CSD 418 COMPS - Stuttering

Beth, a student clinician, was doing a diagnostic evaluation for an adult male. The speech sample was 432 words. She found her client had the following disfluencies:: Part-word repetitions 8, Disrhythmic phonation 3, Interjections 9 Revisions 2, Phrase repetitions 1, and  Single syllable word repetitions 7. Beth decided to report the number of disfluencies, and give the sample size. Which disfluencies are indicative of stuttering?

both disrhythmic phonation and single-syllable word repetitions

T or F: In the diagnostic report, Beth can report the disfluencies as is; she does not need to do any further conversions because she has given the length of the sample.

True

Which of the following pieces of information are most essential to include in Beth's diagnostic report, from the point of view of a speech language pathologist reading the report?

the length of the client’s disfluencies

Beth collects information related to the client’s previous therapy. Which section of the diagnostic report does this information go into?

history

Which one of these items would you NOT find in a typical stuttering diagnostic report?

number of breaths per minute

In which section of the diagnostic report would you find the severity rating of the stuttering?

clinical impressions

Which of these criteria is NOT taken into consideration when assessing stuttering severity on the Illinois scale and the Stuttering Severity Instrument (SSI)?

both speech rate and the impact of stuttering on the client’s life

As stuttering is variable, it is recommended to collect a minimum of ___ sample(s) of speech for a stuttering diagnostic evaluation.

two

T or F: Counting disfluencies is the same thing as counting stuttering

trueO

T or F: One way to assess severity is to assign a number on a scale of 1 to 7

True - #

A 4-year-old child comes to you with a phonological disorder and stuttering. You have determined that it will be important to address both disorders. Which of these models of treatment would be most effective?

cyclic: treat phonology for four weeks, then stuttering for four weeks, and repeat the cycle as necessary.

University of Illinois 14-session program

A program that gives the child structured practice in producing slower easier speech. (4)

Yaruss and Coleman’s family-focused treatment

A parent-centered program that involves clinicians giving feedback to parents about how they are speaking to their child who stutters. (5)

The Lidcombe Program

A parent-centered program that shapes children’s fluency through operant conditioning. (1)

Cook and Botterill’s parent-child interaction

A program that is facilitated through play-based sessions between parent and child. (2)

Demands/Capacity Program

a program where the parents try to minimize both speaking and environments pressures that may affect the child’s stuttering. (3)

You have decided to pursue indirect treatment with a preschool child who stutters. Which of these would NOT be a part of indirect treatment?

have the child practice using slower easier speech

You are trying to decide whether to give a particular child direct treatment or indirect treatment. Which one of these children would be the best candidate for direct treatment?

Sam, 3 years old, has been stuttering for 12 months. His mother reports his stuttering has gotten worse in the last three months, and says that Sam’s grandfather stutters, so she knows quite a bit about stuttering already.

You’ve watched Mrs. Cullen put her hands ears when her son, Jason, stutters. What would be an appropriate response to address this reaction? In other words, which response shows the most empathy?

“Mrs. Cullen, it must be hard for your to hear Jason stutter. Can you tell me about that?”

T or F: In terms of offering treatment, how old the child is more important than how long the child has been stuttering,

False - age

Helping clients become more aware of stuttering serves to ___

gain comfort in talking about stuttering AND learn how to make changes in their speech

Let’s say there is a school-age child who, as in the post in Question #1, reports no negative reactions to his stuttering and is not aware of his stuttering. Which of the following would be helpful information that would lead you to dismiss the client?

The child knows about stuttering and has a plan if it starts to have a more serious impact on him.

Which of the following is an example of evaluative (rather than encouraging) praise?

Good job! AND Your fluent speech is amazing!

Bill is a fourth grader. You’ve just done a speech evaluation and found that he is pretty fluent—he has only 2% stuttering-like disfluencies in his speech. Which of these is true?

Talking to Bill’s teachers and parents will help you determine if he qualifies for services.

You’ve decided to write a goal for your school-age client that he should be able to use voluntary stuttering with people he trusts. This type of goal targets___.

reducing negative reactions to stuttering

Which of these is an example of helping the child become his own clinician?

You ask the child to write a journal entry about how he was able to make progress on a goal he set for himself.

T or F: Tension, struggle, and avoidance are all normal reactions to the loss of control that children experience when they stutter.

True

The primary task of an SLP who works with children who stutter will be to help the child____.

master speech techniques, so he can use them successfully in times of stress

Read the following posted to the ASHA SIG-4 Fluency listserv: I’m working with a 16-year-old girl who presents primarily with prolongations, blocks, and part word repetitions. During the school year I was lucky to see her one time per quarter and treatment was going nowhere. Now that school is out, we have plans to meet 2-3 times per week for 3 weeks. I figured that more intense therapy would give her more bang for her buck. We’ve been focusing on easy relaxed speech with smooth movements. So we’re rapidly approaching the end of the 3 weeks and today she was more disfluent than ever and tearfully, pleadingly looked at me and said, “It’s just not working. I try and try. I try the easy onsets, but they just don’t come out.” Any insight as to what I’m doing wrong? Is 2-3 times a week too much? Am I psyching her out? What can I say to help her, especially when I, myself, remain unconvinced that therapy is actually doing anything?

What would be some practical advice for this SLP? 

Acknowledge that techniques are difficult to do, and suggest a different approach that is based on acceptance of stuttering and making goals related to successful communication.

You are an SLP who has decided to focus on teaching the child about stuttering and focusing on techniques to produce fluent speech. What can this approach do for the child?

It may teach the child that stuttered speech is bad.

T or F: Taking the school-age child out of the therapy room is not practical because it may increase his stuttering and lead to more shame about speaking.

False

What is one advantage of group therapy over individual therapy for adults?

group therapy gives a client a feeling of unity with other who stutter.

Which one of these techniques falls under stuttering modification?

Voluntary stuttering

A therapist tells her client: “A basketball player who misses a shot doesn’t let that take control of his entire game. If you stutter in front of your friends, you might do like the athlete does—shrug it off, tell yourself ‘that’s OK,’ and get back in the game.” What type of therapy is she using? 

cognitive restructuring

A therapist tells her client, "Let's say it slow and easy, just like I did." What therapy is she using?

fluency generating

A therapist tells his client, “When you stutter, I want you to finish the stutter, pause, and say the word again.” What type of therapy is he using? 

stuttering modification

A therapist tells his client, “Here’s some play dough. Let’s make a model that represents your stuttering. Then we’ll imitate your stuttering and smash it.” What type of therapy is he using? 

desensitization

Having an adult identify what he is doing to interfere with forward moving speech is a part of ___ therapy. 

Van Riper’s stuttering modification AND Sisskin’s avoidance reduction

Which of the following statements is true about relapse? Check all that are true.

• relapse occurs if symptoms re-occur after a period of improvement

• if a client experiences relapse, the next time he goes to therapy treatment time will be shorter

Vivian Sisskin’s therapy asks clients to 

• plan activities to confront the shame they feel when speaking

• reduce tension when speaking by slowing speech rate

What are the 3 A's of stuttering therapy for adults? 

The three A's of stuttering therapy for adults are awareness, acceptance, avoiding avoidance. I would address acceptance in stuttering therapy by first helping them become aware of when they are stuttering and then help them accept their stutter in different situations. For example, have them practice with people they are familiar with first and have them ask them questions surrounding their stutter and help them realize that they are their biggest critic. Also have them select one person daily to stutter with so they are exposing themselves to their stutter more often and over time.

Which one of these people who stutters is practicing acceptance, rather than awareness or reduction of avoidance?

Ross goes to work every day wearing a pin that says “National Stuttering Association” on it.

Which of these clinicians is working on counseling with her client?

Sally asks her client if he can accept that he’ll feel embarrassed if he stutters.

Which of these distinguishes Rational Emotive Behavior Therapy from other types of counseling?

disrupting the client’s core beliefs

Which of the following is an example of positive self-talk?

• “If I stutter, I will feel uncomfortable, but I can still get my message out.”

• “I know it is okay to stutter, but I’m afraid to.”

In Cognitive Behavioral Therapy, __.

the clinician helps the client look at unrealistic expectations. 

Which one of these responses is an example of the micro skill of AFFIRMATION?

“That must be so hard".”

What is an example of “all or nothing” thinking?

“I have to do a perfect job on my oral report.” 

Which of these stuttering techniques would work well with Rational Emotive Behavior Therapy?

pesudostuttering

The most important factor in determining the client’s success in stuttering therapy is

the relationship between the client and the clinician

Stuttering therapy is perceived as difficult because there is a large component of counseling in the therapy

• stuttering is a complex disorder

• there is a large component of counseling in the therapy

Match: "I'll always hate my stutter, but that's OK."

acceptance and commitment therapy

Match: "I used to think my stuttering was uncomfortable for the listener because it was taking too much time, but now I take as much time as I need to talk because what I have to say is valuable."

Rational Emotive Behavioral Therapy

Match: "If I think the listener will feel uncomfortable when I stutter, I'll tend not to speak and that will make me feel bad."

Cognitive Behavioral Therapy