9/23/13-Lecture 5

Question 1

After obtaining an extensive case history and have completed your assessment, what are the 4 possible outcomes?

Answer 1

1. no stuttering or at risk behaviors noted
2. not quite sure regarding stuttering
3. child is at risk, not yet stuttering, but indicators are present
4. stuttering behaviors evident including secondary characteristics

Question 2

What should we do if there are no stuttering or at risk behaviors noted?

Answer 2

• affirm parents concerns
• no concern about disfluencies/ no muscle tension observed
• praise them for bringing in their child
• encourage them to make contact again immediately if there is any change in nature of frequency of disfluencies

Question 3

What should we do if you’re not quite sure regarding the stuttering?

Answer 3

• affirm parents’ concerns
• no concern at this point, but you need more information
• parents should track disfluencies, day-to-day, good/bad situations
• parens to note any changes in disfluency
• re-contact in approximately 2 months or sooner if there is a marked change in nature or frequency of disfluency

Question 4

What should we do if the child is at risk, not yet stuttering, but indicators are present?

Answer 4

• enroll in treatment
• determine situations/tasks that increase or decrease disfluencies
• parent track disfluencies
• investigate ways to increase fluent talking time
• reduce disfluent talking time
• positive reinforcement for fluent speech in clinic and at home
• parents are NOT asked to use any fluency enhancing techniques as yet

Question 5

What should you do if stuttering behaviors are evident including secondary characteristics?

Answer 5

• enroll and treat directly

- parents must be actively involved in all parts of treatment

Question 6

In terms of Treatment for young children AT RISK for chronic stuttering, what do we need to identify?

Answer 6

1. situations/ environmental conditions that reduce disfluency
2. situations/environmental conditions that increase disfluency

Question 7

How can we identify situations and environmental conditions that reduce or increase disfluencies?

Answer 7

1. parent charting
2. parent reporting
3. clinician’s systematic observation of child’s speech
4. clinician’s systematic evaluation of parent’s reports

Question 8

in order to develop a plan, what information must we target from parent and clinician observations?

Answer 8

• track fluent and disfluent times/activities/people/situations
• note how others react: what helps/what doesn’t help
• gather all information from parents, possible recordings, notebooks, and tracking sheets
• increase situations that enhance fluency
• decrease situations that inhibit fluency

Question 9

What should we educate parents regarding the nature of stuttering?

Answer 9

• stuttering is cyclical
• stuttering is variable
• they didn’t cause it (the parents)
• it’s okay to talk about rough speech–a warm, supportive response will not make it worse
• avoid old standards like: “slow down” or “think about what you are saying”
• don’t finish sentences or try to help

Question 10

What treatment should we provide for children who we have established that they stutter?

Answer 10

• work with child to increase fluency
• help child to understand his disfluencies by using words like “bumpy and smooth” “jumpy and gliding”
• practice slow speech (turtle, hare, or racehorse)
• practice and create situations for easy speech practice

Question 11

True or false: during the treatment for established stuttering the child doesn’t need to practice being fluent

Answer 11

FALSE

CHILD NEEDS TO PRACTICE BEING FLUENT

Question 12

How can you help the child practice being fluent?

Answer 12

• praise fluency; reinforce easy effortless speech
• okay to acknowledge problems (oh that was a difficult one, let’s do something else, like…)
• model easy speech or whatever enhances fluency
• observe/modify as needed
• keeep parents informed

Question 13

What are some other treatment suggestions for children who have established stuttering?

Answer 13

• attend to the child when speaking, slow down the pace; wait between taking turns at conversation
• each child is different and may need alternate activities to foster fluency
• frequent parent contact and reporting
• environmental factors may maintain disfluency or exacerbate it; BUT not cause stuttering
• need to look at the individual child
• Treat the symptom (analogy: child gets cold, stays home, drinks fluids, stay in bed, take cold medicines–treat symptoms!)
• don’t ask parent to change home routine or their speech unless you have data to support this fact