مقاله انگلیسی مداخلات در در کودکان و نوجوانانی که لکنت زبان دارند
Abstract
Graphical abstract
Keywords
Introduction
Materials and methods
Results
Discussion
Conclusions
Funding
Data availability
Acknowledgements
Appendix A
Appendix B
Appendix C
Appendix D
Appendix E
Appendix F
References
ABSTRACT
Purpose: This systematic review critically appraises and maps the evidence for stuttering interventions in childhood and adolescence. We examine the effectiveness of speech-focused treatments, the efficacy of alternative treatment delivery methods and identify gaps in the research evidence. Methods: Nine electronic databases and three clinical trial registries were searched for systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with children (2–18 years) who stutter. Pharmacological interventions were excluded. Primary outcomes were a measure of stuttering severity and quality assessments were conducted on all included studies. Results: Eight RCTs met inclusion criteria and were analysed. Intervention approaches included direct (i.e. Lidcombe Program; LP) and indirect treatments (e.g. Demands and Capacities Model; DCM). All studies had moderate risk of bias. Treatment delivery methods included individual face-to-face, telehealth and group-based therapy. Both LP and DCM approaches were effective in reducing stuttering in preschool aged children. LP had the highest level of evidence (pooled effect size=-3.8, CI -7.3 to -0.3 for LP). There was no high-level evidence for interventions with schoolaged children or adolescents. Alternative methods of delivery were as effective as individual faceto-face intervention. Conclusion: The findings of this systematic review and evidence mapping are useful for clinicians, researchers and service providers seeking to understand the existing research to support the advancement of interventions for children and adolescence who stutter. Findings could be used to inform further research and support clinical decision-making.
Introduction
1.1. What is stuttering? Stuttering is a speech disorder characterised by involuntary repetition or prolongation of sounds, syllables or words, or by involuntary hesitation or pauses that disrupt the rhythmic flow of speech (World Health Organisation, 2001). Stuttering affects around 1 % of the population (Yairi & Ambrose, 2013) and has significant public health impacts. Evidence suggests later psychological difficulties may originate during the school years in children who stutter (Smith, Iverach, O’Brian, Kefalianos, & Reilly, 2014). School-aged children who stutter are at increased risk of teasing, bullying and anxiety and stuttering is also highly associated with occupational and educational under-achievement and suicidal thoughts (Nye et al., 2013). If not treated during childhood, persistent stuttering can result in lifelong social, educational and occupational reduced quality of life. A higher proportion of adults who stutter have social phobia and anxiety compared to adults who do not stutter (Blumgart, Tran, & Craig, 2010; Craig, Blumgart, & Tran, 2009; Iverach, Jones et al., 2009; Iverach, O’Brian et al., 2009; Kloth, Kraaimaat, Janssen, & Brutten, 1999; Smith et al., 2014; Stein, Baird, & Walker, 1996). According to the WHO International Classification of Functioning, Disability and Health (ICD), treatment for stuttering should aim to make speaking easier, mainly by eliminating or reducing the quantity of stuttering symptoms (World Health Organisation, 2001). Internationally, stuttering treatment approaches have long been debated. There have been diverse theoretical approaches regarding the causes of stuttering and subsequently there are several different treatment approaches for children.