TOP > Projects > Past Projects > brownU > Vol.21, No.11, November 2005 - Keep Your Eye On...Depression on campus - Keep Your Eye On...ADHD or just lack of sleep? - New treatment possibilities for stuttering in pre-school children


Vol.21, No.11, November 2005 - Keep Your Eye On...Depression on campus - Keep Your Eye On...ADHD or just lack of sleep? - New treatment possibilities for stuttering in pre-school children

As college students start settling into a new academic year, the American Psychiatric Association suggests that school administrators and counselors remain vigilant of young adults struggling with eating disorders, substance abuse and depression. Many students will begin the new school year with existing diagnoses and treatment histories. According to the APA, a recent survey shows nearly half of all college students experienced depression and 15% met criteria for clinical depression. The APA has launched a Presidential Task Force on Mental Health on College Campuses that aims to educate students and raise awareness about mental health treatment options, and to support mental health professionals working with college students. [More information is available about the APA's public awareness campaign, "Healthy Minds, Healthy Lives," at []

Keep Your Eye On...ADHD or just lack of sleep?

Is lack of quality sleep in children sometimes mistaken for attention-deficit/hyperactivity disorder (ADHD)? Before prescribing Ritalin and other drugs used to treat ADHD, physicians should be asking parents of hyperactive children to enforce good sleeping habits and to avoid giving them caffeinated drinks at night. If these measures do not work, then parents should consider medication for ADHD. This is the advice being given by researchers at the Technion-Israel Institute of Technology who suggest that excessive motor activity may simply be a tool to stay alert. They say that children who are being diagnosed with ADHD may just be sleepy, which could be one reason why stimulants are effective for treating ADHD. The researchers found that treatment of sleep disorders in children often results in substantial improvements in behavior and cognitive performance as well as significant reductions in anger, fear, bad moods and irritability. []

New treatment possibilities for stuttering in pre-school children

A new randomized, controlled study suggests that a 9-month intervention for stuttering in pre-school children revealed significant improvement after treatment in the Lidcombe program. The study, published in the September issue of the British Medical Journal, found that children reduced their stuttering by 77% in the Lidcombe program compared with children in the control group.

Stuttering, which often begins at 3 or 4 years of age, can lead to severely impaired communication if not treated early. Children who stutter are at risk of developing emotional problems such as fear of meeting new people or speaking on the telephone.

The Lidcombe program is an early intervention behavioral treatment developed specifically for stuttering children under the age of 6 years. The program is administered by a parent or caregiver in the child's everyday environment. Parents are trained to carry out the treatment during weekly visits to a speech pathologist. During the entire program, parents who have been trained by clinicians in the procedures, "provide verbal contingencies for periods of stutter-free speech and for moments of stuttering" during conversational exchanges that take place in the child's natural environment.

A child's speech that is stutter-free is rewarded by feedback from the parent (e.g., "That was good talking" or "That was smooth."). The contingencies for the child's stuttering are acknowledgement (e.g., "That was a bit bumpy."), a request for self-evaluation ("Were there any bumpy words then?"), and then a request for self-correction (e.g., "Can you say that again?"). Treatment is withdrawn when stuttering is maintained at a frequency of less 1% of syllables stuttered for 3 consecutive weeks.

According to the researchers, Mark Jones, from Queensland Clinical Trials Centre, University of Queensland, Princess Alexandria Hospital, Australia, and colleagues, the results of their new study support early intervention for stuttering with the Lidcombe program, which appears to provide effective treatment for children of pre-school age.

The study, carried out at 2 public speech clinics in New Zealand, aimed to evaluate the efficacy of the Lidcombe early-intervention stuttering program compared with a control group. Although several treatments are available for early stuttering, the Lidcombe program is the only one which has been studied with phase I and II clinical trials, according to Jones and colleagues. The program does not seem to change the child's behavior other than speech, or to affect the child's use of language or attachment to the parents.

Participants were children 3 to 6 years of age who presented to the speech clinics for treatment with frequent stuttering of at least 2% syllables stuttered. Proficiency in English was required for both children and parents. Children with onset of stuttering 6 months prior to study recruitment or treated for stuttering 12 months before study period were excluded. A total of 54 children were randomized to receive treatment in the Lidcombe program (N=29) or a control group that received no formal treatment (N=25). Although blinding was not possible during the trial, observers blinded to treatment and control arms assessed the outcomes.

During the study period, parents carried out treatment for certain periods each day, with weekly visits by parent and child to a speech pathologist.

For both treatment and control groups, audiotape recorders were used to collect samples of the children's speech outside the clinic. The speech samples were collected at 3, 6 and 9 months after randomization, and then assessed by speech pathologists.

Results showed that after 9 months, the Lidcombe group showed a reduction in stuttering that was significantly and clinically greater than the control group (p=0.003). The Lidcombe group reduced their stuttering by 77% compared with the control group which reduced stuttering by 43%. Onslow and colleagues suggest that the reduced stuttering in the control group was "presumably from a combination of natural recovery and the ad hoc treatment given to some of the participants."

In the treatment group, the mean proportion of syllables stuttered at 9 months after randomization was 1.5% (SD 1.4) and for the control group 3.9% (SD 3.5). According to the researchers, the effect size of 2.3% "was more than double the minimum clinically worthwhile difference specified in the trial protocol."

Although some children with early stuttering may recover without treatment, identifying these children in advance is not possible, write the authors. Delaying treatment until the school years exposes the child to the "unacceptable risk of experiencing the disabling effects of chronic and intractable stuttering throughout life."

Details of the Lidcombe treatment manual are available from the Australian Stuttering Research Centre at:

Jones M, Onslow M, Packman A, et al.: Randomised controlled trial of the Lidcombe programme of early stuttering intervention. Br Med J 2005; 331(7518):659-661.

The Brown University Child and Adolescent Behavior Letter, November 2005
Reproduced with permission of John Wiley & Sons, Inc.
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