Bibliographic details: Bothe A K, Davidow J H, Bramlett R E, Ingham R J. Stuttering treatment research 1970-2005. I: Systematic review incorporating trial quality assessment of behavioral, cognitive, and related approaches. American Journal of Speech-Language Pathology 2006; 15(4): 321-341. [PubMed]
Quality assessment
This review concluded that some non-pharmacological therapies may help patients to reduce stuttering and/or improve social, emotional or cognitive variables. The authors? conclusions are in line with the evidence presented, but should be treated with caution in view of the small sample sizes and non-comparative design of many of the included studies. Full critical summary
Abstract
PURPOSE: To complete a systematic review, with trial quality assessment, of published research about behavioral, cognitive, and related treatments for developmental stuttering. Goals included the identification of treatment recommendations and research needs based on the available high-quality evidence about stuttering treatment for preschoolers, school-age children, adolescents, and adults.
METHOD: Multiple readers reviewed 162 articles published between 1970 and 2005, using a written data extraction instrument developed as a synthesis of existing standards and recommendations. Articles were then assessed using 5 methodological criteria and 4 outcomes criteria, also developed from previously published recommendations.
RESULTS: Analyses found 39 articles that met at least 4 of the 5 methodological criteria and were considered to have met a trial quality inclusion criterion for the purposes of this review. Analysis of those articles identified a range of stuttering treatments that met speech-related and/or social, emotional, or cognitive outcomes criteria.
CONCLUSIONS: Review of studies that met the trial quality inclusion criterion established for this review suggested that response-contingent principles are the predominant feature of the most powerful treatment procedures for young children who stutter. The most powerful treatments for adults, with respect to both speech outcomes and social, emotional, or cognitive outcomes, appear to combine variants of prolonged speech, self-management, response contingencies, and other infrastructural variables. Other specific clinical recommendations for each age group are provided, as are suggestions for future research.
CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.
Copyright © 2013 University of York.
Dra. Ana, acho que o artigo a seguir é o que há de mais recente em termos de revisão do tratamento farmacológico da gagueira: Overview of the Diagnosis and Treatment of Stuttering
ResponderExcluirFoi publicado em 2012, seis anos depois dessa revisão que você postou. De lá para cá, parece que muita coisa mudou nessa área.
Achei interessante que, na conclusão do artigo, os autores chegam inclusive a citar a associação entre gagueira e PANDAS. Vale a pena ler:
CONCLUSION
Stuttering involves abnormalities in fluency as well as anxiety and cognitive avoidance. In addition to considering the upcoming revision to the DSM criteria, comprehensive treatment should address all aspects of this disorder, including not only the fluency enhancement, but also improvement of social avoidance, anxiety, and cognitive restructuring. The optimal treatment of stuttering involves a multidisciplinary approach.
We suggest that all children, at the age of onset, should be evaluated by a qualified speech-language pathologist. In patients 2-8 years of age, the primary treatment modality should be speech therapy, with possible workup of PANDAS in relevant clinical cases. At 8-12 years of age, speech therapy should be continued and further research on the potential risks and benefits of pharmacological treatment in this age group are warranted.
From adolescence through to adulthood, speech therapy utilizing behavioral and cognitive methods should be continued, and a trial of medications is warranted. Stuttering onset after 9 years of age should be worked up for possible “acquired” causes. An adequate trial of medication is at least 3 months, as studies have suggested that the medication needs to be continued to maintain its efficacy.
We further suggest that a physician should collaborate with a speech-language pathologist to help assess the patient’s progress in treatment and to assist the patient through speech therapy. A clinician should enquire as to the patient’s fluency of speech during different social situations (i.e., at work, during introductions, speaking in front of audience, with family) as the level of stuttering can vary depending on the particular speaking environment.
The clinician should also be aware that stuttering waxes and wanes over time and should expect to see some “dips” in efficacy during the course of therapy. A longitudinal assessment over a period of months is needed to determine if the stuttering treatment is efficacious. Additionally, stuttering treatment should also address the level of social and cognitive avoidance that often accompanies this disorder.
Dra. Ana, acho que o artigo a seguir é o que há de mais recente em termos de revisão do tratamento farmacológico da gagueira: Overview of the Diagnosis and Treatment of Stuttering
ResponderExcluirFoi publicado em 2012, seis anos depois dessa revisão que você postou. De lá para cá, parece que muita coisa mudou na área.
Achei interessante que, na conclusão do artigo, os autores chegam inclusive a citar a associação entre gagueira e PANDAS. Vale a pena ler:
CONCLUSION
Stuttering involves abnormalities in fluency as well as anxiety and cognitive avoidance. In addition to considering the upcoming revision to the DSM criteria, comprehensive treatment should address all aspects of this disorder, including not only the fluency enhancement, but also improvement of social avoidance, anxiety, and cognitive restructuring. The optimal treatment of stuttering involves a multidisciplinary approach.
We suggest that all children, at the age of onset, should be evaluated by a qualified speech-language pathologist. In patients 2-8 years of age, the primary treatment modality should be speech therapy, with possible workup of PANDAS in relevant clinical cases. At 8-12 years of age, speech therapy should be continued and further research on the potential risks and benefits of pharmacological treatment in this age group are warranted.
From adolescence through to adulthood, speech therapy utilizing behavioral and cognitive methods should be continued, and a trial of medications is warranted. Stuttering onset after 9 years of age should be worked up for possible “acquired” causes. An adequate trial of medication is at least 3 months, as studies have suggested that the medication needs to be continued to maintain its efficacy.
We further suggest that a physician should collaborate with a speech-language pathologist to help assess the patient’s progress in treatment and to assist the patient through speech therapy. A clinician should enquire as to the patient’s fluency of speech during different social situations (i.e., at work, during introductions, speaking in front of audience, with family) as the level of stuttering can vary depending on the particular speaking environment.
The clinician should also be aware that stuttering waxes and wanes over time and should expect to see some “dips” in efficacy during the course of therapy. A longitudinal assessment over a period of months is needed to determine if the stuttering treatment is efficacious. Additionally, stuttering treatment should also address the level of social and cognitive avoidance that often accompanies this disorder.