A newly published study on stammering treatment highlights the value of intensive early intervention. PRISCILLA LYNCHreports
AN IRISH audit of outcomes of a stammering intervention in children has found that action taken at pre-school age may help more compared with letting children just grow out of it.
The audit also suggests that a single national centre of excellence providing standardised assessment and management for childhood stammer would be useful.
Founder of the Irish Stammering Association, Patrick Kelly, a senior speech and language therapist who used to work with the HSE, carried out an audit of outcomes from pre-school stammering intervention offered to 64 children aged under five years referred to a single speech and language therapist in Leitrim over an 11-year period (1993-2003).
Therapy was based on a client-centred approach, which combines elements of direct therapy focused on the child’s speech, and a number of indirect approaches involving changing the child’s environment.
Follow-up was conducted by means of a short questionnaire to the parents of the children involved in the audit study, which is published in the latest edition of the Irish Medical Journal.
Questionnaires were returned for 46 of the 64 children, of whom 43 were reported as not stammering, two continued to have a persistent stammer, while data on speech fluency was missing for one child.
The majority of respondents were male and the stammer was deemed as mild for 27, moderate for 13 and severe for six children. The average age of stammer onset was 3.2 years and the children received an average of 5.2 therapy sessions.
Of the two children with a persistent stammer, one was still in therapy at follow-up but was found to be free of the stammer in 2007. The second child attended for one speech therapy session but failed to attend for the further offered sessions.
The study’s 18 non-respondents were assessed informally by the clinic’s school nurse, and no stammering was detected. There were no referrals for speech therapy from schools or other agencies. Thus 61 of the 63 children with documented speech fluency status were reported as free of stammer at follow-up.
Kelly, who suffers from a stammer himself, says the findings from his audit suggest that early and intensive therapy for pre-school stammering using a client-centred eclectic approach may produce better outcomes than natural recovery rates.
He says that in Ireland there is no consensus on the optimal approach to the treatment of pre-school stammering. There are advocates of indirect approaches such as parent-child interaction therapy, where the focus is on changing the child’s speaking environment, and direct approaches such as the Lidcombe Programme, where therapists and parents work directly on the child’s speech.
There is tentative and anecdotal evidence that the policy of offering prompt assessment with a maximum waiting time of four weeks to all children referred with dysfluency in the Leitrim catchment area is already impacting on the prevalence of stammering in the area, says Kelly.
During the period 2003-2008, a total of only seven children aged between five and 16 years were referred to the clinic in Carrick-on-Shannon, despite an increase in the catchment population. Two of the seven referrals were immigrants and none had been seen at the clinic before the age of five years.
Kelly, who offers a national level intensive stammering course for teenagers and adults, says it is noteworthy that no teenagers have been referred for intensive therapy from this catchment area in recent years.
However, the study notes that there may be broader societal trends in relation to parenting styles or other factors that are contributing to a decline in the prevalence of stammering. Data from a formal epidemiological study of stammering prevalence in the relevant catchment area and a control area would be needed to test this theory.
Kelly acknowledges that his audit study has a number of limitations, including the uncertainty regarding natural recovery rates without intervention and the reliance on parental self-reporting and informal school nurse assessment as opposed to a formal one.
As the treating of stammering in adolescence and adult life is difficult and the condition can be associated with significant social handicap, Kelly says the audit findings highlight the importance of ensuring that all pre-school children have access to specialist assessment and therapy within weeks of the detection of initial symptoms.
