Speech and Language Group, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia.
Health Group, Griffith University, Southport, Queensland, 4222, Australia.
J Fluency Disord. 2021 Dec;70:105843. doi: 10.1016/j.jfludis.2021.105843. Epub 2021 Mar 11.
This systematic review critically appraises and maps the evidence for stuttering interventions in childhood and adolescence. We examine the effectiveness of speech-focused treatments, the efficacy of alternative treatment delivery methods and identify gaps in the research evidence.
Nine electronic databases and three clinical trial registries were searched for systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with children (2-18 years) who stutter. Pharmacological interventions were excluded. Primary outcomes were a measure of stuttering severity and quality assessments were conducted on all included studies.
Eight RCTs met inclusion criteria and were analysed. Intervention approaches included direct (i.e. Lidcombe Program; LP) and indirect treatments (e.g. Demands and Capacities Model; DCM). All studies had moderate risk of bias. Treatment delivery methods included individual face-to-face, telehealth and group-based therapy. Both LP and DCM approaches were effective in reducing stuttering in preschool aged children. LP had the highest level of evidence (pooled effect size=-3.8, CI -7.3 to -0.3 for LP). There was no high-level evidence for interventions with school-aged children or adolescents. Alternative methods of delivery were as effective as individual face-to-face intervention.
The findings of this systematic review and evidence mapping are useful for clinicians, researchers and service providers seeking to understand the existing research to support the advancement of interventions for children and adolescence who stutter. Findings could be used to inform further research and support clinical decision-making.
本系统评价批判性地评估和绘制了儿童和青少年口吃干预的证据。我们检查了以言语为中心的治疗的有效性、替代治疗方法的疗效，并确定了研究证据中的空白。
在九个电子数据库和三个临床试验注册处搜索了系统评价、随机对照试验（RCT）和对口吃儿童（2-18 岁）应用干预措施的研究。排除了药物干预。主要结局是口吃严重程度的衡量标准，对所有纳入的研究进行了质量评估。
符合纳入标准并进行分析的有八项 RCT。干预方法包括直接（即利德科姆计划；LP）和间接治疗（例如需求和能力模型；DCM）。所有研究都存在中度偏倚风险。治疗方法包括个体面对面、远程医疗和小组治疗。LP 和 DCM 方法都能有效减少学龄前儿童的口吃。LP 的证据水平最高（LP 的合并效应大小=-3.8，CI-7.3 至-0.3）。对于学龄儿童或青少年的干预措施，没有高水平的证据。替代交付方法与个体面对面干预一样有效。
本系统评价和证据图谱的发现对于寻求了解现有研究以支持口吃儿童和青少年干预措施的发展的临床医生、研究人员和服务提供者非常有用。这些发现可用于为进一步的研究提供信息，并支持临床决策。
