Stuttering Intervention: Preschool Age

Stuttering Intervention: Preschool Children

• Therapy for preschoolers (under 5-6 years old) focuses on improving speech fluency and creating a supportive environment.
• The goal is to help children develop normal speech fluency by altering speech patterns.
• Treatment addresses attitudes towards communication and speaking.

Stuttering Stages in Preschoolers

• Stage 1: (1.5-3 years old) - Repetitions of words and syllables, hesitations, interjections
• Stage 2: (3-6 years old) - Blockages, prolongations, and other speech sound difficulties
• Stage 3: (6+ years old) - More complex and severe stuttering, more pronounced physical tension, and emotional reactions

Stuttering Intervention: Indirect Approach (Parent-Centered)

• Target: Children with phrase repetitions and some word repetitions, low tension, and limited awareness.
• Focus: Counseling and educating parents regarding the developmental nature of fluency.
• Parent Involvement: More time spent working with parents than the child.

Stuttering Intervention: Direct Approach (Child-Centered)

• Target: Children with increased awareness of fluency, often associated with more severe stuttering.
• Focus: Direct intervention with the child, addressing specific aspects of stuttering.
• Goals:
  • Experience Fluency: Engage in activities that promote fluency, such as reading aloud, telling stories, singing.
  • Establish Fluency: Develop strategies to control stuttering, including slow speech rate, easy onset, pauses.
  • Desensitize and Resist Disruptors: Address fear and avoidance associated with stuttering, and manage triggers.
  • Work on Personal Constructs: Challenge negative thoughts, beliefs, and feelings related to stuttering.
  • Transfer and Maintain: Generalize fluency skills to various settings and situations.

Fluency Reinforcement Techniques

• Lidcombe Program: A parent-implemented program that rewards fluency and provides feedback on disfluency to encourage fluency.
• Stocker Probe Technique: Uses a prompt to shape the child's speech, providing feedback and positive reinforcement.
• Smooth Talking: Emphasizes slow speech rate and smooth transitions between words.

Stuttering Intervention: School-Age Children

• Therapy Aims:
  • Improve fluency as much as possible.
  • Encourage healthy attitudes toward speaking, stuttering, and speech therapy.
  • Create a supportive environment for the child with the involvement of parents and teachers.

Stuttering Intervention: Integrated Approach

• Fluency Shaping: Aims to eliminate stuttering by shaping fluent speech.
• Stuttering Modification: Focuses on changing the way a person stutters to reduce fear and avoidance.

Fluency Shaping Techniques

• Rate Control: Slowing down the pace of speech to improve fluency.
• Breathing (pausing and phrasing): Using controlled breathing to manage speech.
• Easy Onset: Starting words and sounds gently to reduce tension.
• Light Contact: Minimizing the pressure of articulators (tongue, lips) to reduce physical tension in speech.
• Continuous Phonation: Maintaining a continuous flow of sound to prevent blocking.

Stuttering Modification Techniques

• Modifying Stuttering Moments:
  • Address fear and avoidance associated with stuttering.
  • Explore, identify, and learn to control the stuttering pattern.
  • Manage attitudes and emotions connected to stuttering.
• Control Techniques:
  • Pullouts: Stopping a stutter in progress and continuing with a fluent continuation.
  • Cancellations: Stuttering, stopping, and repeating a word or sound fluently.
  • Intentional Stuttering: Stuttering deliberately in a relaxed manner.
  • Pseudostuttering: Imitating stuttering to reduce fear of stuttering in real situations and desensitize others.

Stuttering Modification: Feelings and Attitudes

• Reduce Shame and Fear: Address negative emotions associated with stuttering.
• Openly Discuss Stuttering: Talk about stuttering openly and honestly.
• Challenge Negative Thoughts: Identify and change negative thoughts about stuttering.
• Learn About Stuttering: Gain knowledge and understanding of stuttering to reduce fear and stigma.
• Teach Others About Stuttering: Educate peers and others about stuttering to foster acceptance and understanding.

Stuttering Modification: Desensitization

• Behavioral Strategies:
  • Reflecting on stuttering behaviors in the mirror.
  • Describing stuttering experiences in detail.
  • Having a speech-language pathologist model stuttering behaviors.
• Word Avoidances: Deconstruct avowed words through exercises with a therapist.
• Situation Avoidances: Talk through feared situations, creating a hierarchy of fears and exposure.

Stuttering Modification: Stabilization & Generalization

• Stabilize Learned Skills: Practicing newly learned stuttering modification techniques in more stressful situations.
• Generalize Learned Skills: Apply learned skills to different environments and situations, including talking on the phone, public speaking, and social introductions.

Stuttering in the Classroom

• Challenges:
  • Fear of being teased.
  • Fear of reading aloud.
  • Fear of oral presentations.
• Strategies to Help:
  • Maintain eye contact.
  • Pause for 2-3 seconds before responding to the child.
  • Rephrase the child’s remarks to confirm understanding.

Teasing and Bullying

• Addressing Teasing:
  • Acknowledge it before addressing it
  • Learn about teasing, feelings, & reasons.
  • Establish a supportive classroom environment
  • Handle teasing with a matter-of-fact, positive, zero-tolerance approach
  • Collaboratively brainstorm strategies to react to teasing.
  • Involve teachers and parents in addressing teasing.
  • Role Play different scenarios.

Personalized Fluency Program (Cooper)

• Structuring: Create a structured program based on individual needs.
• Targeting: Focus on specific aspects of stuttering that need intervention.
• Adjusting: Adapt the program based on the child's progress and responses.
• Regulating: Use strategies to manage emotions and keep the child motivated.

Healey's CALMS Model (1999)

• A multidimensional and multidisciplinary approach based on the interaction of:
  • Cognitive: Thoughts and beliefs related to stuttering.
  • Affective: Emotions and feelings associated with stuttering.
  • Linguistic: Speech and language skills.
  • Motor: Physical aspects of speech production.
  • Social: Social interactions and communication.
• Key Principles of CALMS Model:*
• Holistic: Address all aspects of stuttering.
• Motivation: Make interventions engaging and enjoyable.
• Success Orientation: Emphasize progress and achievements.
• Hierarchal Approach: Start with easier goals and gradually progress to more challenging ones.
• Eclectic and Individualized: Tailor interventions to fit each child's needs.
• Culturally Diverse: Acknowledge linguistic and cultural differences.

Transfer and Maintenance

• Role Play: Practice stuttering management in simulated situations.
• Discourse: Engage in extended conversation to enhance fluency.
• Telephone: Practice speaking on the phone to manage communication anxiety.
• Competition and Disruption: Practice fluency under challenging conditions.
• Home Programs: Continue therapy strategies at home.
• Self-Monitoring: Encourage the child to track their own stuttering.

Change Parents' Attitudes

• Active Listening: Teach parents to listen attentively to the child's concerns.
• Reflecting Back: Encourage parents to rephrase the child's emotions and feelings.
• Discover the Emotion: Help parents understand the underlying emotions and feelings associated with stuttering.
• Validate the Feeling: Acknowledge the validity of the child's feelings about stuttering.
• Realistic Expectations: Set realistic goals and expectations for the child's progress.

Child's Attitudes

• Personal Interview: Hold conversations with the child to understand their feelings about stuttering, including fears, anxieties, and self-perceptions.
• Self-Rating Scales: Use questionnaires to assess the child's feelings about stuttering.
• Reframing Beliefs: Challenge negative thoughts and beliefs related to stuttering.
• Openness: Encourage the whole family to be open about stuttering.
• Problem-Solving: Help the child develop strategies to manage stuttering in various situations.
• Self-Management: Empower the child to take ownership of their stuttering.

Key Takeaways

• Comprehensive treatment for stuttering in school-age children and adolescents addresses fluency, attitudes, and communication strategies, tailored to individual needs.
• Clinicians incorporate multiple approaches and address the multifaceted impact of stuttering on the child's communication and overall well-being.
• The goal of therapy is to empower individuals with greater control and confidence in their speech.

This quiz focuses on stuttering interventions specifically designed for preschool children aged 1.5 to 6 years. It covers the stages of stuttering and highlights the importance of a supportive environment and parental involvement in therapy. Test your knowledge on effective strategies for enhancing speech fluency in young children.