Ax & Tx - School Aged

Question 1

Intermediate Stuttering (School-aged)

Answer 1

Age 6-13, stuttering several years

• repetitions, prolongations & blocks
• escape & avoidance behaviours
• feelings of frustration & embarassment

Question 2

Key concepts of Clinical Procedures

Answer 2

• fear/avoidance behaviours increase stuttering
• therapy should increase APPROACH attitudes
• struggle/shame reduced by openness

Question 3

Programs focused on goal of fluent speech

Answer 3

• The Lidcombe Program

- The Fluency Rules Program

Question 4

Programs focused on communication attitudes & improved fluency

Answer 4

• Smooth Speech w/ CBT

- Comprehensive Tx

Question 5

Lidcombe Program
Target Pop:
Basic Goals:
Intermediate goals:

Answer 5

• 6-12 years (more variability in stuttering compared to preschool)
• Stutter-free or nearly stutter free
• Two bench marks over 3 weeks
  1. Daily SR by parents

Question 6

Lidcombe Overview

Answer 6

Weekly visits w/ SLP
Daily structured convos w/ verbal contingencies from parent
Gradual replacement of structured convos by unstructured
Parents praise fluency and request self-correction of stuttering
May use tangible rewards

Question 7

Theoretical Basis for Lidcombe

Answer 7

Stuttering can be changed by response-contingent stimuli

Question 8

Fluency Rules Program
Target Pop:
Basic Goal:

Answer 8

Preschool and younger school aged children

Natural sounding fluent speech

Question 9

Fluency Rules Intermediate Goals:
Universal Rules:
Primary Rules:
Seventh Rule:

Answer 9

Universal Rules:
-Reduce rate
-Eliminate repetition of single syllables
-Eliminate prolongations
Primary Rules
-Breathe properly during speech rather than holding breath
-Begin phonation gently rather than blocking at the level of the pharynx
-Touch articulators lightly
Seventh Rule:
-Use only speech helpers to talk

Question 10

Fluency Rules Program General Info:

Answer 10

• Apply progressive linguistic hierarchy
• use procedures that promote generalization to home and school settings
• Develop visual cues to remind child to use fluency rules in natural settings
• Phone child at home to serve as cue, then fade frequency

Question 11

Fluency Rules Theoretical Basis

Answer 11

• Children don’t have enough awareness to self-correct
• Early stage is about heightening awareness w/out creating negative emotion
• Older CWS can struggle e/ coordinating the processes of fluency speech production
• Critical to offer practice in structured hierarchy focused on mindful use of elements of fluent speech production

Question 12

Smooth Speech & CBT
Target Pop:
Basic Goals:
Intermediate Goals:

Answer 12

9-14 years old
Basic:
-teach smooth speech/psychological skills
-improve communication & interaction abilities
Intermediate:
-speak w/out stuttering using smooth speech skills at slow and progressively more typical rates
-complete hierarchy of generalization
-use cognitive techniques to reduce fears/negative attitudes
-develop maintenance plan where client assumes more responsibility and engages in self-practice/self-evaluation

Question 13

Smooth Speech & CBT

Answer 13

-Assess client􏰂s stuttering frequency, naturalness, anxieties, and communication attitudes
– Teach smooth speech over 3 days.
– Videotape client speaking at the appropriate rate 2 times a day; client evaluates recording.
– Practice smooth speech at home each evening.
– Transfer smooth speech to situations according to hierarchy.
– Client assumes responsibility for own progress.
– Client uses cognitive behavioral techniques.
– Develop long-term maintenance strategies.
– Conduct maintenance sessions over a year; review progress; address maintenance issues.

Question 14

Comprehensive Tx 
(no evidence yet)
Target Pop:
Intermediate goals:
Basic Goal:

Answer 14

7-17 years
Intermediate:
-Minimize severity
-Reduce child’s and other’s negative reactions
-Improve child’s communication in real-life settings
-Facilitate generalization and maintain gains in fluency and communication

Basic:
-Effective communicator skills

Question 15

Comprehensive Tx Procedures

Answer 15

• Learn techniques to lessen severity of stuttering.
• Practice techniques in hierarchy of progressively more challenging situations.
• Explore stuttering instances.
• Use voluntary stuttering to reduce fear and physical tension associated with stuttering.
• Use voluntary stuttering in progressive hierarchy of speaking situations.
• Discuss thoughts and fears associated with stuttering.
• Meet with other people who stutter.
• Educate others in environments to accept stuttering.

Question 16

Three similarities b/t Lidcombe, Fluency Rules, Smooth Speech& CBT, Comprehensive

Answer 16

1. Use of reinforcement
2. Use of hierarchies
3. Involvement of families