ACQ Vol 12 no 1 2010

Motor speech disorders

Clinical outcomes of simple behavioural treatments for adults who stutter Three case studies Stacey Sheedy, Mary Erian, Wendy Lloyd, and Margaret Webber

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).

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.

This article has been peer- reviewed Keywords adult case studies simple behavioural treatment stuttering

Stacey Sheedy

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ACQ Volume 12, Number 1 2010

ACQ uiring knowledge in speech, language and hearing