Speech Therapy for Children Who Stutter: A Systematic Review

Speech Therapy for Children Who Stutter: A Systematic Review

Divya Seth (All India Institute of Speech and Hearing, India) and Santosh Maruthy (All India Institute of Speech and Hearing, India)
DOI: 10.4018/978-1-5225-4955-0.ch017

Abstract

This chapter aims to investigate and evaluate the evidence available for stuttering treatment research in children who stutter (CWS) and provide a qualitative review of the same. Studies were considered for review if (1) they were behavioral intervention of stuttering for children, (2) participants were in the age range of 2-18 years, and (3) the outcomes reported assessed stuttering. Twenty-seven studies were obtained through an electronic search of databases covering two approaches and 10 techniques. The analysis of these studies revealed that direct approaches have a stronger evidence base in comparison to the indirect approaches. The most popular approach with maximum studies is the early intervention Lidcombe program. The commonly used outcome measures included the percentage of syllables stuttered, syllables per minute, and severity rating scales. The conclusion drawn from the review suggest that evidence base to support behavioral intervention of CWS exists for a limited number of intervention techniques and among them very few exploring the long-term effects of the intervention.
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Introduction

Stuttering is defined as the disturbance or interruption in the effortless flow of speech. The core features of stuttering as described by Van Riper (1971, 1982) include: (a) sound or syllable repetitions, (b) sound prolongations, and (c) blocks. These core behaviours seem to be involuntary for a person, unlike secondary behaviours that are learned or acquired, often an individual’s response or reaction to his or her stuttering. Secondary behaviours can further be classified as either escape or avoidance behaviours. Escape behaviours are said to occur when a person tries to terminate the stutter. These include eye blinks, head nods and interjections like “uh”. Avoidance behaviours are a result of anticipating the stutter and recalling associated negative experiences. To avoid the stutter the person may resort to behaviours which he or she used earlier as escape mechanism (Guitar, 2014).

As suggested in the literature, stuttering is considered to be a highly prevalent disorder both in children and adults. Yairi and Ambrose (2013) in their review reported significantly higher prevalence of stuttering in preschool children (3.46%) when compared to school-age and high-school children (0.84%). It is also observed that in majority of the individuals, the onset of stuttering is during the preschool period i.e., between 2 to 5 years of age (Andrews and Harris, 1964; Bernstein-Ratner and Silverman, 2000; Geetha, Mahesh, and Swathy, 2015; Guitar, 2014; Johnson and Associates, 1959; Yairi and Ambrose, 1992a, 2005) and the risk of developing stuttering reduces with increase in age (Craig, Hancock, Tran, Craig, and Peters, 2002). This decline in prevalence rate with advancing age is attributed to two factors: first, the low incidence rate after the age of 4 years and second, spontaneous recovery in a significant group of children (Yairi and Seery, 2015). The natural, spontaneous, or recovery without any treatment in young children is considered to be one of the remarkable aspects of stuttering (Yairi and Seery, 2015). A wide range of recovery rates from 30 to 89% have been reported in the literature (Bryngelson, 1938; Craig et al., 2002; Johnson and Associates, 1959; Wingate, 1976; Yairi and Ambrose, 1992b).

Though a large group of these children recover on their own, there still remains a significant number who continue to stutter and these children are at an increased risk of psycho-social problems. Children who stutter (CWS) are reported to be more sensitive, anxious, fearful, introverted and withdrawn (Embrechts, Ebben, Franke, and van de Poel, 2000; Fowlie and Cooper, 1978; Oyler, 1996). They are also known to have more negative quality of mood (Howell et al., 2004; Johnson, Walden, Conture, and Karrass, 2010) and a negative attitude towards communication (Guttormsen, Kefalianos, and Næss, 2015; Kawai, Healey, Nagasawa, and Vanryckeghem, 2012; Vanryckeghem, Hylebos, Brutten, and Peleman, 2001). Moreover, this negative attitude is noticed as early as the preschool age (Clark, Conture, Frankel, and Walden, 2012; Vanryckeghem and Brutten, 2007; Vanryckeghem, Vanrobayes, and De Niels, 2015). The negative attitude towards communication is said to diminish with age in children who do not stutter (CWNS) (Clark et al., 2012; Vanryckeghem and Brutten, 1996) unlike CWS where this relation is strengthened with increase in age (Clark et al., 2012; Kawai et al., 2012; Vanryckeghem et al., 2001). In addition, a direct relation is reported between the severity of stuttering and negative communication attitude (Kawai et al., 2012; Vanryckeghem et al., 2001; Vanryckeghem and Brutten, 1996). Clark et al. (2012) proposed that the early onset of such negative attitude towards communication negatively influences the child’s “ability to establish normally fluent speech-language planning and production”.

Key Terms in this Chapter

Dysfluency: A disruption in the smooth flow/production of speech. These are of two types: stuttering like dysfluencies (SLDs), which include repetitions, prolongation, and blocks; and other dysfluencies (ODs), which include pauses, interjections, and revisions.

Outcome Measures: Variables which measure the effect of a something. In case of intervention using a specific therapy technique, it is the effect of that particular technique on an individual’s behavior.

Gray Literature: Materials and research produced by organizations outside of the traditional commercial or academic publishing and distribution channels. These include reports (annual, research, technical, project, etc.), working papers, and government documents.

Stuttering: A speech disorder characterized by disruption in smooth flow of speech.

Prolongation: A type of dysfluency in which an individual prolongs/elongates/drags a specific phoneme/syllable.

Repetitions: A type of dysfluency in which an individual repeats a syllable/partial word/complete word/phrase several times disrupting the flow of speech.

Blocks: A type of dysfluency where the production of a sound/syllable/word is completely seized and the articulators are fixed in a specific articulatory position.

Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideally controlled conditions when administered or monitored by experts.

Intervention: It refers to the actions performed to modify behavior, emotional state, or feelings of an individual.

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