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Motor speech disorders
20
ACQ
Volume 12, Number 1 2010
ACQ
uiring knowledge in speech, language and hearing
Stacey Sheedy
This article
has been
peer-
reviewed
Keywords
adult
case studies
simple
behavioural
treatment
stuttering
However, it is necessary for it to be contingent on stutters
(James, 1981).
Hewat et al. (2006) reviewed the literature and reported
several advantages of time-out. These include that
speakers can easily self-impose the stimulus thus aiding
generalisation. In contrast to PS, time-out is applied for
moments of stuttering rather than continuously as is the
case for PS. Finally, time-out seems to be capable of
reducing stuttering severity in fewer clinical hours than PS.
Another simple behavioural treatment is rate reduction
(Ingham & Packman, 1977; Starkweather, 1990). “Slow
down” is advice that most people who stutter will report
they have been given, often by well-meaning relatives.
Clinical experience indicates that it does not always work.
However, Onslow (1993) states that rate control “may be
effective for clients with mild stuttering which they wish to
control in specific situations” and it is a treatment to explore
if assessment shows that reduced rate controls the stutter
(p. 103).
Yet another simple treatment approach is for the client
to control stuttering by accessing their own existing fluency
skills (James, 1981; Martin & Haroldson, 1982; Onslow,
1993). Occasionally, clients present for assessment and
when prompted to control stuttering, are able to do so.
These simple treatments may be suitable for some clients.
Laboratory studies have demonstrated that some adults
responded well to simple behavioural treatments. Onslow
and Packman (1997) state: “The sheer weight of the findings
on PS has tended to divert attention from the potential
benefits of operant methods in treating adult stuttering” but
“empirical support is lacking” (p. 369).
There are some advantages to treating adults who stutter
with simple behavioural treatment (Onslow, 1993, p. 122).
Treatment is self-administered during everyday speaking
situations so generalisation is part of the treatment effect.
Treatment does not result in unnatural-sounding speech and
the effectiveness of treatment is apparent in less time.
The Bankstown Stuttering Unit’s policy is to be guided
by the evidence in the literature as well as to assess each
client’s ability to control their stutter using simple treatments
first and clinicians at the Stuttering Unit are mindful that
some adults and adolescents may respond to simple
behavioural treatments and trial these if indicated. Trials are
of a short duration, typically several minutes, so minimal
time is needed to determine whether clients are suitable
candidates. In some cases it is an efficient use of clinician
and client resources to offer simple treatments.
Published reports of treatments for adults who
stutter have predominantly focused on
prolonged speech or its variants. Yet
community clinics are often unable to provide
intensive treatment programs and further,
clients may not require speech pattern
modification. There have been comparatively
few studies of simple behavioural treatments.
These have generally been experimental and
results are varied. This paper presents three
retrospective case studies of simple
behavioural treatments employed in a weekly
format with adult and adolescent clients at the
Stuttering Unit, Bankstown Health Service.
Treatments were self-imposed time-out,
prompts to reduce rate, and training to access
existing fluency skills. The clients achieved
desirable treatment outcomes in few clinical
hours. Applicability for other services is
discussed.
T
he most commonly employed treatment technique
for stuttering in adults and adolescents is prolonged
speech (PS) or a variant. These complex treatments
require the client to be taught to restructure their speech
pattern. Although they are effective, post-treatment speech
is often unnatural sounding and clients need to consciously
control their stutter. Alternatively, there are simple behavioural
techniques that ameliorate stuttering without speech
restructuring. There are limited publications relating to these
treatments. Publications have mainly been experimental and
results have varied. Little is known about outcomes applied
in clinical settings.
Self-imposed time-out (SITO) is one such treatment.
Surprisingly, there have been few studies of SITO (see
James, 1981; James, Ricciardelli, Rogers, & Hunter, 1989;
Hewat, O’Brian, Onslow, & Packman, 2001; MacMillan,
2003; Hewat, Onslow, Packman, & O’Brian, 2006), yet all
have shown a treatment effect for at least some subjects.
Onslow, Jones, O’Brian, Menzies, and Packman (2008)
report that there have been replicated phase I trials of SITO
as well as an unreplicated phase II trial. The basic procedure
is for the client to stop talking for a short time contingent
on stuttering. The duration of the time-out interval has
been reported to be irrelevant to the effect (James, 1976).
Clinical outcomes of simple
behavioural treatments for
adults who stutter
Three case studies
Stacey Sheedy, Mary Erian, Wendy Lloyd, and Margaret Webber