Fluency Ch. 12

Older Preschool Children

children between 3.5 and 6 years of age

Lidcombe Program (LP)

an operant conditioning-based approach to stuttering, delivered in the home by a parent or other caregiver and guided via weekly meetings with the clinician

Operant Conditioning

a type of behavior modification that uses reward and punishments to increase or decrease the frequency of a behavior

Verbal Contingencies

comments to the child made immediately after an event that are intended to change the frequency of that event

Stage 1 (of LP)

the initial step of LP in which the child becomes normally fluent. Criteria for completing Stage 1 are three consecutive weeks in which (a) the parent's weekly SRs average below 2 with at least four 1s and (b) the clinician's SRs for entire sessions are 1s and 2s

Severity Rating Scale

a scale from 1 to 10 used daily by parent to assess child's stuttering. May be used by clinician as well during weekly clinic sessions

Stage 2 (of LP)

when the child meets the fluency criteria to complete Stage 1, this maintenance stage is begun. Weekly clinic meetings are faded systematically so that the parent and child meet with the clinician in this sequence: two, two, four, four, eight, eight, and finally 16 weeks apart. The child must continue to meet fluency criteria

Demands and Capacities

the perspective that the factors associated with the onset and persistence of stuttering are the demands placed on the child by her environments balanced by the child's innate capacity for fluent speech

Concomitant Speech and Language Problems

difficulties with articulation/phonological processing and/or difficulties with language that sometimes accompany stuttering. When this occurs in some children who stutter, it poses a problem of which disorder to work on first

A beginning stutterer

a. will not yet show tension

b. will not yet show secondary behaviors such as eye blinks

c. will have part-word repetitions as the predominant core stuttering behavior

d. all of the above

e. none of the above

c.

Treatment for a beginning stutterer

a. should only be conducted in a structured setting rather than at home

b. includes daily practice of fluent speech

c. should focus first on reducing tension and frustration

d. all of the above

e. none of the above

b.

In the Lidcombe Program,

a. parents conduct daily treatment sessions

b. parents focus first on negatively reinforcing disfluencies

c. parents and the clinician discuss stuttering only when the child is not present

d. all of the above

e. none of the above

a.

The Severity Rating Scale

a. is a standardized test of stuttering

b. is used by the parent for weekly assessments

c. should be "calibrated" to see if the parent and clinician are in agreement

d. all of the above

e. none of the above

c.

During weekly Lidcombe sessions

a. the clinician demonstrates to the parent how to conduct daily sessions

b. the parent and clinician discuss the child's speech while the child is present

c. the clinician assesses the child's fluency

d. all of the above

e. none of the above

d.

Lidcombe treatment sessions

a. should maintain a linguistic level that enables the child to be mostly fluent

b. are conducted only in the clinic

c. include directions for how to produce fluent speech

d. all of the above

e. none of the above

a.

Verbal contingencies for stuttered speech

a. include pointing out a stutter

b. are introduced after a child's fluency has begun to show improvement

c. are given in a ratio of no less than five praises for one contingency

d. all of the above

e. none of the above

d.

If a child ignores a request to self-correct a stutter,

a. the parent or clinician should model the correction

b. praise should be withheld from the next instance of fluent speech

c. it should be noted when determining a severity rating

d. all of the above

e. none of the above

e.

Positive reinforcement of fluent speech

a. should be verbal only

b. can include tangible rewards

c. is rarely as effective as specific fluency training for beginning stutterers

d. all of the above

e. none of the above

b.

Unstructured Lidcombe sessions

a. can take place in a car or at meals

b. can include a 1:1 ration of praise to contingencies

c. should not take place if structured sessions are still being conducted

d. all of the above

e. none of the above

a.

"Maintenance" begins in the Lidcombe Program after three weeks of

a. severity ratings no higher than 3

b. percentage syllables stuttered in the clinic no higher than 5 percent

c. perfectly fluent speech

d. all of the above

e. none of the above

e.

During "maintenance"

a. the child comes to the clinic only on an "as-needed" basis

b. parents no longer give praise or verbal contingencies

c. parents continue to record severity ratings

d. all of the above

e. none of the above

c.

Structured Lidcombe sessions

a. should not be considered by the child as "fun"

b. can include both parents alternating

c. often include siblings

d. all of the above

e. none of the above

b.

If a child stutters more than occasionally during Lidcombe sessions,

a. one-on-one sessions with the parent should be abandoned

b. the clinician can model how to help a child produce linguistically simpler speech

c. the parent should have the child use only one-word utterances

d. all of the above

e. none of the above

b.

Treatment using the Lidcombe Program

a. may be supervised by any speech-language pathologist

b. may be conducted by any parent who has read the online treatment manual

c. is individualized for each stutterer within the parameters of the program

d. all of the above

e. none of the above

c.

Outcome data about the Lidcombe Program

a. is scarce

b. has only come from Australia

c. has not fund negative psychological effects

d. all of the above

e. none of the above

c.

Sheryl Gottwald

a. uses treatment based on the "demands and capacities" theory of stuttering

b. begins treatment by counseling parents

c. believes parents and clinician should talk openly with the child about stuttering

d. all of the above

e. none of the above

d.

Dianne Hill

a. believes that fluency treatment should begin before work on other speech disorders

b. does not involve parents in treatment

c. has not seen many stutterers who also have word-finding problems

d. all of the above

e. none of the above

a.

Sheryl Gottwald

a. does not involve parents in treatment

b. modifies child's speech as well as changes child's environment

c. uses perfect fluency as the criterion for success

d. all of the above

e. none of the above

b.

Edward Conture, Linda Louko, and Mary Louise Edwards

a. believe that other speech problems should not be addressed until a child is fluent

b. use an indirect approach for articulation issues with a child who stutters

c. correct articulation errors at the same time they praise for fluency

d. all of the above

e. none of the above

b.

The author believes that beginning stuttering arises from

an interaction between children's constitutional predispositions interacting with developmental and environmental influences to produce primarily repetitive disfluencies with increased tension

Escape behaviors are also an important component of the disorder as children experience

increasing frustration with their inability to complete a word

Children with beginning stuttering usually have

a large amount of fluency that can be reinforced and generalized to situations that previously elicited stuttering

The Lidcombe Program is a parent-delivered, operant conditioning program for preschoolers in which the parent is

guided to conduct daily treatment conversations and apply verbal contingencies to fluency and stuttering

Treatment with the Lidcombe Program begins in

structured conversations and quickly moves to unstructured conversations throughout the day, so that treatment is conducted in the child's natural speaking environment

Another clinician, Sheryl Gottwald, uses an approach based on

the "demands and capacities" concept and treats both the family and the child