Brief application of simplified habit reversal to treat stuttering in children

doi:10.1016/S0005-7916(98)00034-2

Journal of Behavior Therapy and Experimental Psychiatry

Volume 29, Issue 4, December 1998, Pages 289-302

https://doi.org/10.1016/S0005-7916(98)00034-2 Get rights and content

Abstract

We evaluated a brief therapy protocol involving the simplified regulated breathing method as a treatment for stuttering in children. The simplified treatment included awareness training, competing response training, and social support. Treatment was implemented in a multiple baseline across subjects design for 5 boys between the ages of 5 and 11. Each child received a 1 h treatment session, and $12$ h booster sessions as needed. Four of the 5 children reduced their stuttering to less than 3% stuttered words (the criterion for successful treatment) after one 1 h treatment session. These results were maintained for 3 of the subjects from 6 to 9 months posttreatment. Social validity measures revealed significant differences between ratings on baseline and posttreatment speech samples. Treatment acceptability and credibility measures indicated that the subjects’ guardians found the simplified regulated breathing method a reasonable treatment for stuttering in children.

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Cited by (21)

Reduced stuttering for school-age children: A systematic review
2023, Journal of Fluency Disorders
Treatment of school-age children (6–12 years of age) who stutter is a public health priority. Their clinical needs include a psychosocial focus and stuttering reduction. For the latter clinical need, there is a critical window of opportunity for these children warranting research attention.
The purpose of the review is to guide future clinical research by establishing (a) what interventions are associated with stuttering reduction for school-age children (b) the reported immediate and longer-term effects of those interventions, and (c) the level of evidence for these interventions in terms of study design.
Fourteen databases and three conference proceedings were searched for interventions used to reduce stuttering in school-age children. Primary outcomes were mean stuttering reductions pre-treatment, immediately post-treatment, and any follow-up assessments.
Of the 4305 studies identified from the databases, 67 studies met inclusion criteria. Five different treatment approaches were reported in the literature that might reduce stuttering for a school-age child, but with varying effect sizes. These include (a) operant methods, (b) speech restructuring, (c) combined operant methods and speech restructuring, (d) machine-driven treatments, and (e) treatments with a cognitive behaviour therapy component.
Operant methods warrant investigation in future clinical trial research, as do variants of speech restructuring. Hybrid approaches showed encouraging results, including speech restructuring variants combined with operant methods or with cognitive behaviour therapy. However, evidence is preliminary only at Phase I and II trials. Several treatments with reported clinical promise have been overlooked for decades and require further investigation.
The efficacy of habit reversal therapy for tics, habit disorders, and stuttering: A meta-analytic review
2011, Clinical Psychology Review
Citation Excerpt :
This procedure employs a modified competing response in which clients learn to regulate their breathing when speaking. The regulated-breathing method acts as an incompatible activity to stuttering behavior and has been successfully applied to both adults (Azrin & Nunn, 1974; Azrin, Nunn, & Frantz, 1979) and children (Elliot, Miltenberger, Rapp, Long, & McDonald, 1998). Many studies have examined the efficacy of HRT for habit disorders.
A meta-analysis based on 575 participants in 18 studies found Habit Reversal Therapy (HRT) to be an efficacious intervention for a wide variety of maladaptive repetitive behaviors, including stuttering, tics, nail biting, temporomandibular disorder, thumb sucking, and mixed repetitive oral-digital habits. Compared to control conditions, HRT showed a large effect size pre-treatment to final post-treatment assessment, d = 0.80. Moderator analyses revealed significant treatment effects for HRT for most moderator levels, indicating that HRT is efficacious in a number of variations for a variety of types of maladaptive behaviors, across a wide range of sample characteristics. The findings provide substantial support for the efficacy of HRT for disorders it is commonly used to treat. The findings are consistent with recent arguments for the classification of HRT as a well-established treatment for tic and habit disorders.
Using syllable-timed speech to treat preschool children who stutter: A multiple baseline experiment
2009, Journal of Fluency Disorders
This report presents the results of an experimental investigation of the effects of a syllable-timed speech treatment on three stuttering preschool children. Syllable-timed speech involves speaking with minimal differentiation in linguistic stress across syllables. Three children were studied in a multiple baseline across participants design, with percent syllables stuttered (%SS) as the dependent variable. In the week following the initial clinic visit, each child decreased their beyond-clinic stuttering by 40%, 49% and 32%, respectively. These reductions are only evident in the time series after the introduction of the syllable-timed speech treatment procedure. Participants required a mean of six clinic visits, of approximately 30–60 min in duration, to reach and sustain a beyond-clinic %SS below 1.0. The results suggest that clinical trials of the treatment are warranted.
Educational objectives: The reader will be able to summarize, discuss and evaluate: (1) The nature, impact and treatment options available for early stuttering. (2) The syllable-timed speech treatment protocol administered. (3) The advantages of syllable-timed speech treatment for early stuttering. (4) The questions that further research needs to answer about the syllable-timed speech treatment.
Treatment of stuttering with regulated breathing: Strengths, limitations, and future directions
2000, Behavior Therapy
In this paper a treatment for stuttering known as Regulated Breathing (Azrin & Nunn, 1974) is described, and studies investigating the original procedure and its variations are evaluated. The studies conducted to simplify the procedure are also evaluated. This review demonstrates that both the original and simplified procedures reduce stuttering and increase speech rate. In addition to discussing the efficacy of the original procedure and simplifications, the efficacy of Regulated Breathing is compared to that of other treatments common in speech-language pathology. Finally, a number of limitations of past research and areas for future research are offered.
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