Awareness and Knowledge of Stuttering Among Malaysian School-Aged Children: An Exploratory Study.

INTRODUCTION: Knowledge and awareness of stuttering are closely associated with attitudes toward stuttering. Few studies have been conducted on the knowledge and awareness of school-aged children, and none have been conducted in Malaysia. This study aimed to: (a) determine knowledge and awareness of stuttering among Malaysian school-aged children, and (b) determine whether there are differences between age group, gender and PWS exposure groups. METHODS: A cross-sectional study was conducted among 192 Malay school-aged children (mean age = 9.47, SD = 1.781) recruited via email and social media platforms. They completed a Malay version of the questionnaire devised by van Borsel et al. (1999) on various aspects of stuttering, including prevalence, onset, gender distribution, occurrence in different cultures, cause, treatment, intelligence, and heredity of stuttering. The chi-square test of independence was performed to compare the distributions of survey responses by age group, gender and PWS exposure group. RESULTS: Around half of the school-age children had met a person who stutters, but certain aspects of their knowledge were limited. Knowledge also differed according to age and gender. Girls were more knowledgeable about stuttering than boys. Regarding stuttering treatment, younger children had more positive attitudes than older children. Participants who did not know a PWS were more likely to consult their family doctor rather than a speech-language pathologist in relation to stuttering. CONCLUSIONS: Knowledge and awareness of stuttering among Malaysian school-aged children were limited. Findings of this study could be used to develop a stuttering awareness program specific to children to increase their knowledge and awareness about stuttering.

Consensus on an assessment protocol for children with speech sound disorders in Sri Lanka.

BACKGROUND: Speech sound disorders (SSDs) are the most common form of communication disorders in children. SSD have an impact on children's abilities to make themselves understood to their listeners and can influence a child's social and emotional well-being as well as their academic achievements. Therefore, it is important to identify children with an SSD early, in order to provide appropriate intervention. A wealth of information on best practice in the assessment of children with SSD is available in countries where the speech and language therapy profession is well established. In Sri Lanka, there is a paucity of research evidence supporting assessment practices that are culturally and linguistically appropriate in SSDs. Therefore, clinicians rely on informal assessment methods. There is a need to understand more about how clinicians in Sri Lanka assess this caseload in order to get general agreement regarding comprehensive and consistent procedures for assessment of paediatric SSD in Sri Lanka. This would support speech and language therapists' (SLTs') clinical decision-making in relation to choice of appropriate goals and intervention for this caseload. AIM: To develop and gain consensus on an assessment protocol for Sri Lankan children with SSD that is culturally appropriate and based on existing research. METHOD: A modified Delphi method was utilised to gather data from clinicians currently working in Sri Lanka. The research involved three rounds of data collection, exploring current assessment practices in Sri Lanka, ranking these in order of priority and establishing consensus on a proposed assessment protocol. The proposed assessment protocol was based on the results of the first and second rounds as well as previously published best practice guidelines. OUTCOME AND RESULTS: The proposed assessment protocol achieved consensus in relation to content, format and cultural appropriateness. SLTs affirmed the usefulness of the protocol within the Sri Lankan context. Further research is required to assess the feasibility and effectiveness of this protocol in practice. CONCLUSIONS & IMPLICATIONS: The assessment protocol supports practicing SLTs with a general guide to assessing children with suspected SSDs in Sri Lanka. The application of this protocol built upon consensus enables clinicians to improve their individual practice patterns based on best practice recommendations in the literature and the evidence on culturally and linguistically appropriate practices. This study has identified the need for further research in this area, including the development of culturally and linguistically specific assessment tools that would complement the use of this protocol. WHAT THIS PAPER ADDS: What is already known on the subject The assessment of children with speech sound disorders (SSDs) requires a comprehensive and holistic approach due to their heterogeneous nature. Although there is evidence to support the assessment of paediatric SSDs in many countries where the profession of speech and language therapy is established, there is limited evidence to support the assessment of children with SSDs in Sri Lanka. What this study adds This study provides information about current assessment practices in Sri Lanka and consensus on a proposed culturally appropriate protocol for the assessment of children with SSDs in this country. What are the clinical implications of this work? The proposed assessment protocol provides speech and language therapists in Sri Lanka with a guide for assessment of paediatric SSDs to support more consistent practice in this area. Future evaluation of this preliminary protocol is required; however, the methodology used in this research could be applied to the development of assessment protocols for other range of practice areas in this country.

Stuttering management practices in Sri Lanka: A mixed method study.

PURPOSE: Speech and language therapy is a growing profession in Sri Lanka, and little is known about how stuttering is currently managed in the country. Therefore, this study aimed to investigate the current stuttering management practices in Sri Lanka and to investigate any barriers to service provision. METHOD: A convergent mixed methods design was employed across two phases. Sixty-four Sri Lankan speech and language therapists (SALTs) participated in online surveys in phase one and ten participated in semi structured interviews in phase two. Survey data in phase one was analysed using descriptive statistics and data in phase two was analysed using thematic analysis. Results from both phases were triangulated for the overall interpretation of the data. RESULTS: Sri Lankan SALTs conduct a comprehensive assessment, however some assessment contexts (e.g., stuttering beyond the clinic) were not routinely considered. Speech and language therapists reported using multiple and varied intervention approaches/strategies, which were often adapted and/or combined. It was noted that the delivery of treatment was more challenging. Barriers identified were including limited knowledge of some aspects of stuttering management, limited access to resources, and workplace constraints. CONCLUSION: Overall, findings revealed that most Sri Lankan SALTs employ a comprehensive and holistic approach in assessment; however, some limited knowledge of the disorder and intervention was identified. Findings highlighted the need for further training for SALTs regarding the management of stuttering, the need for culturally and linguistically validated appropriate assessments as well as the need to consider logistical issues in clinical settings and service delivery.

Public attitudes toward stuttering in Malaysia.

PURPOSE: This study aims to: (a) measure public attitudes toward stuttering in Malaysia using the Public Opinion Survey of Human Attitudes-Stuttering [POSHA-S], (b) determine how reported attitudes and knowledge related to stuttering compare to existing data, and (c) determine whether there are differences between groups for identified variables. METHOD: A total of 250 adults (mean age = 29 years; range = 19-60 years) completed the POSHA-S in English. We compared this sample's attitudes toward stuttering to POSHA-S data from other global samples. General linear modeling examined differences in overall stuttering score, beliefs, and self reaction subscores for demographic variables such as age, gender, marital status, parenting, education, employment status, prior exposure to a person who stutters, multilingual, race, and religion. RESULTS: The Malaysian participants' overall stuttering score and the beliefs and self reactions subscores were all considerably lower (i.e., less positive) than the other samples around the world from the POSHA-S database median values. Being male, receiving a higher education, and knowing someone who stutters were linked to having more positive self reactions, but none of those factors was linked to positive or negative beliefs. Those who had previously been exposed to stuttering scored significantly higher than those who had not. CONCLUSION: Malaysians may have less positive attitudes toward stuttering than Westerners. More needs to be done to make society more accepting of people who stutter. Future research should aim to find ways to educate and to raise public awareness about stuttering.

Parental perceptions towards childhood stuttering in Sri Lanka.

INTRODUCTION: Parental perceptions towards stuttering is an important consideration as parents play a crucial role in the initial identification and management of stuttering in young children. Although several studies have been conducted on parental perceptions towards childhood stuttering in other countries, little is known about how stuttering is perceived and managed by parents in Sri Lanka. AIMS: This study explored Sri Lankan parents' perceptions towards childhood stuttering and their experiences regarding attending speech and language therapy for stuttering. METHODOLOGY: Using a qualitative approach, 15 parents of children who stutter were recruited from a stuttering clinic at a state university in Sri Lanka. Parents participated in semi-structured interviews with the first author. The interviews were conducted via telephone in Sinhala language, recorded, transcribed verbatim in Sinhala and then translated into English. The data were analysed using thematic analysis. RESULTS: Five themes emerged from the data: (1) limited knowledge about stuttering and management (2) influence of religion and culture on stuttering (3) variable responses to stuttering (4) impact of stuttering on the parent and child (5) impact and engagement in speech therapy. CONCLUSION: The findings highlighted the need to educate the Sri Lankan public about stuttering as a communication disorder and raise awareness about the profession of speech language therapy in the country. Specifically, it is important for other health professionals and teaching professionals to learn more about stuttering, so that appropriate early referrals can be made for speech and language therapy, lessening the impact on children and their families.

Prevalence and features of comorbid stuttering and speech sound disorder at age 4 years.

BACKGROUND: Stuttering and speech sound disorder may co-occur during early childhood, although the exact rate of comorbidity in a community-cohort sample remains unknown. In isolation, both disorders have the potential for long-term negative effects. Comorbidity rates of 16%-46% reported in previous studies were based on parent report, speech-language therapist surveys, case file audits or direct observation studies from clinical samples. Rigorous methodology utilising a prospective, longitudinal community-cohort design is required to support these previous findings. AIMS: First, to identify the proportion of children with comorbid stuttering and speech sound disorder at 4 years of age drawn from a community-cohort study. Second, to compare demographic and clinical features of this comorbid diagnosis group compared to children with no diagnosis of either disorder, or those with either disorder in isolation. METHODS & PROCEDURES: Participants were drawn from a prospective, longitudinal community cohort study (the Early Language in Victoria Study) at 4 years of age (n = 1607). Demographic and clinical features for comparison were theoretically driven and included: gender, birth history, feeding status, speech and language status, family history of communication difficulties, maternal education, maternal vocabulary, maternal mental health and socioeconomic status. OUTCOMES & RESULTS: Of the 160 children diagnosed with stuttering between 2 and 4 years of age, 6.88 % (n = 11) also had a speech sound disorder. Given the small sample size and number of comparisons performed, there was insufficient evidence to rule out that group differences observed were not simply due to chance. CONCLUSIONS & IMPLICATIONS: The prevalence of comorbid stuttering and speech sound disorder was lower in a community cohort compared to that reported in clinical studies. Higher rates reported in clinical samples may be due to increased parental help-seeking behaviour when the two disorders co-occur. Subsequently, these children may present to clinics more frequently. Accurate representation of prevalence allows for population specific research on best practice assessment and intervention. Currently little is known about how best to manage this caseload, therefore more research is required in this area, including the determination of prognostic variables to provide efficient and effective management.

Evidence for the treatment of co-occurring stuttering and speech sound disorder: A clinical case series.

PURPOSE: There is a paucity of evidence to guide treatment for children with co-occurring stuttering and speech sound disorder. Some guidelines suggest treating the two disorders simultaneously using indirect treatment approaches; however, the research supporting these recommendations is over 20 years old. In this clinical case series, we investigate whether these co-occurring disorders could be treated concurrently using direct treatment approaches supported by up-to-date, high-level evidence, and whether this could be done in an efficacious, safe and efficient manner. METHOD: Five pre-school-aged participants received individual concurrent, direct intervention for both stuttering and speech sound disorder. All participants used the Lidcombe Program, as manualised. Direct treatment for speech sound disorder was individualised based on analysis of each child's sound system. RESULT: At 12 months post commencement of treatment, all except one participant had completed the Lidcombe Program, and were less than 1.0% syllables stuttered on samples gathered within and beyond the clinic. These four participants completed Stage 1 of the Lidcombe Program in between 14 and 22 clinic visits, consistent with current benchmark data for this programme. At the same assessment point, all five participants exhibited significant increases in percentage of consonants correct and were in alignment with age-expected estimates of this measure. Further, they were treated in an average number of clinic visits that compares favourably with other research on treatment for speech sound disorder. CONCLUSION: These preliminary results indicate that young children with co-occurring stuttering and speech sound disorder may be treated concurrently using direct treatment approaches. This method of service delivery may have implications for cost and time efficiency and may also address the crucial need for early intervention in both disorders. These positive findings highlight the need for further research in the area and contribute to the limited evidence base.

Assessment of Reliable Change Using 95% Credible Intervals for the Differences in Proportions: A Statistical Analysis for Case-Study Methodology.

PURPOSE: Case-study methodology studying change is often used in the field of speech-language pathology, but it can be criticized for not being statistically robust. Yet with the heterogeneous nature of many communication disorders, case studies allow clinicians and researchers to closely observe and report on change. Such information is valuable and can further inform large-scale experimental designs. In this research note, a statistical analysis for case-study data is outlined that employs a modification to the Reliable Change Index (Jacobson & Truax, 1991). The relationship between reliable change and clinical significance is discussed. Example data are used to guide the reader through the use and application of this analysis. METHOD: A method of analysis is detailed that is suitable for assessing change in measures with binary categorical outcomes. The analysis is illustrated using data from one individual, measured before and after treatment for stuttering. CONCLUSIONS: The application of this approach to assess change in categorical, binary data has potential application in speech-language pathology. It enables clinicians and researchers to analyze results from case studies for their statistical and clinical significance. This new method addresses a gap in the research design literature, that is, the lack of analysis methods for noncontinuous data (such as counts, rates, proportions of events) that may be used in case-study designs.

Clinicians' management of young children with co-occurring stuttering and speech sound disorder.

Speech sound disorders reportedly co-occur in young children who stutter at a substantial rate. Despite this, there is a paucity of scientific research available to support a treatment approach when these disorders co-exist. Similarly, little is known about how clinicians are currently working with this caseload given that best practice for the treatment of both disorders in isolation has evolved in recent years. This study used a qualitative approach to explore current clinical management and rationales when working with children who have co-occurring stuttering and speech sound disorder. Thirteen participant SLPs engaged in semi-structured telephone interviews. Interview data were analysed based on principles derived from grounded theory. Several themes were identified including multi-faceted assessment, workplace challenges, weighing-up the evidence, and direct intervention. The core theme, clinical reasoning, highlighted the participants' main concern, that not enough is known about this caseload on which to base decisions about intervention. There was consensus that little is available in the research literature to guide decisions relating to service delivery. These findings highlight the need for further research to provide evidence-based guidelines for clinical practice with this caseload.