Deborah Kully

An investigation of interclinic agreement in the identification of fluent and stuttered syllables

Abstract Experienced clinicians in several treatment centers were provided with audio-recorded speech samples from eight stutterers and two normal speakers. They were asked to 1) count the total number of syllables in each sample, 2) count the number of stuttered syllables in each sample, and 3) rate each speaker on a seven-point stuttering severity scale. There were substantial interclinic discrepancies in all three measures. The implications of these results are discussed, and suggestions to improve interclinic agreement are provided.

Five-Year Longitudinal Treatment Outcomes of the ISTAR Comprehensive Stuttering Program.

UNLABELLED Replicated evidence of satisfactory 1- and 2-year post-treatment outcomes has been reported for the Comprehensive Stuttering Program (CSP). However, little is known about longer term outcomes of the CSP. Yearly follow-up measures were obtained from 18 participants for 5 consecutive years. At 5-year follow-up, participants were maintaining clinically and statistically significant reductions in stuttering and increases in rates of speech relative to pre-treatment measures. Standardized effect sizes were large. There were no significant differences among the immediate post-treatment and five follow-up measures, indicating that speech gains achieved by the end of the treatment program were stable over the 5-year follow-up period. Insufficient return rates for self-report data for the third to fifth follow-up measurement occasions prohibited analyzing these data. However, non-significant differences among the immediate post-treatment and two follow-up measures indicated that improvements achieved by the end of treatment in speech-related confidence, and perceptions of struggle, avoidance, and expectancy to stutter were stable over the 2-year follow-up period. Significant differences among the speech-related communication attitudes scores indicated that improvements in attitudes made at the end of the treatment program were less stable. Taken together, these results provide further and longer term evidence of the effectiveness of the CSP. EDUCATIONAL OBJECTIVES Readers will be able to: (1) describe the main components of the Comprehensive Stuttering Program (2) describe a methodology for determining clinically meaningful maintenance of stuttering reductions, and (3) describe the durability and stability of improvements in speech and self-report measures across time.

Evidence-based treatment of stuttering: III. Evidence-based practice in a clinical setting

UNLABELLED At the heart of evidence-based practice in stuttering treatment are four issues: (1) the collection of data to inform treatment; (2) the long standing concern with maintenance of treatment gains; (3) the need to demonstrate accountability to clients, payers and our profession as service providers; and (4) the desire to advance theoretical knowledge. This article addresses the first three of these issues from a practical point of view, illustrating how data collection for stuttering treatment outcome research in a clinical setting is intimately blended with that required for clinical purposes and providing an example of a process of evaluating data for clinical and research purposes. EDUCATIONAL OBJECTIVES The reader will learn about and be able to (1) differentiate between treatment outcome and treatment efficacy research, (2) describe models for integrating data collection for treatment outcome and clinical purposes, and (3) utilize guidelines for treatment efficacy that are applicable to outcome research to evaluate data for use in treatment outcome studies and to design outcome studies.

Post-treatment speech naturalness of Comprehensive Stuttering Program clients and differences in ratings among listener groups

UNLABELLED The purposes of this study were to investigate naturalness of the post-treatment speech of Comprehensive Stuttering Program (CSP) clients and differences in naturalness ratings by three listener groups. Listeners were 21 student speech-language pathologists, 9 community members, and 15 listeners who stutter. Listeners rated perceptually fluent speech samples of CSP clients obtained immediately post-treatment (Post) and at 5 years follow-up (F5), and speech samples of matched typically fluent (TF) speakers. A 9-point interval rating scale was used. A 3 (listener group)x2 (time)x2 (speaker) mixed ANOVA was used to test for differences among mean ratings. The difference between CSP Post and F5 mean ratings was statistically significant. The F5 mean rating was within the range reported for typically fluent speakers. Student speech-language pathologists were found to be less critical than community members and listeners who stutter in rating naturalness; however, there were no significant differences in ratings made by community members and listeners who stutter. Results indicate that the naturalness of post-treatment speech of CSP clients improves in the post-treatment period and that it is possible for clients to achieve levels of naturalness that appear to be acceptable to adults who stutter and that are within the range of naturalness ratings given to typically fluent speakers. EDUCATIONAL OBJECTIVES Readers will be able to (a) summarize key findings of studies that have investigated naturalness ratings, and (b) interpret the naturalness ratings of Comprehensive Stuttering Program speaker samples and the ratings made by the three listener groups in this study.