[ Contents | Next | Previous | Up ]
From: Nathan Lavid
Date: 10/21/02
Time: 5:03:40 PM
Remote Name: 66.171.53.24
Dear Becky,
I’m glad you enjoyed the article and thank you for your questions. You’ve addressed a great topic – one that is not explicitly addressed in a professional education, but one is expected to learn as one becomes a professional.
Explicitly stated, clinical judgment is a principle that one cannot learn from a textbook. While clinical judgment is based on scientific integrity – which is quantifiable and easily applied – it’s practice requires a “gut-feeling” of what is best for the patient.
As this relates to your questions, I cannot offer recommendations on the intensity of therapy in relation to the age the patient – as I do not give much credence to strict adherence to treatment guidelines. For example, I wrote in the article how there is research demonstrating that speech therapy has the most benefit in young children. This observation has been duplicated and can be explained at the molecular level by brain plasticity. With a high degree of scientific integrity, one can endorse intensive speech therapy in the youngest children who stutter.
However, clinical judgment is the authoritative principle. One has to make a decision if the expense and stress inherent in intensive therapy should be recommended. This judgment is critically important in stuttering, as 80% of the youngest children will spontaneously recover.
This is one example of weighing the risks and benefits, and there are no clear-cut absolutes when you care for people. I like this aspect of being a clinician, and hope you take my inability to specifically answer your questions as encouragement to develop your own sense of clinical judgment. Thanks again for the questions. Nathan