Stuttering Lec 3

family focused treatment approach for children who stutter

improved speech fluency

effective comm skills

healthy comm attitudes

effective comm skills

parent focused: modifying comm; understanding and acceptance

child focused: modifying comm; understanding and acceptance

indirect treatment (parent and caregivers)

environmental factors is mainyl what indirect looks at

time pressure

exceeding demands

child uncertainty or stress

family anxiety abt stuttering

purpose of indirect treatment

increase fluency by changing environmental factors

strategies to reduced maintenance of stuttering behaviours

provide education to child and fam

give experiences that change neg views on stutt

train comm partners to modify comm styles

assist caregivers to adopt behaviours to show supportive environment

how to create a facilitative, supportive environment

reduce time pressure - slow rate, turn taking

reduce uncertainty/stressful situations @ home

improve child's sense of self worth/esteem

lidcombe program

behavioural treatment for kids under 6

stage 1: goal is for kid to speak w/no stutt; parents do treatment daily; see SLP/CDA weekly

stage 2: goal is maintenace

verbal contingencies for lidcombe program

comments made by parents when chld does or does not stutter

given specific examples to use

severity rating for lidcombe

0 = no stuttering

9 = extremely severe stuttering

VC: stutter free speech

direct (directly intervening in child's speech)

praise (that was good smootht alking; nice talking, no bumps)

request self evaluation (was that smooth? were there any bumps there?

acknowledge (that was smooth, no bumpy words)

VC: unambiguous stuttering

direct

acknowledge (that was bumpy; you got stuck on that word)

request self correction (can you try that again? see if you can say that again w/o the bump)

palin parent-child interaction therapy (palin PCI)

for kids up to 7yo

mainly indirect - focus on changing environ for successful com

play based sessions, vid feedback, special discussions, special time (parent & kid practice)

lidcombe vs palin

no stuttering vs decreasing trends, unique goals

restart-DCM

indirect

states stuttering associated w/aspects of kid's environ placing too many demands on childs speech

shows how to reduce demands on kids speech

similar to palin (focus on environ)

assessment of restart-DCM

assessment: parent interview, kid assessment, parent-child interaction analysis

Questions parent to child

Turn taking behaviour

Parent response to stuttering

Parent linguistic behaviour

Rate

Other parental behaviour

treatment of restart DCM

Reducing motor, linguistic, emotional, cognitive demands

reinforcement of speech motor, linguistic, emotional, cog capacities

direct therapy w/kids aimed at more fluent speech

direct treatment

explicit, overt, direct attempts to modify kids speech and related behaviours

implementing this depends on age and awareness of prob

4 elements of direct therapy approaches

1. reduce freq and/or severity of stutt behav

2. minimize/remove processes maintaing stutt

3. transfer of new speech behaviurs to daily comm

4. maintain fluency

reduce freq or severity of stuttering behaviours

a. contingency management approach - reinforcmeent depending on fluent speech; behavioural approach

b. fluency shaping approach - speech behaviours taught in systematic way; changes entire pattern; replaces stuttered w/fluent speech

c. stuttering modification approach - modify dysfluencies as they occur; makes stutter more acceptable

techniques to modify stutter

cancellation (before stutter)

pull out (during)

prepatory sets (before)

minimizing/removing processes maintain stutter

identify factors reinforcing stuttering or avoidance behaviours

identify situations associated w/increased stuttering

trasnfering new speech behaviours to daily comm

hierarchy of speaking tasks to apply skills in more difficult sits

transfer skills to specific daytoday sits

setting realistic expectations

fostering maintenance

develop self reliance (self evaluation)

develop independence (effective monitoring)

provide opportunities to talk abt speaking performance; helps see more strats if needed

group vs indiv therapy consideration

interests/motivations

age, maturity, readiness for groups

self-discipline, study habits

concurrent speech/lang delay/disorder

academic performance

severity of stuttering

effect on comm at home and school

previous therapy

fam support/level of concern

concept training

meaningful and age appropriate labels

aud discrimination

production

awareness - articulators/speech helpers

teach normal speech production

diagram of major parts of anatomy for artic, phonation, respiration w/age appropriate terms

techniques - slow and easy talking

helps fluency in beginning stutterers

vowel initial single words, single words, phrases, sentences, convos

techniques - full, relaxed breath

control breath support

big, slow breath before you talk

speak as ypu breathe out slowly

don't hold breath

no shoulder mvmt, only tummy

techniques - light touch

explaining what child needs to do to get light contact of articulators

techniques - stretching

speaker stretches vowel to slow speech

ask child to take full breath, use articulators lightly, and stretch sounds

slow change of position bn consonant and vowel

techniques - full movement

exaggerate movements to produce sounds

move your mouth or full mvmt target

good for kids w/lots of oral tension (esp jaw and lips)

more relaxed myscles

practice in front of big mirror

techniques - easy onset

say initial sounds in easy gentle way

inset /h/ at start to keep VF apart

helps reduce tension

techniques - blending/linking

show how to link words tht so no space/pause bn them

helps say words w/o getting stuck in middle

techniques - pausing/phrasing/chunking

breaks during speaking

more breaks in natural places

gives speech helpers time to catch up and helps relax them

general techniques

increase level of sounds, single words, carrier phrases, sentences, convo, combined lvls

other areas of comm to address in direct therapy with youngre clients

turn taking

eye contact

joint attn

transfers

generalization of learning

voluntary, conscious application of learned speech behaviours

may happen spontaneously

later stage - begin to increase diff lvl by adding interruptions, noice, speech rate, time pressure, listener attn