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This paper examines a prolonged speech treatment model for stuttering, the Camperdown Program. Sixteen participants showed minimal or no stuttering in everyday speaking situations for up to 12 months after entering the program's maintenance phase, with speech rates in the normal range. Results were achieved in a mean of 20 hours of clinic attendance. (Contains references.) (Author/DB)

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 pathologists (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. Key Words: stuttering, adult, speech restructuring, safety behaviors, anxiety, Safety behaviors are overt or covert cognitive or behavioral strategies that those who are anxious commonly use in an attempt to prevent a negative outcome or a threatening event from [...]

Time is past due for public discussion of an article by O'Brian, Onslow, Cream, and Packman (2003) that reported the outcomes of Camperdown, a "reconceptualized" prolonged speech (PS) treatment program. [...]

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. KEY WORDS: stuttering, generalizability theory, perceptual rating scales, speech naturalness, Recently it has become apparent that measures of clients' perceived speech naturalness are an essential addition to documented outcomes of treatments for adult stuttering (Ingham & Cordes, 1999; Ingham & [...]

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. KEY WORDS: stuttering, generalizability theory, perceptual rating scales, analysis of variance, Human observers are frequently used in speech-language pathology, as well as other behavioral sciences, to measure dependent variables in research and clinical practice (Cordes, 1994; Scarsellone, 1998). The behaviors of [...]

Purpose: This study was designed to answer three questions. (a) Does percentage of syllables stuttered (%SS) differ between standard and challenge phone calls. (b) Does anxiety differ between standard and challenge phone calls. (c) Is there a relationship between %SS and anxiety during standard and challenge phone calls? Method: Participants were 230 adults diagnosed with stuttering, who were participants from five clinical trials. Each participant received two 10-min phone calls at pretreatment and a further two phone calls 6 months or 20 weeks postrandomization. One phone call was standard, and the other presented challenge: occasionally disagreeing with, interrupting, and talking over participants, or asking for clarification of their views. Results: Statistically significant, but clinically minor, increases of %SS and anxiety occurred during the challenge phone calls. There was a statistically significant association between %SS and anxiety. Conclusions: Variable phone call procedures to assess stuttering severity in clinical trials are not likely to spuriously inflate or deflate treatment outcomes to a clinically important extent. Regardless, the present results suggest that there is statistical merit in controlling the nature of phone calls during clinical trials with the simple and replicable method developed in this report. Additionally, there is procedural merit in the challenge phone call procedure; it is a more valid representation of the challenges of everyday speech than the standard procedure. However, a disadvantage of the challenge phone call procedure is the practical issues associated with its use. The clinical and theoretical applications of the results are discussed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this laboratory study was to investigate whether rhythmic speech was primarily responsible for stuttering reductions in four school-aged children after the instatement stage of the Westmead Program of syllable-timed speech (STS) intervention. The study was designed to inform further development of the program. Reduction in variability of vowel duration is a marker of STS, and it was predicted that this would be present in the children's conversational speech after Stage 1 of the program if they were using STS. To strengthen such a finding, it was also predicted that there would be no reduction in articulation rate, sentence complexity, and utterance length after treatment, as there is evidence that reductions in these can reduce stuttering. Perceptual judgments of speech quality after treatment were also made by independent listeners. Method: Participants were four children, ages 8–11 years, who completed Stage 1 of an STS program and whose stuttering had reduced significantly. Pre-treatment (PRE) and post-treatment (POST) within-clinic audio-visual recordings of conversational speech were analysed for percentage of syllables stuttered, variability of vowel duration, articulation rate, and length and complexity of utterance. Four blinded listeners made perceptual judgments of speech quality in the POST recordings. Result: Recordings of all children showed that variability of vowel duration clearly reduced from the PRE to POST speech samples. Importantly, articulation rate and language use were not compromised. Some possible indicators of rhythmicity were identified in one child in the perceptual study. Conclusion: The findings suggest that STS was primarily responsible for the clinically significant reductions in stuttering after Stage 1 of the program. There is an urgent need for more evidence-based interventions for stuttering in this age group and further development of STS interventions is warranted. [ABSTRACT FROM AUTHOR]

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 performance-contingent 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. Key Words: Camperdown Program, outcomes, stuttering, We were taken aback by the title of Dr. Ingham's letter, Comments on Recent Developments in Stuttering Treatment Maintenance Research Using the Camperdown Program. We have not done any such [...]

The natural stuttering recovery rate by adulthood is high. Community cohort studies suggest a much lower rate during the first 18 months after onset, but this may be different for clinical cohorts of pre-school aged children. The present research and case presentations add to data reported by Franken et al. by investigating early natural recovery for a clinical cohort. Participants were 16 pre-school children presenting to a clinic with stuttering onset 1–15 months earlier. The children were studied for a mean of 19.4 months (84.3 weeks) using parent report and clinician identification of stuttering from recorded conversations. The children received no treatment during the study. Data were obtained for each participant and are presented graphically. Experienced speech-language pathologists detected stuttering in the recordings of 3 of 4 children identified as recovered by their parents. Only 1 of the 16 children (6.3%) was confirmed as recovered. There is no reason to believe that the early natural recovery rate for clinically presenting children is different from community cohorts. Parent report of natural recovery during the pre-school years needs to be confirmed by clinician observation of the child's speech; otherwise, there is risk of harmful false negative identification. The present data support the Yairi et al. different recovery pathways for children who stutter. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Title: Using Statistical Process Control Charts to Study Stuttering Frequency Variability During a Single Day Journal of Speech, Language, and Hearing Research (2013), 56, part 6, 1789-1799. DOI: 10.1044/1092-4388(2013/12-0328) In [...]

The Lidcombe Program of early stuttering intervention is an evidence-based behavioural treatment originally developed for children younger than 6 years. Problem-solving is inherent during Lidcombe Program treatment. Therefore a number of reflective questions were devised to assist speech-language pathologists (SLPs) to detect clinical procedures that vary from those recommended in the Lidcombe Program Treatment Guide and to employ suitable strategies. A two-stage validation process of the reflective questions was conducted. First, questions were developed and then revised with input from the members of the international Lidcombe Program Trainers Consortium. Then feedback on their clinical usefulness was obtained from public health SLPs. The outcomes of each stage of validation are reported and implications for speech-language pathologists delivering the Lidcombe Program discussed. [ABSTRACT FROM AUTHOR]