LPV Forum - Letter to Editor

Abstract

We have been asked to reply to the letter formulated by Dr. Robert Kroll concerning treatment efficacy research in the area of stuttering in general and to comment on the specific criticisms put forward regarding our study published in this journal in 1999 (4).The main objection expressed by Dr Kroll has to do with the 'lack of data pertaining to the actual fluency' (fluency counts, i.e., stuttering frequency). The reduced focus on audible stuttering is not a flaw in the design of the study. Rather, it is the result of a conscious choice of outcome measures founded in the philosophy of therapy. Consequently, we do not agree with Dr. Kroll that the philosophical issues can be separated from the study design.Our therapy program is influenced by the philosophy of non-avoidance and by thoughts and methods of Sheehan (5), Stromsta (6) and Van Riper (7) among others. The overall aim of the therapy is to guide the clients in finding a better way of coping with their stuttering problem, that is, develop their social and communication skills and learn how to stutter more fluently. The evaluation variables were stuttering severity, stuttering/communication problems, social skills and Locus of Control of Behaviour (3) all in accordance with the purpose of the therapy. The specific outcome measures chosen to reflect changes in these variables were assessed in four different ways: by an independent listener, by self-assessments of the subjects, and by the therapists and youth leaders. Conture (1, 2) stresses the need for a combination of subject-independent and subject-dependent measures of change in a) stuttering or stuttered speech, b) related attitudes and feelings and c) willingness to enter into and engage in various communication situations with various people.We agree with Dr. Kroll that there is a need for peer assessed, published studies of the effects of different stuttering therapy efforts and we welcome discussions regarding both the philosophy behind different therapy approaches and selected outcome methods. However, we are convinced that to focus on fluency alone is to simplify a complex, dynamic and multi-factorial phenomenon.