Analysis of a Simplified Treatment for Stuttering in Children

Abstract

We investigated the effectiveness of a simplified program for the treatment of stuttering in children. The simplified treatment induded awareness training, in which the subjects learned to detect every occurrence of stuttering; training a response incompatible with stuttering, which involved relaxation and regulation of air flow over the larynx when speaking; and social support, which involved parentdelivered prompts and praise of children's use of the techniques in everyday environments. Eight children were treated in their homes with the simplified treatment, in a multiple baseline across subjects design, and all reached the criterion level of less than 3% words stuttered. In addition, the reduction in stuttering generalized to the school setting and was maintained at posttreatment (10 to 13 months). The subjects' rates of speech remained stable throughout baseline and treatment. Pretreatment and posttreatment ratings by the parents showed that they found treatment to be both acceptable and credible. Finally, social validity measures revealed a noticeable improvement in the subjects' speech to parents and speech pathologists.

Applying Behavior Analysis to Clinical Problems: Review and Analysis of Habit Reversal

“…Stuttering may involve a number of disfluences in the production of speech, including repetitions of word sounds, words, or phrases; prolongation of a word sound; or a hesitation (sometimes called a block) when attempting to speak Wagaman et al, 1993). These disfluencies disrupt the rhythmic quality of speech and may be accompanied by secondary behaviors that give the indication that the individual is struggling to speak.…”

“…The issue of assessment is particularly pertinent to research evaluating treatments for habits because many of these behaviors often occur covertly, possibly because of a history of social punishment for the behaviors (e.g., Rapp, Miltenberger, Galensky, Roberts, & Ellingson, 1998;Scotti et al, 1994). Although individuals who stutter or exhibit motor and vocal tics typically engage in these behaviors in the presence of the researchers who can then conduct direct observation assessments (e.g., Azrin & Peterson, 1988Finney et al, 1983;Wagaman et al, 1993), individuals who bite their nails, suck their thumbs, pull their hair, and engage in similar habits may refrain from these behaviors in the presence of the researchers (e.g., Rapp, Miltenberger, Galensky, Roberts, & Ellingson, 1998;. Therefore, it is sometimes necessary to utilize assessment procedures other than direct observation or to modify direct observation procedures to capture the occurrence of the behavior.…”

“…Because habit reversal is a treatment package consisting of numerous components, it was not known which components were necessary for the effectiveness of the package. As a result, researchers subsequently evaluated a number of variations of habit reversal for the treatment of tics, nervous habits, and stuttering in an attempt to simplify the procedure, increase efficiency, and identify the essential treatment components (e.g., Elliott et al, 1998;Wagaman et al, 1993;Woods, Miltenberger, & Lumley, 1996). Most researchers evaluated some HABIT REVERSAL combination of awareness training, competing response training, and social support.…”

“…More recently, researchers have investigated aspects of this robust treatment package, including simplified versions and variations (Miltenberger, Fuqua, & McKinley, 1985;Wagaman, Miltenberger, & Arndorfer, 1993), limitations (Rapp, Miltenberger, & Long, in press), effectiveness across different populations (Long, Miltenberger, Ellingson, & Ott, 1998), treatment adjuncts (Allen, 1998;Long, Miltenberger, Ellingson, & Ott, 1998;Rapp et al, in press), and mechanisms responsible for its success (Woods, Miltenberger, & Lumley, 1996). The continuing interest in, and research related to, habit reversal speaks to its clinical utility.…”

Sequential Application of Major Habit‐reversal Components to Treat Motor Tics in Children

“…Although habit reversal has been shown to be effective, implementation of the entire treatment package tends to be time, labor, and financially intensive (e.g., Woods & Miltenberger, 1995). In an attempt to make treatment more efficient and cost effective, researchers have evaluated simplified versions of the habit-reversal procedure and have concluded that an effective, simplified procedure consists of awareness training and the use of a competing response (Finney, Rapoff, Hall, & Christopherson, 1983;Miltenberger, Fuqua, & McKinley, 1985;Sharenow, Fuqua, & Miltenberger, 1989;Wagaman, Miltenberger, & Arndorfer, 1993). In awareness training, the subject learns to discriminate each occurrence of the tic, and in competing response training, the subject learns to engage in an incompatible behavior contingent on the anticipation or occurrence of the tic.…”