Parentchild interaction therapy: Where is the evidence

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Parent-child interaction therapy Where is the
evidence?

• Millard¹², Edwards² and Cook¹
• ¹The Michael Palin Centre for Stammering
  Children, London
• ²The University of Reading

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Palin parent-child interaction therapy

• Kelman and Nicholas, 2008
• Consultation assessment
• Six clinic sessions
• Indirect component parents make adjustments to
  interaction and management styles
• Direct component child makes changes to speech
  production with parental support
• Six week home consolidation period
• Review 6 weeks, 3 months, 6 months, 1 year post
  therapy

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• Millard, S. K., Nicholas, A., Cook, F. M.
  (2008). Is parent-child interaction therapy
  effective in reducing stuttering? JSLHR, 51(3),
  636-650.
• Millard, S. K., Edwards, S., Cook, F. M.
  (2009). Parent-child interaction therapy Adding
  to the evidence. IJSLP, 11(1), 61-76.

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Millard et al., 2008
PHASE B
PHASE A
PHASE C
(Baseline Phase)
(Clinic and home therapy Phase)
(Follow up)
Review
End of study
End of clinic
Consultation
Session
Therapy
Weekly Video Recordings
Monthly Video
Recordings

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Participants

• Inclusion criteria
• Identified as stammering by minimum of two
  therapists and parents
• Stammering for a minimum of 12 months
• Under age 50
• Both parents using English as the primary
  language at home
• Parents able and willing to attend MPC for therapy

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Participants

• 4 male, 2 female
• Aged 311 to 410
• Time since onset 13-30 months
• Family history
• 1 no family history
• 2 history of persistent stammering
• 3 history of recovered stammering

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Stammering frequency data

• Recordings transcribed and stammering identified
• Transcriber blind to phase
• Inter-rater reliability
• 96.9

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Cusum analysis

• Montgomery (1997)
• Monitors change in data that fluctuate
• Determines whether there is a systematic change
  in the data compared with the variability
  observed in the baseline phase

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(No Transcript)
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Results

• 4/6 children demonstrated a significant reduction
  in stammering during the therapy phases which
  consisted of indirect components only
  (interaction and family management strategies)
• 1 reduced stammering with one parent during
  therapy
• 1 reduced stammering in the follow up phase

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Millard et al., 2009
PHASE A1
PHASE B1
PHASE B2
PHASE A2
(Baseline Phase)
(Clinic Therapy)
(Home Based Therapy)
(Follow up)
Review
6 months Post-clinic therapy

Consultation
Session


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Millard et al., 2009

• Used CHAT and CLAN
• Language assessment RDLS-3
• Parent rating scales
• Stammering severity
• Impact on child
• Impact on parents
• Parents knowledge and confidence

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Participants

• Therapy condition (N 6) P1- P6
• 5 males, 1 female
• Age range 311 411
• 3 had family history of stammering
• Time since onset range 12 - 24 months
• Waiting list condition (N 4) C7-C10
• 4 males
• Age range 43 411
• 3 had family history of stammering
• Time since onset range 22 - 30 months

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ResultsStammering frequency

• Inter-rater reliability 97.9
• 6 children received therapy
• All significantly reduced stammering
• 4 attributed directly to therapy (P3,P4,P5,P6)
• 4 children in control condition
• One child significantly reduced stammering (C7)

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P1
16
C7
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Parent ratings of the impact of the stammering on
the child
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Receptive Language

• At the start of Phase A, 5 of the children who
  received therapy had receptive language scores
  above the average range
• At the end of Phase C, receptive scores remained
  high

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Expressive Language

• At the start of Phase A, four children had above
  average expressive language scores and one had a
  score at the top of the average range
• All of these showed a reduction in expressive
  scores relative to age. At the end of Phase C,
  the scores were closer to average.

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Parent ratings of knowledge and confidence
100.0
80.0
C7
60.0
Mean rating of knowledge and confidence
40.0
20.0
Start of Phase A
End of Phase C
time
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Ratings of the impact of stammering on the parents
100.0
80.0
60.0
Mean impact on the parents
40.0
20.0
C7
0.0
Start of Phase A
End of Phase C
time
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Summary

• 12 children who have received therapy have been
  investigated
• 8/12 demonstrated reduction in stammering
  associated with therapy ie showed improvement in
  clinic and home therapy phases
• 2 reduced stammering in 6 months
• 10/12 received indirect components only
• Prognostic factors identified from non-clinical
  groups so far not indicative of progress in
  therapy

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• 5 CWS who started with advanced language skills
  reduced expressive skills relative to age
• Children who have been stammering for more than
  12 months may still reduce the frequency of their
  stammering without therapy

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Conclusions

• In the cases studied so far
• Palin PCI can be effective for children who have
  been stammering for more than 12 months
• In the majority of cases, indirect components
  have an impact within 12 weeks (6 clinic visits
  and 6 weeks home therapy). If not, further
  intervention should be considered, including
  direct therapy

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Continued..

• Parents feel less worried and anxious and more
  knowledgeable and confident.
• It is possible that there is a language fluency
  trade off in children who have advanced skills.
  Therapy may facilitate this?

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Acknowledgements

• Emily Hughes-Hallett Fund
• Association for Research into Stammering in
  Childhood
• Islington PCT
• Staff at the Michael Palin Centre
• All the parents and children

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Contact details

• Sharon Millard PhD
• The Michael Palin Centre
• Tel [phone]
• Sharon.millard_at_islingtonpct.nhs.uk

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References

• Bernstein Ratner, N., Rooney, B., Macwhinney,
  B. (1996). Analysis of stuttering using CHILDES
  and CLAN. Clinical Linguistics and Phonetics,
  10(3), 169-187.
• Edwards, S., Fletcher, P., Garman, M., Hughes,
  A., Letts, C., Sinka, I. (1997). The Reynell
  Developmental Language Scales III The University
  of Reading Edition. Windsor NFER-Nelson.
• MacWhinney, B. (2000). The CHILDES Project Tools
  for analyzing talk. Transcription Format and
  Programs (3rd edition ed.). New Jersey Lawrence
  Erlbaum Associates.

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Continued.

• Matthews, S., Williams, R., Pring, T. (1997).
  Parent-child interaction therapy and dysfluency
  a single-case study. European Journal of
  Disorders of Communication, 32(3), 346-357.
• Millard, S. K., Edwards, S., Cook, F. M.
  (2009). Parent-child interaction therapy Adding
  to the evidence. International Journal of Speech
  and Language Pathology, 11(1), 61-76.
• Millard, S. K., Nicholas, A., Cook, F. M.
  (2008). Is parent-child interaction therapy
  effective in reducing stuttering? Journal of
  Speech Language and Hearing Research, 51(3),
  636-650.
• Straus, S. E., Richardson, W. S., Glasziou, P.,
  Haynes, R. B. (2005). Evidence-Based Medicine
  How To Practice and Teach EBM (3rd ed.). London
  Elsevier, Churchill Livingstone.