Fluency

Fluency

Reviews: ETIOLOGY ASSESSMENT INTERVENTION

POINTS OF INTEREST

· acquisition of language skills

· best measures of severity

· cognitive versus behaviour therapy

· therapeutic versus spontaneous recovery

THE ISSUE    On the issue of fluency, only the topic of stuttering was addressed by the reviews. Stuttering is characterized by atypical repetitions, prolongations, and pauses in speech. The incidence of stuttering is approximately 1% in the general population (Roseberry-McKibbin & Hedge, 2006). In the majority of cases, stuttering develops in early childhood and is more prevalent in males. Some individuals spontaneously recover without intervention from a speech-language pathologist. Factors such as family history and gender play a role in predicting whether or not dysfluent speech will correct itself. Fluency therapies such as the Lidcombe program for preschool children, fluency shaping, and stuttering modification are commonly used by speech language pathologists in clinical settings.

THE REVIEWS    Nine of the 12 articles focused on interventions, two reviewed the etiology of stuttering, and one examined assessment techniques. There were no systematic reviews of fluency.

WHAT THE REVIEWS CONCLUDE    Stuttering has been associated with general difficulties in children’s acquisition of language skills. More specifically, stuttering has been linked with language skills such as semantics and pragmatics. Children who stutter often have lower lexical skills than children who do not stutter. Clinicians should consider the level of the lexical tasks used in stuttering therapy because children with lower lexical skills may stutter more as tasks become increasingly difficult. Most studies have shown no significant differences between children who stutter and children who do not stutter in terms of pragmatic language skills; however some aspects of pragmatic language have been linked with an increase in children’s stuttering. For example, parents’ use of questions in conversation tends to increase the amount of stuttering children exhibit. Stuttering is likely more prevalent in bilingual children and can affect one or both languages. Assessment and intervention strategies should include attention to children’s language environments. Stuttering has not been linked with the development of children’s speech skills. One review refuted the possibility of an association of stuttering with phonological skills.

The review specific to assessment of stuttering concluded that amount of stuttering, not the types of dysfluencies (e.g., part/whole word repetitions, prolongations, etc.), should be used to measure stuttering severity. Dysfluency-type measures have been shown to have poor reliability. Dysfluency type should instead be used as a descriptor of observable stuttering.

Three of the nine intervention reviews provided methods for enhancing  evidence-based practice. One described the measurement of outcomes from the perspectives of clinicians, clients, families and friends. Two reviews provided examples of how and why clinicians should effectively measure treatment outcomes to inform evidence-based decisions.

Other intervention reviews drew conclusions about the generality of specific stuttering treatments. Successful generalization of acquired fluency skills beyond the clinical setting is challenging for both clinicians and clients. It was suggested that cognitive stuttering therapy may be more successfully generalized than the behavioural stuttering therapies that are commonly used by clinicians, such as stuttering modification or fluency shaping therapies. One review provided specific approaches for enhancing generalization to the school setting. Finally, one review found spontaneous recovery rates in up to 60-80% of children and suggested that clinicians can not reliably discriminate between spontaneous recovery of stuttering and treatment success. These conclusions question the validity of indiscriminately attributing positive outcomes to method of intervention.

Reference
Roseberry-McKibbin, C., & Hedge, M.N. (2006). An Advanced Review of Speech-Language Pathology, 2^nd Edition. Austin, TX: Pro-Ed., Inc.