Friday, October 08, 2010

Effective in eliminating stuttering??

Here is my exchange with Rosalee Shenker on her statement about efficacy in early childhood intervention.
Your statement "Direct treatment for preschool age children has been shown to be effective in eliminating stuttering." is highly misleading. First of all, you don't mention the natural recovery rate. So a clinician can NEVER know whether they have been effective or whether it naturally happened. Second, you don't give the evidence. The not-independent long-term study shows relapse. AND no-one ever mentioned that many children could NOT be contacted any more. Third, stuttering has a neurobiological basis some of which is genetic. NO behavioural treatment will ever change the genes and at best re-shape behaviour to better deal with a neurobiological deficit. But that's hardly an elimination.

Rosalee's reply:
Hi Tom. Thanks for your feedback. Although the natural recovery rate can be as high as 80% in the general population, the paper presented to this conference shows the results of a group of
children treated with the Lidcombe programme after age 6. These children have a longer history of stuttering and are less likely to have a natural recovery without treatment. Regarding the long term follow up studies, Miller and Guitar in a 2009 article that is in the Journal of Fluency Disorders, conducted a study of the long-term effectiveness of the Lidcombe programme. In this study the treatment was administered by clinicians who were newly trained in the approach in a clinic independent of the developers of the programme. A major finding of the study was that 11 of 15 children were not stuttering on follow-up. The remaining four children showed residual stuttering that was rated as ‘very mild’ or ‘mild’ on the SSI-3 scale after follow-up periods of up to nearly 5 years. I think that it is important to note that the term ‘relapse’ does not mean return to pretreatment levels in this study, but failure to meet the established criteria for Stage 2 of the Lidcombe programme that is less than 1% stuttered syllables and perceptual severity ratings that indicate none or very little stuttering. Although I agree with you that much stuttering likely has a neurobiological basis, neural plasticity during the preschool period may allow for changes in response to treatment. I am eager for the day when we will be able to produce some less invasive brain imaging studies of pre-post treatment changes in preschool age children to give us a better idea of what is actually going on during this process.

My reply:
Hi Rosalee. Thanks for your reply. Let's assume the trial is not flawed (which I dispute). Then 11 out of 15 kids recover which is 73.3% (consistent with natural recovery), and 4 out of 15 have reduced stuttering (consistent with a psychosocial adaptation due to behavioural therapy). The follow-up study of the Lidcombe RCT has shown similar effects, again assuming it's not flawed. ---- That's very different to your statement "eliminate stuttering". And on your website "stuttering can be maintained at near zero following treatment", "eliminating the progression of stuttering", and "fluency being maintained for periods up to 4 years." ---- Are you standing by these statements? Would it not be appropriate to modify them to what you have wrote now.

2 comments:

sachin said...

"Thomas doubted, so that we dont have to doubt.."

I thank both Thomas and Tom for their search for Truth!
sachin

PS: This discussion is becoming interesting day by day- and I have learned a lot! Thanks everyone!

Terry said...

Tom,

Didn't you read her response? You do know that children still stuttering by age 6 and older are far far less likely to recover naturally, don't you? So, you can't apply your arguement of "it's just the same as natural recovery" in the same way you would to a study on pre-schoolers. Pre-school and school-age children are significantly different clinical populations.

You also didn't answer my earlier question (in a different comment-post) about your ideal research design for a Lidcombe trial - I'm very interested in your response, as a man of science (you, not me).