Stuttering Treatment in Older Preschool Children

Treatment of Stuttering in Older Preschool Children

• Older preschool children are between 3.5 and 6 years old, sometimes 7 or 8 years old.
• A presentation on stuttering treatment in older preschool children was given by Dr. Fauzia Abdalla.
• The presentation involved a fluency disorder, CDS 432.

Beginning Stuttering: An Integrated Approach

• The approach to stuttering is integrated.
• A mother and child are pictured in both clinic and structured/unstructured home conversations.
• A Child's Stuttering Severity Rating Chart is mentioned as a tool in the process.

Core Behaviors

• Part-word repetitions happen quickly and irregularly.
• Prolongations of sounds may also be present.
• Stuttering involves excessive tension in the voice with abrupt endings and increases in vocal pitch. Blocks may also be present but aren't the main characteristic.

Secondary Behaviors

• Escape devices include eye blinks, head nods, and increases in pitch.
• Avoidances include starting sentences with extra "uh" sounds.

Feelings

• Children experience frustration in their difficulty speaking.
• Some children avoid speaking.
• Fear of stuttering or shame of their speech might be present. (Not fully developed yet).

Nature of Stuttering

• Basic sensory-motor difficulties interact with temperament and developmental and environmental influences impacting repetitions, prolongations and blocks.
• Daily structured fluency practice reinforces neural pathways for fluent speech, resulting in more robust and automatic speech that is more resistant to stress.

Lidcombe Program (LP)

• An operant conditioning treatment for stuttering administered by a parent or caregiver, guided by weekly meetings with the clinician.

• Operant conditioning uses rewards/punishments to either increase or decrease the frequency of a behavior.

• Verbal contingencies, such as remarks made immediately after events (e.g., fluent speech, stuttering), are used to modify behavior frequency.

• Stage 1 goals are to reach normal speech fluency.

• Criteria for completing Stage 1 include three consecutive weeks where:

  • Weekly parent scores average less than 2, with most of sessions rating as 1s or 2s
  • Clinician's sessions rating are mostly 1s-2s.

• Stage 2, focuses on maintaining fluency and gradually decreasing clinic visits.

• The schedule of sessions are spaced out across two-two-four-four-eight-eight- and finally 16-week intervals. The child must consistently meet fluency criteria.

Clinical Procedure

• The initial focus is eliciting fluency in extremely structured situations, and then transferring that to more real-life situations where stuttering occurs.
• Effective treatment helps children gain/regain spontaneous fluency.

Feelings and Attitudes

• Occasional frustration and concerns about talking are normal.
• Conditions fears and avoidance of stuttering are not usually issues to be addressed immediately.
• Families are helped to view the child's speech objectively, whether “smooth” or “bumpy”.
• Open family discussion about the child's stuttering is encouraged.
• Feelings and attitudes are a secondary aspect in the treatment.

How Do We Help Young Children Who Stutter?

• The presentation was delivered by Nina Reeves and J Scott Yaruss.
• Resources are available.

Clinical Procedure-Maintenance

• Continue careful data collection and contact schedule tapering.
• Stress appropriate fluency contingency maintenance at the beginning of treatment.
• Return to meetings to address any potential relapses.

Clinical Methods - Lidcombe Program

• The presentation has a website mention for the 'Australian Stuttering Research Centre (ASRC)'.
• The program is an operant conditioning treatment delivered by a parent or caregiver, guided by weekly meetings with the clinician.
• The parent is educated to consistently give positive feedback mostly when the child is speaking fluently.

Lidcombe Summary

• The approach is direct, focusing on fluency shaping.
• Intended clients are typically preschoolers under 6 years of age.
• The program involves two stages.
• Training/certification is necessary to administer this treatment approach successfully.

Treatment Activity #2b: Changing Stuttering

• The activity encourages the child to prepare for changing stuttering tension through a fist analogy exercise.
• The child is getting instruction on changing stuttering tension using a non-speech analogy.

Treatment of Co-occurring Speech and Language Problems

• Sequential model: Language/articulation issues are addressed first to hopefully remove stuttering issues.
• Concurrent model: Fluency treatment is implemented simultaneously with tackling other issues. Fluency practice is restricted to language structures that have been previously mastered.
• Blended model: Addresses both fluency and other speech/language problems simultaneously.
• Cyclic model: Fluency treatment and language/phonology treatment alternate throughout the year. Concentrated learning sessions are followed by opportunities for spontaneous generalization.