Stuttering Treatment

spontaneous fluency

controlled fluency

acceptable stuttering

three types of fluency behaviors

spontaneous fluency

normal level of speech flow that contains neither tension or struggle behaviors. Does contain more than a few occasional number of repetitions & prolongations. (Fluency of the normal speaker)

controlled fluency

– speaker must attend to his manner of speaking to maintain relatively normal sounding fluency by monitoring the auditory feedback of his speech, speech rate, or the use of preparatory sets/pull-outs.

acceptable stuttering

– level of speech flow where the speaker exhibits noticeable, but not severe disfluency & feels comfortable speaking despite his disfluency.

indirect treatment approaches

▪ Counseling ▪ Support Groups ▪ Family-Focused Treatment ▪ Demands & Capacity (DCM) ▪ Parent-Child Interaction Therapy

direct treatment approaches

▪ Lidcombe Program ▪ Gradual Increase in Length of Complexity of Utterance ▪ Cancellations ▪ Pull-outs ▪ Prepartory Sets ▪ Reducing speaking rate ▪ Relaxed breathing ▪ Increased pauses during turn-taking Allowing the child to finish statements without interruptions ▪ Syllable-timed Speech

direct approaches

Targets the child’s individual speech behaviors.

▪ Implemented when the child is aware & present secondary behaviors (blinking, tapping, head nods etc).

▪ Targets the child’s speech disfluencies. ▪ SLP directed or parent directed.

indirect approaches

Modifying the child's environment rather than working directly with the child.

▪ Implemented when the child is NOT aware, frustrated & presents NO secondary behaviors.

▪ Facilitates fluent speech through changes in the environment & modifying parents’ speaking patterns.

▪ Targets children's attitudes, feelings, & fears.

indirect

at 2-5yr they need ______ treatment because they are not aware, it is family focused

indirect

start with ______ therapy

indirect

______ is mainly for children who are unaware of their dysfluencies

modification

_______ is less structured than shaping

modification

changing and or altering the speech,

reducing tension so stuttering is less severe

reducing fear and avoidance

shaping

teaching the individual to speak more fluently

(more structured)

enhances the speakers motor capabilities and implement various techniques to facilitiate new speech production patterns

▪ Does not incorporated addressing feelings nor reactions

▪ Indication to use this approach: ▪ Stutters openly ▪ Does not avoid speaking ▪ Perceives interference but no personal penalty from stuttering ▪ Feels positive about self ▪ Demonstrates a positive response to fluency shaping trial therapy

modification

use ____ when child is hiding stuttering

avoiding speaking,

feels poorly about self,

perceives personal penalty as a consequence of stuttering

demonstrates a psotive response to modification trial therapy

shaping

use _______ when the child : ▪ Stutters openly

▪ Does not avoid speaking

▪ Perceives interference but no personal penalty from stuttering

▪ Feels positive about self

▪ Demonstrates a positive response to fluency shaping trial therapy

modifying

research shows we want to start with _______ the speech, which should result in fluency

modification

Stuttering ________ strategies involve working directly with stuttering.

1. Increase awareness of stuttered speech, openness, & acceptance

2. Examine and reduce physical tension

3. Reduce negative reactions

4. Change moments of stuttering

stuttering modification helps clients to:

stuttering modification

They help children to reduce struggle behaviors and stutter in a more relaxed way.

▪ Strategies can also decrease sensitivity about stuttering, reduce negative reactions, and increase feelings of control, openness, and acceptance.

▪ Strategies include techniques such as Pull-out, pausing, preparatory set, and Cancellation.

1. Motivation

2. Identification

3. Desensitization

4. Variation

5. Modification 6. Stabilization

stuttering modification, Seven Phase Program: MIDVAS

to Desensitize individual to stuttering

primary focus of stuttering modification

motivation phase

Part of 7 Step program of stuttering modification:

▪ SLP becomes a guide and shares positive information about the treatment process with the client.

▪ Both need to become comfortable & share feelings & emotions regarding stuttering.

▪ SLP must stress the fact that being an active participant in treatment is vital to achieve fluent speech.

identification phase

Part of 7 Step program of stuttering modification:

Recognize & examines the moments of core and secondary behaviors, feelings, and attitudes associated with their stutters. ▪ Strategies used to identify behaviors are

1. Oral reading

2. Discussions

3. Modeling stuttered behaviors

4. Self observations

1. Oral reading

2. Discussions

3. Modeling stuttered behaviors

4. Self observations

strategies used to identify behaviors in the identification phase are

Desensitization Phase

Part of 7 Step program of stuttering modification:

▪ Negative feelings & emotions are addressed to desensitize the individual to stuttering behaviors & listeners reactions.

▪ PWS learns strategies to reduce negative feelings & anxiety associated with stuttering.

▪ Therapy strategies are:

a) Relaxation

b) Pseudostuttering (negative practices)

c) Adaptation

d) Anxiety reduction by modifying stuttering

variation phase

Part of 7 Step program of stuttering modification:

Learning new responses to diminish stuttering moments.

▪ SLP coaches the client through stuttering moments.

▪ Provides the PWS alternative stuttering methods to increase speaking control.

variation phase

Learning new strategies to reduce stuttering

they will not work on every situation

modification phase

Part of 7 Step program of stuttering modification:

going from stuttering moments to more fluent speech, easier speech

child should be more aware and comfortable to their dysfluencues during this phase

changes cognitively

self-monitoring

modification phase

Van riper founded

different techniques to employ to get the person to reduce stuttering

consist of 4 ways

cancellations

speaker changes the form of stuttering after it occurs. Immediately after the stutter, PWS stop & pause for 2-3 seconds

planning

pause

after the stuttered word to silently pantomime a new, easy form of stuttering

pullouts

not waiting until the stutter is over, PWS will take ownership of the stuttered moment and slide out of it.

plosives

one of the most common class of sounds to stutter on

preparatory set

anticipates a word to be difficult. Encourage to work through all sounds of the word slowly and calmly

stabilization phase

Part of 7 Step program of stuttering modification:

PWS becomes self-aware & confident in monitoring their own stutter behaviors.

▪ Become stable in different communicative encounters.

▪ Generalization & maintenance are address

▪ Stabilizing activities:

▪ Delayed auditory feedback

▪ Frequency-altered feedback

delayed auditory feedback

device placed in child’s ear,

individuals who stutter can hear themselves in the device

helps them to self correct

frequency altered feedback

shifts the speakers voice up or down (pitch)

through a headset device

helps reduce portions of the stuttering event

maintencance

• Strategies learned are maintained by the client.

  ▪  When the client feels reoccurring stutter behaviors, it is encouraged to reiterate the phases of therapy with a pseudostutter

generalization

• Client can use the techniques learned in therapy in natural contexts.

•  Client is encouraged to face situations that were feared & avoided prior

  to therapy

•  Client is dismissed from therapy once they become more confident & feels that stuttering moments in everyday situations are manageable.

generalization

• Targets activities first of which the client deems easy in terms of the amount that the client stutters and/or intensity of the emotion experience in settings.

should be real world activities

1. The frequency with which the client encounters them

2. Extent to which the client received negative listener reactions

3. Extent to which client feels unable to remain in control of his speech fluency while talking

These generalization activities are important because

1. Avoidance behaviors

2. Emotional reactions

Two types of measurable covert behaviors

stuttering modification

Measures attitudes & beliefs
▪ Overt aspects only account for 10% of the disorder
▪ Scales can be self-measured, self-monitored, and self-observation

1. Breathing

2. Speech rate

3. Voice production

4. Articulation

5. When children experience more fluency, they often develop greater confidence about speaking. This can decrease negative reactions and promote even more fluency.

Fluency Shaping strategies include techniques that alter the clients’

stretchy speech

prolonged speech is aka

turtle talk

reduced rate of speech aka

• Light articulatory contact

producing the initial sounds of words that are plosives in manner /b, p, d, t, g, k/ these sounds are produced very gently.

Slower speech rates

slowing down the rate of speech may improve fluency.

Relaxed breath patterns

reducing tension globally via focusing on reducing tension in breath patterns can also improve fluency.

Slow/stretched speech

Prolonged productions of speech sounds in a general capacity to encroached fluency on a global level of communication.

easy onset

• producing initial sounds of words that are not plosives (vowels, fricatives /z, s, v, v/ nasals /n, m/ and liquid /l/ also in an easy and gentle way.

1. Programmed Conditioning for Fluency

2. Programmed Therapy for Stuttering in Children & Adults

list the two fluency shaping programs

1. Gradual Increase in Length & Complexity of Utterances

2. Delayed Auditory Feedback

3. Programmed Traditional

4. Punishment

Fluency is established through one of four techniques

Lidcome Program

Parent-directed treatment for stuttering in preschool children.

▪ SLP teach parents to deliver treatment using a 10-point Likert scale to measure the severity of the child’s stuttering.

▪ Two Stages

1. 12 weekly clinic visits

2. Maintenance- continues for at least 12 months

Parent Child Interaction Therapy

• Therapy is delivered through an initial block of six in-clinic sessions, followed by a 6-week home consolidation period where the parents continue to implement the strategies in the home setting.

• ▪  Interaction strategies are introduced within 5-min “Special Times,” which are videorecorded in the clinic and then practiced up to five times per week at home.

• ▪  Parents watch the video recordings of themselves to identify helpful interaction strategies they are already using and explore ways to increase their use of these to support the child’s fluency and communication success.

• ▪  Interaction strategies may include following a child’s lead in play.