الفهرس 
• StutteringOnly 14 pages are availabe for public view
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Abstract
S
tuttering is a fluency of speech disorder, identified via involuntary interruptions in the flow of speech. This disorder is successfully treated in 70% of children who are diagnosed with it and the remaining 30% continue to experience this problem in the long term. The incidence rate of this disorder is 5% among preschool children and about 1% among adults. Although the cause of stuttering has not been identified, a multifactorial hypothesis of stuttering has gained acceptance (Shafiei et al., 2019).
The etiology of stuttering is multifactorial, as the result of a dynamic interaction between a wide and nonlinear spectrum of risk factors caused during child development. Understanding these risk factors is essential to diagnose it early and correctly and so, to provide a more effective intervention for children who stutter (de Oliveira, 2013).
Most clinicians rate stuttering severity quantitatively by counting the frequency of the stuttering expressed by the percentage of stuttered syllables per minute. Although this method appears to be objective and convenient to use, variations in the frequency of stuttering from situation to another make it difficult to depend upon frequency of the stuttering alone while rating stuttering severity. Other clinicans use the Suttering Severity Instrument (SSI) by Riley (Yairi et al., 2011).
A number of therapy programs have been developed for children, aged 6 years or less, who stutter. Treatment programs for children who stutter can be divided into two types, direct and indirect. The Lidcombe Program is a direct treatment method focusing on children’s speech for reducing stuttering in preschool children (Goodhue et al., 2010).
The Lidcombe Program is a direct treatment method focusing on children’s speech for reducing stuttering in preschool children. There is significant clinical evidence supporting the effectiveness of this treatment method for preschool children (Packman et al., 2016).
The Lidcombe Program has been supported by clinical and basic research that has indicated that stuttering can be controlled via verbal contingencies (Shafiei et al., 2019).
Studies indicated that the Lidcombe Program reduces the incidence rate of stuttering in preschool children (Shafiei et al., 2019).
The present study was designed to evaluate the role of family in persistence versus recovery of childhood stuttering through early intervention which can lead to avoidance of development of chronic stuttering problems in this group of patients.
This randomized controlled clinical trial study was carried out at the outpatient clinic of Phoniatrics unit, ENT department, Ain Shams University Hospitals. A total of 60 children were included and divided between two groups. Control group; which included 30 cases who were submitted to parents counselling alone without involving the child with follow up weekly for three months to assess if there was improvement or not by SSI and SPI tools and also to predict the degree of chronicity of childhood stuttering, and test group; which included 30 cases who were submitted to Lidcombe Program.
This study included children aged from 4 - 6 years, diagnosed as developmental stuttering by Ain Shams Protocol of assessment of fluency disorder, children in both groups go with selection criteria for using Lidcombe Program (at least 2% of words stuttered, parents are motivated for therapy, no treatment for stuttering during previous 12 months, onset of stuttering more than six months before recruitment and proficiency in Arabic for children and parents), having average intelligence quotient (IQ) and average mental age, and with no delayed language development.
Results:
No significant differences between study groups as regard age, gender and IQ level as p>0.05
No significant differences between study groups as regard baseline assessment of stuttering severity using stuttering severity instrument as p>0.05
There is statistical significant differences between study groups as regard post-intervention assessment of stuttering severity using stuttering severity instrument as p>0.05. Cases had significant reduction in picture description, duration and physical concomitant. Cases group had significantly lower mean of SSI score 11±6 than controls 26.5±7.6 as p<0.001.
Cases had significant reduction in stuttering severity from 27.6±3.9 to 11±6 after intervention (p<0.001)
Most of cases become very mild (from 3.3% to 46.7%) and mild (from 10% to26.7%) are mild, (13.3%) moderate, (10%) severe and (3.3%) very severe post intervention.
Controls had significant reduction in physical concomitant from 10.5±2.6 to 10±3.5 (p=0.38), but overall SSI score show insignificant difference.
No significant differences between study groups as regard baseline assessment of stuttering severity using stuttering prediction instrument as p>0.05.
There is statistical significant differences between study groups as regard post-intervention assessment of stuttering severity using stuttering prediction instrument as p<0.05. Cases group had significantly lower mean of SPI severity score 14.7±7.4 than controls
Controls had insignificant difference pre and post intervention in SPI severity and prediction score.
Discussion:
The present study was designed to evaluate the role of family in persistence versus recovery of childhood stuttering through early intervention which can lead to avoidance of development of chronic stuttering problems in this group of patients.
In the current study, the mean age of included cases was 5.3±0.81 years, with normal IQ to be suitable for Lidcombe program which is direct treatment method focusing on children’s speech for reducing stuttering in preschool children.
Gender also influences the prevalence of stuttering, because the greatest risk for developing this disorder occurs in male, a study also showed that the risk of stuttering in males increases when there are any other communication disorder associated, regardless of family history the reason for the higher chronicity of the disorder for male sample than female can be explained according to the literature, by the findings that females have a greater tendency for recovering than males.
In the current study, there was no significant differences between study groups as regard baseline assessment of stuttering severity using SPI. There was statistical significant differences between study groups as regard post-intervention assessment of stuttering severity using SPI. Cases group had significantly lower mean of SPI severity score than controls. Also Cases group had significantly lower mean of SPI prediction score than controls. Cases had significant reduction in stuttering severity score, and stuttering prediction score, but controls had insignificant difference pre and post intervention in SPI severity and prediction score.
The long-term impact of the Lidcombe Program has been shown to be significant up to 18 months post-treatment. Furthermore, substantial long-term changes have been observed one year post-treatment, among preschoolers who stuttered, even when treatment was administered by SLPs newly trained in the Lidcombe program.
The results of the present study showed that Lidcombe result in effects that were much different from counselling. It can be said that the Lidcombe Program tried to reduce children’s stuttering successfully through targeting children’s stuttering directly and applying strategies such as praising and asking for self-evaluation of speech without stuttering, providing information about speech with and without stuttering, and asking for self-correction of stuttering.
In this study, cases treated with Lidcomb program improved and become very mild and mild, also severe cases improved to become moderate cases, while in group treated with counselling, only very mild and mild cases who have improved while other cases become the same or got worsen. Cases had significant reduction in stuttering severity score. Also, cases had significant reduction in stuttering prediction score.
We reevaluated cases after three months to assess if there was improvement or not by ASSI and SPI tools and also to predict the degree of chronicity of childhood stuttering, then after 6 months.
Finally, stuttering will remain a perplexing disorder and assessing its severity is a matter of clinician’s clinical experience. Despite the tools used to assess stuttering severity, it is better to assess the child with the disorder rather than assessing the disorder. Taking in considerations that the covert symptoms are the key for deciding the stuttering severity more than the overt symptoms, specifically with the older children.