WCU 530 SLP Final Exam Study Guide

Fluency Facilitating Environment

setting that actively supports and enhances an individual's ability to speak smoothly and confidently. This environment is characterized by specific practices and attitudes that help reduce anxiety and pressure around speaking, particularly for those who may struggle with fluency, such as children who stutter.

Direct Treatment

Therapy that works directly on the child's speech by having them speak more fluently, stutter more easily, or both.

Indirect Treatment

Therapy that involves alleviating stresses that the child might be experiencing in communication at home and in other situations. It specifically does not have the child working on how they speak or how they stutter.

Spontaneous fluency

A child's natural fluency that occurs without work or thought on his part.

Operant Conditioning

Learning is caused when a behavior is immediately followed by a reward or punishment or the relief from punishment.

Stuttering Modification

Ways of managing stuttering that are designed to reduce struggle and tension. Examples are cancellations, pullouts, and preparatory sets, as well as helping the client to be open and unashamed of whatever stuttering remains as treatment proceeds.

Fluency Shaping Techniques

Ways of speaking designed to induce fluency. Examples are slowed rate as well as easy onset of voicing and light contact of the articulators.

Cognitive Behavior Therapy

Treatment based on the notion that persons' perceptions of and thoughts about situations and about themselves determine their feelings and behavior. CBT aims to help the persons see situations and themselves more realistically and more compassionately.

Counseling

The relationship that the clinician builds with the client and/or parents that is so vital in supporting well-being and change.

Empathy

Ability to put oneself in another's place and to identify with the feelings that the other person has.

Critical Thinking

An attitude of mind that encourages questioning; in the current context, the questioning is about whether a treatment will be effective for a particular client.

Evidence-Based Practice

A commitment to use research evidence, client goals, and clinician expertise when choosing assessment and treatment goals and tools.

Genuineness

Honesty about life, oneself, and other people; a sense that the clinician is comfortable with themselves, speaks straightforwardly, and takes actions that are congruent with their thoughts, beliefs, and attitudes.

Warmth

A feeling of positive regard for another person, often conveyed by tone of voice and body language.

Desensitization

gradual desensitization (reducing the threat and fear) of clients to their stuttering, starting in the safe environment of the clinic and moving to more and more challenging real-world situations while keeping up the clinician's support and praise.

Proprioception

Sensory information from the body that conveys position of structures and movement of structures.

Voluntary Stuttering (Pseudo-stuttering)

Deliberately stuttering or pretending to stutter so that one loses some of the fear of stuttering.

Controlled Fluency

A style of speaking that improves fluency by modifying certain elements of speech, including speaking more slowly, pausing, using easy onsets at the beginnings of words, using light contacts of articulators, and employing proprioception (becoming aware of the movements of articulators).

Spontaneous Fluency

Speech without stuttering that doesn't require thinking about it

Deconditioning

Similar to counterconditioning except that instead of a positive stimulus, the previously feared stimulus (stuttering) is paired with a neutral stimulus (no negative consequence)

Maintenance

The process of fading treatment while continuing to support the child and family so that fluency achieved in treatment does not diminish

Fluency Skills

Skills that improve fluency, such as slow rate and easy onset of phonation

Verbal Contingencies

Comments to the child made immediately after an event (eg, fluent utterance; stutter) that are intended to change the frequency of that event

Catch and Release

A term some clients and clinicians use to label staying in the stutter and letting the fear and tension go so that the word can be finished easily and smoothly

Borderline Stuttering

This is the earliest or lowest level of stuttering, usually seen in children ages 2 to 3.5, characterized by more frequent part-word and single-syllable whole-word repetitions than children who are developing typically have, but without awareness or concern on the part of the child.

Beginning Stuttering

This level of stuttering is usually seen in children between ages 3.5 and 6, characterized by more tension and hurry in disfluencies than that seen in borderline stuttering, consisting of repetitions and prolongations, with some children exhibiting blocks.

Intermediate Stuttering

Typical of children in their school-age years, this level of stuttering abounds in repetitions and prolongations, with frequent blocks, escape behaviors, and avoidances due to fear of being 'stuck' in a stutter and fear of listener reactions.

Advanced Stuttering

Characteristic of older teens and adults who have been stuttering since childhood, with ingrained stuttering patterns, especially behaviors associated with avoidance and ways of coping with blocks.

Fluency-Facilitating Environment

A climate in one or more situations that makes it easier for an individual who stutters to speak more fluently, such as when parents speak more slowly than usual and increase pausing, or when family members are accepting of stuttering.

Holding, Tolerating, and Easing Out

The adolescent is encouraged to remain in a stutter longer than usual to reduce tension and anxiety associated with it, by physically representing their stuttering and learning to control it.

Voluntary Stuttering

Practicing stuttering intentionally allows adolescents to become familiar with the feelings of stuttering in a safe environment, starting with fake stutters before moving to real-life scenarios.

Linguistic Hierarchies

Gradual practice of stuttering from easier to more complex utterances (e.g., sounds, words, phrases).

Situational Hierarchies

Tailored lists of social interactions ordered from least to most stressful, helping adolescents gradually face more challenging speaking situations (e.g., talking to a teacher, giving a presentation).

Visual aids

Using tools such as ladders or staircases to depict progression through hierarchies.

Supportive assistance

Clinicians modeling behaviors and providing help to establish trust and a safe space for exploration.

Fluency rate

Rate of Speech refers to the speed at which an individual speaks, typically measured in syllables or words per minute.

Speaking Rate

Total number of spoken words or syllables over a specific period, accounting for pauses and rhythm of speech.

Articulatory Rate

Measures the speed at which individual phrases or utterances are produced, excluding pauses between phrases.

Fluency shaping

Ways of speaking designed to induce fluency, such as slowed rate and easy onset of voicing.

Focus of Stuttering Modification

Concentrates on the experience of stuttering itself and how to navigate it.

Outcomes of Fluency Shaping

Aims for smooth and fluent speech, often resulting in a reduction of stuttering frequency.

Outcomes of Stuttering Modification

Seeks better management of stuttering and increased confidence in speaking, even if stuttering persists.

Initial Meeting in Intervention Plan

Provide a clear overview of evaluation findings, progress expectations, and rationale for recommended interventions.

Fluency-Facilitating Techniques

Use approaches that promote fluency, such as easy onsets and light articulatory contacts during speech.

Parent-Delivered Programs

Consider utilizing structured programs like the Lidcombe Program, where parents play a central role in delivery through daily practice.

Severity Rating Scale

Introduce a daily tracking system for parents to note variations in stuttering severity, fostering active involvement in monitoring progress.

Flexibility

Adapt the treatment plan based on the child's responses and family feedback, ensuring the plan remains tailored to their needs.

Mild Stuttering Symptoms

Indirect therapy is often recommended for children who display borderline stuttering or beginning stuttering characteristics, particularly if their fluency is not significantly impacting their communication or social interactions.

Observational Phase

If the child exhibits disfluencies but demonstrates a high likelihood of recovery (based on factors like decreasing stuttering frequency within the first 12 months post-onset), indirect therapy may be advisable.

Education on Facilitating Speech

Teach parents to use strategies such as a slower speech rate, frequent pauses, and positive comments to create a more conducive environment for fluent speech.

Daily Interactions

Encourage parents to engage in dedicated, uninterrupted one-on-one time with their child to foster positive communication experiences without the stress of performance.

Teacher Collaboration

Work with teachers to ensure they understand the child's needs and encourage an atmosphere of patience and support in the classroom.

Peer Awareness

If appropriate, educate peers about stuttering to help build a supportive social environment and reduce potential bullying or teasing.

Lidcombe Program

An operant conditioning-based approach to stuttering treatment, delivered in the home by a parent or other caregiver and guided via weekly meetings with the clinician.

Stage 1 of the Lidcombe Program (LP)

The initial step of LP in which the child becomes normally fluent. Criteria for completing Stage 1 are 3 consecutive weeks in which (1) the parent's weekly SRs are 0 to 1 during the week before the clinic visit and 4 of the 7 SRs are 0 and (2) the clinician's SR for the entire session is 0 to 1.

Stage 2 of the Lidcombe Program

When the child meets the fluency criteria to complete Stage 1, this maintenance stage is begun. Weekly clinic meetings are faded systematically so that the parent and child meet with the clinician in this sequence: 2, 2, 4, 4, 8, 8, and finally 16 weeks apart. The child must continue to meet fluency criteria.

Praise for Fluency

At the start, parents are encouraged to provide frequent praise for fluent speech (e.g., 'That was really smooth talking!') and low-key acknowledgments of fluency (e.g., 'That was smooth'). Self-evaluation questions (e.g., 'Was that smooth?') can also be introduced after fluent utterances.

Acknowledgment of Stuttering

Once the child is accustomed to positive reinforcement, parents begin to comment less frequently on stuttering. When stuttering occurs, they might gently acknowledge it (e.g., 'That was a little bumpy') or encourage self-correction (e.g., 'Say 'truck' again'). These responses are viewed as mild punishments within the operant framework but are generally perceived as benign by both parents and children.

Impact of Demands and Capacities

The perspective that the factors associated with the onset and persistence of stuttering are the demands placed on the child by her environments, balanced (or not) by the child's innate capacity for fluent speech.

Impact of External Demands

These include pressures from the child's environment, such as communication expectations in social interactions, family dynamics, and peer relationships. High demands—such as rapid speech from others or an expectation to engage in complex conversations—can overwhelm a child and elicit stuttering behaviors.

Impact of Internal Demands

Children may also face internal pressures, including anxiety about speaking, worries related to stuttering, or the cognitive load of rapidly formulating and articulating thoughts. These internal factors can exacerbate speech disfluency, leading to difficulty managing both emotional and physical aspects of communication.

Innate Fluency Potential

Each child possesses a unique set of capacities that contribute to their ability to speak fluently. These capacities may include physical attributes related to speech production, cognitive skills for language processing, and emotional resilience.

Enhancing Capacities

Focusing on strengthening a child's fluency capacities through targeted interventions can positively influence their overall communication.

Gottwald's Multidimensional Approach

Emphasizes addressing both demands and capacities to facilitate better speech fluency.

Direct Interventions for the Child

Techniques aimed at improving the child's speech fluency, fostering self-awareness, and teaching self-correction methods are essential.

Emotional and Social Effects

Stuttering can lead to frustration, embarrassment, and anxiety about speaking.

Collaboration and Communication

Establish a communicative partnership with teachers to discuss the student's specific needs and to implement supportive strategies.

Educational Support Plan

Utilize a Multi-Tiered System of Supports (MTSS) framework where Tier 1 strategies may include environmental modifications.

Benefits of Group Therapy

Mutual Support: Group therapy fosters a strong sense of camaraderie among its members. As individuals confront and work on their stuttering, they find comfort and encouragement from others who understand their struggles.

Facilitated Interaction

An effective group leader can facilitate extensive interactions among members, allowing them to share their hopes, fears, and successes.

Initial Stages of Therapy

Clients who are new to therapy may benefit from individual attention to build trust and rapport with their therapist.

Creating a Facilitating Environment

Establishing a supportive atmosphere is crucial, with parents responding positively to their child's stutters.

Modeling Techniques

Clinicians can demonstrate an easier and slower style of stuttering for children to imitate.

Reinforcement of Success

Rewarding children for producing slower and easier stutters helps build confidence and reinforces desired behaviors.

Successful Management

Focus on the instances where the child successfully manages their stuttering rather than highlighting when they lose control.

Teaching Communication Strategies

Helping children understand that occasional stutters are acceptable and encouraging effective communication practices fosters confidence.

Spontaneous Generalization

As children practice and begin to feel a sense of control over their stuttering, they may demonstrate spontaneous generalization, applying learned techniques in various settings without formal prompts.

Rhythmic Speech Techniques

Using rhythm therapy can provide a fun and engaging way to practice speech, encouraging the child to speak in a rhythmic manner.

Continuous Support and Adaptation

Clinicians should be prepared to adapt strategies as a child progresses, maintaining motivation and encouraging practice.

Bilingual and Bicultural Factors

It's important to recognize how stuttering presents across different languages and ensure assessments are sensitive to the client's linguistic context.

Culturally Responsive Assessments

Use assessment tools that reflect cultural values and beliefs about stuttering.

Building Rapport

Establish trust by being open and nonjudgmental about cultural backgrounds.

Flexibility in Techniques

Adapt therapeutic techniques to align with cultural norms, especially regarding practices that may be stigmatized.