Differential diagnosis of cluttering and stuttering in Bulgaria

Fifteen stutterers, primarily children, who visited the Medical Pedagogical Department at the University of Blagoevgrad were evaluated for a variety of criteria used in Bulgaria to differentiate cluttering, stuttering, and mixed cluttering and stuttering. The same battery of tests was administered to all subjects. Based on these criteria, five subjects were diagnosed as clutterers, six as stutterers, and four as mixed. Daly's (1992–1993) Checklist for Possible Cluttering, Experimental Edition was also utilized to classify the subjects. Differences between the differential diagnostic criteria used by Bulgarian logopedists and other authors are discussed.     

Results of intensive stuttering therapy with adults who clutter and stutter

The purpose of this investigation was to report on the identification of adult clients who clutter and stutter, evaluate their response to a stuttering therapy program, and determine if speech measures typically used in evaluating therapy outcome are sufficiently sensitive indicators of change for clients who clutter and stutter. Results suggest that cluttering-stuttering subjects had a very positive response to stuttering therapy, but greater improvements may have been achieved with additional therapy time and expanded therapy goals. Results also indicate that pretreatment and posttreatment measures of articulatory rate may be a more sensitive measure of change for cluttering-stuttering clients.     

Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering

PurposeRecent research has identified approximately half of children who stutter present with self-regulation challenges. These manifest in elevated inattentive and/or impulsive behaviours, aligned with attention deficit hyperactivity disorder (ADHD) symptoms. These symptoms have been found to influence the child’s responsiveness to their stuttering treatment, and may exacerbate the psychosocial consequences of stuttering for them and their families. Early stuttering intervention identifies parents as key agents of change in the management of their children’s stuttering. This study sought feedback from parents regarding their experiences with an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering, addressing the child’s self-regulation challenges.MethodEight parents of children who stutter who had co-occurring self-regulation challenges completed the integrated program. This incorporated the Triple P--Positive Parenting Program adapted for the developmental stuttering population, and the Curtin University Stuttering Program (CUSP). Semi-structured qualitative interviews were conducted to capture parents’ reflections on, and experiences with, the integrated program.ResultsThematic analysis identified several major themes regarding the parents’ experiences with the integrated program: emotional impact on parents, child self-regulation, link between stuttering and behaviour, parent self-regulation, impact on family dynamics, and overall positive perceptions of the integrated program. All of the parents indicated they would recommend the program to future parents of children who stutter.ConclusionThis study provides insights into parents’ perceptions regarding an integrated intervention approach for early stuttering and behavior management. It also indicates how adopting a holistic approach to stuttering intervention is positive and has social validity.     

Systematic slowed speech: a new treatment for stuttering.

The purpose of the present study was to determine the effectiveness of a treatment for stuttering based on systematic slowing of speech and anxiety management. Subjects were six stutterers between the ages of 21 and 36. Assessment tasks consisted of recorded conversations with strangers, reading and telephone conversations with strangers, conducted pre- and post-treatment and once a month following treatment for six months. Participants were taught to read and speak progressively at 50, 70 and 90 words a minute over a two week period and received anxiety management training to facilitate maintenance of slowed speech outside of treatment sessions. The results indicated a significant treatment effect for both reading and conversation that was maintained for six months. The telephone task, which was used as a measure of generalization, improved significantly but did not maintain over time.     

Breathing retraining, exposure and a combination of both, in the treatment of panic disorder with agoraphobia

The present study investigates the differential effectiveness of three treatment packages for agoraphobia. Patients suffering from panic disorder with agoraphobia (DSM-III-R) received one of three treatments: Breathing Retraining with Cognitive Restructuring (BRCR), graded self-exposure in vivo (EXP), or a combination of BRCR and EXP. Treatments consisted of 8 sessions. Assessments consisted of self-report measures for panic, phobic anxiety and avoidance, depression, general anxiety, somatic complaints and fear of bodily sensations, and of two respiratory measures (respiratory rate and alveolar pCO₂).

The treatments resulted in a reduction in symptomatology on all self-report measures, except panic frequency, and in a decrease in respiratory rate. There was no evidence for a differential efficacy for any of the treatments on any of the variables. Contrary to expectation, and at odds with findings from earlier studies, BRCR had no significant effect on panic frequency. A detailed comparison of sample characteristics of patients in our study and previous studies, did not yield insight into possible causes for the failure to replicate earlier results. The limited effectiveness of breathing retraining in reducing panic, as observed in the present study, leads us to conclude that the role of hyperventilation in panic is less important than previously thought.     

Haloperidol and the treatment of stuttering

Reports of the use of haloperidol in the treatment of stuttering show that it does reduce the severity of the disorder in some subjects. Two trials of the drug in adult stutterers confirmed this effect in 17% of the 52 subjects tested. Side effects —principally drowsiness—caused many subjects to discontinue taking the drug and only one subject voluntarily continued on haloperidol after the trial concluded. It is concluded that haloperidol, a potentially simple remedy, is not the treatment of choice in adults who stutter.     

Long-term stability of cognitive behavioral therapy effects for panic disorder with agoraphobia: A two-year follow-up study

Objective

Cognitive-behavioral therapy (CBT) aims to help patients establish new behaviors that will be maintained and adapted to the demands of new situations. The long-term outcomes are therefore crucial in testing the durability of CBT.

Method

A two-year follow-up assessment was undertaken on a subsample of n = 146 PD/AG patients from a multicenter randomized controlled trial. Treatment consisted of two variations of CBT: exposure in situ in the presence of the therapist (T+) or on their own following therapist preparation (T−).

Results

Both variations of CBT had high response rates and, overall, maintained the level of symptomatology observed at post-treatment with high levels of clinical significance. Effect sizes 24 months following treatment were somewhat lower than at the 6-month follow up. Once patients reached responder status, they generally tended to remain responders at subsequent assessments. Differences were observed for patients that obtained additional treatment during the follow-up period. Expert opinion and subjective appraisal of treatment outcome differed. No robust baseline predictors of 2-year outcome were observed.

Conclusion

Most patients maintain clinically meaningful changes two years following treatment across multiple outcome measures. Approximately 1/3 of patients continued to experience meaningful residual problems.     

Experimental treatment of early stuttering: a preliminary study

This pilot study compared two treatments for stuttering in preschool-age children. Thirty children were randomly assigned to either a Lidcombe Program (LP) treatment or a Demands and Capacities Model (DCM) treatment. Stuttering frequencies and severity ratings were obtained immediately before and after treatment (12 weeks). The stuttering frequencies and severity ratings significantly decreased for both treatment groups. No differences between groups were found. Parents of children in both groups were cooperative in many respects, and there were no differences between them on scales that measured their satisfaction with the two treatments. The findings suggest that randomized controlled trials of LP versus DCM treatments are feasible, and they underline the need for experimental analyses of the two treatments. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe the principles and methods of Lidcombe treatment for early stuttering; (2) delineate principles and methods of Demands and Capacities Model treatment; and (3) summarize results of an investigation that compared these programs' relative effects in a pilot study.     

Predictors of treatment outcome for youth receiving intensive residential treatment for obsessive–compulsive disorder (OCD)

ABSTRACT

Little is known about the predictors of outcome from intensive residential treatment of OCD. This study aimed to examine age, gender, and baseline OCD severity, as well as measures of comorbid anxiety and depressive, internalizing/externalizing, and inattention symptoms, as predictors of treatment outcome in adolescents receiving intensive residential treatment for OCD.

The sample comprised 314 adolescents aged 13–17 years with treatment-resistant OCD and a Children’s Yale–Brown Obsessive–Compulsive Scale Self-Report (CY-BOCS-SR) total score ≥16. Bivariate and multiple regression models were used to evaluate the predictors of continuous OCD severity outcome and treatment response.

Results of the bivariate regression analyses of predictors demonstrated that length of treatment, pre-treatment OCD severity, and symptoms of anxiety and depression significantly predicted post-treatment OCD severity, while only symptoms of depression and anxiety predicted treatment response. When including all predictors in the same model, only baseline OCD severity remained a significant predictor of post-treatment OCD severity, and none of the assessed variables significantly predicted treatment response.

Results indicate that low pre-treatment OCD severity predicts lower OCD severity following treatment, although it did not predict treatment response.     

Bipolar disorder and family communication: effects of a psychoeducational treatment program

Family psychoeducational programs are efficacious adjuncts to pharmacotherapy for patients with schizophrenic and bipolar disorders, but little is known about what these programs change about families. The authors assessed changes in face-to-face interactional behavior over 1 year among families of bipolar patients who received a 9-month family-focused psychoeducational therapy (FFT; n = 22) or crisis management with naturalistic follow-up (CMNF; n = 22), both administered with maintenance pharmacotherapy. Members of families who received FFT showed more positive nonverbal interactional behavior during a 1-year posttreatment problem-solving assessment than families who received CMNF, although no corresponding decreases were seen in negative interactional behaviors. The positive effect of family treatment on patients' symptom trajectories over 1 year was partially mediated by increases in patients' positive nonverbal interactional behaviors during this same interval.     

Altered auditory feedback and the treatment of stuttering: a review

Several authors have suggested that devices delivering altered auditory feedback (AAF) may be a viable treatment for adults and children who stutter. This paper reviews published, peer reviewed journal papers from the past 10 years that investigate the effect of AAF during different speaking conditions, tasks and situations. A review of that literature indicates that considerable experimental evidence and limited Phase 1 treatment outcome evidence has been accumulated about the effect of AAF on the speech of people who stutter. However, critical knowledge about the effect of AAF during conversational speech and in everyday speaking situations is missing. Knowledge about how to determine the correct levels of AAF for individuals, and the characteristics of those likely to benefit from AAF, also needs to be established. At present there is no reason to accept a recent suggestion that AAF devices would be a defensible clinical option for children. In general device development and availability has occurred at a faster pace than clinical trials research. EDUCATIONAL OBJECTIVES: After reading this paper readers should be able to: (1) describe what altered auditory feedback is and common ways the speech signal is altered in stuttering; (2) describe the effects of AAF on the speech of adults who stutter; (3) provide a critical analysis of the literature in the area of AAF and stuttering.     

The impact of an 8-day intensive treatment for adolescent panic disorder and agoraphobia on comorbid diagnoses

Previous research findings have shown positive effects of cognitive-behavioral therapy for primary anxiety disorders as well as for nonprimary, co-occurring anxiety disorders. In this study, we analyzed data from an existing randomized controlled trial of intensive treatment for panic disorder with or without agoraphobia (PDA) to examine the effects of the treatment on comorbid psychiatric diagnoses. The overall frequency and severity of aggregated comorbid diagnoses decreased in a group of adolescents who received an 8-day treatment for PDA. Results suggest that an 8-day treatment for PDA can alleviate the symptoms of some specific comorbid clinical diagnoses; in particular specific phobias, generalized anxiety disorder, and social phobia. These findings suggest that an intensive treatment for PDA is associated with reductions in comorbid symptoms even though disorders other than PDA are not specific treatment targets.     

Genetic and environmental effects on stuttering: a twin study from Finland

The present study explored the prevalence of self-reported stuttering in a Finnish twin population and examined the extent to which the variance in liability to stuttering was attributable to genetic and environmental effects. We analyzed data of 1728 Finnish twins, born between 1961 and 1989. The participants were asked to complete a questionnaire on speech, language, and voice. In two of the questions they were asked to report the occurrence of childhood and present stuttering of their own and that of their sibling. According to the results, 2.3% (52) of the participants were reported to have stuttered as children and 28.8% of them (15) were reported to continue to stutter in adulthood. There was no significant gender difference in the prevalence of stuttering in either childhood or adulthood. For childhood stuttering, the tetrachoric correlation was higher for monozygotic pairs (r=.74) than for dizygotic pairs (r=.27). By means of structural equation modeling it was found that 82% of the variance in liability to childhood stuttering was attributable to additive genetic effects, with the remaining 18% due to non-shared environmental effects. In conclusion, the results of the present study confirm findings from prior studies and support a strong genetic and only a moderate non-shared environmental effect on stuttering. Potential small differences in the prevalence of stuttering in different populations are suggested by our data. EDUCATIONAL OBJECTIVES: The reader will be able to recognize the contribution of genetic and environmental effects on stuttering.     

Adjunctive psychotherapy for bipolar disorder: effects of changing treatment modality

In a randomized, controlled trial, the authors studied an adjunctive, individual psychotherapy, interpersonal and social rhythm therapy (IPSRT) for bipolar disorder. After stabilizing participants with episode appropriate pharmacotherapy and either IPSRT or intensive clinical management (CM), participants were reassigned to IPSRT or CM in conjunction with pharmacotherapy for 2 years of preventative treatment. Early results (n = 82) suggest that altering participants' treatment assignment at entry to the preventative phase is related to risk of recurrence. Participants remaining in the same treatment for both acute and preventative phases had lower rates of recurrence (< 20% vs. > 40%) and levels of symptomatology over the subsequent 52 weeks than those reassigned to the alternate modality. This finding, consistent with the authors' philosophy that bipolar patients benefit from stable routines, suggests that disruptions in the psychosocial treatment plan contribute to worse outcomes.