Effectiveness of Fluency Shaping Technique and Cognitive Behavioral Therapy in Children with Stuttering

Öz

Aim: The examination of fluency shaping techniques, cognitive-behavioral therapy, and approaches that combine these two techniques in children with stuttering. Method: 45 school-aged children with stuttering were included in this study (mean age: 9.42±1.86 years; min-max: 7-12 years). Participants were randomly assigned to three groups. Group-I received the fluency shaping technique, Group-II received cognitive behavioural therapy, and Group-III received a therapeutic method combining these two techniques for 8 weeks. The participants were administered the Revised Child Anxiety and Depression Scale-Child Version (RCADS), the General Health-Related Quality of Life Scale for Children (Kid-KINDL), and stuttering severity assessment (SSA) before therapy (pre-test), after therapy (post-test), and one month later (follow-up test). Results: Statistically significant differences were found between Group-I and Group-III in the pre-test, post-test, and follow-up test in the inter-group comparisons of SSA (p<0.001) and RCADS (p=0.001). In the comparison of the tests performed in three time periods in Group-II, no significant difference was found in SSA (p=0.14), but a significant difference was found in the results of the pre-test, post-test, and follow-up test of the RCADS (p=0.01). No significant difference was found in the Kid-KINDL quality of life scale in the pre-test, post-test, and follow-up tests in all three groups (p>0.05). Conclusion: This study compared the effectiveness of therapy methods for school-aged children with stuttering. It has demonstrated the effects of the fluency shaping technique, cognitive behavioral therapy, and the combined application of these two techniques on stuttering severity, anxiety, and quality of life. The study's results contribute to the development of individualized and comprehensive therapy programs for children with stuttering and offer new perspectives in speech therapy practice. It is thought that the results of therapeutic intervention programs for school-age children with stuttering will contribute to examining the results from a broad perspective.

Anahtar Kelimeler

• Speech
• stuttering
• speech disorders
• quality of life

Kekemeliği Olan Çocuklarda Akıcılık Şekillendirme Tekniği ve Bilişsel Davranışçı Terapi Etkinliği

Öz

Amaç: Kekemeliği olan çocuklarda akıcılık şekillendirme tekniği, bilişsel davranışçı terapi ve bu iki tekniğin birlikte uygulandığı yaklaşımların incelenmesidir. Yöntem: Bu çalışmaya kekemeliği olan 45 okul çağındaki çocuk dahil edilmiştir (Ort yaş: 9,42±1,86 yıl; Min-Maks: 7-12 yıl). Katılımcılar rastgele şekilde üç gruba atanmıştır. Grup-I’e akıcılık şekillendirme tekniği, Grup-II’ye bilişsel davranışçı terapi, Grup-III’e bu iki tekniğin birlikte uygulanmasını içeren terapötik yöntemler 8 hafta uygulanmıştır. Katılımcılara terapi öncesi (ön test), terapi sonrası (son test) ve bir ay sonra (takip testi) Çocuklarda Anksiyete ve Depresyon Ölçeği – Yenilenmiş (ÇADÖ-Y), Çocuklar için Genel Amaçlı Sağlıkla ilgili Yaşam Kalitesi Ölçeği (Kid-KINDL) ve kekemelik şiddet değerlendirmesi (KŞD) uygulanmıştır. Bulgular: Grup-I ve Grup-III ön test, son test ve takip testi grup içi karşılaştırmada KŞD (p<0,001), ÇADÖ-Y (p=0,001) istatiksel olarak anlamlı farklılıklar bulunmuştur. Grup-II’de üç zaman diliminde yapılan testlerin karşılaştırmasında KŞD anlamlı farklılık bulunamamıştır (p=0,14) ancak ÇADÖ-Y (p=0,01) ön test, son test ve takip testi sonuçlarında anlamlı düzeyde farklılık saptanmıştır. Her üç grupta Kid-KINDL yaşam kalitesi ölçeğinde ön test, son test ve takip testinde anlamlı farklılık saptanmamıştır (p>0,05). Sonuç: Bu çalışma, kekemeliği olan okul çağı çocuklarına yönelik terapi yöntemlerini karşılaştırmıştır. Akıcılık şekillendirme tekniği, bilişsel davranışçı terapi ve bu iki tekniğin birlikte uygulanmasının kekemelik şiddeti, anksiyete ve yaşam kalitesi üzerindeki etkilerini ortaya koymuştur. Araştırma sonuçları, kekemeliği olan çocuklara yönelik bireyselleştirilmiş ve kapsamlı terapi programlarının geliştirilmesine katkıda bulunarak, konuşma terapisi uygulamalarında yeni perspektifler sunmaktadır. Kekemeliği olan okul çağı çocuklar için terapötik müdahale sonuçlarının geniş açı ile incelenmesi literatüre katkı sağlayacağı düşünülmektedir.

Anahtar Kelimeler

• Konuşma
• kekemelik
• konuşma terapisi
• yaşam kalitesi

Kaynakça

1. 1. Bayerl SP, Hönig F, Reister J, Riedhammer K. Towards automated assessment of stuttering and stuttering therapy. Springer. 2020:386-396.
2. 2. Sønsterud H, Feragen KB, Kirmess M, et al. What do people search for in stuttering therapy: Personal goal-setting as a gold standard? Journal of Communication Disorders. 2020;85:105944.
3. 3. Ambrose NG. Theoretical perspectives on the cause of stuttering. Contemporary Issues in Communication Science and Disorders. 2004;31(Spring):80-91.
4. 4. Onslow M. Treatment of stuttering in preschool children. Behaviour Change. 2004;21(4):201.
5. 5. Cildir B, Akın Şenkal Ö, Aydın E. Online evaluation of congenital amusia (tone deafness) in paediatric stuttering individuals. Hearing, Balance and Communication. 2019;17(1):27-34.
6. 6. Walden TA, Lesner TA, Jones RM. Is what I think I think really what I think? Implicit and explicit attitudes toward stuttering among practicing speech-language pathologists. Journal of Communication Disorders. 2020;83:105965.
7. 7. Kayıkçı MEK, Belgin E. Okul çağı kekeme Türk çocuklarının kekemelik bulguları. Turkish Pediatrics Archive/Turk Pediatri Arsivi. 2010;45(2):141-143.
8. 8. Nippold PA. Stuttering in school-age children: A call for treatment research. Language, Speech, and Hearing Services in Schools. 2011;42:99-101.

9. 9. Guitar B. Stuttering: An Integrated Approach to Its Nature and Treatment. Philadelphia, Pensilvanya: Lippincott Williams & Wilkins; 2013.
10. 10. Murphy WP, Yaruss JS, Quesal RW. Enhancing treatment for school-age children who stutter: I. Reducing negative reactions through desensitization and cognitive restructuring. Journal of Fluency Disorders. 2007;32(2):121-138.
11. 11. Ward D. Stuttering and Cluttering: Frameworks for Understanding and Treatment. Second Edition. Hove and New York: Psychology Press. Taylor & Francis Group; 2006.
12. 12. Cooper EB. A disfluency descriptor digest for clinical use. Journal of Fluency Disorders. 1982;7(3):355-358.
13. 13. Narullita D, Yuniati E. The Effect of Cognitive Behaviour Therapy (CBT) and Acceptance Commitment Therapy (ACT) to reduce of game online addiction in adolescents. In International Conference on Science, Technology & Environment (ICoSTE). 2020.
14. 14. Steel JL, Bress K, Popichak L, et al. A systematic review of randomized controlled trials testing the efficacy of psychosocial interventions for gastrointestinal cancers. Journal of Gastrointestinal Cancer. 2014;45:181-189.
15. 15. Mendlowitz SL, Manassis K, Bradley S, et al. Cognitive‐behavioral group treatments in childhood anxiety disorders: The role of parental involvement. Journal of the American Academy of Child & Adolescent Psychiatry. 1999;38(10):1223-1229.
16. 16. Spence SH, Donovan C, Brechman-Toussaint M. The treatment of childhood social phobia: The effectiveness of a social skills training-based, cognitive-behavioural intervention, with and without parental involvement. The Journal of Child Psychology and Psychiatry and Allied Disciplines. 2000;41(6):713-726.
17. 17. Packman A. Theory and therapy in stuttering: A complex relationship. Journal of Fluency Disorders. 2012;37(4):225-233.
18. 18. Chorpita BF, Yim L, Moffitt C, et al. Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale. Behaviour Research and Therapy. 2000;38(8):835-855.
19. 19. Gormez V, Kılınçaslan A, Orengul AC, et al. Psychometric properties of the Turkish version of the Revised Child Anxiety and Depression Scale–Child Version in a clinical sample. Psychiatry and Clinical Psychopharmacology. 2017;27(1):84-92.
20. 20. Eser E, Yüksel H, Baydur H, et al. Çocuklar İçin Genel Amaçlı Sağlıkla İlgili Yaşam Kalitesi Ölçeği (Kid-KINDL) Türkçe sürümünün psikometrik özellikleri. Turk Psikiyatri Dergisi. 2008;19(4):409-417.
21. 21. Jones M, Onslow M, Packman A, et al. Randomised controlled trial of the Lidcombe programme of early stuttering intervention. BMJ. 2005;331(7518):659.
22. 22. Bloodstein O, Ratner NB, Brundage SB. A Handbook on Stuttering. Seventh Edition. Plural Publishing; 2021.
23. 23. Craig A, Hancock K, Tran Y, et al. Epidemiology of stuttering in the community across the entire life span. Journal af Speech, Language, and Hearing Rese. 2002;45:1097-1105.
24. 24. Ünalan D, Çetinkaya F, Bafltürk M. Kayseri ili kentsel kesimde 7-12 yaş grubu çocukluklarda kekemelik prevalans. T Klin Pediatri. 2002;11:15-9.
25. 25. Martin A, Volkmar FR, Lewis M. Lewis's Child and Adolescent Psychiatry: A Comprehensive Textbook. Fifth Edition. Philadelphia: Lippincott Williams & Wilkins; 2007.
26. 26. Geetha Y, Pratibha K, Ashok R, Ravindra SK. Classification of childhood disfluencies using neural networks. Journal of Fluency Disorders. 2000;25(2):99-117.
27. 27. Yairi E, Ambrose N. Epidemiology of stuttering: 21st century advances. Journal of Fluency Disorders. 2013;38(2):66-87.
28. 28. Reilly S, Onslow M, Packman A, et al. Natural history of stuttering to 4 years of age: A prospective community-based study. Pediatrics. 2013;132(3):460-467.
29. 29. Laiho A, Klippi A. Long‐and short‐term results of children's and adolescents' therapy courses for stuttering. International Journal of Language & Communication Disorders. 2007;42(3):367-382.
30. 30. Craig A. An investigation into the relationship between anxiety and stuttering. J Speech Hear Disord. 1990;55(2):290-4.
31. 31. Iverach L, O'Brian S, Jones M, et al. Prevalence of anxiety disorders among adults seeking speech therapy for stuttering. J Anxiety Disord. 2009;23(7):928-34.
32. 32. Blomgren M, Roy N, Callister T, Merrill RM. Intensive stuttering modification therapy. Journal of Speech, Language, and Hearing Research. 2005;48;509-523.
33. 33. Ezrati-Vinacour R, Levin I. The relationship between anxiety and stuttering: A multidimensional approach. J Fluency Disord. 2004;29(2):135-48.
34. 34. Iverach L, Jones M, McLellan LF, et al. Prevalence of anxiety disorders among children who stutter. Journal of Fluency Disorders. 2016;49:13-28.
35. 35. Suveg C, Sood E, Comer JS, Kendall PC. Changes in emotion regulation following cognitive-behavioral therapy for anxious youth. Journal of Clinical Child & Adolescent Psychology. 2009;38(3):390-401.
36. 36. St Clare T, Menzies RG, Onslow M, Packman A, Thompson R, Block S. Unhelpful thoughts and beliefs linked to social anxiety in stuttering: Development of a measure. Int J Lang Commun Disord. 2009;44(3):338-51.
37. 37. Menzies RG, O'Brian S, Onslow M, Packman A, St Clare T, Block S. An experimental clinical trial of a cognitive-behavior therapy package for chronic stuttering. J Speech Lang Hear Res. 2008;51(6):1451-64.
38. 38. Irani F, Gabel R, Daniels D, Hughes S. The long term effectiveness of intensive stuttering therapy: A mixed methods study. Journal of Fluency Disorders. 2012;37(3):164-178.