The Fifth Croatia Stuttering Symposium: Part III. Mental health and early stuttering.

PURPOSE: The Fifth Croatia Stuttering Symposium of 2022 continued the Fourth Croatia Stuttering Symposium 2019 theme of the connection between research and clinical practice. At the 2022 Symposium, there were 145 delegates from 21 countries. This paper documents the contents of the third of three Symposium modules. METHODS: The module topic was mental health and early stuttering, and that pre-schoolers who stutter are at risk of developing mental health issues. A clinical situation was considered where a parent of a 3-year-old child asked a clinician what the early signs of mental health issues might be for a child who stutters. RESULTS: A distinguished scholar presented a 5-minute video interpretation of research about this topic. Three master clinicians then each presented a 2-minute video demonstration of how that research might be applied in a clinical situation. Following that, the convenors moderated a discussion between the distinguished scholar, master clinicians, and delegates regarding the research and how it applies to clinical practice.

The Complexity of Stuttering Behavior in Adults and Adolescents: Relationship to Age, Severity, Mental Health, Impact of Stuttering, and Behavioral Treatment Outcome.

PURPOSE: This study investigated the complexity of stuttering behavior. It described and classified the complexity of stuttering behavior in relation to age, behavioral treatment outcomes, stuttering severity, anxiety-related mental health, impact of stuttering, and gender. METHOD: For this study, a taxonomy was developed-LBDL-C7-which was based on the Lidcombe Behavioral Data Language of stuttering. It was used by five experienced judges to analyze the complexity of stuttering behavior for 84 adults and adolescents before and after speech restructuring treatment. Data were 3,100 stuttering moments, which were analyzed with nominal logistic regression. RESULTS: The complexity of stuttering behavior appears not to change as a result of treatment, but it does appear to change with advancing age. Complexity of stuttering behavior was found to be independently associated with clinician stuttering severity scores but not with percentage of syllables stuttered or self-reported stuttering severity. Complexity of stuttering behavior was not associated with gender, anxiety, or impact of stuttering. CONCLUSION: Clinical and research applications of these findings are discussed.

Anxiety in 11-Year-Old Children Who Stutter: Findings From a Prospective Longitudinal Community Sample.

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.

The Lidcombe program of early stuttering intervention: mothers' experiences.

UNLABELLED: 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.

Developing treatment for adolescents who stutter: a phase I trial of the Camperdown Program.

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.

Stuttering and its treatment in adolescence: the perceptions of people who stutter.

UNLABELLED: 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.

Extended follow-up of a randomized controlled trial of the Lidcombe Program of Early Stuttering Intervention.

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.