Podcast
Questions and Answers
What is the recommended time frame for noting improvements in therapy according to Rustin?
The Lidcombe Programme is designed primarily for adults who stutter.
False
What are parents trained to do during therapy sessions?
Change aspects and implement strategies at home during special times
The median treatment time for the Lidcombe Programme is ____ sessions.
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Match the following components of the Lidcombe Programme with their descriptions:
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Which of the following is considered a goal of treatment for preschool children who stutter?
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Fluency reinforcement techniques are only effective for school-aged children.
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What is the Lidcombe Program primarily focused on?
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The ______ Process involves conditioning to promote fluency by using stimulus, response, and reward.
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Match the treatment technique with its primary age group:
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What is the primary focus of indirect intervention for preschool children with stuttering?
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Parents are advised to increase speech demands to help their child with fluency.
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Name one technique used in indirect intervention for enhancing a child's fluency.
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The process of parents observing and participating in their child's interactions is part of the ___________ model.
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Which of the following is NOT a component of parent involvement in preschool stuttering intervention?
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Video analysis can be useful for parents to modify their interaction styles with their child.
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What should parents focus on to improve their child's communication interaction skills?
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Match the techniques to their purpose in preschool stuttering intervention:
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What factor does NOT influence therapy intervention for stuttering?
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The client's permission is required for therapy to proceed.
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What is one characteristic that can change based on the phase of development in children who stutter?
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The three main focus areas of management strategies in stuttering therapy are known as the 3 ____.
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Match the following approaches to their descriptions:
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Which of the following is included in treatment for stuttering management?
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Teasing and bullying are not considered when treating children who stutter.
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What is the main role of parents in the intervention process for children who stutter?
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What is one of the key focuses of intervention in stuttering therapy?
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Parental involvement in stuttering therapy has no effect on treatment outcomes.
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Name one fluency enhancing technique.
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Stuttering is affected by a combination of ______ and ______.
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Match the following categories with their descriptions:
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What rating scale is commonly used to measure the severity of stuttering?
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Fluency shaping strategies are primarily focused on increasing demands on the child.
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What is the role of parents in stuttering treatment?
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Study Notes
Introduction to Stuttering Treatment
- Stuttering therapy can be long term or short term, intensive, weekly or individual and in groups
- Therapy is determined by assessment, severity of stuttering, phase of development, motivation to change, previous therapy, risk factors, and the therapist-client relationship
- The client must agree to therapy.
- The process and approach to intervention are determined by the phase of development.
- Long-term goals, short-term goals, and session goals are determined by the evaluation and assessment.
- Consider the client’s needs and what they desire to change
- The client must learn to manage speech and be open to desensitization.
- Attitudes, emotions, and cognition play a role in treatment as well as potential relapses, transfer, and maintenance.
- Self-determination is important.
Treating Children vs. Adults with Stuttering
- Children are still developing conceptual, linguistic, affective, and neuro-physiological skills.
- Therapy might focus on other concomitants first.
- Teasing and bullying are important considerations.
- Treatment is less direct compared to adults.
- Parents, teachers, and other professionals play a role in treatment.
- An asset-based approach is recommended.
- More likely to obtain fluency.
Preschool Stuttering Treatment
- The primary focus of treatment is the 3 Ps:
- Prevent
- Prepare
- Promote
- Adapt the environment and involve the team.
- Intervention with parents and children is crucial.
- Provide groups and literature for parents.
- Model strategies for parents similar to the Hanen Program.
- Encourage slower speech rate, shorter utterances, reduced complexity, and pauses.
- Teach conversation strategies through pamphlets, videos, books, and websites.
Stages of Development for Stuttering
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Age: Preschool
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Stage: Borderline
- Core Behaviours: Phrase and some word repetitions, low level of tension, generally unaware.
- Feelings/Attitudes/Awareness: Unaware of stuttering.
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Stage: Beginning Stutterer
- Core Behaviours: Word repetitions on initial sounds, prolongations, blocks, tension noticeable.
- Feelings/Attitudes/Awareness: May begin to struggle, may have some awareness.
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Stage: Intermediate Stutterer
- Core Behaviours: More frequent and complex repetitions, prolongations, blocks, physical tension.
- Feelings/Attitudes/Awareness: Aware of their stuttering; feelings of frustration, embarrassment, and anxiety.
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Stage: Advanced Stutterer
- Core Behaviours: Stuttering in all speech situations, blocks, physical tension, avoidance behaviors.
- Feelings/Attitudes/Awareness: High levels of anxiety, fear, and avoidance of speaking.
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Stage: Secondary Behaviours
- Core Behaviours: Physical tension, facial grimaces, eye blinking, head movements.
- Feelings/Attitudes/Awareness: Fear of speaking, social isolation.
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Stage: Borderline
Indirect (Parent Centered) Intervention for Preschool Children
- Focus: Working with parents, not the child, to improve fluency
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Techniques:
- Adjust environmental factors that disrupt fluency.
- Decrease speech demands.
- Reward open, easy, and forward-moving speech.
- Provide explanations, reassurance, and encouragement.
Three Stages of Parent Involvement
- Educational Counseling: Providing information to parents about stuttering.
- Facilitating Communicative Interaction: Teaching parents strategies to improve communication with their child.
- Parents as Observers and Participants: Parents learn to observe and participate in therapy sessions.
Rustin Family Interaction Therapy
- Focuses on parents’ interaction skills to:
- Follow the child’s lead.
- Give the child time to respond.
- Gain the child's attention.
- Improve positioning for communication.
- Adjust their manner of interaction.
- Provide reinforcement.
- Ensure turn-taking.
- Manage rate of speech.
- Improve intelligibility.
Common Parent Behaviors That May Contribute to Stuttering
- Rapid speech rate.
- Interruptions.
- Asking too many questions without waiting for a reply.
- Over-directing in play and conversation.
- Parental passivity.
- Poor listening skills.
- Ambiguous non-verbal communication.
- Conversations unrelated to current activities.
- Parents are trained in therapy to modify these behaviors and implement them at home during special times.
Outcomes of Rustin Family Interaction Therapy
- Improvements should be noted within six weeks.
- Enter a maintenance program if the child shows improvement.
- If there’s no improvement, implement a direct strategy.
Direct (Child Centered) Intervention for Preschool Children
- Lidcombe Approach: Works with children through parents.
- Prognosis: Positive indicators for recovery
- Focus: Gently correcting, eliciting smooth/stutter-free speech, and parent training.
- Operant Conditioning: Positive reinforcement is used.
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Techniques:
- Self-Monitoring: Children learn to monitor their own speech.
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Lidcombe Programme (Onslow, 1995):
- Does not involve non-involvement of the child; works with the child through the parents.
- The treatment of choice for children under 6 years old.
- Uses a direct approach, including self-monitoring, but does not teach a technique.
- Employs operant conditioning/positive reinforcement.
- Gently corrects stuttered speech, eliciting smooth/stutter-free speech, and parent training.
- Extensive empirical data supports its effectiveness.
Lidcombe Programme (Onslow 1995)
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Parents learn how to:
- Identify stuttered and fluent speech in their children.
- Praise and correct in a natural way.
- Take severity ratings every day.
- Adjust treatment based on severity.
- Median Treatment Time: 11 sessions (11 weeks).
- Data: Over 2,000 children have been treated using this program.
Lidcombe Programme Instructions
- Provide information about stuttering.
- Describe the treatment to parents.
- Train parents on the severity rating measure (1-10).
Demands and Capacities Model
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Capacities:
- Motor control (Rate of speech, stuttering behaviors, coarticulation, stress patterns, intonation, rhythm).
- Linguistic (Language skills, syntax, semantics, phonology, and pragmatics).
- Cognitive development (Moving, thinking, and feeling).
- Socio-emotional (Emotional maturity, reactions to disfluency, the ability to move on despite fears, anxiety, and anger).
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Demands:
- Communicative environment (Articulation/phonological plan, parents’ rate and communicative style).
- Environmental demands placed on the individual.
- Linguistic stressors (Words, sentences, and situations).
- Socio-emotional demands impacting speech.
Intervention Approaches Based on Demands and Capacities Model
- Reduce demands: Parent counseling, education, skill development.
- Increase capacity.
- Employ fluency-shaping strategies.
- Work on social/emotional factors.
Fluency Enhancers for Stuttering
- Slow, stretched speech with normal intonation.
- Simple, short sentences.
- Frequent silent periods.
- Elimination of questions, interruptions, and demands for verbal performance.
- Slowed conversation turn-taking style.
- Self-talk and parallel play.
- Following the child’s lead in play.
- Producing disfluencies in conversation.
Therapy Goals
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Accountability:
- Effectiveness
- Eclectic approaches
- Efficiency (Short term)
- Integration
- Parent Training and Involvement: Parents must be educated and informed to change their behavior.
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Parents’ Role:
- Parents do not cause stuttering, and they should not be “stuttering police.”
Factors Associated with Increased Concern for Stuttering
- Stuttering onset after 36 months.
- Relatively poorer speech/language performance.
- No family history or history of recovered stuttering.
- Female gender.
- Decrease in speech and language difficulties (SLDs) over 12 months.
- Early onset of symptoms.
- Strong speech and language skills.
Fluency Reinforcement
- Process: Conditioning and experiencing fluency.
- Stimulus: A cue or prompt.
- Response: Fluent speech.
- Reward: Positive reinforcement for fluency.
Fluency Reinforcement Examples for Children
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Lidcombe Programme:
- Parents and therapists provide positive reinforcement for fluent speech and gentle corrections for stuttered speech, helping children experience fluency.
- Stocker Probe Technique: Focuses on prompting a child to produce a fluent repetition.
- Smooth Talking: Helps the child develop smoother speech by using gentle corrections and positive reinforcement.
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Easy Talker
- Children learn to use easy talk techniques.
- The focus is on reducing tension and increasing fluency.
- Fluency Rules: Teach children rules to use when they are likely to stutter, such as slowing down or taking a breath.
Common Fluency Reinforcement Programs:
- Palin PCI: A fluency shaping program that uses traditional fluency techniques and positive reinforcement to help children speak more fluently.
- Lidcombe Programme: A parent-administered treatment program that uses positive reinforcement to decrease stuttering in young children.
- Smooth Speech & CBT: Uses cognitive-behavioral therapy in addition to fluency shaping techniques.
Fluency Reinforcement Program Information
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Ages:
- Palin PCI: Preschool (around 9 years old)
- Lidcombe: Ages 3-6 years; 6-12 years.
- Smooth Speech: Ages 9-14 years
- Easy Talker: School age
- Fluency Rules: School age
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Therapists:
- Palin PCI: SLT, parents, and teachers.
- Lidcombe: SLT and parents; teachers.
- Smooth Speech: Clinician, parents, and teachers.
- Easy Talker: SLT, parents, and teachers.
- Fluency Rules: SLT, parents, and teachers.
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Frequency:
- Palin PCI: 6/8 weeks
- Lidcombe: 8-12 weeks.
- Smooth Speech: Intensive 5 days in 5 weeks
- Easy Talker: Weekly sessions over time.
- Fluency Rules: Weekly sessions over time.
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Format:
- Palin PCI: Individual and groups.
- Lidcombe: Mainly individual.
- Smooth Speech: Individual and groups.
- Easy Talker: Individual and groups.
- Fluency Rules: Individual and groups.
Stuttering Treatment Overview for Preschool Children
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Goals:
- Improve fluency.
- Help parents and teachers create a fluency-facilitating environment.
- Help the child develop normal speech fluency by changing their speech patterns.
- Maintain healthy, appropriate attitudes towards communication and speaking.
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Description
Explore the various approaches to stuttering therapy, including the influence of client assessment and developmental phases. This quiz covers treatment strategies tailored for both children and adults, emphasizing the significance of client engagement and self-determination in the therapy process.
