Neuroplasticity in Children Who Stutter (CWS): investigating any behavioural and neurological changes after stuttering therapy

The main goal of this research is to identify structural and functional brain differences between children who stutter (CWS) and children who do not stutter (CWNS) and how these differences change due to stuttering therapy in CWS. This research consists of three studies to achieve three goals of the study: 1. To identify the structural and functional neural correlates of developmental stuttering in children close to stuttering onset (study 1) 2. To identify the effect of stuttering therapy on speech fluency and the emotional and psychosocial functioning of children who stutter and their whanau (family) (study 2) 3. To Link treatment-induced behavioural changes (Specific to study 2) with treatment-induced neural changes (study 3) Forty participants will take part in the research. All participants will complete study 1 to identify brain differences between 20 CWS and 20 CWNS. Study 2 and 3 will include the same 20 CWS following same timeline. Control group (CWNS) will participate in study 1 only and will undergo speech-language assessments and MRI scan only once. Children who stutter (CWS) will participates in all of the three studies. CWS will go through speech-language assessments 4 times, each 8 weeks apart: 8 weeks before starting stuttering therapy (baseline), pre-therapy, post-therapy and 8 weeks post therapy. CWS will undergo MRI scan 3 times, each 8 weeks apart: 8 weeks before starting stuttering therapy (baseline), pre-therapy and post-therapy. The three studies involve: Study 1: • Collection of background and speech-language information • Brain scan using Magnetic Resonance Imaging (MRI) -Background information: questions about child’s speech and language, including some general information, for example, medical history of the child and milestones developments (e.g., when the child started walking or said 1st word). -Speech and language assessments: children will undergo a comprehensive assessment including a case history and six assessments of speech and language. Speech and language assessments will take 2-3 hours in total and can be done over 2 separate sessions, depending on each child’s abilities and needs. Speech and language assessments will take place at the University of Canterbury while the brain scan will be conducted in St George’s Hospital in Christchurch. -Brain scan: children will undergo a 1 hour of Magnetic Resonance Imaging’ (MRI) scan session (including preparation + 35 minutes scan time). A trained speech and language therapist will attend the session to prepare the participating children for the MRI scan using the “submarine protocol” (Theys et al., 2014) to make it a fun experience. The MRI scans will be conducted and reviewed by a specialist radiologist. *Total time for study 1 is 2-3 hours of speech-language assessments and 1 hour of MRI scan. Study 2: (CWS only) • Children who stutter will receive 8 weeks of stuttering therapy (RESTART-DCM) • Speech-language assessments and questionnaire regarding impact of stuttering will be collected pre and post stuttering therapy Therapy: Children who stutter will receive 8 weeks of 1 to 1 speech and language therapy sessions using a stuttering therapy called the Demands and Capacities Model treatment (RESTART-DCM). It is a stuttering therapy program that is designed to help reduce stuttering and the impact of stuttering on your child’s daily life. It is an evidence-based treatment. This treatment approach is as effective (Franken et al., 2005; de Sonneville-Koedoot et al., 2015), and a better fit with the whanau-centred strength-based approach to treatment that we prioritised following Maori consultation. Participants will receive 12 hours of therapy. The general structure of a treatment session will be guided by RESTART-DCM methods published by Franken and Laroes (2021). Each treatment session takes about 1 hour and will include a discussion with parents of changes in child’s disfluency, revision of modified speech behaviour and modelling by the therapist when needed, practise of the techniques, time for answering questions and making notes in the parent’s logbook. Parent’s involvements in the treatment is important and a parent must attend treatment session. An essential part of the RESTART-DCM program is that a parent spends 10 minutes, 5 times a week, playing with their child and implementing the learnt modified speech behaviour. In addition, parents are requested to keep daily recording of stuttering severity, which is a simple process that takes few minutes a day. The general structure of a treatment session will be guided by RESTART-DCM methods published by Franken and Laroes (2021). Flexibility to session’s structure will be applied when needed using clinical judgements to make sure maximum benefits of the therapy are achieved. Ideally, individual therapy sessions will be offered twice a week in the 1st month and once a week in the 2nd month, however, individual circumstances, including physical well-being and whanau support available dictate a need for flexibility. Completion of the therapy will be dependent on participant availability, their needs and issues such as Fatigue or sickness. After completion of this treatment, participants will be reviewed after about 8 weeks for follow-up assessments and further treatment as individually required. No strategies are used to monitor adherence to the intervention. Stuttering treatment will be provided by PhD student Grout-Brown, who is a NZ-registered (NZSTA) speech language therapist and has participated in a workshop on RESTART-DCM. She will be supported and guided by her research supervisors Theys and Beal. Treatment will focus on reduction of severity and frequency of stuttering and attitude toward stuttering. Speech treatment will take place in the Speech and Hearing Clinics at the University of Canterbury. These clinics are equipped with purpose-built hard-wired recording devices to ensure that treatment sessions can be recorded for off-line data analysis without being intrusive during the sessions. Speech-language assessment: we will repeat speech-language assessments pre and post therapy to identify speech fluency changes related to therapy. Speech and language assessments will take 2-3 hours in total and can be done over 2 separate sessions, depending on each child’s abilities and needs. Speech and language assessments will take place at the University of Canterbury while the brain scan will be conducted in St George’s Hospital in Christchurch. *Total time for study 2 is 12 hours of stuttering therapy over a period of 8 weeks and about 2 hours of speech-language assessments repeated in 3 different times (8 weeks apart): pre-therapy, post-therapy and 8 weeks post therapy. Study 3: (CWS only) • MRI scans pre and post therapy CWS will undergo MRI scans pre and post therapy. MRI scan session is 1 hour long (including preparation + 35 minutes scan time). A trained speech and language therapist will attend the session to prepare the participating children for the MRI scan using the “submarine protocol” (Theys et al., 2014) to make it a fun experience. The MRI scans will be conducted and reviewed by a specialist radiologist. This study will help us to compare scans from before and after treatment to look for changes in the brain relating to the treatment. *Total time for study 3 is 2 hours of MRI scans (each scan is 8 weeks apart): pre-therapy and post-therapy.