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Practical intervention for early childhood stammering Palin PCI approach, by Elaine Kelman & Alison Nicholas

Jackie Turnbull | 01.06.2009

Review by Jackie Turnbull, Speech and Language Therapist, NHS Leeds

PCI ApproachThis is a comprehensive and very accessible text outlining the approach to working with young children who stammer used at the Michael Palin Centre in London. Over 60 pages of this 286 paged text are given over to photocopiable handouts which SLTs will find an extremely useful addition to their therapy materials. These can also be printed out from a CD which is included with the book.

Chapter 1 provides comprehensive information regarding the nature, onset and development of stammering. In attempting to answer the $64,000 question 'why do some children stammer?' the authors discuss a multifactorial model, using research findings to support the theoretical framework on which their therapy is based. The model is clearly described and easy to read. I particularly liked the use of text boxes entitled 'clinical implications' which relate each part of the model to practice. The last part of the chapter explains the development and current nature, principles and effectiveness of the Palin PCI for young children who stammer. The authors stress the individualised nature of the approach for each child and family they see.

Chapter 2 describes the initial 20 minute screening process used for all referrals. This may be conducted in person, over the phone or by means of a questionnaire and is used by the therapist to make a decision about the appropriate care pathway for the specific child. Broadly speaking, where there are found to be no risk factors, then the pathway will be for 'advice and monitoring'. This pathway is fully described in Chapter 3 and a handout is provided for use with parents. Where any one or more risk factors are present, children move on to a full assessment.

Chapter 4 is entitled 'full assessment'. The total time of the assessment is around 3½ hours. The assessment process is very clearly explained, making this information widely accessible and providing confidence to less experienced therapists wishing to use this procedure. Verbatim examples of 'what to say' and case examples are particularly useful in this respect. There is also a useful 'troubleshooting' section covering difficulties SLTs may feel they will encounter in using this approach, including accounting for the amount of time it takes, worries about attendance and the use of video recording.

Chapter 5 describes how information from the assessment is used in making an individual formulation and in conveying this information to parents. Again this chapter is detailed and clearly presented; giving examples of specific words for the SLT to use in sharing each part of the formulation and in answering questions that parents typically pose.

Chapter 6 moves on to describing the Palin Parent-Child Interaction therapy. The information provided is once again very 'user friendly' and practical.

I really liked Chapter 7 entitled 'family strategies'. The authors offer very useful parenting strategies which they feel may be appropriate for parents who have concerns in this area. The authors stress that they are not 'gurus' of child rearing, nor do they believe that the challenges most parents face in bringing up their children are causes of stammering. Too many areas of family life are covered to mention them all here but among topics discussed are managing two languages, talking about stammering, building confidence, praise, turn taking, dealing with feelings, sleep and behaviour management.

Chapter 8 describes 'child strategies' - speech modification techniques with intriguing names such as 'tortoise talking' (rate reduction), 'bus talking' (pausing to think) and 'aeroplane talking' (easy onset).

The two final chapters entitled 'other strategies' and 'adapting Palin PCI' look respectively at working with children with additional speech problems and use of PCI with other cultural backgrounds or where attendance is problematic.

This book is described on the back cover as a 'detailed guide for therapists working with young children who stammer'. It certainly delivers this and does so in a comprehensive and accessible way.

Publisher: Speechmark Publishing, 2008

Review from the Summer 2009 issue of 'Speaking Out', page 18

Michael Palin Centre website: www.stammeringcentre.org