ACQ Vol 12 no 1 2010

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ACQ Volume 12, Number 1 2010 21
clients completed performance-contingent maintenance
based on that described by Harrison, Onslow, Andrews,
Packman, and Webber (1998). That is, they attended clinic
visits with increasing time intervals between them when they
met the speech criteria. If they did not meet speech targets
at any visit, progress through maintenance was halted until
they did.
The treatments
Treatment 1. Self-imposed time out (SITO)
Two cases using SITO as the primary treatment technique
are outlined. SITO was implemented in a non-programmed
format. The first client (C1) also incorporated the strategy of
accessing his own existing fluency techniques as he was
prompted to “try not to stutter”. The second client (C2) was
exposed to elements of PS to elicit further progress when he
had plateaued.
It is imperative to identify those clients who are likely to
respond to simple behavioural treatments. Onslow (1993)
stated that adults typically have advanced stuttering which
is less responsive to intervention, less variable without
remission, and does not recover without treatment. However,
certain client characteristics may indicate the use of simple
behavioural treatments. These include that a trial results in
a reduction of stuttering, the client has mild stuttering and/
or occasions when speech is stutter-free, or as Hewat et
al. (2006) conclude, the client has had previous speech
restructuring treatment. Treatment choices are based on
evidence in the literature as described. However, clinical skill
is required to select the best treatment option for each client.
This is done on a case-by-case basis in consultation with the
client.
Case studies
Three retrospective adult/adolescent clients were treated
with simple behavioural treatments at the Stuttering Unit,
Bankstown Health Service. The treatments were self-
imposed time-out, prompts to reduce rate and training to
access existing fluency techniques. Treatment was
conducted as part of a routine clinical caseload in a
one-hour weekly format.
Characteristics of clients
Client characteristics are summarised in table 1. For all
clients, case history factors were identified at assessment
which indicated that the stutter might respond to simple
behavioural therapy.
Outcome measures
Treatment outcomes are described using clinician and client
speech measures, collected within-clinic and beyond-clinic.
These measures are percentage of syllables stuttered (%SS)
and severity ratings (SR). The SRs are based on a scale
1–10 (1 = no stuttering, 10 = extremely severe stuttering).
SRs have been shown to be a reliable measure of stuttering
(O’Brian, Packman & Onslow, 2004).Clinicians collected
%SS at most clinic visits and during some beyond-clinic
telephone calls. Clients rated their stuttering severity daily
beyond-clinic using the severity rating scale. The reliability of
these measures was monitored in the weekly clinic visits by
comparing them with the clinician’s ratings.
The goal of treatment for the three clients was to reduce
stuttering to a sustainable level. Goals were negotiated
with each client and regularly reviewed to ensure they were
optimal and achievable. As is common clinical practice,
clinicians problem-solved any treatment issues that arose.
When they had attained consistent speech measures that
met their specified speech targets and had showed stability,
Table 1: Client characteristics
Client Age at initial Language/s Severity at assessment Types of stutters Previous therapy?
therapy visit
C1 39 English SR 8. Reported representative of Multiple repeated movements with During primary school;
worst rating; typically much lower tension and deep breaths with no therapy as an adult
raised shoulders
C2 15 English, Serbian 3.8%SS, SR 4. Typical SR 3 Repeated movements, fixed postures No
reported with and without audible air emission
and verbal superfluous behaviors
C3 29 English, Chinese, 1.8%SS, SR 3. Reported SR 4–5 Initial syllable repeated movements No
Vietnamese at worst and some fixed postures without
audible air emission
5
4
3
2
1
0
1 2 3 4 5 6
% syllables stuttered
Clinic visit
Final
mtn
C1
C2
C3
Figure 1. Within-clinic measures for C1, C2 and C3
Client 1 (C1)
C1 was frustrated with his stutter. He had stuttered since he
was young but had not had therapy as an adult. He stuttered
most on the telephone, when talking to business people,
and when speaking with his father. At assessment, a severe
stutter was evident (see table 1). He presented with SR 8,
but this was reported as his most severe stuttering. Typically
his SRs were reported to be 2–3 although he had periods
most days when stuttering severity increased.
During therapy trials at assessment when C1 was
instructed to “try not to stutter” his SRs reduced from 8–9
to 3. When SITO was trialled in conversation by instructing
C1 to stop talking for several seconds when or before he
stuttered, he stopped stuttering. During those trails C1
reported that he was “speaking properly” and talking with
“slow and pronounced speech” to control his stutter.
C1’s initial therapy visit was one month later. His speech
was rated at SR 7 and 3.9%SS within the clinic. Stutters
consisted of audible inspirations and multiple repetitions.