A Misleading Account of Stuttering Treatment Research A recent ASHA Leader article (July 2014) by Peter Reitzes on parent-administered treatment for preschoolers who stutter makes claims for the efficacy of some treatments that are both misleading and not evidence-based. He refers to a study by Franken and colleagues, published in 2005, and an unpublished study reported by ... Inbox
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Inbox  |   November 01, 2014
A Misleading Account of Stuttering Treatment Research
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Speech, Voice & Prosodic Disorders / Fluency Disorders / Inbox
Inbox   |   November 01, 2014
A Misleading Account of Stuttering Treatment Research
The ASHA Leader, November 2014, Vol. 19, 4. doi:10.1044/leader.IN2.19112014.4
The ASHA Leader, November 2014, Vol. 19, 4. doi:10.1044/leader.IN2.19112014.4
A recent ASHA Leader article (July 2014) by Peter Reitzes on parent-administered treatment for preschoolers who stutter makes claims for the efficacy of some treatments that are both misleading and not evidence-based. He refers to a study by Franken and colleagues, published in 2005, and an unpublished study reported by Franken using the same research design with a larger group of young children who stutter. These studies purport to compare the outcomes of the Lidcombe Program and a Demands and Capacities treatment approach, and find the results to be indistinguishable. However, it is a well-known fact that preschool children who stutter have high rates of untreated recovery, especially those children who have been stuttering for between six and 15 months, which characterizes many of the children in Franken’s groups. Therefore, data from a matched untreated control group of children who stutter are absolutely essential to show that any speech performance improvement (from either treatment) exceeded what likely would have occurred without treatment.
This fatal flaw in Franken and colleagues’ 2005 study (and repeated in the larger study as well) was pointed out in a comprehensive systematic review of treatments for children who stutter. Because Reitzes espouses, appropriately, the importance of speech-language pathologists relying on principles of evidence-based practice, it is puzzling that the negative evaluation reported in this seminal article is not acknowledged.
Please see our blog post on ASHAsphere for a more detailed explanation and references.
Roger J. Ingham and Janis Costello Ingham, Santa Barbara, California
Peter Reitzes responds:
The Inghams write that aspects of my article are “misleading and not evidence-based.” I easily found seven publications in which Roger Ingham or Ingham and colleagues used the word “misleading” when discussing others’ work. Perhaps when Ingham says “misleading,” he means, “I disagree with your perspective.” It is understandable that Nan Bernstein Ratner encouraged him to take a “‘time-out’ from publishing these types of mass indictments.” Ingham has expressed concern over issues in our field being “overstated”; however, evidence suggests that Ingham himself may be a leading cause of this problem.
In several letters, he criticized the Camperdown program for overlooking and not integrating his work into their program. For example, Prins and Ingham wrote, “The authors failed to consider the relevant literature,” and then cited Ingham 12 times in their critique. The Inghams fault me for not citing what they call a “seminal article” by Roger Ingham and colleagues. One may wonder if Ingham, at times, confuses ego-based practice with evidence- based practice.
I note that the limitation the Inghams ascribe to my coverage of Franken’s work appears to be true of all work to date looking at treatment of young children during the dynamic period of spontaneous recovery from stuttering. When spontaneous recovery from a medical condition is approximately 80 to 85 percent, the number of children in each arm of a treatment study needs to be, at least, somewhere over 175 children. No study to date, whether preferred by the Inghams or not, has met this challenge.

The Leader provides a forum for members to express their opinions on clinical and other topics. We thank the writers for presenting alternative views of this issue.

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FROM THIS ISSUE
November 2014
Volume 19, Issue 11