The Effective Clinician
Who said the dirty bandage quote?
Charles Van Riper
What the hell is fluency?
What the listener perceives when listening to someone who is truly adept at producing speech. There are no disruptions in the sequence of sounds and words and the listener is able to attend to the message.
Heritability is a statistical measure of variance of trait in a population of people that can be attributed to genes.
What kinds of interview questions should you ask the parent?
What do parents think about stuttering?
What is the family environment like?
Does the child show frustration or avoidance behaviors?
Academic impact on the child –
Do they avoid class activities?
Do they have difficulty with interpersonal relationships?
Describe in your own words what the life of a stutterer is like by the time a client finally makes the decision to reach out to you.
Adults decide to seek treatment when they are ready to make a change, recognizing that stuttering negatively impacts their quality of life, and may have developed various coping behaviors—both positive, such as slowing down and taking deep breaths, and negative, such as gasping for air or avoiding speaking—to minimize or conceal their stuttering.
Name Van Riper's attributes of an effective clinician and describe one.
1. Empathy
2. Warmth
3. Genuineness
4. Charisma
Name the 3 behaviors that make speech fluent. Describe one.
1. Hierarchical organization: the way the brain structures motor and linguistic skills from simple, well-practiced behaviors to more complex and demanding ones
2. Incremental Processing: Plan is already in place for the next utterance before finishing previous utterance.
3. Paired feedforward and feedback controllers:
Feedforward: desired movement and the motor commands to produce movement
Feedback: anticipated sensory consequences of a behavior, to compare to actual sensory feedback and make adjustments if necessary.
What are the theories of stuttering?
Psychological (temperament and personality)
Learning (classical/operant conditioning)
Physiological (linguistic or motor defect/genetic)
Multifactorial (demands and capacity)
What are the primary considerations when assessing the probability that a child will recover naturally or persist?
If a family member stuttered and if they recovered naturally or persisted.
Strong family history of stuttering is one of the most reliable predictors of chronicity
If it is stable or persisting
Early onset stuttering children are more likely to recover
Boys are more likely to persist
What can you work on in therapy if you don't know what to do?
TALK ABOUT STUTTERING
When they started, how long its been going on, what they think other think about them and stuttering.
What is the primary block to creativity? Name 2 additional blocks for bonus points!
Primary: fear of failure
BONUS POINTS:
Reluctance to play with ideas
Over-certainty
Giving up too soon
Reluctance to push
Inability to accept contrasting views (tolerance for ambiguity)
How does stutering differ from normal or typical disfluency?
Stuttering
occurs when an individual anticipates a loss of control over their speech and attempts to prevent it. These efforts to avoid stuttering are what actually produce the stutter.
repetitions (more than 2 per word), prolongations (>2 seconds)
Typical disfluencies
occur when there are difficulties with planning or organizing speech, often resulting in “ums” and/or stuttering like disfluencies.
Caused by an error in incremental speech processing (still planning on what to say)
Describe the feeling of loss of control.
The individual anticipates stuttering and they do everything they can to prevent it, however, it just happens.
What sorts of questions can you ask to inquire about how the child feels about stuttering or whether they are aware of their own speech fluency?
A-19 scale can be used to see if the child is developing shame about their stutter.
General questions about participation in class and hanging out with friends.
What kinds of questions should you ask when interviewing an adolescent or adult who stutters?
Why do you think you stutter?
How does it affect your quality of life?
Why are you here today?
What do you do to cope?
How long have you stuttered?
What do you think others think about stuttering?
*** You can always talk about thoughts and feelings related to stuttering if you don’t know what to focus on in therapy.
Are you ready for change?
Is this a transitional period in your life?
Why did you choose to seek therapy today?
“You are not alone.” “With determination and persistence you will improve your quality of life.”
What is the clinician's role when working with a stuttering client?
Counseling is the most important part.
Additionally, become calibrated to the client, be willing to join the struggle, and be comfortable, etc.
What are types of normal disfluencies?
whole word repetitions, phrase repetitions, revision, incomplete phrase, interjection
“Uh” “um” – buying time to plan what to say
How is the loss of control central to the experience of stuttering?
Feeling of the “loss of control” is what makes it different from typical disfluencies
Individuals who stutter will experience this
What are some factors to consider when deciding whether or not to recommend a preschool-age child for recurring visits to the clinic?
Is the child aware that they stutter?
Does the child show signs of frustration?
Does the child exhibit avoidance behaviors?
Is it stable or increasing?
Family history – does anyone in the family stutter, and did they persist
When did they start to stutter? And how long has it lasted?
Early onset is more likely to recover
Should you use frequency count to get an accurate picture of an adults stuttering? Name 2 reasons why/why not.
Variability of stuttering
Stuttering varies on a day to day basis. One day they may be perfectly fine, and then the next day it is terrible.
Avoiding stuttering
They may avoid saying certain words because they anticipate stuttering, and you don't get an accurate representation of their stuttering.
Setting differences
Comfortability
What is Cooper & Cooper's Theory
The person who is administering the treatment is the most important variable in creating the process of change.
What are types of stuttering?
Part word repetitions, prolongation, broken word, tense pause
Stuttering is an involuntary response, rather than an acoustic event (what the speaker hears)
Meaning, the individual cannot control their stutter.
Rose is a 3-year-old female who was brought in due to parent concerns about her speech fluency. Observations during structured speech tasks and conversational samples revealed occasional disfluencies, including part-word repetitions and prolongations. Disfluencies occur at a frequency of approximately 3–4 per 100 words, and she does not appear to be aware of her speech differences. There is no observed frustration or avoidance behaviors at this time. Family history is non-contributory, and the child demonstrates typical social and academic engagement for her age.
Questions:
Do you recommend her for therapy? Why/why not?
Do you tell Rose that she stutters?
Why do you think Rose doesn't know she stutters?
1. NO! She is not aware of her stutter, there is no family history, and she is a female.
2. DONT MAKE HER AWARE
3. She has not yet developed theory of mind/self-awareness skills.
What the actual hell is survivorship bias?
We only have data on stutters who choose to seek therapy. Many people will never seek therapy, making it biased.