Marilyn Langevin

The Peer Attitudes Toward Children who Stutter scale: Reliability, known groups validity, and negativity of elementary school-age children's attitudes

UNLABELLED Psychometric properties of the Peer Attitudes Toward Children who Stutter (PATCS) scale (Langevin, M., & Hagler, P. (2004). Development of a scale to measure peer attitudes toward children who stutter. In A.K. Bothe (Ed.), Evidence-based treatment of stuttering: empirical bases and clinical applications (pp. 139-171). Mahwah, NJ: Lawrence Erlbaum Associates.) and the extent to which peer attitudes are negative were re-examined. Results show that internal consistency was .97 and test-retest reliability was .85. In a known groups analysis participants who had contact with someone who stutters had statistically significant higher mean scores (more positive attitudes) than those who had not had contact. Nonsignificant findings for gender and grade call into question the usefulness of these variables as discriminators in future tests of known groups validity of peer attitudes toward children who stutter. Approximately one-fifth of participants had PATCS scores that were somewhat to very negative. These findings support calls for school-based education about stuttering. EDUCATIONAL OBJECTIVES The reader will be able to: (1) summarize the social impacts of stuttering on school-age children who stutter, (2) describe the known groups method to test construct validity, (3) evaluate the psychometric properties of the Peer Attitudes Toward Children who Stutter scale, and (4) provide information about the proportion of students who appear to hold negative attitudes toward children who stutter.

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.

The Peer Attitudes Toward Children who Stutter (PATCS) scale: an evaluation of validity, reliability and the negativity of attitudes

BACKGROUND Persistent calls for school-based education about stuttering necessitate a better understanding of peer attitudes toward children who stutter and a means to measure outcomes of such educational interventions. Langevin and Hagler in 2004 developed the Peer Attitudes Toward Children who Stutter scale (PATCS) to address these needs and gave preliminary evidence of reliability and construct validity. AIMS To examine further the psychometric properties of PATCS and to examine the negativity of attitudes. METHODS & PROCEDURES PATCS was administered to 760 Canadian children in grades 3-6. Measures included reliability, a confirmatory factor analysis (CFA), a known groups analysis, convergent validity with the Pro-Victim Scale of Rigby and Slee, and the negativity of attitudes. OUTCOMES & RESULTS PATCS appears to tap a second-order general attitude factor and three first-order factors representing the constructs of Positive Social Distance (PSD), Social Pressure (SP), and Verbal Interaction (VI). In the known groups analysis, participants who had contact with someone who stutters had higher scores (more positive attitudes) than those who had not, and girls had higher scores than boys. PATCS correlated moderately (0.43, p<0.01) with the Pro-Victim scale. Finally, one-fifth (21.7%) of participants had scores that were somewhat to very negative. CONCLUSIONS & IMPLICATIONS Results provide evidence of the validity and reliability of PATCS and confirm the need for school-based education about stuttering. The PSD and SP factors suggest that education include discussions about (1) similarities and differences among children who do and do not stutter in order to increase acceptance, and (2) making personal choices and handling peer pressure in thinking about children who stutter. The VI factor suggests that open discussion about stuttering may alleviate frustration experienced by listeners and provide the opportunity to give strategies for responding appropriately. Results also suggest that education involve contact with a person who stutters.

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.

Results of intensive stuttering therapy with adults who clutter and stutter

The purpose of this investigation was to report on the identification of adult clients who clutter and stutter, evaluate their response to a stuttering therapy program, and determine if speech measures typically used in evaluating therapy outcome are sufficiently sensitive indicators of change for clients who clutter and stutter. Results suggest that cluttering-stuttering subjects had a very positive response to stuttering therapy, but greater improvements may have been achieved with additional therapy time and expanded therapy goals. Results also indicate that pretreatment and posttreatment measures of articulatory rate may be a more sensitive measure of change for cluttering-stuttering clients.

Stuttering treatment for a school-age child with Down syndrome: a descriptive case report.

BACKGROUND Little is known about optimal treatment approaches and stuttering treatment outcomes for children with Down syndrome. AIMS AND METHOD The purpose of this study was to investigate outcomes for a child with Down syndrome who received a combination of fluency shaping therapy and parent delivered contingencies for normally fluent speech, prolonged speech, and stuttered speech. RESULTS In-clinic speech measures obtained at post-treatment and at 4 months follow-up reflected improvements in fluency of 89.0% and 98.6%, respectively. The participants beyond-clinic follow-up sample reflected an improvement of 95.5%. Following treatment, the participant demonstrated improved self-confidence, self-esteem, and improved participation and functioning at school. CONCLUSIONS Findings suggest that fluency shaping with parental contingencies may be a viable treatment approach to reduce stuttering in children with Down syndrome. Future research using an experimental research design is warranted. EDUCATIONAL OBJECTIVES Readers will be able to describe (a) prevalence estimates of stuttering in individuals with Down syndrome, (b) the main components of a fluency shaping program for a child with Down syndrome who stutters and has co-occurring speech and language delays, and (c) speech and parent-, teacher-, and self-report treatment outcomes.

Using critical realistic evaluation to support translation of research into clinical practice

Abstract A challenge that speech-language pathologists (SLPs) face is the translation of research into clinical practice. While randomised controlled trials (RCTs) are often touted as the “gold standard” of efficacy research, much valuable information is lost through the process; RCTs by nature are designed to wash out individual client factors and contexts that might influence the outcome in order to present the “true” impact of the intervention. However, in the area of behavioural interventions, the interaction of client factors and contexts with the treatment agent can substantially influence the outcome. This paper provides an overview of the theoretical background and methods involved in critical realistic evaluation (CRE) and discusses its current and potential application to speech-language pathology. CRE is based on the premise that a behavioural intervention cannot be evaluated without considering the context in which it was provided. While the ways in which contextual aspects and treatment mechanisms interact may seem endless, CRE methodology attempts to operationalise them into hypotheses to be empirically tested. Research based on these principles has the potential to support clinical translation of research outcomes and reduce the costs of unsuccessful treatment attempts for SLPs, clients and the service provider.

Exploring how preschoolers who stutter use spoken language during free play: A feasibility study

Abstract Purpose: Play is critically important for the healthy development of children. This study explored the viability of a methodology to investigate how preschoolers who stutter use language in play with peers. Method: Transcripts of peer-directed utterances of four preschoolers who stutter and four matched non-stuttering children during free play were analysed for measures of verbal output (numbers of utterances and words), length and complexity of utterances (mean length of communication unit and syntactic complexity), and lexical diversity (number of different words, type token ratio and vocd). Result: Viable speech samples were obtained. Verbal output scores of two children who stutter were the same or higher than their matched controls whereas mean length of communication unit and syntactic complexity scores for three children who stutter were lower than their matched controls. In 22 of the 24 comparisons across number of different words, type token ratio, and vocd, scores of children who stutter were the same or higher than their matched controls. Conclusion: Interpretation of data is limited by the small sample size and lack of standardised testing. However, results indicate that the methodology has promise for future research into the way preschoolers who stutter use spoken language during play and the quality of their play.