Stuttering Intervention and Treatment Strategies

Stuttering Intervention

• Therapy can be short-term or long-term, intensive or weekly.
• Therapy is determined by assessment of intensity, severity, motivation to change and prior therapy.
• Risk factors and therapist-client relationships are also key considerations.
• Client must consent to treatment

Introduction to Treatment

• The process of intervention is determined by the child's developmental stage.
• Evaluation and assessment is necessary for therapy planning.
• Long-term, short-term, and session goals are set.
• Client needs and priorities should be considered
• The client's responsibility is to learn how to manage speech.

Treatment Includes

• Therapy includes desensitization techniques focused on attitudes, emotions, and cognition.
• Consideration of relapse prevention and methods for maintenance.
• Self-help groups and support systems aid in the process.
• Assessments and classifications are important in decision-making and development of the intervention, treatment, and recovery plan.

Treating Children vs. Adults

• Children are still developing neuro-physiological skills; thus, treatment may focus more on concomitant issues.
• Children often face teasing and bullying relating to their speech.
• Adult intervention often focuses directly on managing stuttering.
• Adults have greater chance of improving fluency.
• Parents, teachers, and other professionals may play an important role in the treatment process.

Management: Main Focus

• Adapt the environment to the intervention.
• Involve the treatment team.
• Parents and children work together with intervention methods.
• Group-based interventions can be used.
• Literature is provided for parents to aid in the process.
• Similar strategies to the Hanen Program can be used.
• Model and teach strategies relating to slower speech rate, short utterances, reduced complexity, and pauses.
• Conversation strategies are an integral part of the intervention.

Preschool

• Describe the stages of development considering age, behaviours, and attitudes/awareness.
• Therapy approaches are parent-centered (indirect) or child-centered (direct).
• Awareness level influences the chosen approach.

(1) Indirect (Parent-Centered) Intervention

• Borderline cases, where the child may exhibit minimal tension and awareness of stuttering.
• Parents are counselled regarding typical developmental issues and nature of fluency.
• Most of the allocated time is spent working with parents.
• Intervention techniques include adjusting environmental factors, reducing speech demands, praising open, easy, forward-flowing speech.
• Reassurance and encouragement are beneficial for parents and children alike

(1) Indirect Intervention for the Preschool Child

• Adjust environmental factors to avoid disrupting fluency.
• Decrease speech demands.
• Give rewards for open, easy, and forward-speech.
• Engage in high degree of explanations, reassurance, and encouragement.

3 Stages of Parent Involvement

• Educational counseling for parents.
• Facilitate communication interaction between parents and children.
• Encourage parents observing and participating in interventions.

Preschool Stuttering, RUSTIN's Family Interaction Therapy

• Focuses on modifying parents' interaction skills to improve the child's speech.
• Follows the child's lead, gives time for responses, gains attention, and improves interaction methods.
• Reinforcement, turn-taking, rate of speech, and intelligibility are addressed.
• Video analysis helps parents identify modifications in conversational style and interaction techniques.

Factors Potentially Associated with Childhood Stuttering

• Negative responses to disfluencies by others.
• Fast-paced questions, interference, and limited talking time.
• Major life changes, marital and sibling conflicts, unrealistic demands, fast-paced lifestyles, perfectionistic tendencies, high sensitivity, intense personalities contribute to stuttering.

Achieving Communication Wellness

• Achieve "normal" fluency in conversational style.
• Use easy talking model focused on parent and child interactions.
• Use conversational model for questioning.
• Model and practice interventions, including reducing demands, modified questioning, and conversation pace changes.
• Modify communication attitudes, communicative stressors, and interpersonal stressors

More Concern - Stuttering Classification

• Families with a history of chronic stuttering, male gender, stable or increasingly patterns of stuttering, later onset (over 36 months), below expected speech/language skills, and absence of history of recovered stuttering.

Less Concern - Stuttering Classification

• Decrease in stuttering frequency or latency over 12 months, and early onset of stuttering, and strong speech/language skills.

Fluency Reinforcement

• Conditioning based on the stimulus, response, and rewarding fluent speech.
• Lidcombe, Stocker Probe, and Smooth Talking are examples.
• The treatment process should be based on fluency reinforcement in all practices.

Treatment Overview: Preschool Children

• Treatment goals in preschool children is to improve fluency, provide a supportive environment, and develop a supportive relationship between parents and teachers.
• The goal is developing normal speech fluency in the child by changing and/or promoting positive interaction patterns.
• Maintain appropriate attitudes toward communication and speaking. This may involve managing stress in the home environment as this can impact the child, as well as teaching the child coping strategies.

Teachers - What Can They Do?

• Focus on creating a fun learning environment without overwhelming the child with expectations related to communication and speaking.
• Avoid behaviours that may disrupt fluency.
• Train parents and other teachers to help manage the program methods.