Band One Individual Therapy Programme Up to 20 hours of individual face-to-face specialist therapy sessions for children who stammer under 7 years old

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1 Band One Individual Therapy Programme Up to 20 hours of individual face-to-face specialist therapy sessions for children who stammer under 7 years old This banding provides up to 20 one-hour therapy sessions and is mostly suited to younger children who stammer who require Palin Parent Child Interaction Therapy (Kelman & Nicholas, 2008). This approach involves both parents attending weekly therapy sessions where they explore strategies to support their child s fluency, using video feedback and home practice sessions. Some children also receive a small component of direct therapy to develop their use of specific fluency techniques when needed or the Lidcombe Program of Early Intervention (Onslow, Packman, & Harrison, E., 2003) may be offered as appropriate. The Band 1 funding may also be used for older children who have a milder form of stammering or who require fewer therapy sessions. Introduction Palin Parent Child Interaction Therapy has been developed through many years of clinical experience. We know that parents do not cause stammering and we also know that they are an essential ingredient in helping their child. Stammering in young children is often variable and can be quite unpredictable. Telling a young child what to do is often unsuccessful but by helping parents to become role models in talking, they can have a significant impact. Often we find that when children talk a bit more slowly, or give themselves a bit more time to plan sentences, they are more likely to be fluent. Parents are the best people to guide their children towards more fluency, with the support of their therapist. What is provided Band 1 funding covers the following: up to 20 one-hour therapy sessions (mostly suited to younger children who stammer, although Band 1 funding may also be used for older children who have a milder form of stammering or who require fewer therapy sessions); it involves both parents attending weekly therapy sessions where they explore strategies to support their child s fluency, using video feedback and home practice sessions; some children also receive a small component of direct therapy to develop their use of specific fluency techniques when needed, or the Lidcombe Program of Early Intervention may be offered as appropriate; collection and analysis of data; a clinical report; and a summary of outcomes on request.

2 Predicted outcomes: That children attending Palin Parent Child Interaction Therapy will typically: increase their level of fluency; and their ability to communicate effectively and confidently. That parents attending Palin Parent Child Interaction Therapy will typically report: that their child s fluency has improved and that they are less anxious and worried about the child s future; that they have more knowledge about stammering; and that they have more confidence about how to support their child. Individual outcomes vary depending on the needs of each child and family. During this programme of therapy each client s progress is carefully monitored and at the end of the therapy programme recommendations are made about the client s future needs. How progress is assessed: The following assessments are used to measure progress: Outward Stammering - children describe a series of nonsense cards that typically generate a speech sample of about 250 syllables. A score of percentage syllables stammered is generated. The Palin Parent Rating Scale (PPRS) (Millard et al. 2009; Millard & Davis, in press). This parent-completed series of scales measures parents perception of: - the impact of stammering on their child; - the severity of their child s stammer and the impact of it on them as parents; and - their knowledge and skills in managing their child s stammer. A personalised rating scale from 0-10 where 10 = best hopes and 0 = opposite. This is used to help parents to identify goals and reflect on signs of change. Communication Attitude Test for Preschool and Kindergarten Children who stutter (KiddyCAT). This assessment measures the impact of stammering on the child. Vanryckeghem & Brutten, 2007). Assessment schedule Data is collected at the following points: at the start of therapy; 3 months after the start of therapy; 6 months after the start of therapy; and 1 year after the start of therapy. Further information about the structure and content of Palin Parent Child Interaction Therapy, or any aspect of data collection and reporting, can be obtained by contacting the Centre directly. Evidence Base for Band 1 (Palin Parent Child Interaction Therapy) Outcomes for 19 families who completed their therapy programme in are presented below:

3 Graph 1: Percentage Syllables Stammered (a reduction in frequency signals improvement) Graph 2: Impact of stammering on the child rated by both parents (A downward trend signals reduced impact) Graph 3: Severity of stuttering and impact on the parents (A downward trend signals a reduction in severity and impact)

4 Graph 4: Parental knowledge about stammering and confidence in managing the stammering rated by both parents. (An upward trend indicates improvement) These four graphs show the outcome of Palin Parent Child Interaction therapy (Palin PCI) for 19 families who completed the program in the year 2015/16. Graph 1 shows the frequency of stammering over time, while Graphs 2, 3 and 4 show the outcomes of the Palin Parent Rating Scales. Results show Palin PCI is effective in reducing the frequency of stammering for up to one year after the start of therapy (Graph 1), along with a reduction of the impact on the child (Graph 2). In addition, parents report a reduction in the severity of the stammer beyond the clinic, with a reduction in the how worried they are (Graph 3). Parents are also more knowledgeable and confident in being able to support their child (Graph 4). The results suggest that not only are the improvements and skills maintained, but they continue to improve beyond the completion of therapy (3 months post first day of therapy). There are three research papers reporting the effectiveness of Palin PCI: Millard, S.K., Edwards, S., & Cook, F. (2009). Parent-child interaction therapy: Adding to the evidence. International Journal of Speech-Language Pathology, Volume 11, Issue 1, 2009, Pages Millard, S.K., Nicholas A., & Cook F.M. (2008). Is parent-child interaction therapy effective in reducing stuttering? Journal of Speech, Language and Hearing Research, 51(3), Matthews, S., Williams, R., & Pring, T. (1997). Parent-child interaction therapy and dysfluency: A single-case study. European Journal of Disorders of Communication, 32, Publications by the specialist MPC team Below is a list of the most relevant publications by the specialist team at the Michael Palin Centre about treatment for this age group: Millard, S.K. & Davis, S. (in press). The Palin Parent Rating Scales: Measuring stuttering from parents perspectives. Journal of Speech, Language and Hearing Research Kelman, E. & Millard, S.K. (2014). Approche familiale de Michaël Palin. Approche Neuro psychologique des Apprentissages chez l Enfant (A.N.A.E.), No.130, vol 26 (III). Aumont-Boucand. V., Millard, S.K. & Packman, A. (2014). Early intervention for stuttering: similarities and differences between two programs. SIG4 Perspectives on Fluency and Fluency Disorders, 24(1), 8-19 Kelman, E. & Whyte, (2012) A. Understanding Stuttering and Stammering. Jessica Kingsley Publishing Onslow, M. & Millard, S.K. (2012). Palin Parent Child Interaction Therapy and the Lidcombe Program: Clarifying some issues. Journal of Fluency Disorders, 37, 1-8 Botterill, W., & Kelman, E. (2010). Palin parent-child interaction. In B. Guitar and R. McCauley (Eds.) Treatment of Stuttering: Conventional and Unconventional Interventions. Baltimore: Lippincott Willliams & Wilkins Inc. Millard, SK & Cook, F.M. (2010) Working with young children who stutter: Raising our game. Seminars in Speech and Language vol 31(4) Kelman, E., & Nicholas, A. (2008). Practical intervention for early childhood stammering: Palin PCI approach. Milton Keynes, UK: Speechmark Publishing Ltd.

5 Cook, F., & Fry, J. (2006). Connecting stuttering measurement and management: Accountable Therapy. International Journal of Language and Communication Disorders, 4, Taylor and Frances, United Kingdom. Nicholas, A., & Millard, S. (1998). The case for early intervention with pre-school dysfluent children. International Journal of Language and Communication Disorders, 33, Supplement, Matthews, S., Williams, R., & Pring, T. (1997). Parent-child interaction therapy and dysfluency: A single-case study. European Journal of Disorders of Communication, 32, Rustin, L., Botterill, W., & Kelman, E. (1996). Assessment and therapy for young dysfluent children: Family interaction. London: Whurr. Kelman, E., & Schneider, C. (1994). Parent-child interaction: An alternative approach to the management of children s language difficulties. Child Language Teaching and Therapy, 10, Botterill, W., Kelman, E., & Rustin, L. (1991). Parents and their preschool stuttering child. In L. Rustin (Ed.), Parents, families and the stuttering child (pp59-71) Kibworth: Far Communications. Rustin, L., & Purser, H. (1991). Child development, families, and the problem of stuttering. In L. Rustin (Ed.), Parents, families and the stuttering child (pp1-24) Kibworth: Far Communications. it s taken the problem out of it, he s seeing it less and less as a problem, we talk more openly which we never did before Mother of Zak (4) "We feel that all families would benefit from the therapy delivered at the Clinic, as it forces us to stop, give time and reflect on us. As we lead our busy lives, we do not allow ourselves the time dedicated to concentrate/listen one-onone with our children which is so precious." Isabella, mother of Apollo (7) Being able to give him specific praise has been really helpful to show that what he does is really valued. It s been thoroughly non-invasive from his point of view which for a 4 year old has been great Mother of Zak (4)