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From: Woody
Date: 10/15/03
Time: 2:37:36 PM
Remote Name: 216.240.100.159
Hi Gunars:
If I understand your post correctly, I think I and most other knowledgable people in the field would agree with you that outcome evaluations should include an assessment of the stutterer's emotional and cognitive state, the extent to which he or she is able to avoid (covertly or overtly) and the change in the person's quality of life. I think there should also be an assessment of the amount of effort that the new way of talking requires, since most stutterers who give up on fluency shaping do so because it is just too hard for them to sustain. Also, the actual quality of their speech, not just naturalness which is too narrow a concept, but the way in which their speech is evaluated by their listeners.
The studies cited in the special issue were very poorly controlled, having no controls for placebo, no controls for experimenter bias or the subject's knowledge of the hypothesis under test, and no controls for avoidance behavior, overt or covert.
The fact is that we do not have any adequate way to test for the efficacy of therapy. No one, for example, has ever designed a study with a placebo control that effectively mimicked actual therapy without itself being therapeutically useful. And there are no studies of outcome that control for the demand characteristics of research done with human subjects. I can't imagine how these studies can actually be designed.
Woody