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Pearson's EBP Briefs: Evidence-Based Practice for School-Age Stuttering - Balancing Existing Research with Clinical Practice

Pearson's EBP Briefs: Evidence-Based Practice for School-Age Stuttering - Balancing Existing Research with Clinical Practice
J. Scott Yaruss, PhD, CCC-SLP, BCS-F, Kristin Pelczarski, PhD, CCC-SLP
May 6, 2015
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Editor's Note:  The content of this article was published by Pearson in the journal EBP Briefs. It is offered for CEUs through SpeechPathology.com in cooperation with Pearson. 

Clinical Scenario

Eleanor is a public school speech-language pathologist working in a large and growing suburban district. Her caseload consists primarily of children with language and learning difficulties, though she is seeing an increasing number of children with reading concerns, as well as children on the Autism spectrum. She splits her time between the middle school and high school buildings and works hard to face the challenges of her large and varied caseload.

 

Early each school year, Eleanor conducts screenings of children who are entering middle school to identify those who may be in need of speech and language services. She is acutely aware of the importance of good communication skills for children’s educational and social development, and she wants to ensure that these incoming students have the best opportunity to succeed in their new setting. She always strives to provide optimal service for children with speech and language impairments, in accordance with the requirements of the Individuals with Disabilities Education Act (IDEA; United States Congress, 1997; United States Department of Education, 2006), and the American Speech-Language and Hearing Association (ASHA) Code of Ethics (ASHA, 2003) and Scope of Practice (ASHA, 2001).  

This year, Eleanor is facing a unique challenge. On her screening schedule is a new fifth grade girl with a history of stuttering. The child, Emily, has been receiving treatment since she was in preschool, yet she still stutters severely and has difficulty communicating at school. Parental reports and prior treatment summaries indicate that Emily is able to use various modifications to enhance her fluency while she is in the therapy room, though she rarely, if ever, uses such techniques in the classroom or at home. Of particular concern is the fact that Emily’s behavior at school has started to change. Once an outgoing and friendly girl who regularly and enthusiastically contributed to class discussions, Emily has become quiet and taciturn. She is reluctant to participate in class activities and no longer raises her hand to answer questions. She sits alone at lunch and rarely calls her friends on the phone after school. When asked about these changes, she says that stuttering is embarrassing, so she finds it easier to just not talk. When asked why she does not use the techniques she has learned in therapy, she states, “they’re just too hard” and “they don’t really help.” Although the school year has just begun, Emily’s parents have already contacted Eleanor twice asking how the new clinician will help their daughter. The teacher has also asked what to do about Emily’s speech in the classroom.

Unfortunately, like so many other speech-language pathologists, Eleanor does not feel confident in her skills for helping children who stutter (Brisk, Healey, & Hux, 1997; Cooper & Cooper, 1996; Kelly et al., 1997). She recalls some of the information presented in her graduate class on stuttering, but she has worked with very few children who stutter in her career. As a result, she is uncertain about how to approach this situation. She knows that children can learn techniques that improve their fluency, but she also knows from talking with other clinicians that generalization of such skills can be particularly challenging.  

Because she understands the importance of the research base in making clinical decisions, Eleanor decides to consult the literature to help her identify an appropriate treatment. She recalls from graduate school that there is a wealth of research in fluency disorders. In fact, the sheer size of the literature causes trepidation as she approaches this case. She knows that she cannot possibly evaluate all of the treatment studies on school-age children who stutter, but she also knows that she can simplify her search for evidence by employing the principles of evidence-based practice (EBP). Specifically, she can: (a) pose a well-formed clinical question, (b) search the literature for relevant evidence, (c) evaluate the quality of the evidence she finds, and (d) make a clinical decision based on the evidence (ASHA,2005). 


j scott yaruss

J. Scott Yaruss, PhD, CCC-SLP, BCS-F

J. Scott Yaruss, PhD, CCC-SLP, BCS-F, F-ASHA is a researcher and clinician who specializes in the evaluation and treatment of stuttering across the lifespan. He recently joined the faculty of Michigan State University as Professor of Communicative Sciences and Disorders after 19 years at the University of Pittsburgh. Scott has served on the Board of Directors for the National Stuttering Association (NSA) and on the Steering Committee of the ASHA Special Interest Division for Fluency and Fluency Disorders. His research focuses on the development of stuttering in young children, as well as the evaluation of stuttering treatment outcomes. He has published 70 peer-reviewed papers and 115 other articles, chapters, and books about stuttering, including the Overall Assessment of the Speaker’s Experience of Stuttering (OASES). He frequently presents continuing education workshops designed to help speech-language pathologists improve their confidence and competence in helping individuals who stutter (www.Yaruss.com).


kristin pelczarski

Kristin Pelczarski, PhD, CCC-SLP

Kristin M. Pelczarski, Ph.D., CCC-SLP is an Assistant Professor at Kansas State University where she teaches graduate classes on stuttering and professional issues in speech pathology. She is a certified speech-language pathologist whose primary research is stuttering. Dr. Pelczarski supervises graduate students in clinical management of stuttering across the life span and serves as a co-chapter leader for the local chapter of the National Stuttering Association.



Related Courses

20Q: Early Childhood Stuttering: Less-Direct and More-Direct Treatment
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This course addresses key issues in the treatment of early childhood stuttering, with a focus on less-direct and more-direct treatment approaches. The course will discuss ways that clinicians can draw upon various approaches to develop individualized treatment so that each child’s and family’s individual needs are addressed.

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This is Part 2 of a four-part series. The stuttering experience has a ripple effect that extends far beyond the child who stutters. Parents, teachers, peers, and others must possess both knowledge and skills to best support children who stutter. This course will highlight new clinical tools and resources to provide a community-based treatment approach for stuttering. (Part 1 - Course 9278, Part 3 - Course 9301, Part 4 - Course 9304)

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Ethical Considerations When Working with Those who Stutter
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This course will discuss how the stigma of stuttering, advocacy, empathy, caseload management, and the structure of various settings in which we work (e.g., schools, medical settings, university clinics) impact our work with people who stutter, across the lifespan. Case scenarios involving ethics and stuttering will be presented for participants' consideration.

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