351 L9B - TX for adolescents and adults

what influences treatment for this population

duration of experience with stuttering influences

are the speech disfluencies the biggest obstacle to their wellbeing often?

no! - highly individualise

what to treatment goals and appraoches need to be matched to

client's readiness

what are the three common factors in psychotherapy and their proportional distribution to treatment outcomes

1. contribution of client & environment to tx - include readiness to make change (40%)

2. specific tx approach and strategy used (15%)

3. therapeutic alliance (30%)

4. expectancy - 15% belief that you and the client can made a change

describe the goodness of fit between client readiness and tx techniques used

Client readiness goodness of fit between Tx techniques used & client's readiness to use them is key factor in outcomes of behavioural intervention

what are the three global themes for successful stuttering management

1. learn + used stuttering modification techs to make talking easier

2. change negative thoughts and feelings about stuttering

3. approach talking with less avoidance of words, sounds, or situations

when working on number one - what does the normal talking process involve?

- increase awareness of spontaneously fluent speech

as foundation for controlled fluency & easier stuttering strategies to begin desensitisation

what is fluency shaping

client changes entire speaking patter to produce controlled, stutter-free speech

what is the process of fluency shaping

- start by speaking in novel but totally fluent manner

- explain that strange speech pattern is temporary

- increase naturalness by gradually reinstarating normal prosody, intonation and rhythm

how does one slow their rate

- pausing and phrasing

- prolonged vowels and syllables

- longer turn-switching pauses

how do you decrease muscle tension

- slow, relaxed phonation onset

- light articulatory contacts

who is fluency shaping, slow rating and decrease muscle tension most helpful for

- fluency is highly important

- with severe stuttering who want to experience

- those who can make controlled fluency feel and sound natural

- those who can cope with negative thoughts and emotions or approach talking without avoidance.

what are some examples of approaches for fluency shaping

- rhythmic speech = westmead

- prolonged speech e.g. Camperdown

what is stuttering modification

stuttering more easily as the client IDs and changes moments of stuttering in real time

what does stuttering modification result in

stuttered disruptions that are less frequent, shorted in duration and less physically tense or struggled

what may stuttering modification result in

fewer associated behaviours

what are the 4 parts of the Van Riper strategy

identification

desensitisation

modification

stabilisation

what is important in the identification portion of the Van Riper

- improve client's knowledge about stutters

- ID itself can lead to reduction in overt stuttering

- increasing awareness + attention = could ^ stuttering

what is the rationale behind identification in the Van Riper strategy

- reveal behaviours to target for modification

- require client to take active roles in Tx

- require client to take responsibility for own stuttering

- contribute to desensitisation

what are the 3 steps for modification

step 1 - cancellation (post-block mod, finish word, pause, examine, plan change, resay)

step 2 - pull-put (in-block mod, while saying word examine, plan change, finish word in easier way

step 3 - preparatory set - pre-block mod - before saying the word examine, plan change, and produce word more easily throughout

what is stuttering modification most helplful for clients

o with high degree of emotional reactivity to stuttering

o who frequently avoid sounds, words or situations

o who produce high frequency of inaudible prolongations or long blocks

o who do not want to change whole speech pattern through controlled fluency

what is naturally fluent speech/spontaneous fluency

complete cure, can be realistic goal for pre-schoolers

what is deliberately fluent speech

controlled fluency speech, conscious mental.behavioural monitoring of speech that normally fluent speakers don't use

what are some ways to change negative thoughts and feelings about stuttering (2)

- listening & valuing

- cognitive behavioural therapy (CBT)

- mindfulness

- acceptance and commitment therapy

- narrative therapy

- solution-focused brief therapy (SFBT)

- self-help and support organisations

what is rational-emotive therapy (RET)

- express thoughts and actively take charge of them

- when way of thinking changes, behaviour changes

- focus on positive self-talk

what is the approach talking with less avoidance of words, sounds, or situations (3)

- avoidance reduction in therapy for stuttering (arts) - help clients do less when they stutter

- pseudo stuttering

- self-disclosure

what is some ideas of additional support with social adjustment

- assertive training - adverse situation (fight, flight, hold ground)

- group therapy

what does group therapy provide

- comfort & support of peers

o Express feelings in safe environment

o Share experiences with others

o Practice targets in social context

- Peer feedback

what is the comprehensive stuttering program

example of treatment approach that combines strategies for:

o improved cognitive-emotional adjustment

o reduced severity of stuttering events

o increased fluency

what is involved in the comprehensive stuttering program

- Acquisition, transfer & maintenance phase

- Maintenance after 10 years

- Highly individualised

- Focusing on typically only one component

- combine diff strats to best support client

what is the fluency plus program

integration of fluenncy shaping and cognitive restructuring approaches for asolescents and adults who stutter

what are some non-SLT treatment approaches

- The Mcguire Programme

- Fluency inducing conditions - plays delayed auditory back into the ear.

what are the long-term outcomes/goals

- Skill maintenance

- Prevention of relapse

- Individual & group sessions

what does the literature find to support adults and adolescents who stutter

•Speech restructuring to reduce stuttering was supported by the most number of RCTs

•Interventions via telehealth are non-inferior to face-to-face but more RCTs needed

•Evidence that CBT combined with speech restructuring improves outcomes is limited

•Emerging interventions include transcranial direct current stimulation (tDCS)

•The quality of the evidence for included studies were rated low risk of bias