European Symposium
on Fluency Disorders

Stuttering is a neurologically based disorder which impairs an individual's ability to time and sequence the underlying movement necessary for speech. Stuttering is multifactorial in nature and involves a complex interaction of motor abilities, individual perceptions, emotional reactions, cognitive-linguistic functioning, functional and structural brain differences, genetics, social constraints and psychosocial variables, which influence the stability of the speech motor system. As a result, intervention must be tailored to the unique characteristics of each individual and clinicians must account for a variety of factors that can significantly impact therapeutic outcomes. The goal of this presentation is to identify various ways in which common coexisting challenges can impact a child who stutter's ability or desire to effectively communicate. Intervention strategies for children who stutter that account for concomitant issues will be introduced and discussed. This lecture will be presented via videoconference.

This didactic and experiential seminar will describe the key principles of Acceptance and Commitment Therapy (ACT) and its relevance to stuttering. Developed by Steven Hayes in 1986, ACT is a mindfulness-based approach with a large body of empirical evidence to support its effectiveness. It teaches clients strategies to manage difficult thoughts and feelings more easily, cultivate greater acceptance, reduce experiential avoidance and, through the use of structured goal-setting, make meaningful changes in line with their life values. ACT highlights the point that attempts to control a problem often only exacerbate it and what we do to overcome a problem may serve to maintain it. This is particularly relevant in relation to adult stammering where avoidance is often used to control and suppress.As well as integrating ACT into traditional stuttering therapy programmes, the authors have also developed specific ACT workshops for people who stutter and will present statistically significant outcome data alongside client testimonies based on this work.

The purpose of this workshop course is two-fold. Clinicians commonly report difficulty determining whether the disfluencies produced by their client are indicative of stuttering or unique to cluttering, autism, language impairment or, second language learning. The initial section of this workshop will focus on increasing clinician understanding of the disfluent speech of clinical and non-clinical populations of person who do not stutter. Yet another challenge reported by clinicians is not knowing how to best help their clients successfully navigate their academic and employment settings. The second section of this workshop will focus on targeting communication effectiveness in a manner that will promote measurements of success for persons who stutter (both children and adults) that move beyond decreases in stuttered speech to increases in distinct communication competencies.

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Part I: Increasing understanding of the disfluent speech of clinical and non-clinical populations of persons who do not stutter‍

In our clinical decision making process, the presence of distinctive features unique to specific speech and/or language disorders reduce the complexity of our assessments and presumably increase the reliability and validity, but what happens when those features appear to overlap? For example, the type and frequency of speech disfluencies typically fluent bilinguals produce are in many cases higher than what has been reported to be indicative of stuttering in monolingual English speakers. Similarly, both monolingual and bilingual children with language impairment produce atypically high rates of speech disfluencies. Children who clutter and children with autism also produce disfluent speech behaviors that are in some ways unique to their respective disorders but in others comparable to what is classically considered to be stuttering-like in nature. The purpose of the present seminar is to enhance differential diagnosis of stuttering particularly with regard to those cases wherein clinicians may be misled by similarities in the speech behaviors produced. Participants will learn key differentiating characteristics, areas of overlap, along with other critical assessment considerations that will enhance clinician competence and confidence in their evaluation of speakers for whom there may be an increased risk for mis-identification of stuttering.

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Part II: Enhancing the ability of persons who stutter to successfully navigate academic and employment settings.‍

The vast majority of education curriculum (including elementary, secondary and university) places significant academic emphasis on the acquisition and continued development of public speaking skills. For children and adults who stutter, this emphasis can cause internal as well as external conflict with the most obvious concern being the requirement for fluency as one of the fundamental competencies for public speaking. School age children and adults who stutter who participate in the Lang Stuttering Institute treatment program proceed through a variety of specialized programs. To enhance their communication effectiveness, they complete a series of public speaking formats (including but not limited to formal speeches, debates, interviews) and in each one they focus on the development of one of the aforementioned seven critical competencies. After they have progressed through these initial steps, they then complete more advanced public speaking exercises wherein all competencies are measured simultaneously. Along with their progress towards the acquisition of these competencies, we also include a competency with respect to use of voluntary stuttering, development of a self-disclosure statement, and the ability to discuss stuttering in an objective, informative manner. All participants are required to complete self-evaluations with regard to each competency and specific to their comfort level with stuttering and their overall confidence in their communication skills. Once they have achieved self, peer, and teacher evaluations of excellence and self-evaluations of high confidence in their communication skills and comfort with stuttering, they are awarded a formal certification of communication excellence and a mentorship role in the program. One of the primary goals of this workshop will be to review core competencies for the development of communication excellence in persons who stutter and the assessment tools used to evaluate acquisition for purposes of use by other clinicians.

Learning outcomes:‍

Participants will learn a) the disfluent speech behaviors that overlap across clinical and typical speakers of more than one language, b) the key differentiating speech and language behaviors that distinguish clinical and typical speakers of more than one language, c) additional critical assessment considerations that will facilitate differential diagnosis of speakers for whom there may be an increased risk for mis-identification of stuttering, d) how to systematically target communication excellence, e) how to employ voluntary stuttering in a manner that will facilitate maximum client benefit, and f) how to employ self-disclosure in a manner that will facilitate maximum client benefit.

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Camp Dream. Speak. Live. is an annual summer camp sponsored by The U  of Texas at Austin's Michael and Tami Lang Stuttering Institute for children who stutter where reducing stuttering and/or increasing fluency is not the focus, rather the focus is on the children as individuals, who they hope to be, what they want to achieve and having fun. Through the generous gift of Michael and Tami Lang, Camp Dream. Speak. Live. is entirely free of charge and yet the benefit to each child who attends is of meaningful, lasting value. Together, our campers experience laughter, joy, excitement, and exceptional opportunities to advance their communication, mentorship skills, and self-confidence. Our goals for the children who attend our program include improving communication attitudes and communication effectiveness, as well as increasing resiliency, mentorship skills, and self-advocacy. We are piloting a variety of activities that will help the children to meet these goals as well as tools to allow reliable and valid measurement of progress. Our preliminary data suggest that participation in Camp Dream. Speak. Live. is of significant benefit to the campers and their parents in terms of increasing their positive attitudes towards their communication abilities and decreasing the negative impact of stuttering on their lives. We will continue to assess the additional potential outcomes. We will also continue to explore which measures provide the most valuable assessment of camper benefits such that we can further revise and modify our camp structure to allow for maximum benefit to all participants. We look forward to including campers from across the globe as the more we expand our perspective and participation, the more we will be able to further the mission of the Michael and Tami Lang Stuttering Institute.

In the Netherlands, Demands and Capacities Model based treatment  has been the standard treatment for pre-school stuttering children since the late 1980s.  In 2000, the Lidcombe Program  was introduced.  The RESTART study, which is an acronym of the Rotterdam Evaluation study of Stuttering Therapy in preschool children - A Randomised Trial,  compared  both treatments  on effectiveness and costs.  199 stuttering children aged 3-6 years old were randomised  over both treatments. Treatment was performed by 24 clinicians who were qualified for both treatment methods. Assessments were scheduled pre-treatment, 3, 6, 12 and 18 months post treatment. Randomisation over treatment was stratified by age, gender, time since onset, severity of stuttering, family history of recovery/persistence from stuttering, and clinician. At the conference, the results of the RESTART study regarding recovery of stuttering and cost-effectiveness will be presented, as well as the results of a focus group meeting with the participating clinicians.

The ECSF has been running courses since 2008. Currently more then 100 students from 23 EU and non-EU countries have graduated from the program. The one-year course leads to a qualification as an ECSF-recognized Fluency Therapist. This European group has now developed an additional stepwise procedure to become a European Fluency Specialist to ensure that patients and families receive the highest possible standard of care. This is open to ECSF graduates as well as eligible clinicians and academics with special interest in fluency disorders. The process involves documentation re. clinical and/or academic activities, continued professional development activities, and informal discussion groups, within a time frame of three years. This lecture will focus on the development and application of this certification process.

Lexipontix (Fourlas & Marousos, 2014) is a structured stuttering therapy programme for school-age children. Parents are engaged and therapy addresses the overall stuttering experience following the ICF model. Therapy is fun, it makes sense and produces meaningful changes. Card and roleplay games, behavioural experiments and real life "missions" are used to explore and understand the stuttering experience and to find alternative ways of managing it. In Lexipontix terms, the threatening mouse, which tries to invade and gain control over "the factory of mind" by inducing negative thoughts, emotions, somatic reactions, and unhelpful behaviours, is transformed into a controllable "pet" by means of CBT, PCI and SFBT practices as well as fluency shaping and stuttering modification techniques. The purpose of the presentation is to discuss the structure of Lexipontix in relation to its underlying theories, the clinical tools and practice, the role and the skills of the therapist as well as examples of expected outcomes.

The Lidcombe Programme (LP) is a behavioural treatment for preschool age children who stutter. It is an evidence-based program, with clear outcome evidence generated from Phase I, III and IV clinical trials, conducted in Australia, the US and several European countries. Parents deliver the treatment under the supervision of the Speech-Language Therapist (SLT).  During daily treatment conversations of 10-15 minutes, parents help their child to be stutter-free and provide them with verbal contingencies mainly for their speech. Most recent research into the LP tends to focus 1) on different ways of delivery including webcam, group and standalone treatment and 2) on the types of verbal contingencies that are considered an inherent part of the LP. Outcome data from these studies are presented with possible implications for clinical practice.

The Dutch Association of Stuttering Therapy (NVST) was founded in 1987 and is a membership organization of 60 Speech Language Pathologists and other professionals who are expert/specialized in fluency disorders. All members completed a one/two-year training in stuttering therapy. The association's main purposes are to improve the knowledge and understanding of stuttering, to monitor the quality of diagnosis and treatment of stuttering; and to protect the socio-economic interests of its members. The NVST also aims to train skilled specialists in fluency disorders. To achieve these goals, the NVST organizes courses; peer groups in which therapists discuss their methods and the association develops information materials. Partnership with the ECSF meets those goals on a European level. During this lecture the advantages of the link between ECSF, EFS, and NVST will be discussed, along with ‘aftercare' website for stuttering, and the intensive group treatments for stuttering, complementary to individual therapy.