Trialling group improv and acceptance and commitment therapy as a treatment for childhood stuttering

Description of intervention(s) / exposure: Implementation of Improv groups will each occur over a 6-week period (during a school term) with sessions run once per week for 2 hours. Improv groups will be divided by age (7-9 years, 10-12 years, 13-15 years) into 4-5 cohorts of children/teens who stutter (8-10 children per group). Thirty-two to 40 children and teens will be recruited to participate in the study, allowing for at least one group per age-range while providing flexibility for an additional group in one or two age-groups depending on participant interest. One or two groups will be run per term in Term 4, 2025, and/or Terms 1 and 2, 2026. Groups will be held in a rented community hall in a location central to the group participants in Adelaide, South Australia. A speech pathologist with stuttering treatment and improv teaching experience and an improv teacher will be employed as a Research Clinicians to run the groups. All age groups receive the same content but adapted for age. Course content summary: Weeks 1-2: 1st session- values establishment, rapport building, trust building, and simple games, Establish what is an “o?er”, how do you make one. (An o?er is any dialog or action which advances the scene or a game. All o?ers should be accepted, however, there are some exceptions/ rules to maintain participant safety). Weeks 3-4: Progress to “Troupe/Teamwork” drama games. Weeks 5-6: Progress to “O?er and acceptance”: “yes, and…” kind of games Hierarchy of Games: 1. Rapport Building/ Non-Talking games. 2. Games to encourage dealing with failure + talking. 3. Games with more words Number of games per class: class is designed to include between 8-10 games and 2x 15-minute breaks; Games will run for around 10 minutes each. To assess adherence to the intervention there will be an attendance checklist and a fidelity checklist completed on recordings of the sessions. ACT will be incorporated into each session. In session one, participant values and group norms will be established. Some of the improv games allow for the opportunity to reflect on attitudes towards the situation. ACT approach is conducted during these guided reflection sessions, rather than being overtly discussed. All sessions will have an ACT/reflection portion which will include: ACT/Reflection Prompts Reflection (10 mins): How was that? What was easy/ hard? What was that like for you?" "What was fun or surprising about that?" "Did any tricky thoughts show up? Like 'I need to be good at this”, or “I need to pre-plan what I’m going to say”. "Did you notice any part of you wanting to hide? Or maybe a part that wanted to try anyway?" Facilitators will use and encourage open, non-judgemental questioning, with an emphasis on exploring experiences rather than focusing on outcomes. The approach aims to normalise thoughts and feelings, reframe perceived failure, and invite "next time" thinking to support personal growth and resilience. Co-design process: The program was co-designed by a diverse group that included facilitators with backgrounds in allied health and the arts, along with adults from the improv community, children and adults who stutter, and adults who have experience with or incorporate Acceptance and Commitment Therapy (ACT) into their personal or professional practice. Stakeholders were introduced to the foundations of both improv and ACT, and were invited to share their personal experiences with stuttering. They actively participated in improv games, with opportunities for guided reflection and voting on which games they felt were suitable for inclusion in the course. Participants in the co-design process took part in five 2-hour workshops, spaced three weeks apart, allowing time for reflection and integration between sessions. At the conclusion of the fourth workshop, a draft version of the program was shared with all stakeholders, who were then invited to provide feedback to the research team which was finalised during the fifth workshop.