'Will they grow out of it?'
Spontaneous recovery and the therapists' dilemma

How do speech and language therapists know which children will need therapy? Robert Sedgley reports on a research presentation by Roberta Lees, a specialist in stammering at Strathclyde University.

Recent research carried out by Professor Ehud Yairi from the University of Illinois in the US suggested that most children started to stammer from the ages of three to three and a half. By discovering that the rate of spontaneous recovery for all children who develop a stammer was two out of three, Yairi could then - through further analysis - deduce that one third of children recovered up to the first eighteen months of the onset of stammering, a further third spontaneously recovered after more than 18 months, whilst the remaining third continued to stammer into adulthood.

This presentation on research into the onset and treatment of children who stammer by Roberta Lees to the Safety in Stumblers support group in Glasgow had been eagerly awaited. Roberta began her presentation by outlining Professor Yairi's ground-breaking research into the onset of stammering in children and the rate of 'spontaneous recovery' (a child recovering from stammering without any assistance or structured therapy interventions) which many children make. Yairi's study is proving to dispel many previously held beliefs about the onset of stammering and rate of recovery in children.

These findings can be compared to those carried out by Ashley Craig, an Australian researcher who surveyed the Australian public by telephone to find out what percentage of the populace stammered. He found that between 1.4% of people stammered between two and ten years of age, in adolescence this fell to 0.5% whilst those who retained their stutter into adulthood accounted for 0.37% of the population.

Faced with these statistics, and research showing that two thirds will recover spontaneously before reaching adulthood, Roberta asked: "what amount of resource should be allocated to children who stammer".

Although there is no evidence providing speech and language therapy to children who stammer will stop them recovering spontaneously, research carried out by Ingham and Cordes suggests that if treatment is delayed by 15 months there is a 27% decrease in the results of treatment. The therapist's dilemma is to answer the question of how much resource and time should be put into providing speech and language therapy to a particular patient category where about two thirds recover unaided?

Roberta then opened the discussion on how the findings of this new research should be used to determine the role of speech and language therapists in treating children who stammer. She said that the time spent by the therapist with each child who stammers varies according to the circumstances and treatment programme. She also said that it is not known if there was a correlation between spontaneous recovery and those with right/left sided brains, although interesting work currently being undertaken in Germany is showing the effects of 'dual tasks'. The researchers there have been collaborating with others using PET (Positron Emission Tomography) scans to show that different neural systems might be used by those who stammer for the planning of speech.

Roberta discussed findings from her research in the Highland region that caused concern. A 25 point questionnaire was sent to every GP and health visitor in the region asking what they knew about diagnosing and referring children who stammer for treatment. The response rate was 96% for health visitors and 76% for GP's. It was found that in many cases the level of training provided for GP's and health visitors was inadequate for them to know if a child's level of disfluency was within the normal range. Not enough children were referred to a speech and language therapist because GP's and health visitors believed they could determine if a child would spontaneously recover, and that more training in both the diagnosis of stammering and the administrative process of referring a child for speech therapy were required.

The group agreed that in order to 'solve' the speech and language therapists' dilemma, more needed to be done to identify children who show signs of stammering from as early an age as possible. This strongly supports the work of the BSA in this area. More research into risk factors will make it easier to identify children who are less likely to spontaneously recover. This 'last third' can then be focused on; minimising the chances of these children continuing to stammer into adulthood.

Thanks to founder member John Mann for organising Roberta's presentation.

Contact details of the Safety in Stumblers support group in Glasgow are available from our Information and Support Service.

From the Summer 2003 edition of Speaking Out