A phase II trial of the Westmead Program: Syllable-timed speech treatment for pre-school children who stutter

Abstract

This report presents a Phase II clinical trial of a syllable-timed speech treatment for early stuttering known as The Westmead Program. Of 17 children recruited, eight children aged between 3-4.5 years (mean 3 years 8 months) completed the treatment. The primary outcome measure was percentage syllables stuttered (%SS) measured from independent, blinded speech assessments of beyond-clinic audio recordings. Secondary outcomes were measures of treatment time, speech quality, and parent severity ratings. Dropouts occurred, but at a similar rate to other clinical trials of this nature. For the eight children who completed the treatment, mean pre-treatment stuttering was 6.0%SS and at 12-months post-Stage 2 entry stuttering had decreased to 0.2%SS, representing a mean stuttering reduction of 96%. A large effect size was obtained with a mean of 8.0 clinical hours required for these children to reach Stage 2. Independent listeners judged the everyday speech of all children to be not unnatural in any way. Stuttering reductions were attained with clinical efficiency and simplicity compared to other early stuttering interventions. Further clinical trials development of the treatment is warranted.

The state of the art in non‐pharmacological interventions for developmental stuttering. Part 1: a systematic review of effectiveness

“…The final papers in this group (Andrews et al 2012, Trajkovski et al 2011) examined interventions for preschool and school aged children termed Syllable Timed et al, 2012 Before and after Lower Australia Adults, N = 20 Berkowitz et al, 1994 Before and after Higher USA School age, N = 8 Blomgren et al, 2005 Before and after Lower USA Adults, N = 19 Boberg and Kully, 1994 Before and after Higher USA Adolescents and adults, N = 49 Huinck et al, 2006 Before and after Lower Netherlands Adults, N = 25 Irani et al, 2012 Mixed method Higher USA Adults, N = 7 Laiho and Klippi, 2007 Before and after Higher Finland School age, N = 21 Langevin and Boberg, 1993 Before and after Higher Canada Adults, N = 10 Langevin and Boberg, 1996 Before and after Lower Canada Adults, N = 4 Langevin et al, 2006 Before and after Lower Canada and Netherlands Adults, N = 25 Langevin et al, 2010 Before and after Lower Canada Adults, N = 17 Lawson et al, 1993 Before and after Higher UK Adolescents, N = 15 and 19 Nilsen and Ramberg, 1999 Before and after Higher Sweden Adolescents, N = 13 Rosenberger, 2007 Before and after Higher Germany School-age children and adolescents, N = 19 and 15 Smits- Bandstra and Yovetitch, 2003 Before and after Higher Canada School age, N = 3 Stewart, 1996 Before and after Higher UK Adults, N = 12 Ward, 1992 Before and after Higher UK Unclear, N = 4 Speech (STS), and reported mean stuttering reductions of 96%SS (6%SS to 0.2%SS) at 12 months follow-up (ES = 1.8), and 14.4%SS to 6.7% (ES = 0.7). Data on self-reported severity, situation avoidance and quality of life confirmed these positive outcomes, however the authors noted considerable individual variation in response to the intervention.…”

After the RESTART trial: six guidelines for clinical trials of early stuttering intervention

“…), and one is conceptually and procedurally dissimilar (Trajkovski et al . ). Ideally, the RESTART trial will spur the development of more than two new treatments for children who begin to stutter.…”

“…Indeed, there are several treatment styles that are in early stages of empirical evolution. Some of these are conceptually and procedurally similar to the RESTART-DCM treatment explored with the RESTART trial (Millard et al 2008, Yaruss et al 2006, and one is conceptually and procedurally dissimilar (Trajkovski et al 2011). Ideally, the RESTART trial will spur the development of more than two new treatments for children who begin to stutter.…”

Theory and therapy in stuttering: A complex relationship

“…As referred to above in the description of the development of the P&A model, reducing the variability of contrastive syllabic stress is thought to be an active agent in prolonged speech and rhythmic speech, two of the most widely used fluency enhancing treatments for adults who stutter. Treatments based on rhythmic speech have also been developed recently for children who stutter (Andrews et al, 2012;Trajkowski et al, 2011) According to the P&A model, then, these changes can be seen as reducing the frequency with which the relevant features of spoken language trigger stuttering.…”