Happy Belated Stuttering Awarness Day!

 

På lørdag, 22. oktober, ble Stuttering Awarness Day markert over hele verden.

I den anledning vil vi gjerne tipse om denne NRK-saken som kom samme dag. NRK skriver her om opplevelsen av stamming, informasjonsbehovet blant lærere og mangel på logopeder. Saken finnes også på samisk!

Bildet er hentet fra NKRsaken (https://www.nrk.no/spesial/sebastian-zalo_-halvor-schultz-og-mette-h.-sakariassen-stammer-_-forskere-vet-ikke-hvorfor-1.16135150?fbclid=IwAR1h35GxoUwmmJwaNfmX9640gKPozAAHxo4IZc5GCddMyCtoX5RlhMVw6jA) 

Presentation at Nifs’ annual meeting and conference

 Nifs is the national interest organization for people who stutter and clutter in Norway. It is an active organization that has done much important for the field of fluency disorders in Norway. For instance, they have arranged conferences with highly recognized experts such as David Shapiro and Scott Yaruss and annual camps for youth and family weekends, they have developed information brochures, and are an important voice in political discussions concerning speech therapy and rights for people who stutter and clutter (for more information, see: https://www.stamming.no/logopedbehandling-stamming-lpsk-tale). We are also so lucky to have a representative from Nifs in our reference group. In the mid of March, Kari-Anne and I were invited speakers at Nifs’ annual conference.

We had many topics to cover in our presentation; recent publications such as the Cochrane review (http://theestproject.blogspot.com/2021/09/new-publication-from-est-team.html), the surveys with kindergarten teachers and health nurses (http://theestproject.blogspot.com/2021/09/norsk-publisering-helsesykepleieres.html), the review of implementation quality in stuttering interventions (http://theestproject.blogspot.com/2021/12/implementasjonskvalitet-i.html). This resulted in many fruitful discussions concerning treatment options for young children and stuttering recovery. We really appreciated presenting for such an engaged audience! Thank you so much for this opportunity Nifs, we hope to be invited again for further discussions and presentation of updated results!

                                            

Stuttering may be associated with increased anxiety in some children and adolescents

By PhD student Ria Bernard, UCL

 

At the end of January 2022, we published a new study in the Journal of Speech, Language and Hearing Research following an exciting collaboration between University College London (UCL) and the Western Norway University of Applied Sciences. The study systematically reviewed the literature and analysed findings from 11 studies that had compared anxiety and depression symptoms in children and adolescents (2-18 years) who do and do not stutter.

This project has been a little while in the making – starting when Dr Hilde Hofslundsengen joined UCL as a visiting researcher at the end of 2018! I was last invited to contribute to this blog after my stay with Hilde in Sogndal in May 2019, so I was delighted to be asked to share the study findings now our article has been published!

 

There were several take-home findings from this meta-analysis that we hope will inform clinical practice, future research and benefit young people who stutter.

 

Firstly, although there was substantial variation in reported anxiety symptoms across studies, overall, children and adolescents who stutter report higher anxiety symptoms than peers. At first glance this may not seem that surprising given the elevated risk for anxiety and social anxiety disorder reported in adults who stutter. But the high variability across studies is noteworthy.

 

Secondly, the high variability in outcomes mean that not all young people who stutter experience anxiety. We suggest that elevated anxiety may reflect other risk factors such as exposure to bullying, access to therapy, or family history of anxiety and depression, which may increase risk or resilience in children and adolescents who stutter. Unfortunately, few studies reported these additional variables, so it is currently unclear what factors contribute to this increased risk.

 

Thirdly, there were too few studies investigating depression to reliably comment on risk in young people who stutter. This highlights the need for more research, especially given the co-occurrence of anxiety and depression in the general population.

 

However, our findings do indicate the need to carefully monitor the mental health and well-being of children and adolescents who stutter. Ideally, in future, longitudinal studies that follow large groups of children who stutter over time would help us understand the association between stuttering and anxiety over the course of development.

 

If you would like to read more about this study, you can access it here: https://pubs.asha.org/doi/10.1044/2021_JSLHR-21-00236

 

It’s been an amazing experience collaborating with Hilde and Professor Norbury on this study, and I look forward to working together again soon!

 

We would like to thank our funders the Economic & Social Research Council (ESRC), Action for Stammering Children Charity and the Research Council of Norway for supporting this work.

Meeting with the reference group

 
Around twice a year the EST-project group meets with its reference group. The group consists of representatives of institutions, organizations or groups of people that our research can be beneficial to. The EST project met with the reference group the 13th of December, for an update and discussion about our ongoing work

The meeting started off with an introduction to the latest publications from the EST project, as well as an overview of planned papers. As to the latest publications, you can read about some of them here, here, here and here. It’s been a productive year!

Further, we discussed the ongoing multiple single case (MSC) study, and aspects related to implementation of stuttering treatment that we have experienced in the study. This relates to parents conducting treatment at home, the dosage of treatment, the length of a clinic visit, and experiences with clinic visits online. The members of the reference group provided helpful insights to this matter.

This summer, two students at the master program in Psychology at the University of Oslo conducted interviews with parents in the MSC study before they started EST intervention. One of the students presented their work for the reference group. The interviews was included in their master thesis, which was just finished this fall. Hopefully the results will also be published in a scientific paper next year, the work is in progress from several of the EST team members. 

Finally, the upcoming RCT in the EST project was the topic of the discussion. Recruitment strategies and how to end a study was some of aspects we talked about.

The EST project would like to thank the reference group for helpful and motivating inputs to our work. Further, we would like to use the last blogpost of the year to wish all collaboration partners and readers a very Merry Christmas!

See you all in 2022!

On behalf of the EST-team,

Åse and Linn 

Implementasjonskvalitet i intervensjonsforskning – hva er det og hvorfor er det så viktig?

En intervensjonsstudie har til hensikt å undersøke om et tiltak eller et behandlingsprogram har effekt. Virker det - og i så fall, hvor godt virker det? For å undersøke dette kan det gjennomføres en randomisert kontrollert studie (RCT) eller en kvasi-eksperimentell studie. Begge disse forskningsdesignene kjennetegnes av at deltakerne kartlegges før intervensjon (pretest) og etter intervensjon (posttest), og så sammenlignes resultatene.  I et design som RCT (som vist i figuren her), så randomiseres utvalget til å få tiltaket eller ikke få det, og denne tilfeldige fordelingen gjør at vi kan sammenligne gruppene selv om det er ulike personer med i dem, og si noe om hvilken effekt tiltaket ser ut til å ha.

Imidlertid er det ikke bare forskningsdesign som har betydning for om vi kan si at tiltaket har effekt. Vi må også vite noe om hva som faktisk har skjedd i tiltaksgruppen, vi må undersøke hvordan intervensjonen har blitt implementert, altså iverksatt. Implementasjonskvalitet består av:

•  Intervensjonen selv (slik som protokoller/manual, opplæring)
• Støttesystemet rundt intervensjonen (slik som undersøkelse av fidelity (trofasthet til tiltaket) med overvåkning av kjerneelementer i intervensjonen for å sikre standard levering)

Dersom det ikke er gitt god opplæring eller laget en tydelig plan (manual) for hva som skal gjøres i tiltaket, gjør kanskje logopeder (eller andre som gjennomfører tiltaket) det slik de tror selv det er best. Da kan det bli svært ulik gjennomføring og vanskelig å si noe etterpå om hva som virket. Kanskje ble det planlagt 20 økter over 5 uker og så ble det bare gjennomført 10 økter – det kan ha betydning for om tiltaket har hatt effekt. 

Implementering er viktig. I verste fall kan det se ut til at intervensjonen ikke virker, men så er problemet at det ikke ble gjennomført lenge nok eller på den tiltenkte måten. I litteraturen kalles antall økter, varighet og frekvens for dose (etter medisinsk forskning). I språkforskning kan dose  også handle om antall ganger et ord blir repetert av barn eller voksen. Se en interessant artikkel av Frizelle og kollegaer (2021) for mer forskning om dose. For å få vite hva som faktisk har skjedd må vi følge nøye med på hva som skjer i intervensjonsgruppen – og i kontrollgruppen! Noen ganger kan kontrollgruppen bli for inspirert av å være med, slik at det skjer saker og ting i kontrollgruppen som gjør at effekten av intervensjonen ikke vises.

I EST-teamet har vi akkurat publisert en artikkel om implementasjonskvalitet i stammebehandling. Gjennom å undersøke tidligere forskning har vi funnet at intervensjonsforskningen på stammebehandlingsprogram for barn og ungdom er ganske gode på å beskrive ønsket dose og opplæring av foreldre, men at det er få studier som har undersøkt hva som faktisk har skjedd når foreldrene har gjennomført behandling. Det var også vanskelig å vite hva slags opplæring logopedene fikk før de gjennomførte de kliniske behandlingene. Det gjør at det kan være variasjon mellom hva som står i de ulike programmanualer og det som faktisk skjer i behandling. Da vet vi ikke hva som egentlig fører til økt taleflyt. Det betyr at vi trenger flere grundige studier for å få bedre kunnskap om stammebehandling.

Om du har tid nå i julestria, så les gjerne artikkelen vår her. Det er open access så alle kan lese gratis. Vil du ha mer kunnskap om implementasjon, så rett før vår artikkel kom ut, har Bergþórsdóttir og kollegaer på Island publisert en artikkel innen samme tema. Det er tydelig at dette er et særs aktuelt tema i forskningsverden nå! 

Ta vare på hverandre!  

New publication on the impact of stuttering on preschool aged children

It has been a busy year for the EST project this far. In several upcoming blogpost we will tell you about newly published studies from researchers in the project.

You can read post doc in the EST-project Linn Stokke Guttormsen and co-authors J. Scott Yaruss and Kari-Anne Bottegård Næss newest paper “Parents' Perceptions of the Overall Impact of Stuttering on Young Children” here: https://pubs.asha.org/doi/abs/10.1044/2021_AJSLP-20-00113

In their study, an adaptation of the Overall Assessment of the Speaker's Experience of Stuttering for School-Age Children was designed to ask parents about their perceptions of the impact of stuttering on their young children. Thirty-eight parents of young children who stutter participated. Results indicated that, on average, parents perceived that stuttering affected their children negatively; stuttering was perceived by some parents to affect the children’s mood, self-confidence, and social participation during stuttering moments or periods with stuttering. Furthermore, parent reports revealed that impact of stuttering can change with communication partners or situations. Parents' perceptions of impact are important for clinicians to consider when giving recommendations for therapy, as they can provide important insight into the family's needs. It is also important assess the perspective of the children if appropriate because present findings reveal that parents may not have insight into all aspects of impact, in particular, cognitive reactions to stuttering.

  

Stuttering awareness day 2021

This year, Åse and I (Linn) have participated in two different activities to raise awareness and knowledge of stuttering on the 22nd of October. In a webinar arranged by Statped, Åse brilliantly summarized what we know about stuttering treatment and participated in a panel debate. Hilda Sønsterud, Berit Løkken and Trude Beseth Nordeide also contributed with their insights, reflections and knowledge in the successful webinar with more than 350 participants. 

Katja Evjen asked me to be a guest in the podcast “Læring” in association with the International Stuttering Awareness day. Læring is made by journalist Monica Bjermeland and produced by Shane Colvin. The podcast touches upon many of the different interesting topics that is investigated at the Faculty of Educational Sciences at UiO. 

The other guest in the podcast was Elisabeth Egner, a young woman who has been stuttering since she was five years old. Elisabeth bravely shared her story in the studio, and listeners of the podcast gets an insight into how stuttering can be experienced during childhood and adolescence by hearing Elisabeth's story. When listening to Elisabeth describing her experiences with stuttering and associated thoughts and feelings I kept thinking about how important openness and knowledge about stuttering is. I therefore hope that many listen to this podcast and that it contributes to raising awareness of stuttering. You can find the podcast here.