Speech Pathology Australia Professional Development Event: Paediatric Fluency: What to do when?

Last week, I was fortunate to attend a one day seminar presented by Dr Kate Bridgman from La Trobe University. Kate has researched and practiced in the field of stuttering for many years and has developed particular expertise in delivering evidenced based therapies via tele-practice.

Kate provided a timely reminder about what our national professional association – Speech Pathology Australia – recommends in terms of treatment guidelines for Stuttering Management.  This 27 page document can be found on the SPA website in the Members section – see Clinical Guidelines.

Kate reiterated many key pieces of information:

Early intervention is key.  After 6 years of age, stuttering gradually becomes intractable as neural plasticity diminishes.  Stuttering that persists into adolescence and adulthood is associated with many unfortunate consequences – teasing and bullying, social anxiety, more limited education outcomes and more limited job opportunities.

Evidenced-based practice should guide our therapy provision.  For young children the best evidence remains with the Lidcombe Program.  The RESTART-DCM (a Demands and Capacities approach developed in the Netherlands) has shown good evidence in one study.  Other approaches are yet to meet a good grading for efficacy.

Dos and Donts for improving interaction with school age children who stutter were outlined.  I will detail these in another post soon.  A couple of examples are: Do – allow time for the child to say their entire message. Don’t – finish words or sentences for them.  Kate recommended the Michael Palin Centre’s website for school age handouts and information: http://www.stammeringcentre.org/files/SUGGESTIONS%20SHEETS.pdf

Anxiety.  Research has shown that being anxious doesn’t cause stuttering nor do such temperaments make a child more likely to stutter.  Research has also shown that young pre-school children are mostly not distressed by their stuttering.  Naturally, parents tend to be anxious and concerned about their child’s stuttering and parents often report reduced confidence and frustration related to stuttering in their preschool child.  When preschool children show distress about their stuttering, therapy needs to happen as soon as possible.

However, mostly, anxiety often develops later, in school age children with unresolved stuttering, as they become more aware of the stutter and teasing and bullying become more likely.

Therapy for primary school aged children.   The Lidcombe Program (LP) is often the first therapy to implement depending on previous therapy.  For 6-8 year olds, who have not ever had the LP treatment or have not had ‘correct’ LP therapy, the LP is the first option.  For 9-10 year olds the LP becomes less effective although it can help reduce stuttering to milder levels until the child is old enough to benefit from speech restructuring therapy such as the Camperdown Program.

Telehealth.  Kate outlined how internet based (real time) therapy works as well as face-to-face therapy.  This will become an increasingly popular option for busy families who are time poor and need to access good therapy in their own home and especially for families living in remote areas without access to experienced clinicians.