Direct versus Indirect Treatment for Preschool Children who Stutter: The RESTART Randomized Trial

Caroline de Sonneville-Koedoot; Elly Stolk; Toni Rietveld; Marie-Christine Franken

doi:10.1371/journal.pone.0133758

Direct versus Indirect Treatment for Preschool Children who Stutter: The RESTART Randomized Trial

PLoS One. 2015 Jul 28;10(7):e0133758. doi: 10.1371/journal.pone.0133758. eCollection 2015.

Authors

Caroline de Sonneville-Koedoot¹, Elly Stolk², Toni Rietveld³, Marie-Christine Franken⁴

Affiliations

¹ Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; Speech and Hearing Center, Department of Otorhinolaryngology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands.
² Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
³ Department of Linguistics, Radboud University Nijmegen, Nijmegen, the Netherlands.
⁴ Speech and Hearing Center, Department of Otorhinolaryngology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands.

Abstract

Objective: Stuttering is a common childhood disorder. There is limited high quality evidence regarding options for best treatment. The aim of the study was to compare the effectiveness of direct treatment with indirect treatment in preschool children who stutter.

Methods: In this multicenter randomized controlled trial with an 18 month follow-up, preschool children who stutter who were referred for treatment were randomized to direct treatment (Lidcombe Program; n = 99) or indirect treatment (RESTART-DCM treatment; n = 100). Main inclusion criteria were age 3-6 years, ≥3% syllables stuttered (%SS), and time since onset ≥6 months. The primary outcome was the percentage of non-stuttering children at 18 months. Secondary outcomes included stuttering frequency (%SS), stuttering severity ratings by the parents and therapist, severity rating by the child, health-related quality of life, emotional and behavioral problems, and speech attitude.

Results: Percentage of non-stuttering children for direct treatment was 76.5% (65/85) versus 71.4% (65/91) for indirect treatment (Odds Ratio (OR), 0.6; 95% CI, 0.1-2.4, p = .42). At 3 months, children treated by direct treatment showed a greater decline in %SS (significant interaction time x therapy: β = -1.89; t(282.82) = -2.807, p = .005). At 18 months, stuttering frequency was 1.2% (SD 2.1) for direct treatment and 1.5% (SD 2.1) for indirect treatment. Direct treatment had slightly better scores on most other secondary outcome measures, but no differences between treatment approaches were significant.

Conclusions: Direct treatment decreased stuttering more quickly during the first three months of treatment. At 18 months, however, clinical outcomes for direct and indirect treatment were comparable. These results imply that at 18 months post treatment onset, both treatments are roughly equal in treating developmental stuttering in ways that surpass expectations of natural recovery. Follow-up data are needed to confirm these findings in the longer term.

Trial registration: isrctn.org ISRCTN24362190.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Behavior Therapy*
Child
Child, Preschool
Early Intervention, Educational
Female
Follow-Up Studies
Humans
Male
Quality of Life
Speech Production Measurement
Speech Therapy*
Stuttering / psychology
Stuttering / therapy*
Treatment Outcome

Grants and funding

The RESTART-study was funded by The Netherlands Organization for Health Research and Development (ZonMw; http://www.zonmw.nl/en/) NWO-Health Care Efficiency Research Program (Grant number 945-07-417). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.