ACQ Vol 12 no 1 2010

30 / 60

28 ACQ Volume 12, Number 1 2010 ACQuiring knowledge in speech, language and hearing
Outcomes for the reported clients have been gained
retrospectively through a file audit and are therefore limited in
generalisability. However, there is little outcome information
in the literature on weekly PS treatment to guide clinicians.
Hence, this paper provides some preliminary information
indicating that for some adults who stutter, a one-hour weekly
PS treatment program may be a viable option to consider.
References
Block, S., Onslow, M., Packman, A., Gray, B., & Dacakis, G.
(2005). Treatment of chronic stuttering: outcomes from a
student training clinic. International Journal of Language and
Communication Disorders, 40,(4), 455–466.
Carey, B., O’Brian, S., Onslow, M., Block, S., & Jones,
M. (2009). A randomised controlled non-inferiority trial
of a telehealth treatment for chronic stuttering: the
Camperdown Program. International Journal of Language
and Communication Disorders (electronic publication ahead
of print, retrieved 22 April 2009).
Harrison, E., Onslow, M., Andrews, C., Packman, A., &
Webber, M. (1998). Control of stuttering with prolonged
speech: preliminary outcome of a one-day instatement
program. In A. K. Cordes and R. J. Ingham (Eds.), Treatment
efficacy for stuttering: A search for empirical bases (pp.
191–212). San Diego, CA: Singular Publishing Group.
James, J.E. (1981). Behavioral self-control of stuttering
using time-out from speaking. Journal of Applied Behavior
Analysis, 14, 25–37.
James, J.E., Ricciardelli, L.A., Hunter, C.E., & Rogers, P.
(1989). Relative efficacy of intensive and spaced behavioural
treatment of stuttering. Behaviour Modification, 13, 376–395.
O’Brian, S., Onslow, M., Cream, A., & Packman, A.
(2003). The Camperdown Program: Outcomes of a new
prolonged speech treatment model. Journal of Speech,
Language and Hearing Research, 46 , 933–946.
O’Brian, S., Packman, A., & Onslow, M. (2008). Telehealth
delivery of the Camperdown Program for adults who stutter:
A phase 1 trial. Journal of Speech, Language, and Hearing
Research, 51, 184–195.
Onslow, M. (1996). Behavioural Management of Stuttering.
San Diego, CA: Singular Publishing Group, Inc.
Onslow, M., & Packman, A. (1997). Designing and
implementing a strategy to control stuttered speech in
adults. In R. F. Curlee and G.M. Siegel (Eds.), Naturalness
and treatment of stuttering new directions. (pp. 356–376).
Needham Heights, MA: Allyn and Bacon.
Packman, A., Onslow, M., & Van Doorn, J. (1994).
Prolonged speech and the modification of stuttering:
Perceptual, acoustic, and electroglottographic data. Journal
of Speech and Hearing Research, 37, 724–737.
or improved upon their negotiated criteria. C3 showed a
marginal increase in SRs and %SS from those gained at the
end of the weekly treatment phase. It is noteworthy that C5
did not require all elements of PS to control his stutter.
Discussion
Teaching PS in a one-hour weekly format was an effective
service delivery model for these clients. Despite treatment
visits being spaced a week apart, clients were able to learn
the PS pattern, vary their naturalness levels and apply PS in
everyday situations to reduce their stuttering severity, as
evidenced by beyond clinic SRs. As previously stated, one
client, C3, showed an increase in severity at the end of
maintenance. This increase, however, still fell within the
range of his maintenance criteria and was at levels that C3
reported being satisfied with.
In describing the outcomes of a One-Day Instatement
Program for PS Harrison et al. (1998) reported that 24
treatment hours were required for clients to reach the
maintenance phase. For the Camperdown Program
outcomes, O’Brian et al. (2003) reported an average of 20.1
hours (range 13–29 hours) to reach the maintenance phase.
Block et al. (2005) reported that 45 hours were required to
complete the instatement and transfer phases of a 5-day
intensive PS treatment. The treatment duration for the five
clients presented in this paper was an average of 23 hours
(range 8–43) and is comparable to these other publications.
For certain clients providing PS treatment on a weekly
basis can be advantageous. Weekly treatment can be
tailored to individual client needs particularly in regards to
their goals, learning styles, and circumstances. This is of
great consequence for clients who require an interpreter or
have limited English competency. Additionally, some clients
(e.g., C5) may not require all elements of PS to control their
stutter so treatment can be flexible. Further, when clients
are treated in a non-intensive weekly format, generalisation
of PS is not likely to be adversely affected. Clients can ease
into the use of PS during everyday life situations (Onslow
& Packman, 1997). Finally, many speech pathology clinics
would be able to implement this service delivery model. For
example, weekly treatment is potentially more accessible
to isolated or rural clinicians who may not have appropriate
resources to provide a group intensive treatment format and
smaller clinics who may not receive sufficient numbers of
adult referrals in order to form a group.
There are disadvantages of weekly treatment. For some
clients, treatment may take longer than reported in the
more recent intensive format literature. It is difficult to
determine whether clients treated individually are potentially
“missing” valuable learning experiences that may take
place in a group/intensive format. For example, being able
to interact and practice with other people who stutter or
being exposed to using PS for an extended period of time.
Hearne et al. (2008) hypothesised that for adolescents, the
group component of the intensive day of the Camperdown
Program may be beneficial due to peer support. This may
be relevant to adults. Lastly, more intensive practice of PS
may be indicated if the client is not progressing in a weekly
format.
The method described in this paper is one way of teaching
PS. There are alternative methods described in the literature
that clinicians might consider, in particular that described in
the Camperdown Program (O’Brian et al., 2003; Carey et
al., 2008). Clinicians need to consider the literature as well
as clients’ needs and responsiveness to various teaching
methods when deciding how to implement treatment.
Wendy Lloyd has worked at the Stuttering Unit, Bankstown Health
Service, for 6 years. Wendy treats adults and children of all ages
who stutter and provides phone consultations to speech pathologists
across Australia. Wendy contributes to the Continuing Professional
Education in Stuttering (CPES) program run in conjunction with the
Australian Stuttering Research Centre and Macquarie University
through clinical observation days and workshops.
Correspondence to:
Wendy Lloyd
Locked mailbag 1600
Bankstown, NSW, 2200
phone: + 61 2 9780 2766
email: