Dr Rachael Unicomb

Background: Previous studies have predominantly investigated the impact of having a child who stutters (CWS) on parents and their associated parent¿child relationship. However, there is a gap in the literature regarding the perceptions of stuttering held by siblings living with CWS in Malaysia. Aims: To explore the experiences of fluent siblings of Malaysian CWS. Methods & Procedures: A total of 10 fluent siblings were recruited (mean age = 13.40 years, SD = 3.23, age range = 7¿18 years, four females) and semi-structured interviews were used to explore their perceptions towards their siblings who stutter, their emotional reactions towards their siblings, the strategies they use during communication breakdowns and how stuttering affects their relationships with their siblings. All interviews were performed using Zoom to allow data collection during the COVID-19 pandemic lockdown. To avoid parental bias, all interviews were conducted without the parent's participation in the interviews. Interviews were conducted in both Bahasa Malaysia (Malaysia's native language) and English (the second most spoken language in Malaysia), depending on the participants' preferred languages. Each interview lasted between 20 and 25 min (mean = 22.8, SD = 2.56). Audio recordings were de-identified and transcribed verbatim. Thematic analysis was used to explore the lived experiences of these siblings. Outcomes & Results: Four main themes were identified: (1) how siblings perceive the speech of CWS; (2) the communication strategies used by siblings to repair communication breakdown; (3) the feelings that fluent siblings have about stuttering and how they cope with it; and (4) how the stuttering makes the siblings' relationships closer. Conclusions & Implications: This study's findings provide multiple perspectives on the perceptions and attitudes of siblings around stuttering. In addition, the study offers useful insights about the needs of these siblings and techniques for meeting those needs. These results have the potential to contribute to the existing knowledge base and assist speech¿language pathologists and other healthcare professionals in working effectively with CWS and their families. WHAT THIS PAPER ADDS: What is already known on the subject There is much research on caregivers' perceptions, reactions and emotions around their CWS. However, the experiences of fluent siblings living with CWS are rarely heard in research or clinical discussions. Currently, there are no studies related to the impact on fluent siblings and their perspectives conducted in Malaysia. What this paper adds to the existing knowledge This study explored the experiences of fluent siblings living with CWS. The findings provide an insight into how siblings perceive the CWS's speech, their communication strategies to repair communication breakdown, their feelings about stuttering and coping mechanisms, as well as how the stuttering brings them closer to one another. What are the potential or actual clinical implications of this work? This study provides a variety of perspectives on siblings' beliefs and attitudes towards CWS. This can assist speech¿language pathologists in providing holistic support to families of CWS. A deeper knowledge of how stuttering affects siblings is crucial to ensure a more effective family-centred approach to therapy and even more sibling support during the clinical process.

Purpose: To conduct long-term follow-up assessment on children who had previously undergone concurrent, direct treatment for co-occurring stuttering and speech sound disorder. Methods: Four children (6;10¿7;7 years) were followed-up approximately 40 months after commencing Stage 1 of the Lidcombe Program. The primary outcome for stuttering, percentage of syllables stuttered, was assessed on within¿¿ and beyond-clinic samples. Percentage of consonants correct, the primary speech outcome, was gathered on single-word and connected-speech samples. Primary outcomes were analysed for statistically significant change and to assess stability of treatment gains. Additionally, formal assessment of phonological awareness ability was conducted. Results: At long-term follow-up, 2 participants had experienced relapse of stuttering. Three of the four children were within age-expected norms for percentage of consonants correct, while one participant was rated at a mild-moderate severity level on this measure. All four children had assessment scores that were within normal limits for phonological awareness. Conclusion: Children with co-occurring stuttering and speech sound disorder may be treated concurrently using direct therapy approaches in the short-term, however may be more prone to relapse across both disorders. For this caseload of children, a longer maintenance period is recommended, with regular assessments being undertaken to ensure stability of treatment gains in the long-term.

Purpose: In mainland China, speech therapy is an emerging profession, and it estimated around 13 million people stutter. Currently, best practice for treating stuttering in young children is considered to be implementation of the Lidcombe Program. The Lidcombe Program is a behaviourally based treatment approach which involves parents delivering feedback to their child's stuttered and stutter-free speech in structured and unstructured conversations, in a natural environment. Currently, there is no published research documenting implementation of the Lidcombe Program in mainland China. Given the cultural differences that exist between Australia (where the treatment was developed) and China, an investigation into the feasibility of the treatment into this cross-cultural context is warranted. Methods: This study investigates implementation of the Lidcombe Program to two Mandarin-speaking children using a descriptive single case study design. The primary outcome, percent syllables stuttered (%SS), was measured within¿¿ and beyond-clinic at two assessment points, and analysed for statistically significant change. Results: Both participants in the study achieved a significant reduction in stuttering rates, suggesting the Lidcombe Program may be a viable option to treat some children in a Mandarin-speaking population in China. Additionally, the treating therapists provided feedback on cultural considerations when implanting the program to this population. Conclusion: There is a need for research into effective and evidence-based stuttering treatments for Mandarin-speaking children in mainland China. This study is a preliminary investigation into the effectiveness of the Lidcombe Program in this context.

Purpose: Case-study methodology studying change is often used in the field of speech-language pathology, but it can be criticized for not being statistically robust. Yet with the heterogeneous nature of many communication disorders, case studies allow clinicians and researchers to closely observe and report on change. Such information is valuable and can further inform large-scale experimental designs. In this research note, a statistical analysis for case-study data is outlined that employs a modification to the Reliable Change Index (Jacobson & Truax, 1991). The relationship between reliable change and clinical significance is discussed. Example data are used to guide the reader through the use and application of this analysis. Method: A method of analysis is detailed that is suitable for assessing change in measures with binary categorical outcomes. The analysis is illustrated using data from one individual, measured before and after treatment for stuttering. Conclusions: The application of this approach to assess change in categorical, binary data has potential application in speech-language pathology. It enables clinicians and researchers to analyze results from case studies for their statistical and clinical significance. This new method addresses a gap in the research design literature, that is, the lack of analysis methods for noncontinuous data (such as counts, rates, proportions of events) that may be used in case-study designs.

Speech sound disorders reportedly co-occur in young children who stutter at a substantial rate. Despite this, there is a paucity of scientific research available to support a treatment approach when these disorders co-exist. Similarly, little is known about how clinicians are currently working with this caseload given that best practice for the treatment of both disorders in isolation has evolved in recent years. This study used a qualitative approach to explore current clinical management and rationales when working with children who have co-occurring stuttering and speech sound disorder. Thirteen participant SLPs engaged in semi-structured telephone interviews. Interview data were analysed based on principles derived from grounded theory. Several themes were identified including multi-faceted assessment, workplace challenges, weighing-up the evidence, and direct intervention. The core theme, clinical reasoning, highlighted the participants' main concern, that not enough is known about this caseload on which to base decisions about intervention. There was consensus that little is available in the research literature to guide decisions relating to service delivery. These findings highlight the need for further research to provide evidence-based guidelines for clinical practice with this caseload. © 2013 The Speech Pathology Association of Australia Limited.