عوامل خطر و لکنت زبان: بررسی شواهد برای پزشکان

This paper summarizes and discusses some of the key issues raised in the other four manuscripts in this special edition of Journal of Fluency Disorders. All the four pieces examine risk factors in developmental stuttering from different perspectives and all provide stand-alone contributions to knowledge on the subject. Thus, rather than review, the focus of the present paper is to highlight those matters, which, from a clinical perspective might be seen as either (a) of the greatest contention, (b) of particular relevance to clinicians, or (c) requiring greater emphasis in future research, on the basis of the conclusions from the authors involved. Educational objectives: This paper provides an overview of points of particular clinical interest arising from the four contributions to this special edition. Readers will be able to (a) understand arguments for and against whole word repetitions being included as moments of stuttering in the SSI-3 assessment, (b) understand arguments relating to psychological components in early onset stuttering, (c) understand some of the complexities in interpreting data pertaining to recovery from stuttering, (d) understand where future efforts in research into risk of stuttering should be placed.

The purpose of this special edition of Journal of Fluency Disorders is to draw data and opinion from four different sources on the phenomenon of developmental stuttering in children, and in particular, to examine data that pertain to one of the most fundamental, yet perplexing issues for the disorder: that of recovery from the disorder (either with or without therapy) in childhood. The four manuscripts offer information and perspectives on persistence and recovery, but all do so from very different perspectives. Cook, Donlan, and Howell report findings on 54 children who attended a 3 week intensive fluency therapy program. Pre therapy, children were administered a standardized and commonly used stuttering assessment (stuttering severity index, SSI-3; Riley, 1994) together with measures of lexical diversity and psychosocial impact. These measures were repeated post therapy alongside questionnaire data. Logistic regression approach to the statistical analysis was applied to determine which, if any of these potential factors were predictors of successful therapy outcome. The use of statistical procedures, and in particular, the potential advantages in applying logistic regression to the analysis of risk factors in the development and persistence of stuttering forms the basis of Reed and Wu's contribution to this special edition. Howell's solo authored paper builds on themes explored in both his recent publications (most notably, Howell & Davis, 2011) and this issue (co-authored with Cook and Donlan) and addresses the question of whether the SSI-3, or aspects of it, can predict future stuttering and persistence of stuttering, rather than just describe the presence or absence of stuttering at the time of its administration. Within this remit, Howell's paper focuses heavily on that meatiest of bones of contention within the field of stuttering assessment – whether single syllable whole word repetitions (WWRs) should be analyzed as moments of stuttering, or viewed as normal non fluency. Finally, Yairi and Ambrose offer a comprehensive overview on the epidemiology of stuttering. In addition to evaluating and summarizing existing opinion, the authors explain the influence of recent advances in understanding of stuttering across six areas relating to risk of ever stuttering and risk of persistence. These comprise onset, incidence, prevalence, developmental paths, genetics and subtypes. In so doing, the authors challenge views and opinions expressed by authors elsewhere in the special edition. The role of this present paper is to summarize the data and salient points presented by contributing authors, wherever possible examining how they inter-relate and in particular to offer an opinion as to the relevance of these findings for practicing fluency clinicians. Comment will be limited further where the ramification for others’ studies has already been made clear by the authors themselves. It is important to make clear that this is not intended as a review paper. Whilst following a unifying theme, all these manuscripts stand on their own as contributions to knowledge on stuttering, and Journal editors, associate editors and reviewers will already have commented on each contribution in turn. With this in mind, I offer little in the way of critique of each individual contribution, and comments, for the very large part, will not address matters relating to method and procedure within the various submissions. Instead, I constrain comments to issues where, (a) integration of the various perspectives on stuttering risk offered in this special edition can usefully be drawn together to further potential clinical intervention strategies, or (b) significant dissonance between authors’ perspectives requires help to clarify the implications for those working in clinical settings.

This special edition of Journal of Fluency Disorders reports important developments in our potential to test for risk of stuttering amongst school age children and to predict outcomes in therapy programs. Specific statistical procedures are explained which are key to allowing these assertions on risk to be made with confidence. The special edition also provides a forum for a comprehensive review on the status of our understanding of risk, and an update on recent developments. From a clinical perspective, the potential is that with further research and greater understanding, we may be moving toward a point where service provision could be targeted on the basis of our increased understanding of risk of developing a stutter, and for those who already have a diagnosis, risk of the stutter persisting. Further research is needed to (a) validate the use of the SSI-3 as an accurate predictor of risk, and see if particular subcomponents of assessment might be identified as significant factors. And if so, (b) whether more risk factors alongside those contained within the SSI-3 assessment can be found. One potential bi-product of such research could be the discovery of stuttering subgroups. Such research can only lead us toward a greater understanding of the epidemiology of stuttering, itself.