Fluency therapy may improve stuttering in Down syndrome

By Liam Davenport

Stuttering among children with Down syndrome may be substantially improved with fluency shaping therapy and parental contingency measures, leading to greater self-confidence, self-esteem, and school participation, suggest Canadian researchers.

Although stuttering is estimated to have a prevalence among children with Down syndrome of up to 48%, there has been little investigation into optimal treatment approaches and outcomes. A number of options have been suggested, including fluency therapy, which has raised concerns among clinicians about its applicability.

To investigate further, Jessica Harasym and Marilyn Langevin, from the University of Alberta, in Edmonton, provided a stuttering treatment program to a girl aged 8 years and 10 months with Down syndrome whose profound stuttering was characterized by part word repetitions, silent and audible prolongations, and had a marked impact on her home and school life.

The researchers devised a treatment program based on the Comprehensive Stuttering Program for Children and consisting of a number of phases: establishment of fluency skills; intensive fluency skill practice; transfer, with fluency skills practised in a wide variety of settings; refinement of fluency skills and home programming; and maintenance and follow up. The child was assessed using a series of speech measures, severity ratings, and self-, parent-, and teacher-reports.

The team reports in the Journal of Fluency Disorders that the child's stuttering decreased from an average of 59.3% syllables stuttered (SS) at pre-treatment to 6.4% SS immediately post-treatment, and 0.8% SS at follow up. Her speech rate consequently increased from 33.4 syllables spoken per minute (SPM) to 149.8 SPM and 182.9 SPM, respectively.

On all measures, the child demonstrated improved self-confidence, self-esteem, and participation following therapy, and improved school participation and performance. However, the child's mother found the demands on the daily home practice challenging, and had concerns about the risk for isolating her other child.

The team writes: "Findings of this descriptive case report suggest that treatments that use a combination of direct fluency-skill training and parent administered behavioural contingencies may be a viable treatment approach for school-age children with Down syndrome and that therapy can be an enjoyable experience."

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