Selecting Treatments and Monitoring Outcomes: The Circle of Evidence-Based Practice and Client-Centered Care in Treating a Preschool Child Who Stutters Purpose The purpose of the present clinical forum is to compare how 2 clinicians might select among therapy options for a preschool-aged child who presents with stuttering close to onset. Method I discuss approaches to full evaluation of the child's profile, advisement of evidence-based practice options open to ... Clinical Focus
Clinical Focus  |   January 09, 2018
Selecting Treatments and Monitoring Outcomes: The Circle of Evidence-Based Practice and Client-Centered Care in Treating a Preschool Child Who Stutters
 
Author Affiliations & Notes
  • Nan Bernstein Ratner
    Department of Hearing and Speech Sciences, University of Maryland, College Park
  • Disclosure: The author has declared that no competing interests existed at the time of publication.
    Disclosure: The author has declared that no competing interests existed at the time of publication.×
  • Correspondence to Nan Bernstein Ratner: nratner@umd.edu
  • Editor-in-Chief: Shelley Gray
    Editor-in-Chief: Shelley Gray×
  • Editor: Courtney Byrd
    Editor: Courtney Byrd×
  • Publisher Note: This article is part of the Clinical Forum: Treatment of Stuttering in Children.
    Publisher Note: This article is part of the Clinical Forum: Treatment of Stuttering in Children.×
Article Information
Speech, Voice & Prosodic Disorders / Fluency Disorders / Research Issues, Methods & Evidence-Based Practice / Clinical Forum: Treatment of Stuttering in Children / Clinical Focus
Clinical Focus   |   January 09, 2018
Selecting Treatments and Monitoring Outcomes: The Circle of Evidence-Based Practice and Client-Centered Care in Treating a Preschool Child Who Stutters
Language, Speech, and Hearing Services in Schools, January 2018, Vol. 49, 13-22. doi:10.1044/2017_LSHSS-17-0015
History: Received February 2, 2017 , Revised June 27, 2017 , Accepted October 29, 2017
 
Language, Speech, and Hearing Services in Schools, January 2018, Vol. 49, 13-22. doi:10.1044/2017_LSHSS-17-0015
History: Received February 2, 2017; Revised June 27, 2017; Accepted October 29, 2017
Web of Science® Times Cited: 1

Purpose The purpose of the present clinical forum is to compare how 2 clinicians might select among therapy options for a preschool-aged child who presents with stuttering close to onset.

Method I discuss approaches to full evaluation of the child's profile, advisement of evidence-based practice options open to the family, the need for monitoring of the child's response, and selection of other approaches, if the child appears nonresponsive to the 1st-line approach.

Results Although some researchers and clinicians appear to favor endorsement of a single recommended treatment for early stuttering, I do not find this approach helpful or consistent with newer mandates for patient-centered care. I am also most comfortable recommending RESTART demands and capacities model as the 1st treatment approach, with parent consent, because its mechanism of action appears transparent and well-documented.

Conclusions There are numerous well-supported intervention options for treating preschool children who stutter. No single therapy can possibly work for all clients. I discuss available options that I feel have sufficient evidence-based support for use with young children who stutter. I emphasize the need to consider more, not fewer, acceptable therapy options for children who do not respond positively to a selected treatment approach within a reasonable time frame.

Acknowledgments
The author acknowledges research funding support from NIDCD: 1 R01 DC015494-01 (Brian MacWhinney, co-PI): a shared database for the study of the development of language fluency, and NSF BCS-1626300/1626294: the development of language fluency across childhood. N. Bernstein Ratner (PI) & B. MacWhinney, co-PI (Collaborative Research). Thanks also to Courtney Byrd for inviting the original debate panel and the immense patience of reviewers who helped me (and I presume the other presenters) shape our debate into something publishable.
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