Stuttering: Preschool Assessment and Treatment – Flashcards

Case history Evaluate stuttering behaviors Evaluate parent/child attitudes Diagnostic probes (fluency enhancing conditions; time pressure; stutter modification) Prognosis/recommendations/counseling

Based on a telephone interview, you can determine whether a child needs a full evaluation or just a consultation. Get basic case history: Time and manner of onset Initial stuttering and changes in features/severity Family history

Consultation: 12 months since onset; onset after 3.5yo Fairly consistent Male More SLD than normal fluencies Parents concerned and child aware Family history Other language issues Presence of secondary behaviors

Artic and language screening Detailed history Observation of stuttering with various communication partners and in various situations Decision: further evaluation or counseling/follow-up

Videotaped analysis of stuttering (play, story retell, and activity with time pressure) Detailed history Full speech/language assessment Decision: Follow-up and treatment if necessary; short-term therapy leading to follow-up; intensive therapy and gradual dismissal leading to follow-up

In young children, we typically see: WW repetitions, disfluencies at sentence initiation, normal tempo, lack of awareness of concern, evidence of language formulation stress, episodic In CWS: PW repetitions, single-syllable word repetitions, disrhythmic phonation, higher mean repetition units But, no official criteria for when in becomes stuttering For adults, >10SLD/100 or >2 disfluencies on a word or adjoining words indicates a need to treat

Gender (male = increased risk) Family History Age at Onset (age 4-5+ = increased risk) Phonology (poor scores indicate risk only close to onset) Language (expressive: Not clear; continuous high scores may indicate risk) Secondary characteristics

Postponement Avoidance Starter behaviors Escape behaviors

Increased risk factors More SLD than normal Tension in speech Child awareness Persistent since onset Concomitant issues Treatment factors: Child temperament (how to structure therapy) Phonological/language abilities (mainly fluency or just fluency component to language therapy) Parent participation

Give vocabulary to talk about stuttering Separate their feelings from child's feelings Give specific strategies (constructive task)

7 Strategies from Australia 1. reduce the pace 2. ask questions 3. use full listening 4. take turns 5. build confidence 6. create special times 7. apply normal rules/discipline

To improve fluency To develop communication skills To develop appropriate attitudes about language

Direct: treatment involving CWS as recipient Indirect: treatment method targeting parent behaviors

Based on puppet experiment which showed that stuttering reacts to operant conditioning Assumptions: EI in vital because stuttering is changeable; feedback develops self-monitoring and then fluency Parent-based; direct treatment program for preschoolers (limited success and mixed results over 6yo) with >6% unambiguous stuttering and 6+ months from onset Focuses on reinforcement and reward (behavioral feedback) during 10 minute talking sessions, 2x/day Parent gives praise/request for self-eval/acknowledgment after fluent phrase and acknowledgement/request for self correction after unambiguous stutter (with 5:1 ratio) Measurement: daily parent ratings, %SS during weekly meeting with SLP Goal: 0% (or near zero) syllables stuttered for 3+ weeks Supported by data/literature

Unambiguous: Sound or syllable repetition Prolongation Block More typical disfluencies with tension or >3 repetitions Behaviors signaling avoidance of stuttered syllable Ambiguous: Hesitations Interjections Revisions Whole word repetitions Phrase repetitions <3 repetitions

Theory: Children possess genetically influenced general tendencies for fluency breakdown that dynamically interact with environmental factors that both originate and maintain the problem= capacities and demands model. Provides a framework by which the clinician can create therapy routine that builds child's capacities for fluency while decreasing environmental and internal demands. 1. Structured direct activities -clinician establishes communicative control -simple levels of discourse -clinician models slow, easy speech, turn-taking, "easy" stuttering -stuttering modification (smooth/bumpy) 2. Structured indirect activities -parent learns to promote healthy communicative environment -more casual play activities -move toward introducing home component (work up to 15min/day) -parent charts behaviors and changes 3. Spontaneous activities -parent models communication skills -move from 15min/day to any time the child needs support with fluency -used during gradual dismissal 4. Problem solving -review parent concerns -What did you notice this week? -What did you focus on in your speech?

family involvement

Theory: based on capacities/demands model (stuttering comes from child factors/interpersonal stressors/communicative stressors) 1. Parent education and counseling sessions -identify disfluency types -map schedule/situational factors that affect fluency -parents note their recations 2. Parent observations/strategy practice 3. Direct child intervention Role of families: Help develop goals Provide emotional support to child Practice skills with child/praise use Change talking environment Educate others

Capacities/demand

Parents need to know... Causes of stuttering Spontaneous recovery Characteristics of normal fluency Signs of stuttering risk Things that maintain stuttering The therapy process Regression Behavior management Talking about stuttering (w/ child and w/ others [soccer coach, grandma, etc])

*Parent language* Decrease speech rate (match child) Pause between conversational turns Eliminate complex questions Respond to content Acknowledge struggle/show empathy Listen patiently Reinforce fluency Use comments (v. questioning) Use easy/relaxed speech Repeat stuttered word ("maybe we can say it together?") Rephrasing *Environment* Establish turn-taking Decrease pressure and emotional/physical excitement Use more relaxed pace Promote self-confidence Allow ample time for activities/transitions Eliminate talking at stressful times Maintain structure and routine Set up parent/child playtime

Slow normal speech rate Model relaxed speech style and slow/relaxed conversational pace Pauses and silences Reduce requests for non-spontaneous speech Use disfluencies that are normal for child's age (as clinician) Use books to share emotions