www.stutter-ed.com, online seminars by Professor Mark Onslow

Review: Kirsten Liddle, Speech and Language Therapist, Hartlepool PCT

If you log onto www.stutter-ed.com you will currently find two very interesting seminars. Seminar 1 is entitled 'Treating Preschool Children Who Stutter: What Works, How Quickly, and How Well?' and Seminar 2 is the equivalent for school-age children. The seminars are presented by Mark Onslow from the Australian Stuttering Research Centre at the University of Sydney and are an attempt to draw together research findings and discuss clinical implications for clinicians working within the field of stammering. In order to view the seminars you must register and pay for each seminar. Registration entitles you to view the seminar at any time within a 24 hour period and also includes a downloadable worksheet and reference list and regular email updates.

Seminar 1 on preschool children covers the following topics: what is a clinical trial (outlining the differences between phase I, II and III trials); findings from a number of phase I, II and III trials examining Verbal Response Contingent Stimulation treatment, effect sizes with this particular type of treatment and findings from other types of treatment such as Syllable Timed Speech, Speech Restructuring and Indirect Treatments; and finally a summary of key points from the discussion.

Seminar 2 on school-age children follows a similar format. It again includes information about criteria for varying levels of clinical trials, plus an outline of the results of clinical trials using Speech Restructuring, Verbal Response Contingent Stimulation treatment, EMG Biofeedback and Regulated Breathing. There is then an outline of effect size and treatment hours needed for each of these treatment types. Again, there is a summary of key points from the seminar to finish.

I was looking forward to viewing the seminars as a new way of accessing research information and wondered how I would find this format in comparison to the more traditional means. My initial enthusiasm was a little dampened by some technical difficulties downloading the seminars, though there is a free introductory video which should help check that you meet its system requirements.

My personal theoretical stance is very much grounded in the multifactoral framework and therefore I was concerned by the purely fluency focus - none of the treatment outcomes focused on thoughts, feelings or beliefs. However, Mark Onslow did offer some thoughts on why he felt the research was heavily focused on the elimination of stuttered speech. He suggested that this may be the only important clinical outcome for pre-school children or that alternatively, clinical trials may have been conducted to look at other aspects but found no effect and therefore weren't published ('File drawer effect' Rosenthal, 1979). I agree that clinical practice must be driven by the evidence base but remain very anxious about the possible bias towards purely fluency focused treatment. My own clinical experience has shown that there are a number of preschool children who stutter for whom the negative thoughts and feelings about talking are extremely strong and therefore an essential part of the treatment programme.

As registration only allows you to view the seminars within a 24 hour period any viewer must be prepared to set aside a significant amount of time to view, pause and make notes and re-listen to the information. I did find the format slightly annoying in that each treatment type is discussed and details of clinical trials are given but the results of clinical trials are then all dealt with together in a later section. Presumably this format was used in an attempt to more easily compare effect sizes of different types of treatment. However, I found myself wanting to know the results whilst thinking about each individual treatment type and not wanting to wait!

Overall I found the seminars thought-provoking viewing and would recommend them to clinicians as part of the process of building their evidence base. As with all things clinicians should be prepared to critique the information given and debate the interpretations of the presenter.

From the Winter 2008 issue of 'Speaking Out', page 17.