PURPOSE:Severity ratings (SRs) of children's stuttering assigned by parents and speech-language pathologists (SLPs) have advantages over methods based on stuttering counts. They are valid, simple, and convenient; without cost; and can be used without the child's awareness. The aim of this project was to study, for the first time, the use of an SR scale by parents and SLPs to track stuttering severity for preschool children over a typical day. For that purpose, we used 10 case studies. METHOD:Participants were 10 preschool children who stuttered (3-4 years of age) and their parents. Each child's speech was audio-recorded by their parent for an entire day at home, commencing at approximately 8:00 a.m. During that day, an SLP made a randomly timed phone call, during which a 10-min sample of the child's speech was audio-recorded. At the end of the day, both before and after training in the use of a 10-point scale, parents assigned a "typical" SR score for their child's speech for the day. An independent SLP later assigned an SR to each 15-min segment of each child's recording from across the day. RESULTS:The severity of all children's stuttering varied throughout the day, and in more than half the children, it varied by as much as 4-6 SR scale values. SRs showed no consistent trend of stuttering increasing or decreasing during the day. There was close correspondence between parent- and SLP-assigned SRs for the day. Parent training in the use of the scale, which occurred at the end of the day of recording, did not change that correspondence. A random 10-min speech sample provided a reasonably valid SR score to represent typical stuttering for the entire day. CONCLUSION:These findings can be applied in clinical and research contexts where measurement of early stuttering may be used to monitor a child's speech for a substantive period.

PURPOSE:In this clinical focus article, we draw attention to the need for immediate intervention shortly after stuttering onset. More than half of stuttering onsets occur before 3 years of age. We argue that existing interventions for preschool children who stutter require varying levels of cognitive engagement from children; hence, they are not suitable for children of that age. For this reason, we argue that there is no clinical trials evidence for treatment efficacy with children younger than 3 years of age. CONCLUSIONS:There are many recommended parent strategies that do not require any active participation from children, which, therefore, may be suitable for immediate stuttering intervention. Two of these have laboratory support in their favor: parent speech rate reduction and increased interturn speaker latency. Therefore, we developed a clinical protocol based on those two parent strategies and showed the clinical viability of the protocol with three children who stuttered. We argue that automation of our proposed treatment with lifelike artificial intelligence-generated avatar clinicians will make it globally viable, and a suitable target for future Phases I-IV clinical trials.

PURPOSE:Understanding initial parent responses to early stuttering provides a foundation to build a strong therapeutic alliance, and promotes shared decision-making during intervention, allowing for tailored education and support. In a digital age where health-related decision-making often begins with an internet search, it is important to understand how it might influence their initial responses. Therefore, this study explored how access to internet-based information may influence parent responses to childhood stuttering onset. This helps clinicians to understand knowledge and beliefs parents may bring to initial clinical consultations. METHOD:Participants were parents of 2-4-year-olds who did not stutter, and who had no prior experience of stuttering. They were given information about early stuttering and shown five video clips depicting varying degrees of stuttering severity in preschool-age children. They were asked to reflect on five actions they would take if their child began to stutter. These actions were guided by either internet searches or relied on intuition alone. A reflexive thematic analysis was used to examine and interpret patterns in these parent responses. CONCLUSIONS:Compared to parents in the spontaneous response group, internet-informed parents more frequently described self-modification, with adjustments to their own speech and a "wait-and-see" approach. In contrast, spontaneous parent responses more often described speech-focused strategies directed at the child. Results provide insights that inform speech-language pathology practices by helping clinicians (a) align treatment planning with parent perspectives, (b) correct misinformation, and (c) foster stronger therapeutic alliances from the outset.

PURPOSE:In our original article, we draw attention to the lifetime quality-of-life impairment that can result from childhood stuttering-hence, the need for immediate intervention after onset. We drew on existing experimental outcomes that parent speech-rate reduction and increased interturn speaker latency may reduce stuttering. We developed a two-factor treatment protocol based on those variables in combination and showed its clinical viability, suggesting that it would be a suitable target for Phase I-IV clinical trials. Chang and Bernstein Ratner wrote letters to the editor on our article, to which we respond. CONCLUSIONS:Our response to these letters to the editor covers the following issues raised by Chang and Bernstein Ratner: mechanisms of action for the proposed treatment, the evidence base for the treatment, plans to explore its treatment effects, and the need to verify its safety.

AIM:The aim of this Phase I trial was to assess the safety, compliance, and potential efficacy of iLidcombe, a standalone internet version of the Lidcombe Program for young children who stutter. METHOD:We used a prospective single-group design involving 6 months of access to iLidcombe. Assessments occurred pretreatment and after 6 months of access. Participants were 20 parents of young children who stuttered. RESULTS:There was evidence of stuttering severity reduction after using iLidcombe for 6 months. Compliance with the program was favorable, and there was no suggestion of any psychologically adverse impact on children. CONCLUSION:The results of this Phase I trial provide a roadmap for further Phases II-IV clinical trial development.

PURPOSE:The present study aims to report on the psychosocial outcomes of children aged 6-12 years who did or did not respond to the Lidcombe Program. METHOD:Thirty-seven 6- to 12-year-old children participated in a Phase II trial of the Lidcombe Program using video telehealth. Treatment progress was documented using stuttering severity ratings and three psychosocial outcome measures (Overall Assessment of the Speaker's Experience of Stuttering-School-Age Children, Communication Attitude Test, and Spence Children's Anxiety Scale). We examine the results of these psychosocial outcomes in relation to children who did and did not respond to the program. RESULTS:Significant improvements were observed across all psychosocial measures, irrespective of responsiveness group. Individual trajectories highlighted heterogeneity, but group data revealed statistically significant reductions in measures of stuttering impact, negative communication attitudes, and anxiety symptoms from pretreatment to 12 months posttreatment, with no evidence of differential effects between responsiveness groups. CONCLUSIONS:Findings suggest that the Lidcombe Program may provide psychosocial benefits beyond stuttering reduction to some children, potentially through the therapeutic alliance fostered between clinicians, children, and families. The Lidcombe Program appears to be psychologically safe and may confer psychosocial advantages for school-age children who stutter, regardless of whether their stuttering partially reduced, stopped, or persisted. Future research should explore longer term maintenance of these psychosocial gains and conduct a randomized controlled trial to evaluate the effect of the Lidcombe Program relative to a control group.

PURPOSE:This viewpoint explores the idea that a neurodiversity-affirming social model and a medical model of stuttering health care are not mutually exclusive. In all cases, they should be used in combination. For any client, the only way to attain an optimal clinical outcome is to apply a combined medical and social health care perspective. The two models have a changing contribution across the lifespan, according to the client's requirements, age, and presenting complaints and the viability of neuroplastic change of the speech mechanism. CONCLUSIONS:The benefits of neurodiversity applied to stuttering are a "feast" that is "moveable" according to the developmental stage of stuttering and the personal needs of clients. A less flexible view of the matter may prevent the best treatment outcome for clients. In the case of early stuttering, an inflexible approach may cause serious, long-term harm to children.

PURPOSE:Stuttering is associated with clinically significant social anxiety, which emerges during early childhood for some, but not all, children who begin to stutter. The purpose of this review article is to develop a model of social anxiety development during early childhood stuttering and to present an empirical method by which it can be tested. METHOD:We propose a mediation model of how the exposure variable of stuttering may lead to an outcome of social anxiety. Our model includes confounder and mediator variables. We explain the concepts and procedures of mediation analysis and present a method to test our model. RESULTS:We present the idea that negative peer responses to stuttering and negative self-perception of children are mediators of social anxiety development. We propose several confounder variables that involve children, their parents, and the home environment. We depict our model with a directed acyclic graph, and we present details of how it can be tested with a longitudinal research design. DISCUSSION:This is the first attempt to model the development of social anxiety shortly after stuttering onset with an empirically testable method. The intended benefit of this innovation is to direct future clinical directions for the clinical management of stuttering arising shortly after childhood onset.

Parents of children who have begun to stutter need an explanation why this has occurred. For that explanation, clinicians have many research findings available to them from many disciplines. It may be challenging for junior clinicians and students of speech-language pathology to integrate and synthesise that knowledge for parents. The purpose of this clinical conversation is to provide guidance in that matter. The issue was discussed by speech-language pathologists and researchers. Written conversational turns in an exchange were limited to 100 words each. There was general agreement about core material to be conveyed to parents: An explanation of stuttering onset needs to be multifactorial, incorporating a physical mechanism driving causality. We recommend this explanation needs to include current empirical research and theoretical perspectives about stuttering. To do that, clinicians need to keep up to date with current research and thinking about the condition. An explanation to parents must not overwhelm or alarm them, but be supportive and provide groundwork for intervention. Finally, it is essential to explore parent views about why a child began to stutter. Supplementary materials are provided (Appendix A): Participants present their model of how they would tell parents why their child began to stutter and a reading list is provided.

PURPOSE:To discuss what assessment is necessary before clinical management of pre-schoolers who stutter, and to inform junior clinicians and students of speech-language pathology about this matter. METHOD:The issue was discussed by two experienced clinicians who provide clinical services and two university researchers. Written conversational turns in an exchange were limited to 100 words each. When that written dialogue was concluded, participants provided a final reflection about the matter. RESULT:There are many formal and informal assessments that may be used, and clinicians need to choose judiciously from among them. The key to choosing assessments is whether they will influence treatment. There was some disagreement about whether identification of early stuttering is a clinical challenge. CONCLUSION:The participants presented their views of what routine assessments are required before clinical management of pre-schoolers who stutter. In the Appendix A, the participants list their recommendations for parent case history, non-standardised assessments, and standardised testing and screening.

Purpose eHealth treatments have been developed for a range of conditions. They provide an accessible, cost-effective, and convenient model for clients and families to access treatment. The aim of this paper is to provide details and results of user testing of an eHealth speech treatment for adults who stutter: iCamperdown. Method An iterative user-testing process was conducted using a think-aloud method and structured questionnaires. End users were adults who stutter and speech-language pathologists (SLPs). Results Based on user feedback, the program underwent several modifications. Changes made to the program included functional enhancements. These include automatic activation of audio instructions on each page to improve navigation, aesthetic modifications to improve acceptability such as rearranging of information, changes to instructions provided to users to improve clarity, and enhancing the quality of audio recordings to increase efficiency. Conclusion The iCamperdown program is now ready to be evaluated with a Phase I clinical trial, focussing on evaluating safety, compliance, and preliminary outcomes. Further clinical trialing could investigate baseline predictors and treatment moderators to identify which individuals are most likely to benefit from the program. iCamperdown has advantages and disadvantages, which we explore. We explore the prospect of automating iCamperdown with advanced machine learning techniques. Potentially, the iCamperdown Program for stuttering reduction, with translation into other world languages besides English, could be a transformative change to SLP practices internationally.

PURPOSE:Thirty-five years ago, the Lidcombe Program was introduced as a new evidence-based treatment for early stuttering. This milestone presents an opportunity to examine the Lidcombe Program and its relevance today. METHOD:Four Lidcombe Program developers, together with 17 members of the Lidcombe Program Trainers Consortium, reflected on the program's historic origins, early reception, current status, and future direction. CONCLUSIONS:This review of the program explores its origins in the context of causal theories of stuttering and its place in the modern clinical context. We point out that the Lidcombe Program intervention process incorporates social and medical perspectives of childhood stuttering. Empirical knowledge about stuttering and its effects early in life are considered. We consider the evidence base supporting the Lidcombe Program and its implementation in the current international speech-language pathology community. We also consider future directions for the treatment.

PURPOSE:To discuss how speech-language pathologists can keep up with stuttering treatment research. To inform junior clinicians and students of speech-language pathology about this matter. METHOD:The issue was discussed by two university researchers and two speech-language pathologists who provide clinical services. Written conversational turns in an exchange were limited to 100 words each. RESULT:There was agreement among the group that keeping up to date with stuttering research is essential for speech-language pathologists, and to do so requires a basic understanding of research methods. For treatment research, there are several levels of evidence, and there was agreement that they are all relevant to clinical practice. All in the group agreed that basic research is essential to inform clinical practice, particularly in five domains. The volume of stuttering research is challenging for generalist clinicians to keep up with. CONCLUSION:We make recommendations about how speech-language pathologists can keep up with stuttering treatment research in a time-efficient manner. This may be particularly useful for junior clinicians and students of speech-language pathology.

BACKGROUND:For children older than 6 years who stutter, there is a gap in clinical research. This is an issue for speech-language pathologists because the tractability of stuttering decreases and the risk of long-term psychological consequences increase with age.PURPOSE:To report a Phase II trial of a telehealth version of the Lidcombe Program with school-age children.METHODS:Participants were 37 children who stuttered, 6-12 years of age, from Australia, New Zealand, Hong Kong, and Singapore. Parents were trained by video telehealth how to deliver the Lidcombe Program to their child. Primary and secondary outcomes were stuttering severity and psychosocial functioning measured pre-treatment and at 6 months and 12 months after starting treatment. Parents submitted two 10-minute recordings of their child speaking in conversation, and three measures of anxiety, impact of stuttering, and communication attitude.RESULTS:Six months after starting treatment, seven children (18.9%) attained Lidcombe Program Stage 2 criteria, 25 children (67.6%) showed a partial response to treatment, and five children (13.5%) showed no response. By 12 months, 12 children (32.4%) had reached Stage 2 criteria. Psychosocial improvements were observed 6 and 12 months after starting treatment.CONCLUSIONS:The Lidcombe Program may eliminate or nearly eliminate stuttering for about one third of children 6-12 years of age. Randomized controlled trials with this age group involving the Lidcombe Program are warranted. In the interim, the Lidcombe Program is a clinical option clinicians can implement with this age group to reduce stuttering and its psychosocial impacts.

Purpose To discuss how clinically important mental health is during management of early stuttering. To inform early-career clinicians and students of speech-language pathology about contemporary views on this issue. Method The issue was discussed by three speech-language pathologists and a clinical psychologist. Written conversational turns in an exchange were limited to 100 words each. When that written dialogue was concluded, the moderator summarised the discussion. Result All agreed that it is essential to take account of mental health during management of early stuttering. Conclusion The following key points were raised: a) There is a prominent risk that a child with early stuttering will be or will become socially anxious, b) parent anxiety is a clinical consideration, c) support and counselling of children and parents needs to be within the scope of speech-language pathology practice, and d) referral of a child or parent, or both, to a clinical psychologist may be required, facilitated by formal testing if needed.

PURPOSE:To discuss among neuroscientists and community speech-language pathologists what brain imaging research means to clinicians. METHOD:Two university neuroscientists and two speech-language pathologists in private practice discussed the matter. Written conversational turns in an exchange were limited to 100 words each. When that written dialogue was concluded, each participant provided 200 words of final reflection about the matter. RESULT:For now, neuroscience treatments are not available for clinicians to use. But sometime in the future, a critical mass of neuroscientists will likely produce such treatments. The neuroscientists expressed diverse views about the methods that might be used for that to occur. CONCLUSION:Neuroscience does have practical clinical application at present and, in a way, that does not exclude a concurrent influence of the social model of disability. As such, the current practices of clinicians are supported by basic neuroscience research.

PURPOSE:The Fifth Croatia Stuttering Symposium in 2022 continued the Fourth Croatia Stuttering Symposium 2019 theme of the connection between research and clinical practice. At the 2022 Symposium, there were 145 delegates from 21 countries. This paper documents the contents of the first of three Symposium modules.METHODS:The module topic was that three treatments for early childhood stuttering are supported by randomized controlled trial evidence. A clinical situation was considered where a parent of a 3-year-old child asked what results to expect of stuttering treatment.RESULTS:A distinguished scholar presented a 5-minute video interpretation of the research concerning the randomized controlled trial evidence for the three treatments. Three master clinicians then each presented a 2-minute video demonstration of how those research findings might be applied in a clinical situation. Following that, the convenors moderated a discussion between the distinguished scholar, master clinicians, and delegates regarding the research and how it applies to clinical practice.