SHS 10-14 EXAM

Clinician's Beliefs

Clinician should have a well developed perspective on the etiology of stuttering and the forces that cause some stuttering to become severe and persistent.

How clinicians beliefs affect evaluation procedures?

Only with a detailed perspective about the onset and development of stuttering can the clinician effectively evaluate clients of all ages and counsel them and their families.

How clinicians beliefs affect treatment strategies?

Treatment choice must be based on a good understanding of the dynamics underlying a particular client's stuttering. One size treatment does not fit all.

Treatment goals: reduce frequency of stuttering

- Without creating extraneous behaviors

- How much reduction depends on level

Treatment goals: reduce the abnormality of stuttering

- Depends on age and level

- client has choice about how she stutters

Treatment goals: reduce negative feelings about stuttering and about speaking

- Depends on age and level

- Change may occur as by product of increased fluency or classical conditioning may be needed

Treatment goals: reduce negative

- Thoughts and attitudes

- Will affect amount and abnormality of stuttering

- Will affect behavior before starting to speak and after stuttering

Treatment Goals: reduce avoidance

- Client needs to learn new behaviors before reducing old behavior (start by giving the client a tool to reduce stuttering)

- reducing negative emotions reduces need for avoidances

Treatment Goals: increase communication abilities

- May be a major goal of some approaches

- Some clients may need more than others depending in part on level

Treatment Goals: create fluency facilitating environment

- Important for borderline and beginning

- Class environment (and home) important for school age children

- Adults can change their own environments with help and support from clinician.

Cognitive Therapy

- Explain how thoughts affect feelings, which in turn affect behaviors

- Explore and help client change such things as negative self talk

As clinician helps client explore and accept responsibility for his stuttering, clinicians blank in the client's stuttering and his feelings about it are crucial?

Curiosity and genuine interest

When working with school-age children we use several activities to help child reduce shame.

- Playing with the moment of stuttering to compete with the clinician for the longest and loudest stutters

- Drawing pictures of stutters and talking about stutters feel

- Making music enhanced videos of the child's work and play with his stutters

As client learns to stutter openly and tolerate stuttering the clinician?

Helps client accept his feelings of frustration, fear, and vulnerability

As client learns to stutter in an easier way and stop rewarding tense stutters, feelings of resistance, anger, and shame may arise. The clinician can help by?

Listening for these feelings and verbalizing acceptance for them.

For borderline stuttering the environment?

Can be changed to become more fluency enhancing.

For beginning stuttering what approach can be used?

Operant conditioning based such as Lidcombe Program.

For intermediate and advanced stuttering, reducing frequency, instead of reducing the abnormality of stuttering should be?

Reversed for only those clients who have few negative emotions associated with their stuttering.

For rare clients in reducing frequency what can be used?

Fluency shaping approach

Fluency shaping approach

Establish fluency using slow rate, easy onset, light contacts, proprioception, and pausing to shape normal sounding speech.

Therapy Procedures: Reducing Abnormality of Stuttering begin by?

- Reducing negative emotion associated with stuttering

- Explore stuttering with much praise and acceptance as client learns about his stuttering

- Play with/experiment with the stuttering so he learns he isn't helpless to change stuttering

- Guide the client to stay in the moment of stutter

- Help client learn to produce appropriate sound associated with first sound of word that is being scattered as he stays in the stutter

- Use rewards

- Guide client to ease out of stutter slowly and loosely after tension in stutter has subsided and finish the word

Younger Preschool Children Borderline Stuttering

Age between 2 and 3.5 years

Stuttering is mostly easy?

Repetitions but may have two iterations.

Nature of borderline stuttering?

Stuttering results from interaction of three forces (constitutional, developmental, and environmental factors).

Environment factors can be lessened, stuttering will tapper off and become?

Normal fluency

The clinicians role of nature of borderline stuttering is?

To help family discover their own best changes to make the environment fluency facilitating.

Speech behaviors targeted for therapy?

Aspects of family's speech and non speech behaviors (if absolutely needed, child's stutters can be targeted for change.

Fluency goals

Spontaneous fluency

Feelings and attitudes

Work with family's feelings, behaviors, and attitudes to keep the child feeling positive about speech.

Maintenance procedures

Keep contact with family even after child has achived fluency; gradually taper off, remaining open to future contact if needed.

Severity Ratings

- Use Lidcombe Severity Rating Scale

- 1 to 10

- 1= typical fluency; 10=extremely severe stuttering

- clinician can also use this in session

Baseline Measures

Clinician records first 10-15 minutes of each clinic session and notes child's SR for session and compares with parent's SR.

Parents should arrange how much time per day of one-on-one time with child to practice parent-child interaction changes?

10-15

Many children who are starting to stutter are worried about?

What's happening to there talking.

Clinicians should observe parent child interactions when?

The beginning of each session; observe not only speech rate but also some of the other aspects, such as frequent questions.

Typical family interaction patterns that may stress a vulnerable child?

- High rates of speech

- rapid fire conversational pace

- frequent open ended questions

- many critical or corrective comments

- inadequate or inconsistent listening to what the child says

- vocabulary far above child's level

- advanced levels of syntax

A child with borderline stuttering does not ?

- Show improvement with indirect therapy after several weeks.

- I have parents continue to create a fluency enhancing environment but add praise for fluency which is done during one-on one times during the day

Praise for fluency is suited to what?

Feels natural for the child and parent