If your child is under 5, this is probably the approach your therapist will suggest you try first.
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However, if a young child has been stammering for several months and it seems to be getting worse, it may be best to start direct therapy straight away. These "demands" may come from other people around them or from a child's own enthusiasm and determination to communicate. The aim of indirect therapy is to create an environment where a child feels less pressure when speaking. The Lidcombe Program is a widely used direct behavioural therapy for the treatment of stammering in young children. It's designed to be done by the child's parents under the guidance of a speech and language therapist SLT.
The Lidcombe Program is based on the principle of providing consistent feedback to your child about their speech in a friendly, non-judgemental and supportive way. The Speech Disorder website has more information about the Lidcombe Program. Stammering that persists until a child is old enough to go to school is significantly more challenging to treat. As time passes, the effects of stammering become an additional part of the problem. These include anxiety about speaking, fear of stammering, and feelings of embarrassment.
Therapy with older children and adults will often take account of both the speaking behaviours and the social, emotional and psychological aspects of stammering.
In addition to direct and indirect therapy, there are other options that can help people who stammer, particularly older children and adults with persistent stammering and those who develop stammering later in life acquired or late-onset stammering. These therapies do not treat stammering directly, but can be helpful if you experience negative feelings as a result of your stammering.
The Stammerer's Choice - A Comparative Survey of Speech Therapy - eBook
These devices are often fitted inside or around the ear, similar to a hearing aid , and can help improve the fluency of some people's speech. Domain four educational status contained five items that assess the problems faced by the speaker in class, with teachers, and in academics. Domain five employment and job opportunity contained eight items examining the degree of difficulty a speaker has when selecting a job and the difficulty faced by the speaker in the working environment.
Domain six effect of speech therapy contained four items that assess the current status of stuttering, whether the fluency of speech has been improved or remained the same post therapy. For each item of the questionnaire, response scales were equipped so that greater scores indicated a higher degree of negative impact 2 for almost always associated with stuttering and lesser scores indicated a lower negative impact 1 for sometimes and 0 for not at all.
In the third step, the developed questionnaire was then subjected to content validity by obtaining ratings of seven speech language pathologists. The rating form for content validation required experts to provide their ratings in terms of relevance on a 5-point scale where a rating of 5 indicated an item to be extremely relevant and a rating of 0 signified the item to be not at all relevant. Based on the ratings obtained from the experts, the content validity index was calculated for further judgment about the items of the questionnaire.
All participants diagnosed with mild-to-moderate severity of stuttering were given a copy of the questionnaire and were instructed to fill the questionnaire themselves based on the response format provided 2—almost always, 1—sometime, and 0—not at all. Based on the scores obtained by the participants, the internal consistency and test-retest reliability of the questionnaire was estimated.
The details of goal-specific statistical analysis have been summarized in Table 1.
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The content validity index 48 was used to evaluate the content validity of the questionnaire as judged by the subject experts. The Cronbach's alpha was applied to estimate the internal consistency of the questionnaire, and paired t -test was used to estimate the test-retest reliability of the questionnaire. Further, descriptive statistics was used to understand the nature of reposes obtained from the study participants on the developed QOL questionnaire.
The stammerer's choice; a comparative survey of speech therapy.
The average rating of relevance and the content validity index for each domain and question of the questionnaire as judged by seven speech language pathologists. The present study was conducted with an aim of developing a questionnaire to assess the QOL of people who stutter. The objectives of the study were to develop a questionnaire, perform a content validity of the same, and assess its test-retest reliability and internal consistency. The questionnaire consisted of 37 questions to be rated on a 3-point rating scale across six domains by people who stutter.
The first draft of the questionnaire was given to seven speech language pathologists who rated the relevance of each domain and each question on a 5-point rating scale. The rating of 4 or 5 on the scale indicated a higher relevance of the entity, whereas the rating of 3, 2, or 1 indicated a lower relevance or no relevance. A content validity index was calculated for each domain and question, based on the average rating obtained by the seven speech language pathologists.
The details of the average rating and content validity index of the questionnaire are provided in Table 1. The content validity index of greater than 0. As can be observed from Table 1 , all the domains and questions had a content validity index of greater than 0. The validated questionnaire was then given to 30 adults who stutter to rate their QOL across the six domains. The details provided in Table 2 depict the percentage distribution obtained for the rating of each question on the questionnaire.
Table 2. The percentage distribution obtained for the rating of each question on the questionnaire by the adults with stuttering. When domain-specific analysis was performed, it was found that all the questions of domain one, ie, speech-related fear and anxiety, received an average score of 1. Therefore, it can be interpreted that all the participants of the study found speech-related fear and anxiety to be present sometimes. The analysis of domain two, ie, interpersonal and social relationships, revealed that except for D2Q1 Do you avoid talking to opposite sex?
The question coded D2Q1 was perceived as being not at all by the majority of the study participants. The scenario in the domain three, ie, behavioral reaction to stuttering, was similar to that obtained in domain one where all the answers indicated behavioral reactions to stuttering present sometimes.
The analysis of domain four, ie, educational status, revealed that the problem of speaking in an academic setup was present sometimes except for question coded D4Q4. The item D4Q4 Does your stuttering has any influence on your relation with teachers and classmates? The domain five, ie, employment and job opportunity, possessed scattered findings. The items coded D5Q1 Do you think your stuttering has influenced your choice of occupation? The item coded D5Q3 Did you choose a job where little speaking is required? The remaining two items, ie, D6Q1 Are you currently attending or have you ever attended speech therapy for stuttering?
The scores obtained by the participants of the study were then subjected to the Cronbach's alpha for the estimation of the internal consistency. The details of the domain-specific internal consistency have been summarized in Table 3. Table 3. The overall and domain-specific internal consistencies of the questionnaire.
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For the estimation of the test-retest reliability of the questionnaire, the questionnaire was readministered on 5 out of 30 study participants. The paired t -test was administered on the scores obtained by the participants across the two trials to assess the presence of significant differences, if any. The details in Table 4 provide the domain-specific paired t -test results.
Table 4. The domain specific t -value and P -value obtained from the comparisons of the scores of two trials by five participants. This indicates presence of good test-retest reliability for the various domains and questions of the developed questionnaire. Effect of stuttering on QOL of the affected individuals has recently gained the attention of researchers. Multidimensionality of the disorder is also reflected in multiple domains of life that get affected.
There are a number of instruments available for determining the wide ranging aspects of stuttering, such as self-efficacy scale of stuttering, influence of stuttering on speaker's life, speech-related anxiety assessments, 22 , 23 , 49 and OASES. All of these above-mentioned instruments would significantly enhance clinician's understanding about adults who stutter. The present study was an attempt to explore the QOL of adults who stutter in the Indian regions. The design of the study was divided into two phases.
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The first involved the framing process of the questionnaire done with its content validity determined by the experts.