Michelle Lincoln

Prevalence of anxiety disorders among adults seeking speech therapy for stuttering

The present study explored the prevalence of anxiety disorders among adults seeking speech therapy for stuttering. Employing a matched case-control design, participants included 92 adults seeking treatment for stuttering, and 920 age- and gender-matched controls from the Australian National Survey of Mental Health and Well-being. A conditional logistic regression model was used to estimate odds ratios for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and International Classification of Diseases (ICD-10) anxiety disorders. Compared with matched controls, the stuttering group had six- to seven-fold increased odds of meeting a 12-month diagnosis of any DSM-IV or ICD-10 anxiety disorder. In terms of 12-month prevalence, they also had 16- to 34-fold increased odds of meeting criteria for DSM-IV or ICD-10 social phobia, four-fold increased odds of meeting criteria for DSM-IV generalized anxiety disorder, and six-fold increased odds of meeting criteria for ICD-10 panic disorder. Overall, stuttering appears to be associated with a dramatically heightened risk of a range of anxiety disorders.

The relationship between mental health disorders and treatment outcomes among adults who stutter

UNLABELLED The ability to reduce stuttering in everyday speaking situations is the core component of the management plan of many who stutter. However, the ability to maintain the benefits of speech-restructuring treatment is known to be compromised, with only around a third of clients achieving this [Craig, A. R., & Hancock, K. (1995). Self-reported factors related to relapse following treatment for stuttering. Australian Journal of Human Communication Disorders, 23, 48-60; Martin, R. (1981). Introduction and perspective: Review of published research. In E. Boberg (Ed.), Maintenance of fluency. New York: Elsevier]. The aim of this study was to determine whether the presence of mental health disorders contributes to this failure to maintain fluency after treatment. Assessments for mental health disorders were conducted with 64 adults seeking speech-restructuring treatment for their stuttering. Stuttering frequency, self-rated stuttering severity and self-reported avoidance were measured before treatment, immediately after treatment and 6 months after treatment. Stuttering frequency and situation avoidance were significantly worse for those participants who had been identified as having mental health disorders. The only subgroup that maintained the benefits of the treatment for 6 months was the third of the participants without a mental health disorder. These results suggest that prognosis for the ability to maintain fluency after speech restructuring should be guarded for clients with mental health disorders. Further research is needed to determine the benefits of treating such disorders prior to, or in combination with, speech-restructuring. EDUCATIONAL OBJECTIVES The reader will (1) evaluate the impact of one or more mental health disorders on medium-term outcomes from speech-restructuring treatment for stuttering, (2) describe how this finding affects prognosis for certain groups of stuttering clients, (3) evaluate how these finding are consistent with estimates of post-treatment relapse after speech-restructuring treatment, (4) describe two test instruments for detecting mental health disorders, and (5) outline the findings about the relation between pre-treatment stuttering severity and mental health disorders.

Long-Term Outcome of Early Intervention for Stuttering

This paper reports the long-term outcome of treatment from two previous studies: Onslow, Costa, and Rue (1990), and Onslow, Andrews, and Lincoln (1994). These studies evaluated the effect of a pare...

Peer learning in clinical education

The purpose of this paper is to raise awareness of peer learning as a process that is potentially beneficial to clinical education. Peer learning is a well documented learning strategy in paediatric educational literature. Many allied health clinical education programs purport to utilize it as a learning technique. Do we really know what peer learning is, how to promote it and why it is beneficial to facilitate it? This paper addresses these questions by considering terminology and definitions of peer learning and briefly outlining theoretical justification for its use in clinical education. Literature regarding the application of peer learning in clinical education is reviewed and the reported and purported benefits of peer learning are discussed.

Survey of the rural allied health workforce in New South Wales to inform recruitment and retention

OBJECTIVE To investigate the demographics, employment, education and factors affecting recruitment and retention of New South Wales (NSW) rural allied health professionals. DESIGN Descriptive study, cross-sectional survey. SETTING Regional, rural and remote areas of NSW, Australia. PARTICIPANTS The sample includes 1879 respondents from more than 21 different allied health occupations. MAIN OUTCOMES MEASURES Variables included gender, age, marital status, employment sector, hours worked, community size, highest qualification, rural origin and continuing education, as well as others. Certain variables were compared for profession and gender. RESULTS Women made up 70% of respondents, with a mean age of 42 years. Men were older, with more experience. Sixty per cent were of rural origin and 74% partnered, most with their partner also working. Eighty-four per cent worked in centres of 10,000 or more people. The public sector accounted for 46% of positions and the private sector 40%. Eleven per cent worked across multiple sectors and 18% were self-employed. Two-thirds worked 35 hours or more per week, although only 49% were employed full-time. Job satisfaction was high but 56% intended leaving within 10 years, 28% to retire. Over 90% of respondents qualified in Australia and more than 80% held a degree or higher qualification. Almost half were dissatisfied with access to continuing education. CONCLUSIONS The NSW rural allied health workforce is strongly feminised, mature and experienced. Recruitment should target rural high school students and promote positive aspects of rural practice, such as diversity and autonomy. Retention strategies should include flexible employment options and career development opportunities.

A Clinical Trial of an Operant Treatment for School-Age Children Who Stutter

The purpose of this investigation was to determine the effectiveness of a nonprogrammed, operant treatment for school-age children who stutter. The treatment was administered by clinicians and pare...

Twelve tips for effective international clinical placements

As universities adopt an increasingly international focus, student health professionals are keen to gain clinical experiences in other countries. Such clinical placements provide students with the opportunity to share their knowledge and at the same time acquire new clinical and cultural skills. The experience gained will not only enhance their clinical practice overseas, but will also enhance it in their home country where they are likely to work with people from culturally, linguistically and clinically diverse backgrounds. Careful preparation and adequate supports are critical if students and the host institutions are to gain maximum benefit from cross-cultural clinical placements. The tips below are based on an ongoing collaboration between the Indian Institute of Cerebral Palsy, Kolkata, India and The University of Sydney, as well as recommendations from the burgeoning literature on international clinical placements. The authors are from both the sending and the receiving institutions, and have found that close collaboration between the home and host institutions along with student reflection, evaluation and the opportunity to integrate new knowledge with other clinical experiences are keys to a satisfactory outcome for all concerned.

The attitudes, knowledge and beliefs of Arab parents in Kuwait about stuttering

UNLABELLED An Arabic version of the Public Opinion Survey of Human Attributes Inventory [POSHA-E; St Louis, K. O. (2005), a global instrument to measure public attitudes about stuttering. (The ASHA Leader, 22, 2-13)] was administered to 424 Arab parents of preschool and school age children in 18 government schools across all six governorates in Kuwait. The survey questions pertained to and investigated attitudes, knowledge and beliefs towards stuttering as well as comparative attitudes toward several other conditions. The aim was to identify whether potential barriers existed that might hinder the establishment and conduct of treatment programs for stuttering within Kuwait. These potential barriers might be negative stereotypes, misconceptions about stuttering, cultural beliefs as well as lack of awareness of the disorder within Kuwaiti society. The instrument successfully sampled a variety of beliefs, reactions and emotions that identified cultural beliefs, societal ignorance and confusion about the disorder. It was found that although stuttering appears to be a disorder that most people in Kuwait are aware of and familiar with, their level of knowledge about stuttering in general and about some specific aspects of the disorder was limited. This indicates a need to disseminate scientific information about stuttering in Kuwait and possibly other Arabic speaking countries. EDUCATIONAL OBJECTIVES Readers will be able: (1) to evaluate the status of speech-language pathology in Kuwait and the Middle East and compare it to that in other countries, such as Australia and the United States; (2) to list similarities in the stereotypes and attitudes towards stuttering cross-culturally. Readers will also be able to: (3) discuss the differences in knowledge and attitudes according to age, gender and educational level in Kuwait; (4) discuss public awareness and knowledge of stuttering among Arabs in Kuwait specifically.

Screening for personality disorders among adults seeking speech treatment for stuttering.

UNLABELLED Stuttering is frequently associated with negative consequences which typically begin in early childhood. Despite this, no previous studies have investigated the presence of personality disorders among adults who stutter. Therefore, the aims of the present study were to screen for personality disorders among adults who stutter, and to compare these screening estimates with matched controls from a national population sample. Using a matched case-control design, participants were 94 adults seeking treatment for stuttering, 92 of whom completed the International Personality Disorders Examination Questionnaire (IPDEQ) as a first-stage screener, and 920 age- and gender-matched controls from the Australian National Survey of Mental Health and Well-Being (ANSMHWB). A conditional logistic regression model was used to estimate odds ratios for the primary outcome: first-stage presence of any personality disorder; as well as specific personality disorders. Based on first-stage screening, the presence of any personality disorder was significantly higher for adults in the stuttering group than matched controls, demonstrating almost threefold increased odds. This difference between groups remained significant for all specific personality disorders, with four- to sevenfold increased odds found for Dissocial, Anxious, Borderline, Dependent and Paranoid personality disorders, and two- to threefold increased odds found for Histrionic, Impulsive, Schizoid and Anankastic personality disorders. In conclusion, stuttering appears to be associated with a heightened risk for the development of personality disorders. These results highlight the need for research regarding the assessment and treatment of personality disorders among adults who stutter. EDUCATIONAL OBJECTIVES The reader will be able to: (1) describe the nature of personality disorders, including factors thought to contribute to their development; (2) identify some of the negative consequences associated with stuttering which may contribute to the development of personality disorders among adults who stutter; (3) describe the process involved in screening for personality disorders, including various methods of scoring; and (4) summarize findings regarding the first-stage presence of personality disorders among adults seeking speech treatment for stuttering in the present sample in comparison with age- and gender-matched controls from a national population sample.

Retention of allied health professionals in rural New South Wales: a thematic analysis of focus group discussions

BackgroundUneven distribution of the medical workforce is globally recognised, with widespread rural health workforce shortages. There has been substantial research on factors affecting recruitment and retention of rural doctors, but little has been done to establish the motives and conditions that encourage allied health professionals to practice rurally. This study aims to identify aspects of recruitment and retention of rural allied health professionals using qualitative methodology.MethodsSix focus groups were conducted across rural NSW and analysed thematically using a grounded theory approach. The thirty allied health professionals participating in the focus groups were purposively sampled to represent a range of geographic locations, allied health professions, gender, age, and public or private work sectors.ResultsFive major themes emerged: personal factors; workload and type of work; continuing professional development (CPD); the impact of management; and career progression. ‘Pull factors’ favouring rural practice included: attraction to rural lifestyle; married or having family in the area; low cost of living; rural origin; personal engagement in the community; advanced work roles; a broad variety of challenging clinical work; and making a difference. ‘Push factors’ discouraging rural practice included: lack of employment opportunities for spouses; perceived inadequate quality of secondary schools; age related issues (retirement, desire for younger peer social interaction, and intention to travel); limited opportunity for career advancement; unmanageable workloads; and inadequate access to CPD. Having competent clinical managers mitigated the general frustration with health service management related to inappropriate service models and insufficient or inequitably distributed resources. Failure to fill vacant positions was of particular concern and frustration with the lack of CPD access was strongly represented by informants.ConclusionsWhile personal factors affecting recruitment and retention of allied health study participants were similar to doctors, differences also existed. Allied health professionals were attracted by advanced work roles in a context of generalist practice. Access to CPD and inequitable resource distribution were strong ‘push’ factors in this group. Health policy based on the assumption of transferability between professions may be misguided.