Exam 2 - Fluency Disorders

Stuttering relates to a complex interaction between...

the environment and the PWS (and the skills and abilities the PWS brings to that environment)

Stuttering rarely operates in a _________; it may relate to subtle _________ in other areas

vacuum; difficulties

According to the Manning (1991) survey, what views and attitudes did clinicians hold regarding stuttering?

-PWS have psychological problems

-parents were cause

-not skilled in treating stuttering

-more comfortable working with artic disorders than with PWS (majority)

Goals of an initial evaluation

1. observe overt characteristics

2. quantify it

3. note types of disfluencies (w/ examples)

4. make conclusion about severity

5. examine speech behaviors (physical characteristics)

6. covert characteristics (emotional reactions)

7. situational/environmental aspects

8. what, if anything, has been done in the past for the problem?

Analysis of Concomitant Behaviors

- physical characteristics/ accessory characteristics

- awareness

- avoidance of words, sounds, or speech in general

- data from language/phonology measures

- complete observation report

The Stuttering Severity Instrument-3 and 4 look at what 3 areas?

1. frequency

2. duration

3. physical concomitants

For SSI-3 and 4, what extra step must you do with the duration?

look at 3 longest blocks and take the average

For SSI-3 and 4, physical concomitants are ranked on a scale of...

0-5

SSI-4 recommends using two ________-syllable samples

200

SSI-4 recommends taking samples from both ______ and _______

reading, conversation

For SSI-4, how is the total score derived?

sum of the 3 components (frequency, duration, physical)

When do we use SSI-4? (2 answers)

-when we first assess someone who stutters

-when we evaluate progress at major intervals

What are the 3 types of Speaking Attitude Scales?

1. Modified Erickson Scale of Communication Attitudes (S-24)

2. Perceptions of Stuttering Inventory (PSI)

3. OASES (Overall Assessment of the Speaker's Experience of Stuttering)

What are the 3 types of Speaking Attitude Scales specifically for children?

1. A-19 Scale for Children who Stutter

2. Communication Attitude Test

3. Assessment of Child's Experiences of Stuttering (ACES)

What is the Two Type Model for Stuttering?

shows the two routes stuttering can take (recovered, persistent), along with how treatment may affect the chance of recovery, persistence, or improvement

A normally disfluent child has fewer than ___ disfluencies (SLDs) per 100 syllables

3

For a normally disfluent child, disfluences consist of what?

ODs (other disfluencies; phrase reps, interjections, revisions)

When a normally disfluent child repeats, there are typically ____ or fewer repeated units

2

For a normally disfluent child, repetitions are ______ and _____ in tempo

slow; regular

For a normally disfluent child, all disfluencies will be _____ with no _______

relaxed; awareness

A borderline disfluent child will have more than ____ disfluencies (SLDs) per 100 syllables

3

Borderline disfluencies include ____ reps, ____ reps, and ___________.

part word, whole word, prolongations/blocks (DPs)

When a borderline disfluent child repeats, repetitions may be more than _____ per instance.

2

Disfluencies are still _________ and _______ in borderline disfluent children.

loose; relaxed

Why are we still on the fence with a borderline disfluent child?

We are not sure which way the stuttering will go--- may recover or may persist

What are some signs of beginning stuttering?

-presence of tension and hurry

-rapid, abrupt reps

-pitch rises during reps and prolongations

-difficulty starting airflow/phonation

-facial tension

-aware and frustrated

-uses escape behaviors to terminate blocks

To evaluate the entire disorder, what are some questions to answer?

1. what etiological factors may contribute to stuttering?

2. what are the child's observable stuttering behaviors?

3. what are the child's reactions (ABCs)?

4. what are the reactions of those in the child's environment?

5. what is the overall impact of stuttering on the child's life?

speech sample analysis: less precise method

count # of words in a passage, then count the # of disfluencies or stuttered words

why is counting stuttered words the less precise method for quantifying disfluencies?

you can have more than one type of disfluency in a word

speech sample analysis: more precise method

count # of syllables in a passage, then count # of disfluencies in each word (every instance)

refresh: stuttering-like disfluencies

part-word rep, single-syllable whole-word rep, disrhythmic phonations (blocks/prolongations)

refresh: other disfluencies

phrase reps, revisions, interjections

Manning (1996) Clinician vs. Technician: characteristics of a TECHNICIAN

-technique directed

-pre-planned procedures

-dogmatic treatment

-narrow focus, on problem

-static

Manning (1996) Clinician vs. Technician: characteristics of a CLINICIAN

-client directed

-flexible procedures

-treatment alternatives

-open focus, on person

-dynamic

Clinician Skills:

1. Become less _______

2. Open your ________

3. Calibrate to the _________

4. Take ___________

5. __________ the client

6. Sense of _________

1. inhibited

2. focus

3. client

4. risks

5. challenge

6. humor

Clinical Management of Stuttering: differences in procedure due to what two things?

1. changing nature of the disorder itself (what path it takes dictates treatment)

2. effect of age itself (how you talk about it)

What two questions do we aim to answer in the assessment of preschoolers?

1. Does the child stutter?

2. What is the child's risk for continuing?

What is the primary goal of preschool treatment?

improve fluency

What are three goals that help reach the primary goal of preschool treatment?

1. help parents and teachers provide a fluency-facilitating environment

2. help child develop normal speech fluency by changing the child's communicative patterns

3. help the family maintain healthy, appropriate attitudes toward communication

what is a fluency-facilitating environment?

parents and teachers change their own speech to help the child change theirs

examples of fluency-facilitating environments

-slower speaking rate

-less hurried pace; easier interaction style

-increased pause time

-less hectic scheduling of activities

-one-on-one time

what is the purpose of the bucket analogy?

identifies factors that may be associated with stuttering and helps parents understand the multi-factorial nature of stuttering

examples of possible stressors w/in the child

-sensitive

-perfectionistic

-easily frustrated/upset

-"intense" personality

-highly competitive

-performance anxiety/fear of speaking

-more disfluent when tired/ill

-other speech/lang or communication difficulties

-genetics

examples of possible stressors w/in the environment

-hectic daily routines

-intense sibling rivalry or competition for talking time

-limited opportunities for free time/quiet time

-shares communication environment with others who talk fast or interrupt frequently

-has experienced stressful life situations

-experiences high expectations imposed by others

Concern: child may be attempting to use faster speaking rate, express more advanced concepts, or produce more complex utterances than he is able while still maintaining fluent speech.

What is the solution?

Identify specific factors (demands) that stress child's fluency, then work with parents to provide a model that minimizes those stressors (reduced-demand model)

Concern: CWS are at risk for developing negative communication attitudes

What is the solution?

Help parents learn to:

1. model appropriate attitudes and reactions

2. listen to child's concerns about speaking

3. talk to child about stuttering

Concern: child and parent do not have a way to discuss stuttering

What is the solution?

-Introduce a vocab accessible to child and adult for discussing stuttering

-use analogies

Which theory did indirect therapy grow from?

Diagnosogenic Theory

What were the two types of early treatment methods for indirect treatment?

1. parent counseling

2. psychoanalysis

Early parent counseling methods focused on...

what NOT to do

Direct treatment: 1970s

-metronome

-slow speaking rate

-often included parent counseling, teaching them to model slow, easy speech

Current Preschool Therapy Options: Direct Therapy

1. U of Illinois Therapy Program (Yairi)

2. Tortoise Talking vs. Racehorse Talking

Current Preschool Therapy Options: Indirect Therapy

Parent-Child Interaction Therapy (PCI)

UI Preschool Therapy Program Procedures: Based on slow speaking rate, slowing pace of activity through...

-clinician modeling for child

-parent's modeling

-direct practice

What does UI Preschool Therapy Program begin with?

massive stimulation

UI Preschool Therapy Program: what do you do for milder stuttering?

model

UI Preschool Therapy Program: what do you do for more than mild stuttering?

echo what they said in a slower, more fluent way

UI Preschool Therapy Program: what comes after massive stimulation?

structured drill activities

In structured drill activities, what 2 things are involved?

-balance with play

-slowly increase length of units (GILCOU)

When doing Turtle Talk, it is important for the child to be able to ______ fast/slow rates as well as produce them.

identify

basic principles of direct intervention

1. keep the demands low for the beginning of treatment

2. keep tasks within the child's current level of language ability

3. incorporate fluency tasks centered around common vocabulary

4. scaffold fluency tasks into gradual increases in linguistic demands

5. be consistent in the structure of treatment

Where was PCI developed?

Michael Palin Centre for Stammering in London, ENGLAND!!!!!!

Principles of Interaction Therapy:

1. stuttering is ____________, and therapy needs to be individually tailored

2. interaction is a _____ way process (parents influence child and vice versa; clinician takes a backseat)

3. parents _____ or support fluency; they don't _____ disfluency

1. heterogeneous

2. two

3. facilitate; cause

What is the rationale for PCI?

PCI focuses on the expert, intuitive understanding that parents have about their children and develops this in order to facilitate the child's natural fluency. When parents can modify their interaction styles, these changes can increase fluency in their child.

PCI aligns with what model of stuttering?

multi-factorial

Following a comprehensive assessment (MPC suggests a 4 hour assessment), what 3 steps should be taken?

1. identify stuttering behaviors, level of concern, and need for therapy

2. create individual profile of vulnerability

3. formulation with parents

What is the Individual Profile of Vulnerability?

based off of the multi-factorial model, assesses various risk factors for stuttering

PCI Management Options: Low Risk

active review; parent packs

PCI Management Options: Medium Risk

-active review; parent packs

-PCI therapy

-with/without video

PCI Management Options: High Risk

PCI with video

According to PCI, what does it mean to support a child's fluency?

-parents accommodating to their child's preferred interaction style

-target more of what the parents are doing when the child is fluent

-when child is disfluent, what could parents do differently?

Why is parental involvement key in PCI?

Because parents are most prevalent in their children's lives at this time (spend most time together)

What are some areas of concentration for parents in PCI? (don't need to know all, just a few examples)

-following child's lead in play

-length and complexity of utterances (are they at child's level?)

-balance of comments and questions

-repetition, expansion, rephrasing

-complexity of questions at child's level

-language is semantically contingent on child's focus

-allowing child to finish utterances

-allowing child time to answer question

-allowing child time to initiate

-use of pausing before and between utterances

-rate of input when compared to child's rate

-using eye contact to gain & maintain child's attention

-using positioning, touch, humor, or surprise to gain and maintain child's attention

-letting child solve problem

Overview of PCI program

-takes place over 6 weeks, 1 session/week

-review homework, create and watch video, establish targets for "special time" at home

-continue to do ST at home and send in homework sheets for 2 months

-2 month review (consider continuing ST), 4 month, 6 month

According to PCI, how long should "special time" ("talking time" in UI program) be implemented?

5 minutes a day, 3 days a week

advantages of PCI approach

-can be used when direct therapy not indicated

-considers child's temperament

-lays foundation for direct therapy component

-age and child's cognitive skills no barrier

Why are efficacy studies limited for preschoolers?

difficult to differentiate between natural recovery and effectiveness of therapy

Indirect Therapy: 3 things to remember

-parent training

-ongoing monitoring

-less frequent to intensive

Direct Therapy: 3 things to remember

-cognitive behavioral (when they stutter)

-parental involvement

-intensive to less frequent (become their own clinician; school age)

Direct Preschool Intervention can be categorized in what 2 ways?

cognitive and behavioral

Cognitive Direct Preschool Intervention focuses on...

-slow/fast

-smooth/bumpy

-easy/hard

Behavioral Direct Preschool Intervention focuses on...

-rate

-continuity

-effort

In direct preschool therapy, (behavior/cognition) is dictated by (behavior/cognition).

behavior, cognition

7 things to include in parent counseling

-most children stop stuttering (75%)

-help is available

-provide good/current info about stuttering

-stuttering does not have to ruin child's life

-parents are not alone in quest to help child

-parents have not done anything wrong

-gradually, help them understand the continuum of fluency (fluent and nonfluent days) and the various disfluencies (types)

Formula for parent counseling

"about your child... and so.... as a result... so remember"

From "Why is My Child Stuttering?" PPT: telling parents why their child began to stutter

-multifactorial explanation (flower)

-physical mechanism & causality (respiratory, laryngeal, articulation)

-use of current empirical research and theoretical perspectives

-tone: supportive, not alarming or overwhelming

-exploration of parents' views

What areas of speech/language might you also address in an assessment?

articulation, language, phonology