Contemporary issues with stuttering: The Fourth Croatia Stuttering Symposium

PurposeDuring the 2019 Fourth Croatia Clinical Symposium, speech-language pathologists (SLPs), scholars, and researchers from 29 countries discussed speech-language pathology and psychological practices for the management of early and persistent stuttering. This paper documents what those at the Symposium considered to be the key contemporary clinical issues for early and persistent stuttering.MethodsThe authors prepared a written record of the discussion of Symposium topics, taking care to ensure that the content of the Symposium was faithfully reproduced in written form.ResultsSeven contemporary issues for our field emerged from the Symposium.ConclusionEffective early intervention is fundamental to proper health care for the disorder. However, as yet, there is no consensus about the timing of early intervention and how it should be managed. Currently, clinical translation is a barrier to evidence-based practice with early stuttering, and proactive strategies were suggested for junior SLPs. Apprehension emerged among some discussants that treatment of early stuttering may cause anxiety. For persistent stuttering, assessment procedures were recommended, as were strategies for dealing with childhood bullying. There was agreement that SLPs are the ideal professionals to provide basic cognitive-behavior therapy for clients with persistent stuttering. Questions were raised about our discipline standards for basic professional preparation programs for stuttering management.     

Childhood stuttering and dissociations across linguistic domains

The purpose of this investigation was to evaluate the possible presence of dissociations in the speech and language skills of young children who do (CWS) and do not stutter (CWNS) using a correlation-based statistical procedure [Bates, E., Appelbaum, M., Salcedo, J., Saygin, A. P., & Pizzamiglio, L. (2003). Quantifying dissociations in neuropsychological research. Journal of Clinical and Experimental Neuropsychology, 25, 1128-1153]. Participants were 45 preschool CWS and 45 CWNS between the ages of 3;0 and 5;11 (years;months), with the two groups matched by age, gender, race, and parental socioeconomic status. Children participated in a parent-child interaction for the purpose of disfluency analysis and responded to four standardized speech-language tests for subsequent analyses as main dependent variables. Findings indicated that CWS were over three times more likely than CWNS to exhibit dissociations across speech-language domains, with 44 cases of dissociation for CWS and 14 for CWNS across 10 possible comparisons. Results suggest that there may be a subgroup of CWS who exhibit dissociations across speech-language domains, which may result in a greater susceptibility to breakdowns in speech fluency. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) summarize findings from previous studies examining differences in speech and language performance between children who do and do not stutter; (2) describe what is meant by "dissociations" in the speech and language skills of young children who do and do not stutter; and (3) discuss three hypotheses that could account for the present findings that suggest CWS, more often than CWNS, exhibit dissociations in their speech-language system.     

No other choice: Speech-Language Pathologists’ attitudes toward using telepractice to administer the Lidcombe Program during a pandemic

PurposeTelepractice has been shown to be a viable modality for the delivery of stuttering treatment. Since the advent of COVID-19, speech-language pathologists must adapt in-clinic treatments for online presentation. This research aimed to gather information from speech-language pathologists on their experiences of telepractice to deliver the Lidcombe Program to treat stuttering in young children.MethodsThis paper presents the findings of an online survey that polled the clinical experiences of 106 speech-language pathologists who were delivering the Lidcombe Program via telepractice during COVID-19.ResultsThe majority of respondents were experienced clinicians from the United States and Canada who had attended a Lidcombe Program workshop. Prior to COVID-19, 80 % had provided some clinical services online (up to 10 % of the time), and at the start of COVID-19 public lockdown orders, 77 % viewed telepractice as both a necessity and an opportunity. Three months after the public lockdown orders, the large majority, 94 %, said that they would continue to use both telepractice and in-clinic treatment in the future. Technology issues, concerns about establishing the clinical relationship, and identification of mild stuttering featured as challenges of telepractice service delivery, while benefits included time efficiency, flexibility of scheduling, and improved clinical processes.ConclusionRespondents reported that the Lidcombe Program was easily translatable to telepractice and the majority intend to continue telepractice in the future.     

Academic and clinical education in fluency disorders: an update

This paper presents a survey of the academic and clinical education in fluency disorders provided by American Speech-Language-Hearing Association (ASHA)-accredited training programs. Respondents were 159 programs (out of 256, return rate = 67.4%) that completed a questionnaire seeking information about the courses and clinical experiences they require, the expertise of their faculty and supervisors, changes following the 1993 modification of training requirements for the ASHA certificate of clinical competence (CCC), and preliminary plans for changes in preparation for the 2005 standards. Results, which supplement findings from an earlier survey distributed in 1997 (Yaruss, 1999), indicated that nearly one-quarter of programs allow students to graduate without coursework in fluency disorders, and nearly two-thirds allow students to graduate without clinical practicum experiences. Findings suggest a trend toward fewer required classes taught by less experienced faculty, fewer clinical hours guided by less experienced supervisors, and a greater likelihood that students will graduate without any academic or clinical education in fluency disorders. Given the repeated finding that many speech-language pathologists are uncomfortable working with people who stutter, as well as ASHA's apparent de-emphasis of fluency disorders within the increasing scope of practice in the field of speech-language pathology, these results are a cause for concern about the future of fluency disorders. EDUCATIONAL OBJECTIVES: The reader will learn about (1) the coursework and clinical practicum experiences that are currently required for students in ASHA-accredited training programs; (2) trends indicating a reduction in training requirements for fluency disorders; and (3) ways of improving these requirements.     

Ineffective discipline and conduct problems in males: Association, late adolescent outcomes, and prevention

In the current study, social learning theory and findings on the association of ineffective parental discipline and childhood conduct problems was reviewed In addition, the association of ineffective discipline in childhood to arrests and academic achievement in adolescence was tested. The reviewed studies were multi-agent, multimethod passive longitudinal, prevention, and clinical studies conducted at the Oregon Social Learning Center (OSLC). Measurement of childhood discipline included observational data. Analyses predicting to adolescent outcomes were conducted for the Oregon Youth Study sample of approximately 200 males at risk for delinquency. The finding of an association between ineffective discipline and childhood conduct problems was replicated in three OSLC studies. Ineffective discipline at Grade 4, controlling for Grade 4 antisocial behavior, was found to predict to a more serious juvenile arrest record (two or more arrests) and to failure to enter higher education. Prevention efforts need to be directed toward promoting effective discipline skills, especially in parents of young children. Effective discipline includes such skills as structuring situations, redirecting child behavior, encouragement, and also consistent use of a mild to moderate consequence such as time out or privilege loss.     

Female laryngectomees' satisfaction with communication methods and speech-language pathology services

132 female laryngectomees responded to a questionnaire regarding satisfaction with their communication methods as postlaryngectomees and speech-language pathology services. Respondents were satisfied overall with their primary communication selection; however, most would like to try a method that produced a more feminine-sounding voice. 68% were satisfied with their speech-language pathology services.     

Effects of speech and language treatment on recovery from aphasia

Language recovery in aphasic patients who received one of three types of speech and language treatment was compared with that in aphasic patients who received no treatment. One hundred aphasic patients were followed from 2 to 4 weeks postonset for 1 year or until recovery, using a standardized test battery administered at systematic intervals. Both treatment methods provided by trained speech-language pathologists were efficacious, while the method provided by trained nonprofessionals approached statistical significance. Small group size prevented resolution of the question of whether one type of treatment was superior to another.     

Comparison of the Family Therapy Educational and Experience Requirements for Licensure or Certification in Six Mental Health Disciplines

In a review of literature on clinical licensure programs and certified mental health disciplines, no studies specifically compared didactic methods and clinical training standards for family-based interventions. Consequently, consumers and insurers of these services have no basis from which to evaluate the relative competency of each of the mental health disciplines in providing family-based interventions. This study used content analysis to examine the amount of family based training that is required by six core mental health disciplines (Clinical Psychology, Psychiatry, Psychiatric Nursing, Professional Counseling, Marriage and Family Therapy, and Social Work) in each of the 50 United States. Results indicate that a marriage and family therapist is required to have three times more family therapy coursework than any other professional mental health discipline. Also, before becoming licensed a marriage and family therapist, must complete 16 times more face-to-face family therapy hours than a mental health professional from any other discipline. Implications for consumers and practitioners are discussed.     

Reprint of: technology and the evolution of clinical methods for stuttering

The World Wide Web (WWW) was 20 years old last year. Enormous amounts of information about stuttering are now available to anyone who can access the Internet. Compared to 20 years ago, people who stutter and their families can now make more informed choices about speech-language interventions, from a distance. Blogs and chat rooms provide opportunities for people who stutter to share their experiences from a distance and to support one another. New technologies are also being adopted into speech-language pathology practice and service delivery. Telehealth is an exciting development as it means that treatment can now be made available to many rural and remotely located people who previously did not have access to it. Possible future technological developments for speech-language pathology practice include Internet based treatments and the use of Virtual Reality. Having speech and CBT treatments for stuttering available on the Internet would greatly increase their accessibility. Second Life also has exciting possibilities for people who stutter.Educational objectives: The reader will (1) explain how people who stutter and their families can get information about stuttering from the World Wide Web, (2) discuss how new technologies have been applied in speech-language pathology practice, and (3) summarize the principles and practice of telehealth delivery of services for people who stutter and their families.     

Technology and the evolution of clinical methods for stuttering

The World Wide Web (WWW) was 20 years old last year. Enormous amounts of information about stuttering are now available to anyone who can access the Internet. Compared to 20 years ago, people who stutter and their families can now make more informed choices about speech-language interventions, from a distance. Blogs and chat rooms provide opportunities for people who stutter to share their experiences from a distance and to support one another. New technologies are also being adopted into speech-language pathology practice and service delivery. Telehealth is an exciting development as it means that treatment can now be made available to many rural and remotely located people who previously did not have access to it. Possible future technological developments for speech-language pathology practice include Internet based treatments and the use of Virtual Reality. Having speech and CBT treatments for stuttering available on the Internet would greatly increase their accessibility. Second Life also has exciting possibilities for people who stutter.Educational objectives: The reader will (1) explain how people who stutter and their families can get information about stuttering from the World Wide Web, (2) discuss how new technologies have been applied in speech-language pathology practice, and (3) summarize the principles and practice of telehealth delivery of services for people who stutter and their families.     

Reinstatement as a method to increase the effectiveness of discipline in the school or home

Ninety first-grade boys who left their seats and played with toys in a tempting situation were assigned randomly to one of three conditions of reinstatement: minimal reinstatement, verbal reinstatement, or verbal and behavioral reinstatement. Half of each group received mild discipline, the other half, no discipline. Discipline was defined as the withdrawal of a physical resource (a marble) and a verbal rebuke. Reinstatement was defined as the detailed rehearsal (either behavioral or verbal) of the undesirable behavior sequence. After an intervening task, the boys were placed in the tempting situation again, and time before playing with some toys was recorded. Results confirmed two hypotheses and did not confirm two other hypotheses: discipline was significantly more effective than no discipline; reinstatement significantly increased the effectiveness of discipline; discipline with verbal and behavioral reinstatement was no more effective than discipline with verbal reinstatement alone. Verbal reinstatement and verbal plus behavioral reinstatement were no more inhibiting than minimal reinstatement when followed by no discipline.     

Predictive Value of Informant Discrepancies in Reports of Parenting: Relations to Early Adolescents’ Adjustment

Research has demonstrated a lack of agreement between parent and child reports across a range of parent and child variables. These discrepancies hinder the interpretation of research findings as well as diagnostic and treatment decisions in clinical practice. The current study examined the hypothesis that discrepancies between parent and child reports of parenting can be useful as predictors of future child outcomes. The participants included 559 early adolescents and their primary caregivers (79% African American, 21% Caucasian). Both respondents provided information on parental nurturance, harsh discipline and inconsistent discipline. A year later, information of adolescents’ internalizing problems, externalizing problems, and social competence was collected. Structural equation modeling revealed that parent-child discrepancies in parenting reports could be explained by a latent factor which was a significant predictor of child internalizing problems and social competence, but not of externalizing problems, after adjusting for initial internalizing and externalizing problems. The three models applied across gender and ethnicity.     

Future of neuropsychology]

The future development of neuropsychology as an independent discipline, which has as its principal subject the relationships between the brain as a material substrate and the psychic behavior shown by human beings as well as animals, is discussed on the basis of a schematic presentation of the possible structure of this discipline (general, genetic, clinical and pathological, and applied neuropsychology.     

Where has all the psychology gone?: A critical review of evidence-based psychological practice in correctional settings

Evidence-Based Practice (EBP) represents the gold standard for effective clinical psychological practice. In this review, we examine ways in which EBP tenets are being neglected by correctional psychologists worldwide. We examine three key aspects of EBP currently being neglected: (a) individualized and flexible client focus, (b) the therapeutic alliance, and (c) psychological expertise. We also highlight two highly related issues responsible for correctional psychologists' neglect of EBP. The first relates to policy makers' and correctional psychologists' overreliance on the Risk–Need–Responsivity Model to guide correctional practice. We argue that the narrow focus and implementation of this model has resulted in a severe identity problem for correctional psychologists that has severely exacerbated the dual relationship problem. That is, the tension psychologists experience as a result of engaging in psychological practice while also obliging the risk and security policies of correctional systems. The second issue concerns psychologists' response to the dual relationship problem. In short, psychology, as a discipline appears to have acquiesced to the dual-relationship problem. In our view, this constitutes a ‘crisis’ for the discipline of correctional psychology. We offer several recommendations for injecting EBP back into correctional psychology for the individual, psychology as a discipline, and correctional policy makers.     

National Stuttering Association members' opinions about stuttering treatment

As stuttering support groups, such as the National Stuttering Association (NSA), have gained prominence and visibility, it has become increasingly important for speech-language pathologists (SLPs) to learn about the people who participate in such groups. This article presents results of a brief survey completed by 200 members of the NSA to examine the opinions of support group members regarding the field of speech-language pathology and stuttering treatment options. Results indicate that NSA members hold a variety of opinions, both positive and negative, about the resources available to them. Findings highlight a number of ways in which SLPs can work with stuttering support groups, both to learn more about the needs of people who stutter and also to provide needed information about treatment options that are available for people who stutter. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to describe (1) the role of support groups in stuttering treatment; (2) the people who are members of the NSA; and (3) their opinions about various issues related to stuttering and its treatment.     

Self-control,parental crime,and discipline across three generations

The objective of this study is to examine the relationships between self-control, parental crime, and use of discipline across three generations. Data spanning 30 years from the National Longitudinal Survey of Youth, are analyzed using Structural Equation Modeling. This study focuses on whether different types of discipline used by parents predict the self-control of each successive generation. We also examine whether self-control and criminal activities of parents are predictive of parenting and resulting self-control of children. We find that discipline has a weak relationship to self-control but that parental crime and self-control do relate to the self-control of later generations.     

Magnitude-estimation scaling of speech intelligibility: effects of listeners' experience and semantic-syntactic context

Fifteen speech-language pathologists with extensive experience judging speakers' intelligibility and 15 control subjects with no such previous experience provided magnitude-estimation responses for two sets of nine audiotaped speech samples. These samples were three utterances composed of a group of 17 words that contained all the consonant phonemes of English. These words were arranged to form a set of either meaningful or nonsense utterances. Nine separate versions of both the meaningful and nonsense utterances were created by systematically increasing the number of phonemes produced incorrectly on each of the nine recordings. The analysis indicated no significant difference between the magnitude-estimation scaling responses of experienced and inexperienced listeners. A significant over-all difference was found for listeners' responses to meaningful versus nonsense utterances. The advantages of magnitude-estimation scaling as a measure of speakers' intelligibility are discussed.     

On the Structure of Bioethics as a Pragmatic Discipline

This article analyzes certain aspects of the structure of bioethics as a discipline. It begins by arguing that bioethics is an academic discipline of a pragmatic nature and then puts forward a classification of the main problems, issues, and concerns in bioethics, using this classification as a way to outline the limits and framework of the field. Pushing further, it contends that comprehensive treatment of any topic in bioethics requires that three normative dimensions (the ethical, the moral, and the political) be taken into account. It concludes that the classification of the issues and analysis of each issue's normative dimensions can provide valuable contributions toward understanding the sui generis structure of bioethics as a pragmatic discipline.     

A survey of communicative disorders students' attitudes toward stuttering

Cooper's (1975) Clinician Attitudes Toward Stuttering (CATS) inventories were conpleted by 1,902 speech-language pathology and audiology students from 33 universities, each in a different state. The majority of respondents perceived stutterers as having psychosocial problems and believed that client and parental counseling were essential aspects of treatment. These views were relatively unaffected by student training and clinical exposure. In addition, most of the assumptions of Johnson's diagnosogenic theory of stuttering were held by the majority of the students surveyed. Most of the respondents believed that stuttering was difficult to modify and that speech clinicians were neither adept nor comfortable treating stutterers. These latter attitudes were significantly affected by training, i.e., the more advanced the students' training, the more pessimistic their views on clinician competence. Other professional attitudes and the effect of training on them are also discussed.