Research at the Centre has increased and improved considerably over the last six or seven years. There are many areas that we still do not know about stammering and an infinite number of potential projects that could excite us. However, our resources are very limited and it is important that we direct our efforts in a way that will have the greatest impact on the work that we do and therefore the greatest benefit for the children and families who come to us. We have therefore refined the aims of our research:
1) To investigate the nature of stammering, with an emphasis on research that has potential relevance for the clinical work that we do.
2) To investigate the effectiveness of therapy with children and teenagers who stammer.
The nature of stammering
Alison Nicholas is currently leading a research study to investigate the temperament of children who stammer. This study is being carried out with Professor Ehud Yairi from the University of Illinois Urbana Campaign and Dr Steve Davis, from UCL. There is little known about the temperament of children who stammer, how temperament interacts with stammering and whether there is a relationship between temperament and therapy outcome. This is the first study to monitor temperament over a long period of time and when it is completed, this will be the largest study into temperament and stammering.
Alison’s study is focusing on children between the age of 10 and 14 years, both children who stammer and children who do not stammer. The study requires completion of questionnaires on two occasions six months apart by both parents and the child. While this study is drawing to a close, if you would like to take part, either as a child who stammers or a child who does not stammer, please contact Alison at the Centre. (Alison.Nicholas@islingtonpct.nhs.uk )
The effectiveness of therapy
This is a huge area with an infinite number of potential projects, which is complicated by the individual nature and impact of stammering for each child and family and the range of therapy methods used to meet these needs. Since therapy aims to help people to feel greater control over the stammering and less worried about it (both the child and the parents), we feel that it is essential that evaluations of therapy effectiveness consider how the child and parents view the problem.
In order to help us focus and structure our research activities we have adopted a clinical effectiveness research framework that has been presented by Robey and Schultz (1998). The model advocates systematically investigating therapy through a progression of levels moving from treatment efficacy research, where therapy is investigated under optimal conditions (for example, implemented by SLTs expert in the application of the therapy programme, in a specifically-resourced specialist environment), to treatment effectiveness research, where therapy is investigated under clinical conditions (for example, in typical settings for SLTs). As the research progresses through the different levels, the factors that influence outcome are isolated and investigated. The framework has been applied to the investigation of Palin parent-child interaction therapy (Palin PCI), which is the most commonly used approach with young children who stammer at MPC, as well as to the investigation of the intensive courses for children who stammer and their parents and the intensive courses for teenagers who stammer.
Palin PCI
Clinical reports detailing the positive impact for individual clients has been available for a number of years (Rustin, et al, 1996). Matthews, Williams and Pring (1997) conducted a more structured single case systematic investigation of Palin PCI. They monitored the progress of a four-year old boy for six weeks before therapy, six weeks during therapy and six weeks post therapy. The percentage of words stammered was calculated from speech samples obtained while the child played with each parent in the clinic for a period of twenty minutes, once a week. The therapy resulted in a significant reduction in the frequency of the child’s stammering.
We have recently had an article accepted for the Journal of Speech, Language and Hearing Research, which reports on the progress made by six children who had been stammering for longer than 12 months before they began therapy. This means that they were at high risk of persistent stammering. The study showed that four of the six children significantly reduced the frequency of their stammering with only the video interaction component of Palin PCI, while two went on to have some therapy focusing more directly on speech production.
This led to the development of another study that investigated this therapy and compared children’s progress with a group of children who did not receive therapy over the same time period. The results showed that those who received therapy made greater reductions in stammering frequency, the impact that the stammering had on the child, the parents’ perceptions of stammering and the impact that the stammering had on the parents, than those who did not have therapy. This study was carried out by Sharon Millard and has recently been completed and submitted as part of the requirements for her PhD. If you would like further information about the Palin PCI research programme please contact Sharon Millard at the Centre (Sharon.millard@islingtonpct.nhs.uk).
Intensive courses
Information from the intensive courses has been collected over many years and those of you who attended in the past will remember making recordings of your speech at the start and end of the course and at all the follow up sessions!, along with the many questionnaires we asked you to complete! This information has not been published, but it has provided us with enough data to support these courses and to indicate that further research is warranted. It has also helped us to work out which measures seem to be the most sensitive and relevant for monitoring change.
Jane Fry and Willie Botterill are leading a research study investigating the impact of the intensive courses. They have been collecting data from course participants before, during and after the course and are in the process of analysing it. These are exciting studies that will provide us with the information and support that we need to develop larger studies.
Would you like to be involved in research at the Michael Palin Centre?
We are always keen to hear your views about research into stammering and the therapy that is provided. While resources will limit what we can achieve, we would like to be guided by the opinions of people who stammer and their families, so if you have an idea about an area of research – let us know!
In addition to giving your opinion about what research we should be conducting, you might also be interested in being part of a research study steering group; helping to develop an idea into a project; be involved in running a project; the analysis of the data collected; or writing articles so that we can make the results accessible to a wider audience. You don’t need any particular knowledge about research, just lots of enthusiasm!
MPC Publications
This is a list of the most recent publications from staff at MPC, divided into peer reviewed articles, book chapters and books.
Peer reviewed articles
Biggart A, Cook FM & Fry J, 2007, 'The role of parents in stuttering treatment from a cognitive behavioural perspective', Proceedings of The Fifth World Congress on Fluency Disorders, Dublin, Ireland, 25-28th July, 2006., pp268-375.
Buck SM, Lees R & Cook F, 2002, 'The influence of family history of stuttering on the onset of stuttering in young children', Folia Phoniatrica and Logopaedia 54, pp117-124.
Cook F & Botterill W, 1999, 'A profile of risk for generalist therapists', Proceedings of The Fifth Oxford Dysfluency Conference, pp154-159.
Cook F & Fry J, 2006, 'Connecting stuttering measurement and management: III. Accountable therapy', International Journal of Language and Communication Disorders 41, pp379-394.
Cook F & Rustin L, 1997, 'Commentary on the Lidcombe Programme of early stuttering intervention', European Journal of Disorders in Communication 32, pp250-258; discussion 261-256.
Davis S, Howell P & Cook F, 2002, 'Sociodynamic relationships between children who stutter and their non-stuttering classmates', Journal of Child Psychology and Psychiatry 43, pp939-947.
Kelman E, Nicholas A & Millard SK in press, PCI 2005 (Parent-Child Interaction Therapy). The Seventh Oxford Dysfluency Conference 2005, Oxford.
Matthews S, Williams R & Pring T, 1997, 'Parent-child interaction therapy and dysfluency: a single-case study', European Journal of Disorders of Communication 32, pp346-357.
Millard SK, 1998, 'The value of single-case research', International Journal of Language and Communication Disorders 33, pp370-373.
Millard SK, Nicholas A & Cook FM, in press, 'Is parent-child interaction therapy effective in reducing stuttering', Journal of Speech, Language and Hearing Research.
Millard SK & Rustin L, 2003, 'Children's drawings as a measure of change', Proceedings of The SIxth Oxford Dysfluency Conference, 26th-29th June 2002.
Nicholas A & Millard SK, 1998, 'The case for early intervention with pre-school dysfluent children', International Journal of Language and Communication Disorders 33 Supplement, pp374-377.
Nicholas A & Millard SK, 2003, 'A study to investigate the effectiveness of parent child interaction therapy: Preliminary findings', Proceedings of The Sixth Oxford Dysfluency Conference, 26th-29th June 2002, pp145-158.
Nicholas A, Millard SK & Cook F 2003 Parent-child interaction therapy: Child and parent variables pre and post therapy. The International Fluency Conference, 2003, Montreal,2004, pp108-116.
Rustin L & Cook F, 1998, 'The Communication Skills Approach to Stuttering in Adolescence', Logopedics Phoniatrics Vocology 23, pp59-63.
Books
Kelman E & Nicholas A, (in press) Practical Intervention for Early Childhood Stammering: Palin PCI
Rustin L, Cook F, Botterill W, Hughes C & Kelman E, 2001, Stammering: A Practical Guide for Teachers and Other Professionals.
Rustin L, Cook F & Spence R, 1995, The management of stuttering in adolescence: A communication skills approach, Whurr Publishers, London.
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