From: Anne Bothe
Date: 10/19/00
Time: 11:15:57 AM
Remote Name: 128.192.22.206
Thanks, Jane! Funny you should ask about combining direct and indirect treatments – there isn't much research, because people who believe in direct treatments will tend to tell you that there is no empirical support for indirect treatments, so there is no point in adding indirect procedures to direct procedures because direct procedures have been shown to work fine in many/most cases on their own. People who believe in indirect treatments would tell you that adding in direct features is a bad idea because the entire point of indirect treatments is to avoid being direct. The funny thing about this argument, though, is that I often get the sense that it is one of those arguments that The Researchers tend to have among themselves even as the real clinicians in the world are out there combining all possible approaches on the general theory that if none of it can hurt, and if something seems to be working with their own clients, then why not put as much together as possible? One very common example is to teach the child to use easy onsets and gentle speech sorts of approaches while also suggesting that parents should slow down their own speech and not put the child on the spot for "performance speech," or something like that. One of my master's students just completed a nice little project that showed that adding parental reduced rate to parent-administered timeout made no difference at all – it was pretty clear in her data that timeout was the effective variable. I'm not aware of too many other explicit research comparisons of direct, indirect, and direct-plus-indirect, but on the whole my answer would be that there is lots of evidence to show that direct procedures can reduce children's stuttering, minimal evidence to show that indirect procedures can reduce stuttering, and therefore basically no need to be asking parents to change things in their own speech or otherwise adding in indirect procedures if you've chose to use direct procedures.
Your other question was about the idea that stuttering is related to a sensitive temperament. I've read some of these ideas, yes, primarily from Dr. Conture's writing, and I guess what I would say is primarily to echo your comment that there hasn't been much research about it. I will repeat that children who get direct treatments, from every source that I am aware of, enjoy the experience, get lots of positive reinforcers for lots of things, seem happy, and end up not stuttering or stuttering substantially less than they did at the beginning – but I really don't know how that would fit in with the idea that stuttering is related to being sensitive. Sorry I can't be more help on that one.