JCPSLP Vol 21 No 3 2019

2, and the Slow Response group required a mean of 94.2 ( SD 28.5) with a median of 92 weeks. The Rapid Response group showed a mean reduction of 25.5% ( SD 21.5%) of parent severity rating scores during weeks 1–4 of treatment, and the Slow Response group showed a mean reduction of –1.3% ( SD 18.6%). The mean number of years that the clinicians had worked at the Stuttering Unit with clients who stuttered did not differ between the two groups of children: 4.6 years (range 0–8 years for the Rapid Response group, and 0–9 years for the Slow Response group). Based on data file entries at assessment, stuttering type was coded as repeated movements only or repeated movements plus either fixed postures or extraneous behaviours. One child’s file in the rapid response group was missing assessment details, so it could not be coded for stutter type. The waiting time for treatment of the 20 participating children averaged 30.4 weeks (range 10–58 weeks, SD = 11.6). During the Lidcombe Program treatment process, weekly clinic appointments were scheduled for parents to attend the clinic with their child. At each clinic visit a sample of the child’s speech was measured for stuttering severity by both the SLP and child’s parent. At most clinic visits the SLP also measured %SS. Parents assigned daily stuttering severity ratings to their children’s speech using the same 10-point scale as the SLP. Guided by results of quantitative and qualitative studies of the Lidcombe Program treatment process (Goodhue, Onslow, Quine, O’Brian, & Hearne, 2010; Guitar et al., 2015; Hayhow, 2009; Jones et al., 2000; Kingston et al., 2003; Koushik et al., 2011; O’Brian et al., 2013; Rousseau et al., 2007 ), data files of the 20 participating children were audited for the information in the files that was available for the following categories: assessment data, treatment responsiveness, case details, Stage 2 data, and treatment process issues. For treatment process issues, file entries were coded according to whether there were any notes of child-related issues that were interfering with the treatment process. Examples of notes in file entries were: a child refusing to participate in practice session activities, a child being distractible and having difficulty attending for the entire practice session, and a child being “bossy” and taking control of the practice session conversation. File entries were also coded in relation to whether parent skill was interfering with the treatment process. Examples of notes in file entries were: slowness to learn treatment procedures, poor confidence with the treatment, anxiety about the treatment, poor problem-solving abilities, accurate delivery of verbal contingencies in accordance with clinician recommendations, and difficulty identifying stuttering moments. File entries were coded by the first author and confirmed by the second author. Ambiguous or discrepant codings were resolved through discussion. Results Demographic information This research method revealed nothing unusual about the demographics of the Slow Response group or the Rapid Response group. Figure 1 shows that the gender of the children, reported family history of stuttering, age at the start of treatment, and onset-to treatment interval were approximately equivalent.

8

2

5

50.2

13.8

Slow

Rapid

7

3

8

52.1

13.9

treatment start

Girls

Boys

Age at

Onset-

Family

history

interval

treatment

Figure 1. Demographic information

Stuttering severity Figure 2 shows that this analysis consistently revealed differences between the Slow Response group and the Rapid Response group in terms of SLP and parent assessment. Severity ratings and %SS scores given by SLPs and parents at assessment and at the first treatment session were consistently lower for the Rapid Response group compared with the Slow Response group. At assessment, more children in the Rapid Response group had stuttering comprising repeated movements without any fixed postures or superfluous behaviours. More children in the Slow Response group had stuttering moments including fixed postures and/or superfluous behaviours. Exploratory data analyses confirmed the impression conveyed by Figure 2. T -tests suggested effects for clinician severity rating at assessment ( p = 0.04), average

5.5

20.6

8

5.1

5.9

Slow

Rapid

3.8

6.1

2

3.0

2.4

SR at

Family

history

%SS at assessment

week 1

assessment

Clinician %SS

at assessment

Stuttering type: only

repeated movements

Figure 2: Stuttering severity SR = severity rating, %SS = percentage syllables stuttered, FP = fixed postures, EB = extraneous behaviours NOTE: Since conducting this study, the severity rating (SR) scale changed from 1–10 to 0–9 (Bridgman, Onslow, O’Brian, Block, & Jones, 2011). Consequently, the treatment targets changed from SR 1–2 to SR 0–1, respectively. This graph describes treatment with the former targets.

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JCPSLP Volume 21, Number 3 2019

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