Scholarly Article Reviews-Week 1

We have 2 reviews for you this week!

The first article review is brought to you by Katie Cohen, SLP at Maupin and Roosevelt-Perry Elementary schools:

Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Stuttering in School-Age Children: A Comprehensive Approach to Treatment. Lang Speech Hear Serv Sch, 43(4), 536-548.

This article is a response to an article written and published by the editor of LSHSS, Dr. Marilyn Nippold that included the following scenario:

A young SLP contacts a former professor to request help with a student, Ben, for whom she is assessing and developing a treatment plan.  The former professor responds to the SLP stating there is a need for more research on treatments that specifically decrease the frequency count of stuttering events for the pediatric population.

· I have an issue with this: The former professor should have suggested another resource, maybe a colleague or practicing SLP from whom this SLP could have gotten some help on creating a treatment plan for Ben rather than broadly stating that we need more research.

In her article, Dr. Nippold formally calls for more research on treatments that decrease the frequency of stuttering.

This article responds to Dr. Nippold directly using three themes.

Theme 1. Agreement with Dr. Nippold’s call for more research.

Very straightforward.  I agree we do need more research on techniques to improve speech fluency.

Theme 2. Overview of recent literature including strategies to improve speech fluency, as well as, increase acceptance and decrease negative consequences.

Suppose an SLP solely focuses on decreasing the frequency count. If students avoid certain words and respond in very short utterances, they will likely exhibit a decreased frequency count. However, this can occur with increased anxiety, fear, and lack of acceptance.  On the other hand, acceptance can “lead to reduced stuttering severity, increased fluency, and improved communication.” Acceptance is an integral part of the therapy process and includes concepts that are also central to mindfulness, acceptance and commitment therapy, as well as, cognitive behavioral therapy.

Stuttering is a multi-dimensional disorder; therefore, there is not one specific treatment type to help our students with fluency impairments.

Theme 3. Several strategies to minimize the adverse academic impact of stuttering on the school age population.

The authors’ strive to make suggestions that are “consistent with common clinical practice” and “reflective of real life experiences”.  Here are two long-term objectives (LTO) with short-term objectives (STO) the author’s provide.

LTO1: Ben will experience a decrease in bullying.

STO1.1: Ben will talk with the SLP about what is going on in the classroom.

STO2.1: Ben will participate in a fluency group with other students who have a fluency impairment. –Ben will gain acceptance, identify a role model, and practice self-expression in a safe environment.

STO3.1: Ben will invite a close friend/ classmate to attend a speech therapy session with him at which Ben (with the SLP) will educate the peer about stuttering.

STO4.1: Ben will create and give a presentation to his class in order to teach about stuttering.

 

LTO2: Ben will be able to answer questions when called upon.

STO1.2: Ben will raise his hand to participate in class at least once each day. – Ben has a sense of control over when he speaks, which decreases the anxiety, however, he is still answering a question.

STO2.2: Ben will answer questions out-loud on prearranges topics of his choice that he is most comfortable with. – This will improve his participation in the classroom, as well as, build confidence.

Comprehensive assessment:  When evaluating (or in some cases re-evaluating) a student with fluency of speech needs, it is imperative to look closer at the whole picture in order to develop a treatment plan more tailored to the individual student’s needs.  Factors that should not be overlooked include:

· classroom participation via observation and teacher (or instructional assistant) interview

· emotions via observation and interview (parent, teacher, self, etc.)

· fluency count via direct measure of speech sample

· avoidance behaviors via observations and interviews (parent, teacher, self, etc.)

 

In summary, this article claims that SLPs, when working with school-aged students with fluency impairments, should focus on decreasing the frequency count in addition to -rather than instead of- acceptance.

Thanks, Katie!

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5 thoughts on “Scholarly Article Reviews-Week 1

  1. Jamie Priddy says:

    Great summary, Katie! I agree that fluency is a multi-dimensional disorder and there is more to consider than just the frequency of dysfluencies. During one of my clinical rotations in grad school, I worked with a wonderful fluency therapist and she put just as much, if not more, effort into the emotional side of the disorder. At the beginning of each session, she would complete two rating scales with the student: one to measure how often the student believed he or she stuttered throughout the week and another to measure his or her emotional state. They almost ALWAYS went hand in hand. Just a good reminder that this disorder has the ability to cause so much fear, anxiety, and loneliness if we don’t take our students’ emotions and experiences in the classroom into consideration.

  2. Jane Stosberg says:

    Thank you for sharing, Katie. I have really been working to balance the multi-dimensional needs of my fluency student this year. It has been complex and has changed significantly from the needs he has demonstrated in years past. I also really like the idea that Jamie shared about the rating scales. Ultimately, I do wish there were more research about fluency therapy with specific examples about best practice and how to implement it in a school setting. It has been really helpful to read these article summaries.

  3. allison forrester says:

    Thank you for sharing this article summary. I completely agree that therapy for students who stutter should be multi-dimensional, encompassing the emotional/acceptance side of stuttering, as well as reducing the frequency of dysfluencies.

  4. Kelly Miklosh says:

    Thanks for the article review. I do believe that the cognitive-behavioral component is correlated to the frequency of dysfluencies. I know personally I can improve on targeting that aspect of stuttering, perhaps by implementing a rating scale at the beginning of the session.

  5. Krista RIce says:

    Thank you for the summary you provided! I feel like I am always researching different therapy practices to address fluency. I agree with the statement and the other SLP’s comments related to the multi-dimensional needs of our fluency students and the impact it has on their speech. What I’ve struggled with is the student who stutters but appears to lack the emotional “motivation” (if you want to call it that) to address the dysfluencies. From my experience, if a student does not have an emotional connection to stuttering, then motivation in therapy often lacks.

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