Treatment of Stuttering PDF

Treatment of Stuttering  r f a mil ie s of c hil d r en Instructions fo who stutter r t e a c he r s d e ali ng Instructions fo t te r t ud e nt s w h o s t u with s d u lt st ut t e r e r...

Treatment of Stuttering  r f a mil ie s of c hil d r en Instructions fo who stutter r t e a c he r s d e ali ng Instructions fo t te r t ud e nt s w h o s t u with s d u lt st ut t e r e r s and Instructions for a it h them m un ic a t ing w those com rap y tech ni q u es Stuttering the Instructions for families of children who stutter 1. Reduce the pace:  Model slow and relaxed speech. Speak with your child in an unhurried way, pausing frequently, but don't speak so slowly that it sounds abnormal.  Wait a few seconds after your child finishes before you begin to speak.  Your own easy relaxed speech will be far more effective than any advice such as “slow down” or “try it again slowly”. 2. Full listening:  Try to increase those times that you give your child your undivided attention and your real listening with maximum concentration. 3. Turn taking:  Help all members of the family take turns talking and listening. Children find it much easier to talk when there are fewer interruptions 4. Normal rules apply:  Discipline the child who stutters just as you do with your other children and just as you would if he didn’t stutter. 5. Building confidence:  Use descriptive praise to build confidence. An example would be “I like the way you picked up your toys. You’re so helpful,” instead of “that’s great.”  Praise strengths unrelated to talking as well such as athletic skills, being organized, independent, or careful. 6. Special times:  Set aside a few minutes at a regular time each day when you can give your undivided attention to your child.  This quiet calm time – no TV, iPad or phones - can be a confidence builder for young children. As little as five minutes a day can make a difference. 7- Don’t show negative feelings:  Try not to be upset or annoyed when stuttering increases.  Your child is doing his best as he copes with learning many new skills all at the same time. Your patient, accepting attitude will help him immensely. 8- Reassure your child:  If your child is frustrated or upset at times when his stuttering is worse, reassure him.  Some children respond well to hearing, "I know it's hard to talk at times...but lots of people get stuck on words...it's okay."  Other children are most reassured by a touch or a hug when they seem frustrated. Instructions for teachers  Don’t tell the student “slow down” or “ just relax.” and don’t push him to complete or finish his words.  Don’t complete words for the student or talk for him or her.  Don’t ask questions to stutterers directly and suddenly in class, instead you can repeat questions in a slower rate and give them time to prepare themselves.  Expect the same quality and quantity of work from the student who stutters as the one who doesn’t.  Speak with the student in an unhurried way, pausing frequently.  Convey that you are listening to the content of the message, not how it is said.  Have a one-to-one conversation with the student who stutters about needed accommodations in the classroom.  Respect the student’s needs and preferences and praise his strengths.  Talk with peers or other students who do care for the stutterer to be so much friendly and to give him support by being always around by his side in the class and outside at home or in any other social environments to broaden his social networks and build his self confidence.  Don’t make stuttering something to be ashamed of. Talk about stuttering just like any other matter.  Talk with parents routinely about class assignments to be prepared previously at home before being presented on real time in class. Ways to deal with oral reports and class demands:  Discuss order, whether he wants to be one of the first to present, in the middle, or one of the last to present.  Discuss audience size, whether to give the oral report in private, in a small group, or in front of the entire class.  Discuss whether he should be timed, or whether grading criteria should be modified because of his stuttering.  Being called on, whether he feels comfortable being called on at any time in class, only when his hand is raised, or when signaled first by the teacher. Instructions for communicating with adults who stutter  Speak in an unhurried way — but not so slowly as to sound unnatural. This promotes good communication with everyone. Don’t make remarks like: “Slow down,” “Take a breath,” or “Relax.” Such simplistic advice can be felt as demeaning and is not helpful.  Don’t attempt to finish sentences or fill in words or push the speaker to complete or finish his words.  Let the person know by your manner that you are listening to what he or she says — not how they say it.  Maintain natural eye contact and wait patiently and naturally until the person is finished.  Be aware that those who stutter usually have more trouble controlling their speech on the telephone. Be patient in this situation, if you pick up the phone and hear nothing, be sure it is not a person who stutters trying to start the conversation before you hang up. Therapy techniques for stuttering  The main goal for stuttering therapy is to manage and control your stuttering by taking advantage of two approaches: 1- First, through modifying your feelings and attitudes about your stuttering by decreasing your speech fears and avoidance behaviors. 2- Second, through modifying the irregular stuttering behaviors by using certain techniques which will change the form of your stuttering so you can speak without abnormality.  Working on accomplishing the objectives of therapy will not be easy, It will take time and determination not only to work on reducing your fear of difficulty but also to change the pattern of your speaking behavior.  Remember, you are your own therapist, and you may have no one to supervise you if you do not follow and practice the instructions for therapy.  Schedule practice sessions to coincide with routine daily activities such as mealtimes, lunch breaks, or going to and from work or school. Unscheduled practice generally leads to little or no practice.  Seek motivation and make a real effort to sincerely go along with each of the therapy guidelines to the best of your ability. Give yourself a strong dose of will power and have confidence in your ability to make progress.  (1) Speech (2) modification Stuttering (Fluency modification Shaping)  Speech modification/Fluency shaping techniques  Those are techniques that facilitate more fluent speech.  Fluency shaping techniques aim to make changes to the timing and tension of speech production or alter the timing of pauses between syllables and words.  It aims to help stutterers speak with increased fluency. Improving their fluency of speech makes them confident and reduces negative feelings regarding stuttering. 1-Speak more fluently  It aims at increasing the fluency of speech and not focusing on the stuttering moments themselves.  It involves beginning with producing easy simple single-word responses with pauses between them and increases gradually in complexity until reaching the more complex phrase and sentence structures in a much fluent manner.  The stutterers' speech is gradually increased from limited passage reading to monologue speech, ending in conversational speech with normal speaking rates and normal fluency. 2-Slower easy relaxed speech/ Smooth movement/ Stretching technique  It involves mastering very deliberate, slow and smooth speaking by slowing down the speech rate through stretching out sounds and syllables and extending the transitions between sounds in syllables and words.  Break every word down into its syllables and every syllable into it’s sounds. Then, try to stretch out every syllable in the word and every sound in the syllable for at least 2 seconds and do not forget to pause at the end of each word and phrase.  Start with a smaller number of syllables per minute then introduce faster speaking rates of up to 150 syllables per minute which is the typical syllable rate of adults who are fluent. 3-Light articulatory contacts  This involves using easy soft contacts between articulators to produce various speech sounds with less tension and struggle in the speech apparatus.  Firstly, determine which articulators you use to make a sound. For example, to say “ball,” you are primarily using your lips to make the /b/ sound. Next, feel your mouth come into that position to say that sound.  Then, make the lightest touch of your lips to make the /b/ sound and continue with the word.  This would help stutterers to say even the worst-feared-words with the least bit of stuttering. 4-Gentle onset/initiation  This technique reduces the tension on the muscles involved in speech production where excess pressure on the laryngeal muscles can prevent them from coming together and moving in harmony with one another to produce smooth speech.  In easy initiation, the stutterer is learned not to apply hard force while producing the first sound of every word or syllable.  The stutterer would assume a deep breath and with a low volume he begins speaking with the lowest vibrations of the vocal folds.  Then, gradually increases the volume, and strength of their voice to a level that feels normal for them, then, again decrease the strength and volume back gradually to the initial soft level once again.  Stuttering modification techniques  Those are techniques that aim to reduce physical tension and struggle by helping stutterers to identify core stuttering behaviors, recognize physical concomitant behaviors, locate the point of physical tension and struggle during moments of disfluency, and ultimately reduce that physical tension.  It helps a stutterer learn about the speech mechanism and how it operates during both fluent and disfluent speech so he or she can modify it.  Increasing awareness and self-monitoring skills helps to reduce unproductive behaviors that interfere with fluency and may allow stutterers to further alter moments of stuttering to be less tense and disruptive to communication. 1-Stutter more fluently  Underlying this technique is the notion that stuttering results from various avoidance behaviors and feared situations and thus it aims to reduce speech-related avoidance behaviors, fears, and negative attitudes.  It modifies stuttering moments by decreasing the tension, so the stuttering is less severe, and the fear or avoidance behaviors of stuttering are eliminated.  It is okay to be a stutterer and so do not try to hide or avoid your stuttering because of fearing people or being embarrassed or ashamed from your stuttering.  Stutter normally along with modifying some of your stuttering patterns (i.e., changing a sound repetition pattern into a syllable or word repetition pattern or reducing the duration of a prolongation pattern)  However, this may in turn increase the frequency of the stuttering moments if used in severer cases and without using any fluency enhancing/shaping techniques. 2-Cancellation  When you stutter on a word, the first thing you do is to finish saying the word on which you blocked—i.e., complete the entire word.  Then, you are to pause momentarily to allow time for you to think back and figure out what you did which caused the stutter and plan how to correct it.  After you have stopped, try to relax the tension in your speech mechanism, particularly in your throat.  The pause allows the stutterer to prepare his speech mechanism for modification by reducing muscular tension and by returning the articulation to a neutral position. It gives him an opportunity to try to calm himself and to begin the next word slowly.  As you pause and relax, think back and ask yourself what caused you to get stuck on that sound —what did you do wrong—what did you do that was abnormal.  Review what you can do to slowly modify or change the errors you made on this sound or word.  Then, mentally rehearse or silently mimic how it would feel to have your mouth slowly make these corrections to modify your usual pattern of stuttering and move through the word.  Finally, repeat the word as you feel yourself making the corrections.  Although this post-block correction may seem to take a long time and you may be embarrassed by the pause, do it anyway. This is where your determination pays off— you have no other choice. The more you do it and become adept at it, the less time it will take.  The slow prolonged manner of working your way through the sound while keeping your voice flowing will give you plenty of time to feel yourself making the corrections you need to make and will help you gain confidence in your ability to control your speech. 3-Pull-out  When you find yourself in the middle of a block, don’t pause and don’t stop and try again.  Instead, continue the stuttering, slowing it down and letting the block run its course, deliberately making a smooth prolongation of what you are doing. In doing this, you will be stabilizing the sound by slowing down a repetition or changing the repetition to a prolongation.  Hold the stuttering long enough to feel that you can control the duration of your stuttering by changing the rate and learning to smooth out your stutter. Then, figure out what you are doing wrong and what needs to be done to change your faulty actions.  After you have figured this out, then voluntarily release yourself by discontinuing the prolongation or repetitions— and in slow motion apply the ways you decided would reverse or correct the abnormal speech muscle action.  If for any reason you are unable to get hold of your stutter and move out of the block as described in the pull-out technique, then it would be better for you to apply a cancellation technique for you to keep the feeling of being in control. 4-Preparatory set  Stutterers would need to learn how to make preparations to prevent and/or control their stuttering before it happens.  When you anticipate stuttering on a word or sound, you are to pause just before saying the word to plan how you will attack it.  You do not proceed to speak the word until you have thought about how you usually stutter on the sound and figure out what needs to be done to correct or modify the errors you usually make when stuttering on that sound. Other therapy techniques Chewin Rhythm g ic techniq speech ue Delayed Shadow respons ing e Rhythmic cued speech/singing  Stuttering can be controlled through auditory rhythm which is used to improve temporal rate of speech.  In rhythmic speech, the stutterer speaks to an auditory stimulation. This is presented as a rhythmic pattern (played live with an instrument or synthesizer), or in the form of a more complex musical piece.  There are two modes of rhythmic speech production, namely metric and patterned.  In metric cueing a pulsed auditory stimulation is used (usually produced by a metronome). The stutterer is asked to match either one syllable or one full word to one beat.  In patterned cueing the stutterer reproduces a pre-structured rhythmic sentence at a given tempo (e.g. as a rhyme or as in singing a song). Delayed Response  It involves delaying the time of response usually by counting before starting to speak and before producing each word  It aims at helping the stutterer to relax, not to hurry up, to slow the rate of speaking in order to reduce tension and struggle. Chewing technique  Chewing anything while speaking helps in reducing stuttering. When we chew while talking, our concentration goes into chewing that stuff and removes it from speaking.  Also chewing sends signals to the brain that everything is okay, and it helps you relax, which is the best way to reduce stuttering.  However, you must know that this a temporary solution and you cannot always chew while talking. Shadowing  In the shadowing method, the stutterer follows the words spoken by the therapist.  The therapist reads a text or describe events in pictures or narratives with a slower rate than normal and with a loud voice, then he demands the stutterer to read with him the same text but at a lower voice than that of the therapist.  Then, the therapist would gradually lower his voice until it fades, with the stutterer’s voice being the only predominant one.  This aims to reduce fear and anxiety and to help the stutterer gain much self confidence in different speaking situations. General guidelines 1- Make a habit of always talking slowly and deliberately whether you stutter or not  Building the habit of always talking slowly and deliberately will result in a more varied and relaxed manner of speaking.  Taking your time when talking tends to counteract feelings of time pressure that stutterers sometimes have when called on to speak.  To help reduce time pressure, it is also suggested that when you talk, you should often pause momentarily between phrases (or sentences). This will help lessen time pressure reactions.  This may not be easy to do and will take concentration, particularly if you have been in the habit of speaking rapidly. It may also feel unnatural at first, but if you can adjust to this manner of talking, it will be beneficial. 2- When you start to talk, do it easily, gently and smoothly without forcing and prolong the first sounds of words you fear.  When you stutter let your voice smoothly flowing into the sounds of words with light, loose movements of your lips, tongue and jaw. Slide smoothly and gently into the words in as easy and calm manner as possible.  While talking easily, you prolong the first sound of any word you fear. And furthermore, that you make a point of prolonging the transition to the next sound or sounds of that word.  It is not suggested here that you prolong all sounds of all words, this only refers to words you fear. 3- Stutter openly and do not try to hide the fact that you are a stutterer  Trying to hide your stuttering only helps to maintain or sustain it. Tell people with whom you talk that you are a stutterer and adopt an attitude of being willing to stutter voluntarily.  Feelings of shame and embarrassment only tend to increase your fear of difficulty. And fear of difficulty helps to build up tension or tightness in your speaking apparatus which aggravates your trouble.  If you do not try to hide the fact that you stutter, you would be less sensitive about your problem, and thus increase your ability to tolerate stress and build your self-confidence. 4- Identify and eliminate any unusual gestures, facial or body movements which possibly you may exhibit when stuttering or trying to avoid difficulty.  Find out and identify what secondary symptoms you have. This information is needed so you can work on eliminating them.  If you find you have such behaviors, you must work on getting rid of them.  One way to start bringing it under control is to consciously and voluntarily make such movements purposely while not talking, for instance, if you have the habit of blinking your eyes, do it purposely in your accustomed manner when alone and not talking. Then, when talking to yourself consciously and purposely vary the timing or speed of the blink and then to stutter on the word without it.  Bringing such a habit under conscious control will make it easier to manage. 5- Do your best to stop all avoidance, postponement or substitution habits  Such habits which are acquired to put off, hide or minimize your stuttering increase your fears and cause more trouble on the long run.  To help cancel fear, you should do your best not to: avoid speaking situations and social contacts, leave the scene of approaching trouble, substitute words or use postponements and don’t avoid words you might stutter on as much as possible.  It would be good if you could develop a feeling inside yourself that you will eagerly hunt out and eliminate avoidances. This feeling will come if you can make a practice of doing things you fear without giving yourself time to take yourself out of them. 6- Maintain eye contact with the person to whom you talk.  Because they are ashamed of their speech difficulty, many who stutter tend to avoid looking at their listener when stuttering.  Using continuous normal eye contact will work toward reducing feelings of shame and embarrassment.  Start looking your listener in the eye continuously in a natural way. It is particularly important for you not to look away when you stutter or expect to. 7- Analyze and identify what your speech muscles are doing improperly when you stutter.  Find out what you are doing wrong or unnecessarily which needs to be modified or corrected.  When you study your speech muscle behavior, then you can duplicate it to compare it with your speech when you talk without difficulty.  One way to observe yourself would be to hold on to your stuttering blocks long enough to determine what you are doing or stutter slowly enough to give you time to get the feel of what is happening. Or watch yourself in the mirror when making phone calls—or listen to a playback of a tape recording of your speech, etc.  Seeing yourself and hearing yourself stuttering can be both revealing and 8- Take advantage of the correction procedures and techniques designed to modify or eliminate your abnormal speech muscle stuttering behavior. 9- Always keep moving forward as you speak.  Try to say what you have to say without repeating or back-tracking. Do your best not to ever repeat or hold sounds or words unless you are repeating purposely to emphasize a word or thought.  Continuing the flow of your voice will work against any tendency to hold a block, prolong or repeat sounds or words on which trouble is anticipated.  Keep your voice moving forward from one sound or word until the next. When you anticipate trouble on a word, plan to use a prolonged easy onset on the first sound and on the transition to the next sound but keep the voice going forward. 10- Try to talk with rhythm and melody without sounding affected or artificial.  Avoid talking in a monotone and keep varying your speaking rate and its loudness.  Using variations in tone and rate will make your talking more relaxing and pleasant. 11- Pay attention to the fluent speech you have.  Listen to yourself when you are fluent and feel its movements and postures.  You need to recognize and remember your successful and pleasant speaking experiences and feel your fluency to build your confidence.  To help give yourself that feeling, spend time speaking or reading to yourself when relaxed and alone. Do some of this while watching yourself in the mirror.  Remind yourself that you can speak fluently and easily without effort in a normal way without difficulty. 12- Try to talk as much as you can  You will need every opportunity to work on the therapy procedures recommended and so speak out when you want to and whenever it is possible.  If opportunities to talk do not exist, you should do your best to create them. Let others hear your ideas. If you can’t find a listener, there’s always the phone. Call a department store and ask a question or whatever.