JCPSLP Vol 21 No 3 2019

It is known that clinical measures of pretreatment stuttering severity predict the time to complete Stage 1 in terms of number of clinic visits and weeks (Guitar et al., 2015; Jones, Onslow, Harrison, & Packman, 2000; Kingston, Huber, Onslow, Jones, & Packman, 2003; Koushik, Hewat, Shenker, Jones, & Onslow, 2011; O’Brian et al., 2013; Rousseau, Packman, Onslow, Harrison, & Jones, 2007). O’Brian et al. (2013) reported that, during Stage 1, for each increase of one scale value pretreatment on a 10-point severity rating scale, there was a 17% increase of the number of clinic visits required. Two reports (Jones et al., 2000; Kingston et al., 2003) have shown that children who have been stuttering for less than 12 months require more Stage 1 treatment time than children who have been stuttering for more than 12 months. However, none of the cited reports have found any association between age and treatment time. None of those reports have found any link between gender and treatment time. One of the reports (Rousseau et al., 2007) found that receptive and expressive language scores combined predicted treatment time, but phonological development did not. This information is useful for SLPs when planning and conducting Lidcombe Program treatments with clinical caseloads; gender and age at the start of treatment seem not to influence treatment time, but pretreatment stuttering severity and onset-to-treatment interval do. The standard method of establishing that information has been regression modelling of treatment time with case variables. The present research was designed to use a different method to identify variables potentially involved in influencing Lidcombe Program treatment time. Our research method involved a study of selected children from a clinical cohort who had the the most rapid responses and the slowest responses to treatment. The design of this reseach method was intended to increase the overall power of the study to detect effects that may have been overlooked with previous methods. Additionally, our design incorporated measures as potential predictors that were not included in the original studies. Method Ethics approval was received for this project from the South Western Sydney Local Health District Human Research Ethics Committee (HREC/10/LPOOL/10). Design The method used was selective, using retrospective case studies of 10 children from a larger cohort with rapid treatment responses and 10 children with slow treatment responses. The rationale for this method was to maximise the chance of identifying any case differences between the groups. At the Stuttering Unit, a specialist stuttering clinic in South Western Sydney Local Health District (Sydney, Australia), clients attended an initial assessment within 8 weeks of referral. According to Stuttering Unit routine procedures, children attended an assessment that included a collection of case history variables (see Table 1) and measurement of stuttering. The SLP listened to the child talk during play in the clinic. The SLP counted syllables spoken and the number of stutters, and %SS was calculated. That same speech sample was assigned a severity rating using a 10-point scale with 0 representing no stuttering and 9 representing extremely severe stuttering anchors at either end.

Table 1. Case history variables collected from assessment reports

Case history variables

Age at first therapy visit

Gender

Parental work status

Client other disorders / diagnosis

Behavioural concerns

Severity rating at initial assessment

Types of stutters at initial assessment

Presence of superfluous behaviours

Children were then placed on a waiting list until a SLP at the Stuttering Unit had an appointment available to offer them for treatment. Client demographics and basic treatment details were entered on a clinical database at assessment and throughout treatment until discharge. Participants Participants were 20 children (15 boys, 5 girls) who had been diagnosed with stuttering, commenced treatment when they were under the age of 6 years old, and were successfully treated at the Stuttering Unit during the period 2010–2013. All these children completed both stages of the Lidcombe Program, with no clinical relapse during Stage 2 that would have required their re-entry into Stage 1. Throughout the time that the children were treated, there were between five and six SLPs at the Stuttering Unit working exclusively with clients who stuttered. During the period of the study, 139 eligible children began treatment with the Lidcombe Program, and 78 (56%) did not complete Stage 2. Reasons for non-completion include client failing to attend scheduled appointments and subsequently being discharged, client choosing to withdraw from treatment for personal reasons, or client no longer being eligible for services from the Stuttering Unit for reasons such as moving away from catchment area. Selection criteria were (a) children treated with the Lidcombe Program during the period 2010–2013, (b) children younger than 6 years at the start of treatment, and (c) children discharged after successful, routine completion of Stage 2. The clinical database was used to identify potential participants who met these criteria. Participants were selected from the 61 candidate children who met the selection criteria. Procedure The database was used to calculate the number of clinic visits and the weeks to complete Stage 1 of the Lidcombe Program for all candidate children. The 10 children with the fewest clinic visits to reach Stage 2 and the 10 children with the most clinic visits to reach Stage 2 were selected for the study. Two authors verified the number of clinic visits with reference to the children’s files. The Rapid Response group required a mean of 8.9 ( SD 2.9) with a median of 9 clinic visits to reach Stage 2, and the Slow Response group required a mean of 60.5 ( SD 25.4) with a median of 60 clinic visits. The Rapid Response group required a mean of 12.3 ( SD 3.0) with a median of 12.5 weeks to reach Stage

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JCPSLP Volume 21, Number 3 2019

Journal of Clinical Practice in Speech-Language Pathology