Dr Rachael Unicomb

Dr Rachael Unicomb

Lecturer

School of Humanities and Social Science

Rachael Unicomb is pioneering the treatment of co-occuring communication disorders

Dr Rachael Unicomb has created preliminary guidelines for treating co-occurring stuttering and speech sound disorders at the same time. These guidelines are the first of this kind in almost 25 years. She is now looking to expand her study to a larger population.

Stuttering can have a long term impact on many aspects of an individual’s life. The true cause of stuttering remains unknown, although many studies indicate that this mysterious condition is most likely a problem related to neural speech processing.

Stuttering is thought to affect as many as approximately 12 percent of children up to the age of four years. More mysterious still is the fact in 30 to 40 percent of cases, stuttering is reported to co-occur with speech sound disorders.

Most children will make some mistakes with their sounds as they are learning to talk. A speech sound disorder occurs when these mistakes continue past a certain age.

In an earlier study, Rachael reported that many Australian speech pathologists will typically treat these two co-occurring disorders separately – often stuttering first then the speech sound disorder.

Rachael, a speech pathologist with a background working in early childhood intervention, finished her PhD in 2015 and says she has always been fascinated by speech sound disorders.

“It’s always been a clinical area of interest for me – why speech sound disorders occur and the clinical decision making around how we treat them,” she said.

“When I touched base with the person who would later become my PhD supervisor, Dr Sally Hewat, she suggested I consider stuttering disorders when they co-occurs with speech sound disorders. This is a really unchartered area. We know they co-occur a lot but there is actually no current evidence to suggest how to treat both disorders at the same time.”

After completing a series of qualitative interviews with Australian speech pathologists, Rachael discovered that clinicians were crying out for guidelines, particularly as the evidence for both disorders in isolation has evolved so much in the past couple of decades. This led to the main study in her thesis, looking at how to treat stuttering and speech sound disorders together using best practice treatment approaches.

Until now there has been doubt about the effectiveness of treating both disorders concurrently. For this reason, the study was conducted cautiously with a small number of children – single case studies – with very tight ethical protocols in place.

“We monitored the children’s progress very closely from week to week to ensure we weren’t making one or the other disorder worse by treating them both at the same time. As it turns out, we had successful outcomes treating this way for the majority of our participants.

“Off the back of my PhD research I am going to follow-up these participants in the long term, because we do know that stuttering is a relapse-prone disorder. It has been about two years since I finished treating these children and in that time, they have all started kindergarten, so I would like to check how they are going. We also know that even having a speech sound disorder in the preschool years can put a child at risk for later literacy development, so it would be good to follow up these variables.”

Rachael is also interested in delving deeper into the research that has looked at the rate of co-occurrence to date.

“Rates of co-occurrence are reported to be as high as between 30 to 40 percent, but that is largely based on a lot of retrospective file audit data and clinician feedback, so we need some stronger data to actually confirm these reports,” she explained.

“I am currently working with teams from the University of Melbourne and the Murdoch Children’s Institute on this project. They have a project and data set called the ELVS study (Early Language in Victoria Study), where they have prospectively followed a community cohort of almost 1,700 children from infancy who are now heading into adolescence. So it will be great to use some of this data – some prospective data – to look at the figures on co-occurrence.”

Rachael is also working on another project in speech sound disorders with Ms Joanne Walters, a fellow lecturer and researcher in speech pathology at the University of Newcastle, looking at the sounds “k” and “g”.

“Working clinically we see a number of children who are in Kindergarten and Year One who still may not have mastered those sounds – but the normative data, which is what informs our profession and what we use to base our decision-making on when we’re doing an assessment and considering treatment, says the sounds should be produced correctly at around three to three-and-a-half years of age,” she explained.

“It’s important because if a child comes in at four years of age and they haven’t acquired or mastered “k” and “g” the clinician might choose to work on that with the child, which could be costly to the service provider and caregiver, in terms of finance and time, particularly if perhaps the normative data, which is varied and dated, is perhaps underestimating the age of mastery for these sounds.”

Rachael hopes a preliminary study to further investigate speech pathologists’ perceptions on the acquisition of these sounds, will inform and lead to the development of a larger project to gather updated normative data for these consonants.

Rachael Unicomb

Rachael Unicomb is pioneering the treatment of co-occuring communication disorders

Rachael Unicomb is a Lecturer and Researcher for the Speech Pathology (honours) program at the University of Newcastle, Australia.

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Career Summary

Biography

Current role

Rachael Unicomb is a Lecturer and Researcher for the Speech Pathology (honours) program at the University of Newcastle, Australia. Teaching into the majority of years in this program, Rachael has a clinical and translational research interest in the communication of young children (paediatrics), in particular those with speech sound disorders and stuttering.

Past clinical experience

Rachael has worked with a paediatric caseload across a variety of settings including early intervention, community health and private practice. Rachael has also worked with families and children from disadvantaged and vulnerable backgrounds, and played an integral role in setting up a program for Uniting Care Burnside’s Newpin program. Newpin has a focus on breaking the cycle of abuse and neglect with a focus on positive parent-child interactions. With programs set up in Sydney’s outer western suburbs, Newpin aims to work with parents and children to focus on emotional development and wellbeing in a safe and structured environment. Rachael assisted setting up a program that looks at parent-child interactions with this caseload with a focus on communication development. Rachael provided assessment and group therapy to Newpin participants, and provided training to staff members so that these skills could be embedded as an integral part of the Newpin program. Rachael has previously been employed for the University of Newcastle in the capacity of clinical educator, working in the specialist stuttering clinic, as well as for the Speech Pathology in Schools Program (SPinS).

Research and interests

Rachael completed her PhD in 2015. Her thesis looked at the treatment of co-occurring stuttering and speech sound disorder in young children. Stuttering and speech sound disorder are both communication disorders that occur frequently in isolation in young children. However, it is well known that the two disorders do in fact co-occur, and when they do, there is little evidence to guide a treatment approach. Rachael’s research continues in this area, and she has presented the outcomes of her research at international conferences (ASHA, Asia Pacific Conference), and has published in international peer reviewed journals.

Rachael has also published in the area of the significance of clinical outcome data. Clinical data are valuable and can contribute greatly to the profession of speech pathology, and may go on to lead to larger research projects, which in turn may translate to a change in current practice.

Rachael is always open to discuss research collaborations in the areas of:

  • Stuttering
  • Speech sound disorders
  • Co-occurrence of stuttering
  • Clinical data for research



Qualifications

  • Doctor of Philosophy, University of Newcastle
  • Bachelor of Speech Pathology (Honours), University of Newcastle

Keywords

  • Blended learning
  • Clinical Education
  • Clinical skills
  • Evidence-based practice
  • Fluency
  • Paediatric language
  • Paediatric speech sound disorders
  • Professional issues
  • Speech sound disorders
  • Stuttering

Fields of Research

Code Description Percentage
170204 Linguistic Processes (incl. Speech Production and Comprehension) 20
110399 Clinical Sciences not elsewhere classified 60
170299 Cognitive Sciences not elsewhere classified 20

Professional Experience

UON Appointment

Title Organisation / Department
Lecturer University of Newcastle
School of Humanities and Social Science
Australia

Professional appointment

Dates Title Organisation / Department
23/06/2011 - 30/01/2015 Clinical Educator University of Newcastle
Speech Pathology
Australia
1/12/2009 - 29/06/2012 Speech Pathologist Firstchance Early Intervention Centre
Australia

Awards

Prize

Year Award
2014 Research Higher Degree Publication Prize
The University of Newcastle, NSW

Scholarship

Year Award
2011 Australian Postgraduate Award
The University of Newcastle, NSW

Teaching

Code Course Role Duration
LING3200 Speech and Language Disorders
The University of Newcastle, Australia
Course coordinator, lecturer, tutor 7/02/2017 - 7/03/2017
SPTH1001 Child speech and language 1
The University of Newcastle, Australia
Course coordinator, lecturer, tutor 1/02/2016 - 30/06/2016
SPTH2080 Clinical Practice (2nd year)
The University of Newcastle
Lecturer, Tutor 1/02/2016 - 7/03/2017
SPTH4030 Professional Issues 1
The University of Newcastle
Course coordinator, lecturer, tutor 7/02/2017 - 7/03/2017
SPTH4210 Research Review
The University of Newcastle, Australia
Course coordinator, lecturer, tutor 7/02/2017 - 7/03/2017
SPTH1080 Introduction to Clinical Practice
The University of Newcastle, Australia
Tutor 7/02/2017 - 7/03/2017
SPTH2002 Child Language 3 and Hearing Across the Lifespan
The University of Newcastle, Australia
Tutor 7/02/2017 - 7/03/2017
SPTH2001 Fluency Across the Lifespan
The University of Newcastle, Australia
Course coordinator, lecturer, tutor 7/02/2017 - 7/03/2017
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Journal article (3 outputs)

Year Citation Altmetrics Link
2017 Unicomb RA, Hewat S, Spencer E, Harrison E, 'Evidence for the treatment of co-occurring stuttering and speech sound disorder: A clinical case series', International Journal of Speech-Language Pathology, 19 251-264 (2017) [C1]
DOI 10.1080/17549507.2017.1293735
Citations Scopus - 1Web of Science - 1
Co-authors Elizabeth Spencer, Sally Hewat
2015 Unicomb R, Colyvas K, Harrison E, Hewat S, 'Assessment of reliable change using 95% credible intervals for the differences in proportions: A statistical analysis for case-study methodology', Journal of Speech, Language, and Hearing Research, 58 728-739 (2015) [C1]

© 2015 American Speech-Language-Hearing Association. Purpose: Case-study methodology studying change is often used in the field of speech-language pathology, but it can be critic... [more]

© 2015 American Speech-Language-Hearing Association. 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.

DOI 10.1044/2015_JSLHR-S-14-0158
Citations Scopus - 3Web of Science - 2
Co-authors Kim Colyvas, Sally Hewat
2013 Unicomb R, Hewat S, Spencer E, Harrison E, 'Clinicians' management of young children with co-occurring stuttering and speech sound disorder', International Journal of Speech-Language Pathology, 15 441-452 (2013) [C1]

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 trea... [more]

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.

DOI 10.3109/17549507.2013.783111
Citations Scopus - 3Web of Science - 5
Co-authors Elizabeth Spencer, Sally Hewat

Conference (10 outputs)

Year Citation Altmetrics Link
2017 Unicomb RA, Hewat S, Harrison E, 'Concurrent treatment of stuttering and speech sound disorder: Parents¿ experiences', Concurrent treatment of stuttering and speech sound disorder: Parents¿ experiences (2017)
Co-authors Sally Hewat
2017 Unicomb RA, Hewat S, Byrne N, Walters J, Spencer E, 'Confidence in working with people with communication disorders: The effects of an online University course delivered to non-speech-language pathology students', Confidence in working with people with communication disorders: The effects of an online University course delivered to non-speech-language pathology students (2017)
Co-authors Nicole Byrne, Joanne Walters, Sally Hewat, Elizabeth Spencer
2017 Unicomb RA, Hewat S, Harrison E, 'Long-term follow up of children treated concurrently for stuttering and speech sound disorder: Four case studies', Long-term follow up of children treated concurrently for stuttering and speech sound disorder: Four case studies (2017)
Co-authors Sally Hewat
2016 Unicomb R, Hewat S, Harrison E, '2016 Speech Pathology Australia National Conference: Making Waves' (2016)
Co-authors Elizabeth Spencer, Sally Hewat
2016 Unicomb RA, Hewat S, Harrison E, 'Clinical case studies: How to analyse for statistical significance', Clinical case studies: How to analyse for statistical significance (2016)
Co-authors Sally Hewat
2015 Unicomb R, Hewat S, 'Single case research: Using a new method of statistical analysis to determine change following treatment for speech sound disorder' (2015) [E3]
Co-authors Sally Hewat
2013 Unicomb RA, Hewat S, Spencer E, Harrison E, Kolyvas K, 'Treatment of co-occurring stuttering and speech sound disorder: Analysis of a single case', Treatment of co-occurring stuttering and speech sound disorder: Analysis of a single case. (2013)
Co-authors Sally Hewat, Elizabeth Spencer
2013 Unicomb RA, Hewat S, Spencer E, Harrison E, 'Concurrent treatment of stuttering & speech sound disorders: Phase I trial', American Speech and Hearing Association Conference Proceedings (2013)
Co-authors Elizabeth Spencer, Sally Hewat
2013 Unicomb RA, Hewat S, Spencer E, Harrison E, 'Co-occurring stuttering and speech sound disorder: Concurrent intervention using direct treatment approaches.', Conference Program (2013)
Co-authors Sally Hewat, Elizabeth Spencer
2012 Unicomb RA, Hewat S, Spencer E, Harrison E, 'Young children with stuttering and speech sound disorders: Clinical decisions.', Conference program (2012)
Co-authors Sally Hewat, Elizabeth Spencer
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Grants and Funding

Summary

Number of grants 6
Total funding $37,500

Click on a grant title below to expand the full details for that specific grant.


20172 grants / $16,000

Strategic Network and Pilot Projects Grant$15,000

Funding body: Faculty of Education and Arts, University of Newcastle

Funding body Faculty of Education and Arts, University of Newcastle
Project Team

Society Health Disability Research Group

Scheme Strategic Network and Pilot Project Grants Scheme
Role Investigator
Funding Start 2017
Funding Finish 2017
GNo
Type Of Funding Internal
Category INTE
UON N

FEDUA Conference Travel Grant$1,000

Funding body: Faculty of Education and Arts, University of Newcastle

Funding body Faculty of Education and Arts, University of Newcastle
Scheme FEDUA Conference Travel Grant
Role Lead
Funding Start 2017
Funding Finish 2017
GNo
Type Of Funding Internal
Category INTE
UON N

20162 grants / $11,500

An exploration of current speech therapy management for school-age children who stutter$10,000

Funding body: Massey University

Funding body Massey University
Project Team

Dr Anna Hearne, Massey University, NZ and Dr Sally Hewat, University of Newcastle

Scheme Massey University Research Fund
Role Investigator
Funding Start 2016
Funding Finish 2017
GNo
Type Of Funding External
Category EXTE
UON N

FEDUA Conference Travel Grant$1,500

Funding body: University of Newcastle - Faculty of Education and Arts

Funding body University of Newcastle - Faculty of Education and Arts
Scheme Travel Grant
Role Lead
Funding Start 2016
Funding Finish 2017
GNo
Type Of Funding Internal
Category INTE
UON N

20151 grants / $5,000

Evidence for the treatment of co-occuring stuttering and speech sound disorders$5,000

Funding body: University of Newcastle - Faculty of Education and Arts

Funding body University of Newcastle - Faculty of Education and Arts
Scheme FEDUA New Staff Grant
Role Lead
Funding Start 2015
Funding Finish 2016
GNo
Type Of Funding Internal
Category INTE
UON N

20141 grants / $5,000

Speech Pathology Australia Higher Degree Student Research Grant$5,000

Funding body: Speech Pathology Australia

Funding body Speech Pathology Australia
Project Team

Rachael Unicomb

Scheme Research Grant
Role Lead
Funding Start 2014
Funding Finish 2016
GNo
Type Of Funding External
Category EXTE
UON N
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Research Supervision

Number of supervisions

Completed0
Current1

Total current UON EFTSL

PhD0.1

Current Supervision

Commenced Level of Study Research Title Program Supervisor Type
2017 PhD Investigating Perceptions, Knowledge and Use of Health Promotion in Speech Pathology PhD (Speech Pathology), Faculty of Education and Arts, The University of Newcastle Co-Supervisor
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News

Research Directions 2016

July 7, 2016

Read the latest research highlights from the Faculty.

Dr Rachael Unicomb

Position

Lecturer
School of Humanities and Social Science
Faculty of Education and Arts

Contact Details

Email rachael.unicomb@newcastle.edu.au
Phone (02) 4921 5716
Fax (02) 4921 7386

Office

Room GPG2.26/27
Building General Purposes Building
Location Callaghan
University Drive
Callaghan, NSW 2308
Australia
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