Equitable access to stuttering treatments: Developing distance and self managed treatment models

正常言语交际的发展对人类健康至关重要。口吃是一种普遍存在的疾病，严重干扰交流。它可能会毁容，通常会导致与言语相关的社交焦虑。社交恐惧症存在于大约一半受影响的成年人中。它阻碍了职业潜力的实现，口吃的儿童通常在学校受到嘲笑和欺凌。在过去的十年里，NHMRC项目的资金使目前的团队能够进行世界级的口吃基础研究和临床试验。这项研究取得了重大成果，特别是在拥有重大证据基础的各年龄段开发了治疗方法。然而，越来越清楚的是，这些循证治疗的实施存在严重障碍，需要创新的治疗发展来解决这一问题。特别是，为农村和偏远地区的患者及其家人提供的言语病理服务资金不足，即使在城市环境中，工作场所的限制也导致言语病理学家提供不完整和零敲碎打的治疗。该研究计划将开发以下创新的治疗模式来解决这一问题：�远程干预模式，为农村患者及其家人和其他与治疗服务隔绝的人提供语音病理服务。�针对儿童和成人口吃的自我管理治疗模式，包括将成年人普遍存在的复发问题降至最低的程序。人们普遍认为，社交焦虑对许多口吃者来说是一个严重的问题，迫切需要研究确定不同年龄段口吃者的社交焦虑程度及其对治疗效果的负面影响。因此，这项研究计划的另一个目标是：�确定哪些患者的社交焦虑可能构成成功治疗的障碍。�开发了补充干预措施，以满足那些社交焦虑患者的需求。口吃的原因尚不清楚。了解有效的行为治疗的机制将有助于理解口吃的原因。因此，这个研究项目还旨在：�确定行为疗法为什么有效，从而产生关于因果因素的新知识。

The development of normal verbal communication is of the utmost importance to human health. Stuttering is a prevalent disorder that severely interferes with communication. It can be disfiguring and typically causes speech related social anxiety. Social phobia is present in around half of adults affected. It prevents attainment of occupational potential and children who stutter are typically teased and bullied at school. For the past decade NHMRC Project funding has enabled the present team to conduct world class basic research and clinical trials in stuttering. Significant gains have resulted from that research, in particular the development of treatments across the age groups that have a significant evidence base. However, it is becoming increasingly clear that there are serious barriers to the implementation of these evidence based treatments, and innovative treatment developments are needed to address this. In particular, speech pathology services for rural and remotely located patients and their families are incompletely funded, and even in urban settings workplace restrictions have resulted in speech pathologists delivering incomplete and piecemeal treatments. The program of research will develop the following innovative treatment models to solve this problem: �Distance intervention models for the delivery of speech pathology services to rural patients and their families and others who are isolated from treatment services. �Self-managed treatment models for children and adults who stutter, including procedures to minimise the ubiquitous problem of relapse in adults. It is widely understood that social anxiety is a significant problem for many stutterers and research is urgently needed to establish the extent of social anxiety in stutterers across the age groups and its negative effects on treatment effectiveness. Thus, a further aim of this program of research is to: �Identify those patients for whom social anxiety is likely to constitute a barrier to successful treatment. �Develop supplementary interventions to meet the needs of those socially anxious patients. The cause of stuttering is unknown. Understanding the mechanisms underpinning effective behavioural treatments would contribute to understanding causal factors in stuttering. Thus, this program of research also aims to: �Establish why behavioural treatments work, thereby generating new knowledge about causal factors.