JCPSLP Vol 21 No 2 2019 DIGITAL Edition

Measurement and evaluation in practice

Evaluating the treatment of co-occurring stuttering and speech sound disorder Parents’ perspectives Rachael Unicomb, Sally Hewat and Elisabeth Harrison

Previous literature has explored parents’ perceptions of their involvement in treatment for stuttering and/or speech sound disorder (SSD) in isolation. However, no studies have documented these perceptions when children have co-occurring disorders. The aim of this study was to explore parents’ experiences of their involvement in their children’s treatment for co-occurring stuttering and SSD. Semi- structured interviews were conducted with four parents whose children had undergone concurrent, direct treatment for co-occurring stuttering and SSD in a previous research trial. Interviews were conducted around 40 months after entry into the original trial. Data were analysed using thematic analysis. Thematic analysis identified three core themes. The data revealed important clinical parents around their roles in treatment, and barriers and facilitators to this form of service delivery. Identified facilitators included structured clinic and home sessions, tangible reward systems, and parental/child motivation. Parents’ experiences were largely positive, and evaluation of caregiver perspectives allows more holistic investigation of treatment approaches. T wo communication disorders that are commonly reported to co-occur are stuttering and speech sound disorder (SSD). The co-occurrence of these two communication disorders has been reported, variously, between 16% and 46% (Unicomb, 2015). While effective treatments are available for each communication disorder in isolation (Baker & McLeod, 2011; Reilly et al., 2017), there are only two research reports of treatment outcomes for participants with the co-occurring disorders (Conture, Louko, & Edwards, 1993; Unicomb, Hewat, Spencer, & Harrison, 2017). Conture et al. (1993) conducted a pilot study on eight children, investigating the effectiveness of treating stuttering considerations, including provision of accessible information and support to

and SSD simultaneously, using predominantly indirect treatment approaches (i.e., those that manipulate the child’s environment and/or provide models for optimal speech output). Participants were allocated into two groups. Group 1 consisted of four children (mean age 69.7 months) with a comorbid diagnosis of stuttering and SSD, while group 2 comprised four children (mean age 71.5 months) who stuttered in isolation. Treatment was delivered weekly, in a group setting for 45 minutes during semester time of a university year. For both groups, stuttering treatment involved use of indirect strategies such as modelling speech output at a slower rate and with minimal physical tension. For the group with the dual diagnosis, treatment for SSD involved strategies such as modelling and auditory bombardment. In this group, treatment goals for both stuttering and SSD were delivered simultaneously within the same activities. All parents of children involved in the research received education and training sessions that ran simultaneously with the children’s group sessions. Three of the children in the stuttering-only group had a reduction in the frequency of their stuttering levels, while one child increased in frequency by 42%. Contrastingly, only two children in the group with the dual diagnosis exhibited decreased stuttering frequency. The other two children in this group had increased stuttering levels. On average, the children in the dual diagnosis group had an average reduction in the use of targeted phonological processes of 25%; however, three of the four children had an increase in the use of some targeted processes. Contemporary best practice treatments for SSD and stuttering in isolation involve the use of direct treatment approaches (i.e., treatments that aim to directly modify speech output). Unicomb et al. (2017) used evidence- based, direct treatment approaches for stuttering and SSD. The five participants in this study were delivered the Lidcombe Program as manualised (Packman et al., 2011) 1 to treat their stuttering, and treatment for SSD was individualised based on analysis of each child’s sound system. Treatment for both disorders was delivered concurrently (i.e., treatment for both disorders occurred at the same time, with treatment goals addressed discretely within each weekly clinic visit). The children in this study all exhibited statistically significant improvements in outcomes for SSD from pre- to post-treatment (12 months post). Four of the five children reached Lidcombe Program Stage 2 in between 14 and 22 clinic visits, consistent with benchmark data (Onslow et al., 2017). A shared feature across the

KEYWORDS CONCURRENT TREATMENT CO-OCCURRING DISORDERS HOME PRACTICE

LIDCOMBE PROGRAM PARENTS’

THIS ARTICLE HAS BEEN PEER- REVIEWED PERSPECTIVES SPEECH SOUND DISORDER (SSD)

Rachael Unicomb (top) and Sally Hewat

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JCPSLP Volume 21, Number 2 2019

Journal of Clinical Practice in Speech-Language Pathology