vol. 47, no. 5, pp. 1081-1087.View/Download from: Publisher's site
This study investigated the comparative reliability of 2 stuttering measurement tools when used by experienced judges: percentage of syllables stuttered (%SS) and a 9-point severity scale (SEV). The study also investigated the degree to which scores on 1 tool predict scores on the other and the distributions of stuttering when measured by these tools. Twelve experienced judges watched 3-min videotapes of 90 stuttering and 10 nonstuttering participants. Half the judges rated %SS, and half made severity ratings. Results showed very high intrajudge and interjudge agreement for both measures. There was a strong linear correlation between %SS scores and SEV scores. Based on this finding, it seems that the 2 measures can be regarded as largely interchangeable. The exception to this, however, was in cases where there was either a small number of significant fixed postures (blocks and prolongations) or a large number of innocuous repeated movements (repetitions) in the speech sample. In such cases, it appears that %SS and SEV scores combined would be needed to provide a valid measure of stuttering. SEV scores were more normally distributed than %SS scores, which were clearly skewed. The advantages and limitations of the SEV scale are discussed.
O'Brian, N, O'Brian, S, Packman, A & Onslow, M 2003, 'Generalizability Theory I: Assessing reliability of observational data in the communication sciences', Journal of Speech, Language, and Hearing Research, vol. 46, no. 3, pp. 711-717.View/Download from: Publisher's site
Perceptual rating scales can be valid, reliable, and convenient tools for evaluating speech outcomes in research and clinical practice. However, they depend on the perceptions of observers. Too few raters may compromise accuracy, whereas too many would be inefficient. There is therefore a need to determine the minimum number of raters required for a reliable result. In this context, the ideas of Generalizability Theory have become increasingly popular in the behavioral sciences; suggestions have been made for their application to the assessment of speech-language disorders. Here we review the concepts involved, which are applied in a companion article dealing with speech naturalness data obtained from clients who recently completed treatment for their stuttering. We pay particular attention to the statistical requirements of the theory, including some cautions about possible inappropriate use of these techniques. We also offer a new interpretation of the results of the analysis that aims to be more meaningful to most speech-language pathologists.
O'Brian, S, Onslow, M, Cream, A & Packman, A 2003, 'The Camperdown Program: Outcomes of a new prolonged-speech treatment model', Journal of Speech, Language, and Hearing Research, vol. 46, no. 4, pp. 933-946.View/Download from: Publisher's site
Considerable research has been directed at the outcomes of prolonged-speech (PS) treatment for the control of chronic stuttering, but little research to date has focused on the PS treatment process. This report examines a Stage 2 clinical trial of a reconceptualized PS treatment model known as the Camperdown Program. This program requires fewer clinician hours than traditional programs and has no formal transfer phase. Additionally, it incorporates the following treatment process innovations, which replace treatment process components that are intuitively and empirically problematic: (a) PS is taught without incorporating target behaviors in clinician instruction, (b) participants learn to control stuttering without programmed instruction, and (c) the treatment process does not involve clinician identification of stuttering moments. Thirty participants were initially enrolled in the trial. Final outcome data are presented for the 16 participants who completed all trial requirements, including 12 months posttreatment data collection. These 16 participants showed minimal or no stuttering in everyday speaking situations for up to 12 months after entering the maintenance program, with speech rates in the normal range. Speech naturalness and social validation data were also favorable. Although self-report data generally confirmed the speech data, the results were not as positive. The present outcomes were achieved in a mean of 20 hours of clinic attendance per participant, which is much fewer than the hours required by treatment programs reported recently that run intensively over 2-3 weeks. The promise of this Stage 2 clinical trial has led the authors to initiate a Stage 3 randomized controlled trial of the Camperdown Program.
O'Brian, S, Packman, A, Onslow, M & O'Brian, N 2003, 'Generalizability Theory II: Application to perceptual scaling of speech naturalness in adults who stutter', Journal of Speech, Language, and Hearing Research, vol. 46, no. 3, pp. 718-723.View/Download from: Publisher's site
Generalizability theory has been recommended as the most comprehensive method for assessing the reliability of observational data. It provides a framework for calculating the various sources of measurement error and allows further design of measurements for a particular purpose. This paper gives a practical illustration of how this method may be used in the analysis of observational data. We use the ratings of 15 unsophisticated raters using the 9-point speech naturalness scale of R. R. Martin, S. K. Haroldson, and K. A. Triden (1984) to evaluate the speech of adults before and after treatment for stuttering. We calculate various sources of measurement error and use these to estimate the minimum number of raters and ratings per rater for a reliable result. For posttreatment data, the average of three independent raters, and for pretreatment data, the average of five independent raters should give a result within one scale point of the hypothetical true score for the speaker in at least 80% of samples. The example illustrates the advantages of using this method of analysis.
O'Brian, S, Packman, A, Onslow, M, Cream, A, O'Brian, N & Bastock, K 2003, 'Is listener comfort a viable construct in stuttering research?', Journal of Speech, Language, and Hearing Research, vol. 46, no. 2, pp. 503-509.View/Download from: Publisher's site
This article reports the development of a tool for measuring how comfortable a person feels when communicating with someone who has undergone treatment for stuttering. The person rates the speaker on a 9-point Listener Comfort Scale (9 = extremely comfortable, 1 = extremely uncomfortable). In a preliminary investigation of the reliability and validity of the scale, 15 unsophisticated listeners rated video recordings of 10 adults before and after a prolonged-speech treatment for stuttering and of 10 matched controls. The results were compared with those of another 15 listeners who rated the same recordings with the widely used 9-point Speech Naturalness Scale (R. R. Martin, S. K. Haroldson, & K. A. Triden, 1984). Results showed that reliability of the Speech Naturalness Scale was superior to the Listener Comfort Scale, although users of both scales were able to distinguish between pretreatment speech, posttreatment speech, and the speech of controls. The results suggest that the Listener Comfort Scale captures information that is somewhat different than the information captured by the Speech Naturalness Scale. The authors concluded that the concept of listener comfort is a potentially useful additional way of investigating the social validity of behavioral treatments for stuttering.
Onslow, M & O'Brian, S 1998, 'Reliability of clinicians' judgments about prolonged-speech targets', Journal of Speech, Language, and Hearing Research, vol. 41, no. 5, pp. 969-975.View/Download from: Publisher's site
Treatments for stuttering based on variants of Goldiamond's prolonged- speech procedure involve teaching clients to speak with novel speech patterns. Those speech patterns consist of specific skills, described with such terms as soft contacts, gentle onsets, and continuous vocalization. It might be expected that effective client learning of such speech skills would be dependent on clinicians' ability to reliably identify any departures from the correct production of such speech targets. The present study investigated clinicians' reliability in detecting such errors during a prolonged-speech treatment program. Results showed questionable intraclinician agreement and poor interclinician agreement. Nonetheless, the prolonged-speech program in question is known to be effective in controlling stuttered speech. The clinical and theoretical implications of these findings are discussed.
Onslow, M, O'Brian, S & Harrison, E 1997, 'The Lidcombe Programme of early stuttering intervention: Methods and issues', International Journal of Language and Communication Disorders, vol. 32, no. 2, pp. 231-250.View/Download from: Publisher's site
The Lidcombe Programme is an operant intervention for early stuttering that parents administer to children in their everyday speaking environments. The treatment was developed at the Suttering Unit, Bankstown Health Service, Sydney, and The University of Sydney. Recently, staff from the Australian Stuttering Research Centre, The University of Sydney, toured universities and clinics in the UK to present lectures about this treatment. We were encouraged to write this paper because an independent survey showed that most speech and language therapists who attended the presentations were open to this treatment. Prior to and following that lecture tour, publications in the press and professional journals in the UK alluded to many positive features of the Lidcombe Programme, but also raised several issues about it. The purpose of this paper is to summarise the Lidcombe Programme and address the following criticisms of the treatment that were raised in the UK: (1) Stuttering is complex but the Lidcombe Programme is simple; (2) the Lidcombe Programme is not an operant treatment, but invokes positive changes in children's environments; (3) the Lidcombe Programme is harmful to children; and (4) the scientific evidence in support of the Lidcombe Programme is flawed. Each of these issues is addressed from logical, theoretical and empirical viewpoints. Le Lidcombe Programme est un traitment qui agit directement dans le cos de bégaiement précoce, et que les parents administrent À leurs enfants dans le cadre linguistique quotitien. Ce traitement a été mis au point au sein de l'Unité du Bégaiement du Service de Santé de Banktown À Sydney, et dans l'Université de Sydney. Récemment des membres du Centre de Recherches sur le Bégaiement de l'Université de Sydney ont fait une tournée d'Universités et de cliniques britanniques pour donner des conférences sur ce traitement. L'encouragement À écrire cet article est venu du fait qu'une enquete indépendante a montre que la plupart des orth...
Onslow, M, O'Brian, S, Packman, A & Rousseau, I 2004, 'Long-term follow up of speech outcomes for a prolonged-speech treatment for stuttering: The effects of paradox on stuttering treatment research' in Evidence-Based Treatment of Stuttering: Empirical Bases and Clinical Applications, pp. 231-244.View/Download from: Publisher's site