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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

There are many treatments currently available for stuttering, for both children and adults. These range from direct interventions intended to reduce the severity and/or frequency of the speech behaviors of stuttering, to those intended to alleviate the anxiety and other mental health issues that can accompany the disorder. However, as there are little supporting data for many of these treatments, there is little consensus about which to use. Another way to evaluate stuttering treatments is to explore the extent to which they address the cause of the disorder. However, the cause of stuttering is not yet known. In this theoretical paper, a 3-factor causal model is presented, to which the mechanisms thought to be driving different treatments are then aligned. The model is innovative, in that it attempts to explain moments of stuttering. It is argued that all causal factors must be operating at each moment of stuttering. The model is intended as a new way of looking at cause, and how treatments may address cause. It is hoped this will stimulate discussion and lead to further lines of inquiry. Educational objectives : The reader will be able to: (a) describe the P&A 3-factor causal model of moments of stuttering; (b) state how indirect direct stuttering treatments relate to cause, according to the P&A model; (c) describe how direct stuttering treatments relate to cause, according to the P&A model; (d) state the purpose of cognitive behavior therapy; and (e) describe at least one suggestion for further research arising from the P&A model. [Copyright &y& Elsevier]

This Phase I pilot study assessed the viability of a clinician-free Internet presentation of speech restructuring treatment for chronic stuttering. Two participants reduced their percentage of stuttered syllables by 59% and 61% respectively from pre-treatment to immediately following completion of the program. Additionally, self-reported stuttering severity and situation avoidance were also reduced. These results were attained with optimal clinical efficiency, without any clinician contact, after 6 weeks for one participant and 4 weeks for another. Participants did not incur costs such as clinic fees, travel, or time away from work for clinic attendance. We conclude that further development of this stand-alone Internet treatment and clinical trialling is warranted. [ABSTRACT FROM AUTHOR]

Purpose: This prologue serves to introduce a research forum composed of studies that address the topic of stuttering in school-age children and adolescents. Researchers are encouraged to continue to build the knowledge base that sustains evidence-based practice in this area. Method: The nature of stuttering as it evolves from early childhood into the school years is briefly described. Beyond the preschool years, children are unlikely to spontaneously recover from stuttering, and they often go on to suffer negative consequences, academically and socially, because of their disorder. If they are to overcome or manage their stuttering successfully, school-age children and adolescents require high-quality treatment. Three data-based studies that address the topic of stuttering in school-age children or adolescents are described, the ongoing need for empirical evidence regarding the management of stuttering is emphasized, and several issues relevant to future studies in this area are discussed. Conclusion: Progress has occurred in the management of stuttering in school-age children and adolescents. Nevertheless, important questions remain unanswered concerning the most effective techniques and strategies to use in helping students who stutter achieve more fluent and natural-sounding speech in their quest to become more confident and effective communicators. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate how a child's fundamental frequency (F[sub 0]) and estimated voice level (dB SPL) change in distinct speaking environments. Method: A child age 5;7 (years;months) wore a National Center for Voice and Speech voice dosimeter for 4 days. The 2 parameters measured were F[sub 0] and dB SPL. During analysis, the F[sub 0] and dB SPL data were segmented to represent 4 typical speaking environments of school-age children: (a) free-play (2.5 hr), (b) preschool (3 hr), (c) home (10.7 hr), and (d) adult (5.6 hr). Unique to this study, the child's voice data were presented as voice use profiles. Results: The child's F[sub 0] and dB SPL patterns within an adult environment were similar to that found in the literature but showed much greater variation in the free-play environment. The preschool environment elicited speech of a lower modal F[sub 0] than did the home, but a higher median and mean F[sub 0], as well as a somewhat elevated mean dB SPL. Conclusion: The child produced significantly different F[sub 0] and dB SPL patterns across 4 different speaking environments. If future studies substantiate this pattern, clinicians and researchers must be aware of this difference when working with children. [ABSTRACT FROM AUTHOR]

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. Conclusion & Implications: Results essentially replicate the previous study by producing similar outcomes to those attained with clinical trials. The Camperdown Program is recommended as a clinical environment for speech-restructuring speech pathology student training. [ABSTRACT FROM AUTHOR]

Abstract: The World Wide Web (WWW) was 20 years old last year. Enormous amounts of information about stuttering are now available to anyone who can access the Internet. Compared to 20 years ago, people who stutter and their families can now make more informed choices about speech-language interventions, from a distance. Blogs and chat rooms provide opportunities for people who stutter to share their experiences from a distance and to support one another. New technologies are also being adopted into speech-language pathology practice and service delivery. Telehealth is an exciting development as it means that treatment can now be made available to many rural and remotely located people who previously did not have access to it. Possible future technological developments for speech-language pathology practice include Internet based treatments and the use of Virtual Reality. Having speech and CBT treatments for stuttering available on the Internet would greatly increase their accessibility. Second Life also has exciting possibilities for people who stutter. Educational objectives: The reader will (1) explain how people who stutter and their families can get information about stuttering from the World Wide Web, (2) discuss how new technologies have been applied in speech-language pathology practice, and (3) summarize the principles and practice of telehealth delivery of services for people who stutter and their families. [Copyright &y& Elsevier]

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 validity. Conclusions & Implications: The present study demonstrates the validity and utility of the UTBAS scales in assessing negative cognitions associated with speech-related anxiety among adults who stutter. Results also confirm previous evidence of a high rate of social phobia among adults who stutter, and reveal that the UTBAS discriminates between adults with and without social phobia. In terms of clinical applications, the UTBAS scales could be used to screen for indicators of social phobia among adults who stutter, and may prove useful in identifying negative cognitions which have the potential to impact treatment outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact on percentage of syllables stuttered of various durations of delayed auditory feedback (DAF), levels of frequency-altered feedback ( FAF), and masking auditory feedback (MAF) during conversational speech. Method: Eleven adults who stuttered produced 10-min conversational speech samples during a control condition and under 4 different combinations of DAF, FAF, and MAF. Participants also read aloud in a control condition with DAF and FAF. Results: A statistically significant difference was found between the NAF conversation condition and the 4 combined altered auditory feedback (AAF) conditions. No statistically significant differences in percentage of syllables stuttered were found in conversation or reading between the control conditions and the FAF/DAF or MAF conditions. The analysis of individual participants' data showed highly individual responsiveness to different conditions. Conclusions: Participants' varying responses to differing AAF settings likely accounted for the failure to find group differences between conditions. These results suggest that studies that use standard DAF and FAF settings for all participants are likely to underestimate any AAF effect. It is not yet possible to predict who will benefit from AAF devices in everyday situations and the extent of those benefits. [ABSTRACT FROM AUTHOR]

Abstract: Speech-language pathologists (SLPs) are advised to consider the distress of preschoolers and parents along with the social consequences of the child''s stuttering when deciding whether to begin or delay treatment. Seventy-seven parents completed a survey that yielded quantitative and qualitative data that reflected their perceptions of the impact of stuttering on their children and themselves. Sixty-nine (89.6%) parents reported between 1 and 13 types of negative impact (modal=2). The most frequently reported reactions of children were frustration associated with their stuttering, withdrawal, reduced or changed verbal output, making comments about their inability to talk, and avoidances. The most frequently reported peer reaction was teasing (27.3%). Seventy parents (90.9%) reported that they were affected by their child''s stuttering. Their most frequently reported reactions were worry/anxiety/concern, uncertainty about what to do, frustration, upset (parent term), self-blame (fear that they had caused the stuttering), taking time to listen, waiting for the child to finish talking, modifying their own speech, and asking the child to modify speech. Findings support calls for SLPs to consider the distress of preschool children and their parents and the social consequences of the children''s stuttering when making the decision to begin or delay treatment. Learning outcomes: Readers will be able to describe parents’ perceptions of the impact of stuttering on their children and themselves. In particular, readers will learn about (1) parents’ perceptions of young children''s awareness and reactions to their stuttering, (2) parents’ perceptions of the social consequences of stuttering for young children; and (2) the emotional effect of stuttering on parents. [Copyright &y& Elsevier]

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 results provide evidence to support the use of the Camperdown Program delivered by telehealth as an alternate to the face-to-face treatment delivery of this programme for adults who stutter. Such a model will increase accessibility to this evidence-based treatment for adults currently isolated from treatment services. Trial registration: Current Controlled Trials ISRCTN 48954432. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated peer responses to preschoolers' stuttering in preschool and sought to determine whether specific characteristics of participants' stuttering patterns elicited negative peer responses. Method: Four outdoor free-play sessions of 4 preschoolers age 3-4 years who stutter were videotaped. Stutters were identified on transcripts of the play sessions. Peer responses to stuttered utterances were judged to be negative or neutral/ positive. Thereafter, participants' stuttering behaviors, durations of stutters, and judgments of the meaningfulness of peer-directed stuttered utterances were analyzed. Results: Between 71.4% and 100% of peer responses were judged to be neutral/positive. In the negative responses across 3 participants, peers were observed to react with confusion or to interrupt, mock, walk away from, or ignore the stuttered utterances. Utterances that elicited negative responses were typically meaningless and contained stutters that were behaviorally complex and/or of longer duration. Other social interaction difficulties also were observed-for example, difficulty leading peers in play, participating in pretend play, and resolving conflicts. Conclusions: Results indicate that the majority of peer responses to stuttered utterances were neutral/positive; however, results also indicate that stuttering has the potential to elicit negative peer responses and affect other social interactions in preschool. [ABSTRACT FROM AUTHOR]

This paper describes a study in which Systemic Functional Linguistics was applied to describe how people who stutter use language. The aim of the study was to determine and describe any differences in language use between a group of 10 adults who stutter and 10 matched normally-fluent speakers. In addition to formal linguistic analyses, analyses drawn from Systemic Functional Linguistics were used to further investigate the expression of both syntactic and semantic complexity. The findings from this study replicated previous findings of Packman et al. in which they found that the language used by people who stutter was significantly less complex than the control group. Another major finding was that adults who stuttered used the linguistic resource of modality significantly less than the normally-fluent matched peers. The implications these strategies have on communication and social participation will be discussed. [ABSTRACT FROM AUTHOR]

Background: Persistent calls for school-based education about stuttering necessitate a better understanding of peer attitudes toward children who stutter and a means to measure outcomes of such educational interventions. Langevin and Hagler in 2004 developed the Peer Attitudes Toward Children who Stutter scale (PATCS) to address these needs and gave preliminary evidence of reliability and construct validity. Aims: To examine further the psychometric properties of PATCS and to examine the negativity of attitudes. Methods & Procedures: PATCS was administered to 760 Canadian children in grades 3-6. Measures included reliability, a confirmatory factor analysis (CFA), a known groups analysis, convergent validity with the Pro-Victim Scale of Rigby and Slee, and the negativity of attitudes. Outcomes & Results: PATCS appears to tap a second-order general attitude factor and three first-order factors representing the constructs of Positive Social Distance (PSD), Social Pressure (SP), and Verbal Interaction (VI). In the known groups analysis, participants who had contact with someone who stutters had higher scores (more positive attitudes) than those who had not, and girls had higher scores than boys. PATCS correlated moderately (0.43, p<0.01) with the Pro-Victim scale. Finally, one-fifth (21.7%) of participants had scores that were somewhat to very negative. Conclusions & Implications: Results provide evidence of the validity and reliability of PATCS and confirm the need for school-based education about stuttering. The PSD and SP factors suggest that education include discussions about (1) similarities and differences among children who do and do not stutter in order to increase acceptance, and (2) making personal choices and handling peer pressure in thinking about children who stutter. The VI factor suggests that open discussion about stuttering may alleviate frustration experienced by listeners and provide the opportunity to give strategies for responding appropriately. Results also suggest that education involve contact with a person who stutters. [ABSTRACT FROM AUTHOR]

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 minority of children do relapse and will require their parents to reinstate the treatment procedures. [ABSTRACT FROM AUTHOR]

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 during maintenance, 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. [ABSTRACT FROM AUTHOR]

Abstract: Adolescence is a complicated phase of maturation during which a great deal of physical, neurological and social development occurs. Clinically this phase is thought to be the last chance to arrest the development of the disorder of stuttering before it becomes chronic in adulthood. However, little treatment development for this age group has occurred. Previous research on the impact of stuttering during adolescence presents a complex picture of apprehension about speaking which does not, however, appear to interfere with social life. The purpose of the present study was to investigate further the experiences of adolescents who stutter with respect to: (1) their experience of stuttering during the adolescent years, (2) reasons for seeking or not seeking therapy during the adolescent years, (3) barriers to seeking therapy during the adolescent years, (4) their experience of therapy during the adolescent years, and finally (5) suggested improvements to therapy for adolescents. Two focus groups and seven individual interviews were conducted with 13 adolescents and young adults. The major finding was a perceived lack of awareness about stuttering by teachers and parents, as well as other adolescents. In addition it appeared that having a stutter was, in itself, not enough reason to seek treatment. However when adolescents did seek treatment, for reasons such as joining the workforce, group therapy was well liked. Educational objectives: The reader will summarize key features that characterize: (1) the complex developmental phase of adolescence, (2) evaluate the experience of stuttering during the adolescent years, (3) discuss the experience of stuttering therapy during the adolescent years, (4) list adolescents’ reported barriers to seeking therapy during the adolescent years, and (5) suggest possible ways to improve management of stuttering in adolescence. [Copyright &y& Elsevier]

Purpose: The aims of this study were to evaluate the efficacy of telehealth delivery of the Lidcombe Program of Early Stuttering Intervention, compared with a control group, and to determine the number of children who could be regarded as "responders." Method: A speech-language pathologist provided telehealth delivery of the Lidcombe Program during telephone consultations with parents in their homes, remote from the clinic. The study design was an open plan, parallel group, randomized controlled trial with blinded outcome assessment. Children in the no-treatment control group who were still stuttering after 9 months then received the same treatment. The primary outcome measure was frequency of stuttering, gathered from audiotape recordings of participants' conversational speech in everyday, non-treatment situations, before and after treatment. Results: Analysis of covariance showed a 73% decrease in frequency of stuttering at 9 months after randomization in the treatment group, as compared with the control group (95% confidence interval = 25%-90%, p = .02). Measures of treatment time showed that telehealth delivery of the Lidcombe Program requires around 3 times more resources than standard presentation. Conclusions: Telehealth delivery of the Lidcombe Program is an efficacious treatment for preschool children who cannot receive the standard, clinic-based Lidcombe Program. Avenues for improving efficiency are considered. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether measures of stuttering frequency and measures of overall stuttering severity in preschoolers differ when made from audio-only recordings compared with audiovisual recordings. Method: Four blinded speech-language pathologists who had extensive experience with preschoolers who stutter measured stuttering frequency and rated overall severity from audio-only and audiovisual recordings of 36 preschool children who were stuttering. Stuttering frequency (percentage of syllables stuttered [%SS]) was based on counts of perceptually unambiguous stutterings, made in real time, and overall severity was measured using a 9-point rating scale. Results: Stuttering frequency was statistically significantly lower by around 20% when made from audio-only recordings. This was found to be directly attributable to differences in the counts of stuttered syllables, rather than to differences in the total numbers of syllables spoken. No significant differences were found between recording modalities for the ratings of overall severity. Correlations between %SS scores in the 2 modalities and severity rating scores in the 2 modalities were high, indicating that observers agreed on data trends across speech samples. Conclusions: Measures of %SS made from audio-only recordings may underestimate stuttering frequency in preschoolers. Although audio-only %SS measures may underestimate stuttering frequency at the start of a clinical trial to a clinically significant extent, posttreatment scores at or below 1.0%SS are likely to underestimate by 0.2%SS or less, which is clinically insignificant. [ABSTRACT FROM AUTHOR]

Purpose: This Phase I trial investigated the viability of telehealth delivery of the Camperdown Program with adults who 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-to-face treatment. [ABSTRACT FROM AUTHOR]

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Abstract: Knowledge of variables that predict treatment time is of benefit in deciding when to start treatment for early stuttering. To date, the only variable clearly related to treatment time with the Lidcombe Program is pre-treatment stuttering frequency. Previous studies have shown that children whose stuttering is more severe take longer to complete Stage 1 of the program. However, studies to date have not investigated phonology and language as predictors of treatment time. In the context of a Phase II clinical trial, the present prospective study showed that phonological development does not predict treatment time but that, together, stuttering severity, MLU and CELF Receptive Score predict 35–45% of the variance for time taken to complete Stage 1. Learning outcomes: The reader should be able to (1) understand guidelines developed for the timing of intervention with the Lidcombe Program based on previous retrospective studies, (2) determine whether pre-treatment language and phonological development play a role in treatment-led recovery with the Lidcombe Program and (3) understand recent empirical evidence on time taken by preschool children to complete Stage 1 of the Lidcombe Program. [Copyright &y& Elsevier]

In this article we report the use of a simple, nonprogrammed, syllable timed speech procedure to treat stuttering in a 3-year-old boy with a 2-year history of stuttering. The treatment involved the boy and his parents visiting the clinic 7 times, and the parents modelling syllable timed speech 2 to 6 times per day for 5- to 10-minute intervals in and around the home. After 7 weeks, clinic measures and objective, blinded measures of speech beyond the clinic showed stuttering frequency below 1.0% syllables stuttered. Along with low severity ratings made by the parent each day, this meets the stuttering criteria of another, proven treatment for early stuttering intervention. However, in this study reduction in stuttering was achieved with a simpler and more cost efficient procedure. With the caveat that this is a nonexperimental case report, we discuss its potential implications. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to develop guidelines for the statistical analysis of percentage of syllables stuttered (%SS) data in stuttering research. Method: Data on %SS from various independent sources were used to develop a statistical model to describe this type of data. On the basis of this model, %SS data were simulated with varying means, standard deviations, and sample sizes. Four methods for analyzing %SS were compared. Results: Results suggested that %SS data can be adequately modeled with a gamma distribution. Simulations based on a gamma distribution showed that all 4 analysis techniques performed favorably with respect to Type I error except for F. E. Satterthwaite's (1946) t test, which had increased Type I error on two occasions. Power was generally lower for the Wilcoxon-Mann-Whitney test compared with the other methods. Analysis of variance (ANOVA) performed on square-root-transformed data performed adequately under all scenarios, but ANOVA performed on nontransformed data and Satterthwaite's t test performed poorly when sample sizes were small or when sample sizes and variances of the groups were markedly different. Conclusions: Standard techniques such as t test and ANOVA are appropriate for most analysis scenarios with %SS data. Two occasions when this is not the case are when sample size is small, with fewer than 20 in each group, or when sample sizes and variances of the groups are markedly different. Under these circumstances, analyses should be based on standard methods, with a suitable transformation performed prior to analysis. [ABSTRACT FROM AUTHOR]

Background: Clinical trials have shown that behavioural treatments based on variants of prolonged‐speech (PS) are best practice for reducing the stuttering rate in adults. However, while stuttering is significantly reduced or eliminated for most adults in the short‐term with such treatment, relapse in the longer‐term is common. Consequently, there has been interest in attempting to establish variables that predict responsiveness to PS‐based treatments. Identifying such variables would enable risk prediction and also contribute to the tailoring of treatments to suit individuals who are less likely to benefit in the long‐term from the conventional PS‐based treatments. Variables that have been investigated to date are the stuttering severity, the attitude to communication and the locus of control. Aims: The present study revisited this issue with methodological improvements. Methods & Procedures: Prospective, continuous measures of outcome several years after treatment, and well‐powered, least‐squares multivariate regression, with backwards elimination, were used to determine the best model to predict short‐ and long‐term outcomes of a PS‐based treatment. Other predictor variables were also included. The stuttering rates of 78 participants were measured immediately after the intensive stage of treatment, and during a surprize telephone call 3.5–5 years after treatment. Outcomes & Results: Attitude to communication and locus of control were separate constructs to stuttering rate. While the stuttering rate predicted outcome, neither of the two non‐behavioural variables predicted outcome in either the short‐ or the long‐term. Conclusions: The most significant finding is that the non‐behavioural variables of attitude to communication and locus of control did not predict treatment outcomes. This is contrary to the findings of most previous studies. [ABSTRACT FROM AUTHOR]

Abstract: Several authors have suggested that devices delivering altered auditory feedback (AAF) may be a viable treatment for adults and children who stutter. This paper reviews published, peer reviewed journal papers from the past 10 years that investigate the effect of AAF during different speaking conditions, tasks and situations. A review of that literature indicates that considerable experimental evidence and limited Phase 1 treatment outcome evidence has been accumulated about the effect of AAF on the speech of people who stutter. However, critical knowledge about the effect of AAF during conversational speech and in everyday speaking situations is missing. Knowledge about how to determine the correct levels of AAF for individuals, and the characteristics of those likely to benefit from AAF, also needs to be established. At present there is no reason to accept a recent suggestion that AAF devices would be a defensible clinical option for children. In general device development and availability has occurred at a faster pace than clinical trials research. Educational objectives : After reading this paper readers should be able to: (1) describe what altered auditory feedback is and common ways the speech signal is altered in stuttering; (2) describe the effects of AAF on the speech of adults who stutter; (3) provide a critical analysis of the literature in the area of AAF and stuttering. [Copyright &y& Elsevier]

Background: It has been suggested that one way to increase speech pathologists' confidence in working with people who stutter is to provide them with relevant and stimulating clinical experiences during their professional preparation. This paper describes a treatment programme for adults who stutter that is conducted by speech pathology students, under supervision, in an Australian university setting. The aim of the research presented here was to establish speech outcomes for this programme, and to determine whether the programme meets benchmarks set by reports of similar programmes, in addition to providing mentorship for student clinicians. Methods & Procedure: Participants were 78 adults who were treated in one of five consecutive treatment programmes during a 3‐year period. The treatment was a traditional intensive speech restructuring treatment known as Smooth Speech, conducted over a 5‐day period. Speech assessments were conducted 1 week and 1 day before the start of the treatment programme. Post‐treatment assessments were conducted immediately following the intensive component of the programme, and 3 months, 12 months and 3.5–5 years post‐treatment. The student clinic treatment model in this report produced objective speech data for more subjects in one outcome study than has ever been reported before. Data for 87% (68/78) of participants were available at 3.5–5‐year follow‐up. Results showed that outcomes for stuttering, speech naturalness, and client self‐reports were all comparable with existing reports of similar programmes. The present results were attained with a student/supervisor ratio of around 8:1. Conclusions: We conclude that a clinician‐supervised student clinic has the potential to supply services for those with chronic stuttering, as well as providing effective clinical education for student clinicians during their professional preparation. The student clinic treatment model produced varied, objective speech data for more subjects than has ever been reported before in one study. The present findings also replicated a previous finding that stuttering was more severe within the clinic than in speech samples collected in everyday speaking environments. [ABSTRACT FROM AUTHOR]

This paper reflects on the application of Systemic Functional Linguistics (SFL) to the field of stuttering. It is argued that the SFL theory may offer insight into the impact that stuttering has on language use. Two case studies are presented to illustrate the application of SFL theory. The two SFL analyses found to be of most use in this pilot study were the analysis of how language is modulated in response to interpersonal aspects of communication (modality) and the analysis of how information is foregrounded (theme). The implications of applying the SFL model to consideration of the utilisation of language resources in people who stutter are discussed. [ABSTRACT FROM AUTHOR]