Treatment for Preschool Children
For ______ direct/indirect treatment, a clinician counsels parents, models facilitating interaction and parentes practice facilitating interaction at home.
DIRECT
Describe how and why you might make a task hierarchy to help with the desensitization process
Brainstorm situations where the client uses language
Order situations by level of difficulty
Co-create goals that help client increase communication and confidence in these settings (e.g., advertising a stutter, pseudo-stuttering, role plays, participation goals)
Design and facilitate activities to achieve these goals with client
True or False:
It is not recommended that therapists target secondary behaviors for stuttering.
False
They are learned and good targets for therapy if a client is interested
These are tips to share with communication partners for PWS
Don't tell the person to slow down or relax
Model slow and relaxed speech yourself
Don't interrupt or talk over
Listen patiently
Pause before you respond
Don't show annoyance, focus on message
Do NOT measure reading fluency through oral reading rate for a CWS.
Goals for dealing with emotions (affective/emotional objectives)
¨ Student will report entering into previously avoided speaking situation 3x as measured by self-report.
¨ Student will use pseudostutter in 3 different speaking situations as measured by clinician observation.
¨ Student will state 3 statements to counter bullying or teasing about stuttering as measured by clinician log.
¨ Student will demonstrate increased positive attitudes as measured by self-rating scales.
Though parents are coached to take slightly different approaches during this time, in both the Lindcombe and Palin PCI program, parents are asked to spend the same amount of "speech time" with a child who stutters, it's this amount of time.
10-15 minutes
Scott Yaruss says that stuttering treatment can be understood as a methods to change these two elements that both begin with the letter t:
What are timing & tension?
This assessment is the gold standard for stuttering. Evaluations focus on a speaker's experience and can be used to develop a self evaluation measure regularly used in therapy.
Versions for these ages exist: 7-12, 13-17, 18+
What is the OASES?
A child friendly phrase to describe the mechanisms of speech that you might use while teaching a child how speech is produced.
What is the speech machine?
Goals for changing behaviors (behavioral objectives)
¨ Client will demonstrate ability to ease in and ease out of 80% feigned or actual stutters in tx room as measured by clinician data.
¨ Client will demonstrate appropriate rate during oral reading passages from text on 80% opportunities as judged by teacher and SLP.
¨ Client will demonstrate ability to change tense stuttered words (feigned) within self-generated sentences to relaxed productions on 80% opportunities as measured by clinician data.
¨ Client will use cancellation strategy at least 1x per session over 3 sessions when speaking to peer as measured by clinician data.
The goal of this treatment program are to acknowledge and discuss stuttering, provide a speech model, normalize a child's stutter, build resilience and assertiveness and desensitize parents and children to stuttering. Children are not 'rewarded' for smooth speech.
What is Palin PCI?
These are techniques to change which element?
Reducing speaking rate (stretch words/prolongations, slower rate of speaking)
Pausing (increase pause times, natural locations)
Pace (may not be needed ALL the time)
What is TIMING?
This is a counseling approach borrowed from psychology often used in stuttering therapy that aims at changing mindsets about stuttering.
What is cognitive behavioral therapy?
Name props that could be useful in stuttering therapy.
Hint: one mimics the movement of the lungs and can be used to show how hard it is to get air out when there is tension.
The other is also related to tension and goes on your fingers
What are balloons and finger traps?
Goals for changing thinking about stuttering (cognitive objectives)
¨Client will explain speech mechanism including 5 key components following instruction as measured by portfolio.
¨ Client will create informational presentation (speech brochure) including at least 5 key facts about stuttering as measured by portfolio.
¨ Client will identify thoughts, feelings and behaviors associated with stuttering within 2 different speaking situations with SLP assist as measured by self-rating scale and discussion.
¨ Client will set up and complete experiment evaluating his thoughts for one speaking situation above, with SLP assist and will provide a positive response to counter negative thoughts as measured by portfolio.
This stuttering tx program includes two phases:
1. Parent & child visit clinic each wee and when pre-established criterion levels are met. . .
2. Move to stage 2 in which the goal is to hand over management of stuttering to parents
Children are rewarded for "smooth talking" with verbal contingencies and asked to repeat stuttered phrases/words.
What is the Lidcombe Program?
Verbal contingencies:
1. Praise for not stuttering. (e.g., smooth talking, good talking, no bumps)
2. Request for self evaluation. (Were there any bumps in there?)
3. Acknowledgement. (That was smooth. That was bumpy. That was a stuck word)
4. Occasional request self correction. (Can you say that smoothly?)
Changing this element might mean using some of these strategies:
light contacts
easy starts
Easy (pseudo)-stuttering (bouncing, gliding, stretching)
What is TENSION?
The more tension->the more stuttering
Tension and struggle are normal reactions to stuttering, but effort not to stutter becomes part of the pattern
PWS may avoid these.
situations/people
specific words/phonemes
Related Goal: prevent, reduce or eliminate negative coping strategies
ISN'T
Sample annual IEP Goal and Objectives
•From The Source for Stuttering Ages 7-18 (adapted):
•Sample Annual Goal
•[Client] will participate in activities designed to improve his attitudes/emotions towards stuttering from a level requiring clinician support to an independent level outside the clinic.
•Sample Objectives
•[Client] will demonstrate the ability to use pseudo-stuttering in a familiar situation when prompted by the clinician in 80% of opportunities as measured by clinician data collection.
•[Client] will demonstrate the ability to educate a peer about stuttering when asked by the peer at least two times prior to progress review as measured by student report.
•[Client] will advertise his stuttering to a familiar adult or peer in the school setting at least two times prior to progress review as measured by student report.
The Demands and Capacities Model (DCM) proposes that stuttering happens when a child's social environment exceeds their cognitive, linguistic, motor or emotional capacities for fluent speech. Treatments might include. . .
Modeling slow rates of speech
Using simpler language
Following the child's lead in play
Time between conversational turns
MN state standards say that dysfluent behaviors must occur in at least five percent of the _____ (words/syllables) spoken in two or more speech samples.
What are WORDS?
Goals may be built around finding and using positive coping strategies including. . .
Acceptance
Self Confidence
Easy stuttering
Fluency management strategies
Talking about stuttering
These are school-friendly ideas that could be used to educate others about stuttering.
Create a brochure
Teach someone how to stutter
Sample short term objectives focused on specific strategies
During structured small group and 1:1 practice, [client] will demonstrate and complete structured activities based on at least FIVE of the following EIGHT concepts with the speech-language pathologist:
1. Label and describe parts of the Speech Machine (including respiration/phonation/articulation in fluent and nonfluent speech)
2. Answer fact vs. fiction questions about stuttering
3. Educate another person about stuttering
4. Identify word avoidances and fears
5. Identify situational avoidances and fears
6. Identify secondary behaviors
7. Identify ways of being a good communicator
8. Develop a plan to deal with bullying and teasing