Establishing Benchmarks for Linguis6cally Diverse Popula6ons Treatment Time for the Lidcombe Program

Transcription

1 Establishing Benchmarks for Linguis6cally Diverse Popula6ons Treatment Time for the Lidcombe Program ì Rosalee C. Shenker & Kristy Findlay March 2014 European Symposium on Fluency Disorders 2014

2 Onset of Stuttering ì Typically in preschool years ì 5 8.5% incidence 1 ì 75% natural recovery 2 ì Early treatment can avoid nega>ve consequences 3

3 Lidcombe Program 4 ì Behavioral treatment ì Developed for preschool age ì Parents provide feedback ì Structured/unstructured conversa>ons ì Stage 1 con>nues un>l zero/near zero stujering ì Stage 2 maintenance for at least 1 year

4 Lidcombe Program ì Studies support effec>veness ì Randomized Control Trials ì results more efficacious than natural recovery ì Best evidence for effec>ve interven>on for CWS under 6 years of age 3

5 Clinical Benchmarking ì ì Defini6on: ì Collec>ng & repor>ng data on clinical process & outcome ì Used to iden>fy & track progress to the goal ì Compared to similar measures of peers ì Part of the process of iden>fying best prac>ce Benefits: ì Contributes to clinical process ì Helps compare treatment delivery to standard ì Useful in alloca>on of funds/management of services ì LiJle published on stujering

6 Can treatment duration be predicted? ì 3 studies; Australia, UK, North America 4-6 ì 430 monolingual children ì Median sessions to Stage 2 LP = 11 ì Pre- treatment severity (%SS) significant predictor of treatment >me

7 Goal of this study Replicate previous audits with a linguis>cally diverse sample

8 Subjects ì 54 children ì Aged months (median 50 months) ì 45 males 9 females ì All treated at MFC ì No co- morbid speech/language factors ì English/French speaking predominately

9 Linguistic Diversity ì All exposed to an environment where 2 + languages spoken ì Exposure prior to age 4 ì ì In school At Home ì Language exposure reported by parents during ini>al assessment

10 Methodology ì Jones et al (2000) procedures replicated ì Retrospec>ve file audit ì All trea>ng clinicians had completed 2- day LP workshop ì Children ajended MFC ì All < 6 years at onset of treatment ì All completed Stage 1; met criteria for Stage 2 ì Files excluded when these criteria were not met

11 Variables ì Dependent ì Number clinic visits to Stage 2 ì Predictor Variables ì Gender ì Age at first treatment visit ì younger/older than 4 years ì Onset to treatment interval ì Less than 12 mths/12 mths or more ì StuJering severity (%SS) at first treatment visit ì +- 5%

12 Results: Descriptive Onset to treatment (months) StuAering Severity at 1 st clinic visit (%SS) Clinic Visits to Stage II Mean Standard Devia>on Range

13 RESULTS: Descriptive Comparison Ling. Diverse n=54 N. America n=134 Unite Kingdom n=66 Australia n=250 0 # Visits to Stage 2 Severity at 1st visit (%SS) Age (mths) Onset to Tx (mths)

14 RESULTS: Univariable Logistic Regression Variable Austalia, UK and NA Cohort Linguis6cally Diverse Sample Odds Ra>o 95% Confidence p- value Odds Ra>o 95% Confidence p- value %SS at 1st Clinic Visit <5% 5% (5-9.9%SS) 5.2 (10%+SS) ** <0.0001** ** Onset- to- Tx <12mths 12mths Gender Male Female Age <4 years 4 years

15 RESULTS: # Visits to Stage II Least # visits Median Most # Visits Ling. Diverse N. America United Kingdom Australia

16 RESULTS: 90 th Percentile comparison Linguis>cally Diverse United Kingdom North America Australia

17 DISCUSSION ì Replicated monolingual findings on a linguis>cally diverse popula>on ì Median # visits to Stage 2 similar ì Pre- treatment stujering severity a significant predictor of treatment >me for a bilingual sample ì Median (central tendency represen>ng 50 th %) similar in all three studies

18 Discussion ì First benchmarking data for treatment >me to Stage 1 of the LP for a linguis>cally diverse popula>on ì Replicates studies with monolingual children ì First step in comparing outcome for bilingual children ì Useful when planning and delivering early stujering interven>on

19 Future studies ì Similar methodology from other treatments ì Do trained clinicians get the same results? ì Languages other than English/French ì Impact of choice of treatment language on treatment >me; e.g., mother tongue/l2 ì Long term outcome for bilinguals ì Importance of severity as a predictor