Clinical Guideline Stuttering in Children, Adolescents and Adults
Pertijs, M. A. J., Oonk, L. C., et al. (2014).
Woerden (Netherlands): Nederlandse Vereniging voor Logopedie en Foniatrie, 1-170.
This guideline provides recommendations primarily to speech-language pathologists and fluency specialists about the diagnosis, treatment, follow-up care and management of children, adolescents, and adults who stutter. The guideline is targeted toward developmental stuttering only.
Dutch Association for Logopedics and Phoniatrics (NVLF)
<div>"Where there is a suspicion of social anxiety or depression in the person who stutters.... the speech & language therapist or fluency specialist should consult with the PWS [person who stutters] or the parents about a referral to the GP [general practitioner] for a potential referral to a psychologist or psychiatrist" (p. 138).</div>
<div>"The speech & language therapist or fluency specialist will start treatment 12 months after onset, when the severity of stuttering has not clearly decreased in the last 3-6 months" (p. 48). A clear decrease is stuttering is defined as an observable decrease by both parents and speech-language pathologists of at least two points on the eight-point stutter severity scale or a reduction of two points on the Lidcombe Program stuttering severity scale.</div>
<div>"During the assessment, the SLT [speech and language therapist] will provide information to the PWS [person who stutters] regarding the treatment options in order to enable an informed choice regarding the treatment" (p. 138).</div>
<div>"In general, the use of Altered Auditory Feedback based devices is not recommended [for adolescents and adults]. However, in specific circumstances, such equipment may reduce the stuttering rate in some PWS [person who stutters].... [however] this effect may not be maintained" (p. 121).</div>
<div>"The SLT [speech and language therapist] and other professionals involved with PWS [people who stutter] in a specific region set up a working agreement concerning collaboration, referring and information transfer. When referring to another SLT or Fluency Specialist, the SLT formulates specific questions incorporating all relevant ICF [International classification of Functioning] elements" (p. 139).</div>
<div>"Discuss with the parents of children up to 6 years of age who stutter the benefits of stuttering treatment no treatment option (reduction of percentage stuttered syllables and stuttering severity). Explain the differences between the 'Lidcombe program' and treatment based on the 'Demands and Capacities Model.' Come to a shared decision with the parents which of the two approaches is preferred" (p. 76).</div>
<div>"The speech & language therapist or fluency specialist will take into account the recovery pattern of stuttering in the family, gender, phonological skills, additional disorders and the temperament of the child in the decision to start intervention or to monitor fluency development" (p. 48).</div>
<div>"The speech & language therapist or fluency specialist assesses functions, external factors, contextual factors, individual factors, participation and activities according to the ICF [International Classification of Functioning] principles during diagnostic assessment. The Behaviour Assessment Battery is recommended as a diagnostic instrument for children over 6 years, adolescents and adults. For children under 6 years of age no specific recommendation is given due to the lack of specific diagnostic instruments for this age group" (p. 66).</div>
<div>"Any therapeutic approach to stuttering must include methods which promote long-term effects, and deal with possible setbacks.... At the end of the clinical treatment the SLT [speech and language therapist] proposes a programmed approach for an individualized follow up program lasting for 2 years" (p. 146).</div>
<div>"The speech & language therapist (SLT) needs to be able to implement the recommendations ... regarding diagnostic and therapeutic approaches. If the SLT lacks the experience or knowledge to do so, the client should be referred to an SLT with more expertise in the field of stuttering or to a Fluency Specialist" (p. 138).</div>
<div>"In cases of children over 6 years of age, adolescents or adults, seeking help in stuttering, the speech & language therapist or fluency specialist will, together with the client, make an inventory of ICF-elements (International Classification of Functioning, Disabilities and Health) to find out whether treatment is indicated" (p. 49).</div>
<div>"The speech & language therapist or fluency specialist will start intervention (even if the child has been stuttering for less than 12 months) if the child suffers from stuttering, if the parents are concerned about the child’s stuttering or if the child is showing reluctance to communicate" (pp. 48-49).</div>
<div>"The speech & language therapist or fluency specialist will monitor the child who started to stutter, before four years of age, for signs of spontaneous recovery during a period of one year after onset" (p. 48).</div>
<div>"Depending on what has been agreed by the [adolescent or adult] who stutters and the speech & language therapist/fluency specialist, the treatment will focus on the psychosocial aspects (emotional; and cognitive reactions to speaking), on verbal-motor aspects or on both" (p. 121).</div>
<div>"The treatment of stuttering for adolescents and adults should be individualized. Therapy may take place in an individual and/or group setting. The treatment plan is established in a dialogue between the Speech and Language Therapist (SLT) and the Person Who Stutters (PWS) ('shared decision making'); the treatment plan contains all ICF-elements [International Classification of Functioning]. The wishes and needs of the PWS form the basis of that treatment plan" (p. 121).</div>
<div>"The speech & language therapist or fluency specialist will inform the medical professionals, teachers and supervisors at day care centers within his/her network about the purpose and usage of ... [stuttering screening tools]" (p. 49).</div>
<div>For adolescents and adults "elements of stuttering therapy should include: Promoting transfer - it is essential that the PWS [person who stutters] applies the skills learned and insights in daily living. Promoting and maintaining self-management - the PWS is able to evaluate the stuttering and the associated behaviour and adjust this if necessary" (p. 121).</div>
<div>"The treatment of stuttering in children between the ages of six and thirteen years should be based on a treatment plan that contains all ICF [International Classification of Functioning] elements and focuses on the types of behaviors, emotions and cognitions that have been identified, in collaboration with the child who stutters and his parents during assessment" (p. 89).</div>
<div>"The speech & language therapist or fluency specialist determines stuttering severity with a suitable instrument. The Stuttering Severity Instrument (SSI) is preferred because the SSI is used internationally, is valid and seems to be reliable" (p. 66).</div>
<div>"If during two-or three-monthly evaluations of the therapy process, the realistic and achievable treatment goals may have not been sufficiently realized ... the SLT [speech and language therapist] should discuss the possibility of referral to another practitioner" (p. 138).</div>
<div>"The treatment of children who begin to stutter before the age of four, starts before they become five years of age" (p. 48).</div>
<div>"In case of stuttering children and young people, the SLT [speech and language therapist] should explore the problem of bullying. This may include a suitable questionnaire for bullying. If bullying is identified, the SLT should discuss this with the parents and agree a plan of action" (p. 138).</div>
<div>"If a child who stutters up to aged 6 years has not made progress with 11 to 12 therapy sessions or within 3 months, a Fluency Specialist should be consulted" (p. 138).</div>
