Behaviour Management Week 5 (Wk 12) Flashcards
Behaviour management with Stuttering intervention
Common challenges (Stuttering treatment for adults)
=> Motivation to practice
*essential for successful therapy,
*low self-efficacy or confidence to do therapy
*may have a lack of confidence in therapist-> must sound as knowledgeable as you can
*stuttering due to brain injury/stroke (change in personality, motivation, comprehension)
=> Generalisation
*positive learning is transferred to another setting
=> Maintenance
*treatment gains are maintained over time (relapse happens)
Stuttering treatment for children:
LIDCOMBE PROGRAM
- early intervention for preschool children (6 and under)
- parent-administered program (verbal contingencies)
- POSITIVE and NEGATIVE verbal contingencies for stutter and stutter-free speech
- Verbal contingencies in STRUCTURED (e.g. book reading) and UNSTRUCTURED way (e.g. free speech)
- Rx THEN maintenance program
- RCT evidence for efficacy! (Well researched program)
Challenges in LIDCOMBE PROGRAM
- Parents may not praise enough (e.g. due to cultural background), not enough positive reinforcement
- Parent may be TOO negative
- Parent doesn’t give enough feedback
- Treatment effects are not generalised beyond structured conversations
- Child may not maintain stutter-free speech
Solutions to challenges in LIDCOMBE PROGRAM:
=> doesn’t praise enough/parent too negative
e. g. gives too much correction (gives a lot of attention to stutter OR ignores stutter-free speech)
e. g. correction becomes adversive (parent appears angry/disappointed)
SOLUTION:
- model, get the parent to role play with their child, provide feedback (education/learning)
- provide attention/praise
- vary phrase: “good speaking”, “smooth-talking” (avoid satiation?)
- explain how goal will be achieved quicker if the parent provides sufficient R+ (education)
- look at potential cross-cultural issues e.g. cultures don’t give much praise (have to teach them)
- lower tone if voice sounds negative
- advice parents to WORK TOGETHER and be CONSISTENT (timing of homework, giving enough corrections)
- advise parent to be in control/calm (not aggressive, yelling etc.)=detrimental to progress, non-constructive=> may not look forward for next homework session)
- wait for the child to say word he/she is saying (may be tempted to “jump in” to help them) *remind parents of importance not to do that
- set aside time when you can talk to child WITHOUT distractions (focused/directive/non-disruptive)
- speak slowly, provide opportunities and cues to take turns talking
5 types of Reinforcement
(1) social=> smile, pat, hug and praise
(2) material=> food
(3) activity=> play with toy
(4) manipulative=> colour in, jig saw puzzle (manipulative if they are doing something/changing something)
(5) processional=favourite dress, private room
Considerations of Reinforcement for children
💚R+ needs to fit child individually (parent knows child best and knows what will engage them)
💚allow child to choose amongst number of R+ (e.g. token/star chart)=makes them feel like they have a choice, avoid satiation
💚look at use of R+ frequency (HIGH initially THEN gradually decrease):
->1st HIGH=continuous reinforcement for every correct response reinforced; fast learning but fast extinction (due to satiation?)
->LATER (when more confident and has made more gains)=intermittent reinforcement. Only some correct responses are reinforced; maintenance of behaviour (reduces the risk of satiation)
💚consider which schedule to use: Fixed Variable ratio, Fixed Variable duration
What to do in early stages of stuttering therapy?
early stages in therapy:
- > child has opportunity to receive R+ (e.g. short stutter-free speech periods will HELP child’s motivation/confidence with therapy and homework)
- > select optimal times (when child is NOT tired/hungry)
- > gradually decrease amount of R+ provided (constant to intermittent) and extend Stutter-free period for R+
Parent education for reinforcement (and reason for education)
- > IMPORTANT for the effectiveness of parent administered program
- > educate parents about rationale of therapy (e.g. importance of POSITIVE R+ and INTERMITTENT feedback/praise)
- > makes them feel more confident with you if you appear knowledgeable
- > model therapy with child, provide feedback to parent
- > make sure to say “It’s okay if you don’t understand what I have said”. (encourage them to clarify their knowledge with you)
- > allow space to ask Qs
- > use open questions to test parent’s understanding, not just yes/no=> hard to see what they actually know (may feel obligated to say yes)
How to maximise the effectiveness of R+?
- deprivation of R+=child must be deprived of it for a period of time, unique
- Satiation=during “experimental phase” child may get R+ to an extent that it does not have reinforcing power
- Immediacy=desired behaviour & R+ straight away
- Instructions=help speed up process (if they understand that they have to perform a particular behaviour?)
- Natural R+=maintenance and transfer (generalises easily if it is natural)
Solutions to challenges in LIDCOMBE PROGRAM:
=> parents don’t give enough feedback
- > use role-play to assess their level of understanding and skill for Rx
- > demonstrate how to give feedback (model it)
- > build confidence and motivation (make sure you educate them/provide skills as they are beginners!)
- > provide opportunities for parents to ask Qs
- > consider different types of feedback that can be used (verbal contingencies)
Solutions to challenges in LIDCOMBE PROGRAM:
=> treatments are not generalising beyond structured conversations or across settings
- > generalising=tranferring behaviour (stutter-free speech) to new settings
- > transferring from target situations (e.g. clinic) to where we want to generality to occur (e.g. home and the school setting)
- > Likely to perform a behaviour in a NEW situation if it is SIMILAR to the situation where behaviour was learned (more physically similar training and target situations are=generalisation)
🧸Program COMMON stimuli across settings 🪀
🏝️Train sufficient stimuli exemplars 🌋
Solutions to challenges in LIDCOMBE PROGRAM:
How to program COMMON stimuli across settings (trouble with generalising)
🧸Program COMMON stimuli across settings 🪀
- > bring stimuli from home=favourite game/story
- > train parent to use some R+ at home (e.g. star chart used in clinic)
- > include older sibling in session and at home
- > teach therapy to BOTH parents
- > HOME VISITS for THERAPY
- > schedule structured conversations across multiple settings (e.g. parks, shopping centres, grandparents house)
- > provide opportunities for unstructured conversations (ideally want stutter-free speech for this behaviour)
- > re-arrange clinic (mimic home setting? comfy chairs, removing distractions especially in early Rx)
- > train sufficient stimuli exemplars
Solutions to challenges in LIDCOMBE PROGRAM:
How to train sufficient stimuli exemplars (trouble with generalising)
🏝️Train sufficient stimuli exemplars 🌋
- > plan training to occur in LARGE number of situations with LARGE number of stimuli (later in therapy when they have more confidence)
- > e.g. moving activity to NEW location (mix it up a bit-move to new location in house, park, grandparents)
- > relocating people (introduce new people in program e.g. siblings)
- > change time of activity (e.g. change time of day for when practice occurs)
- > vary training situation (e.g. chairs, tables, games, reinforcers)
- > Think about aspects of environment that Rx is conducted in (e.g. limiting people, objects, TV-> eliminating distractions)
- > Initiating learning phase in a quiet, distraction-free environment THEN increase number of people and number of different settings/environment
Solutions to challenges in LIDCOMBE PROGRAM:
=> strategies if child isn’t maintaining stutter-free speech
- > want behaviour to LAST (maintenance is crucial)
- depends upon whether behaviours will continue to be reinforced
- > let parent know if child made good progress at the end of therapy (remind them that they still need to provide positive reinforcement)
- > “Behaviour trapping”=designed to use contingencies available in natural environment e.g. seeing grandparents every weekend-> get grandparents to do it during unstructured conversations with them (hence behaviour will be “trapped”/maintained by natural environment)
- > Important to carry homework out between clinic visits: If not, why?
- > continue to practice across different settings
- > If relapse occurs, find out reasons and work to resolve them
- > enhancing maintenance (anxiety, bullying/teasing-> can hinder generalisation)
- > demonstrate that progress is being made though it is slow (tap into confidence/motivation if they are told that they are progressing normally)
- > may need “booster” sessions with therapist to get them back on track
Solutions to challenges in LIDCOMBE PROGRAM:
=> strategies if child relapses (maintenance)
- > assess why this has happened:
- distracted? worried? upset?
- big change in their environment?
- school holidays (had positive opportunities with teachers, peers-> helped practice stutter-free speech. Don’t have that opportunity during the holidays)
