POINTS OF INTEREST
of language skills
measures of severity
cognitive versus behaviour therapy
versus spontaneous recovery
On the issue of fluency, only the topic of stuttering was addressed by the
reviews. Stuttering is characterized by atypical repetitions,
prolongations, and pauses in speech. The incidence of stuttering is
approximately 1% in the general population (Roseberry-McKibbin & Hedge,
2006). In the majority of cases, stuttering develops in early childhood
and is more prevalent in males. Some individuals spontaneously recover without
intervention from a speech-language pathologist. Factors such as family
history and gender play a role in predicting whether or not dysfluent
speech will correct itself. Fluency therapies such as the Lidcombe program
for preschool children, fluency shaping, and stuttering modification are
commonly used by speech language pathologists in clinical settings.
Nine of the 12 articles focused on interventions, two reviewed the
etiology of stuttering, and one examined assessment techniques. There were
no systematic reviews of fluency.
THE REVIEWS CONCLUDE
Stuttering has been associated with general difficulties in children’s
acquisition of language skills. More specifically, stuttering has been
linked with language skills such as semantics and pragmatics. Children who
stutter often have lower lexical skills than children who do not stutter.
Clinicians should consider the level of the lexical tasks used in
stuttering therapy because children with lower lexical skills may stutter
more as tasks become increasingly difficult. Most studies have shown no
significant differences between children who stutter and children who do
not stutter in terms of pragmatic language skills; however some aspects of
pragmatic language have been linked with an increase in children’s
stuttering. For example, parents’ use of questions in conversation tends
to increase the amount of stuttering children exhibit. Stuttering is
likely more prevalent in bilingual children and can affect one or both
languages. Assessment and intervention strategies should include attention
to children’s language environments. Stuttering has not been linked with
the development of children’s speech skills. One review refuted the
possibility of an association of stuttering with phonological skills.
The review specific to assessment of stuttering concluded that amount of
stuttering, not the types of dysfluencies (e.g., part/whole word
repetitions, prolongations, etc.), should be used to measure stuttering
severity. Dysfluency-type measures have been shown to have poor
reliability. Dysfluency type should instead be used as a descriptor of
Three of the nine intervention reviews provided methods for enhancing evidence-based practice. One described the measurement of
outcomes from the perspectives of clinicians, clients, families and
friends. Two reviews provided examples of how and why clinicians should
effectively measure treatment outcomes to inform evidence-based decisions.
Other intervention reviews drew conclusions about the generality of
specific stuttering treatments.
Successful generalization of acquired fluency skills beyond the clinical
setting is challenging for both clinicians and clients.
It was suggested that cognitive
stuttering therapy may be more successfully generalized than the
behavioural stuttering therapies that are commonly used by clinicians,
such as stuttering modification or fluency shaping therapies. One
review provided specific approaches for enhancing generalization to the school setting.
Finally, one review found spontaneous recovery rates in up to 60-80% of
children and suggested that clinicians can not reliably discriminate
between spontaneous recovery of stuttering and treatment success. These
conclusions question the validity of indiscriminately attributing positive
outcomes to method of intervention.
Roseberry-McKibbin, C., & Hedge, M.N. (2006). An Advanced Review of
Speech-Language Pathology, 2nd Edition. Austin, TX: Pro-Ed.,
©2006 by Canadian Centre for Knowledge Mobilisation. All