Therapy leads in treatment of stammering
5th World Congress on Fluency Disorders, 2006

In July 2006, therapists and researchers from around the world met for the 5th World Congress on fluency disorders in Dublin to present current therapy and research. Here, information and support manager David Vitler gives an overview of some of the highlights which would be most useful from the point of view of answering calls on the BSA helpline, particularly from parents of small children.

Hans Mansson - complexity and diversity in early childhood stuttering

In this seminar, Hans Mansson presented some findings from a long-term study of about 1,000 children born between 1995 and 1996 on the Danish island of Bornholm. Data was collected about these children from 1998 to 2004. Some of the findings were very striking. Nearly 19% of the children showed signs of stammering at three years of age. There was a rapid onset of stammering; coinciding with periods of rapid language development, with marked differences for girls and boys. The study found that 95% of the children recovered from stammering, which included a high level of natural recovery.

The scale of the study makes this an important piece of research that everyone involved in designing stammering therapy for children will want to study as soon as a full report is available.

Isobel Pickering and Fiona Hamilton - the effects of play situations in childhood dysfluency

Isobel and Fiona are two NHS speech and language therapists from East Anglia who work with pre-school children using parent-child interaction therapy. Having asked themselves the question: 'when we ask parents to play with their children, is it possible to be more specific about what types of play are more likely to encourage fluency?', they then went on to use video recording to study two different types of play. This took place over several sessions, with a number of different parents and children. The two types of play were:
structured play - ie play which involves rules such as taking turns, eg picture lotto, picture dominoes, etc, and
unstructured play - ie play involving creative activities with toys such as model farmyard animals, play food, etc.
Analysis of the sessions indicated that unstructured play involved more linguistic demands on the child, in part because this type of play is less likely to be parent-led. This would suggest that structured play would be the preferred option at the beginning of therapy, and perhaps also while children are on a waiting list.

Daniel Hunter - risk profiling young children who stammer to give a client-centred clinically effectual service

Daniel is speech and language therapist working for the NHS in Rochdale. He was appointed as the only stammering specialist in the department and asked to set up a new service for children under five years old with dysfluency problems. He described how, in order to prioritise those children with the greatest need or most at risk, he devised a risk profile based on the following criteria. These were all based on a reading of the available literature.

1. Age of onset - children aged over 38 months at the onset of stammering are considered at greater risk;
2. Level of dysfluency - children with gradual onset are considered more at risk than those with severe onset;
3. Time since onset - children who have been stammering for more than three years are considered a higher priority;
4. Genetics - children with a family history of stammering are considered at higher risk;
5. Speech rate - children with a faster speech rate are considered more at risk;
6. Phonological difficulties - children presenting with any difficulties in this area are considered a higher risk;
7. Language development - children with either notably advanced or delayed language development are considered a higher risk;
8. Motor co-ordination - children with poor motor co-ordination are considered a higher risk;
9. Child's awareness - children who are conscious of stammering are considered higher risk;
10. Environmental factors - these are taken into consideration from the perspective of the demands and capacities model.

Daniel also mentioned that treatment for children in his department is based on the 'least first' approach - ie the least clinically invasive form of treatment is generally tried with the child in the first instance.

Alex Warren and Margaret Leahy - making stuttering manageable: the use of narrative therapy

This was a joint presentation by Margaret Leahy, a lecturer and researcher in speech and language therapy in Ireland, and Alex, one of her clients, who has endured a severe stammer. Margaret draws on narrative therapy to provide the client with an opportunity to analyse the undesirable parts of how they see their life story.

Alex has had a lot of speech therapy in the past. There only needed to be minimal contact - they had email contact once a month, and face-to-face meetings for an hour once every six weeks.

Alex presented his progress with speech therapy:
1985 - attended a 'stammering cured' course - gained control of his speech for a year, followed by a complete collapse.
1997 - attended a 'coping with stammering' course run by Patrick Kelly and Louise Wright. Made an immense leap forward both with his speech and psychologically.
2004 - due to personal problems (illness of parents, etc) entered a period of increasing loss of control of his speech and increasingly negative attitudes about it.

Since embarking on narrative therapy, Alex has made a number of important discoveries as a result of this process:
1. It has been helpful for him to think in terms of having a relationship with his 'stammering identity', because all relationships have their good days and bad days.
2. He has come to understand that there exists a person without a stammer - it is possible for him to plan a future for this new identity.
3. He has a choice about whether to direct his life towards supporting one or other of these identities.
4. He is coming to a greater understanding of the relationship between behaviour, thinking and feeling - and especially how they influence each other.

Also from the 5th World Congress:
Physiological indices of speech and language processes: new windows on the onset of stuttering in young children - Anne Smith
Using counselling in stammering therapy - presentation by Jackie Turnbull

From the Winter 2006 issue of 'Speaking Out', pages 12-13