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Fluency > Comprehensive Stuttering Program for School-Aged Children (7-11/12 years) > Flashcards

Comprehensive Stuttering Program for School-Aged Children (7-11/12 years) Flashcards

1
Q

Considerations of Choosing a Tx

A
  • evidence base
  • known predictors of tx outcome
  • child and parent reactions of therapy
  • experience of SLP
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2
Q

Comprehensive stuttering program for school-aged children (CSP-CS)

A

Integrated approach that addresses both stuttering behaviours, psychological, emotional and social consequences of stuttering.

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3
Q

CSP-SC Treatment Goals & 3 phases

A
  • speech related goals
  • attitudinal/emotional goals
  • self-management goals
  • environmental goals

Phases: acquisition, transfer, maintenance

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4
Q

Environmental Goals

A
  • Cause & development of stuttering
  • Process of speech/attitudinal change
  • Managing environmental variables that facilitate or disrupt fluency (e.g. fast rate, questions, etc.)
  • How to deliver therapy
  • How to deal w/ regression/relapse
  • Bullying management
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5
Q

Self-management goals

A
  • Develop problem solving skills
  • Self-monitoring/evaluation/reinforcement
  • Manage environment
  • Plan practice activities
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6
Q

Family Involvement

A
  • heavy

- a lot of reinforcement, monitoring, decision making

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7
Q

CSD-SC Speech-Related Goals

A
  • Use fluency-enhancing skills (FS) in all speaking environments
  • Manage residual stuttering
  • Improve communication skills
  • Praise for fluent speech achieved with or without fluency skills (when appropriate - from LP)
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8
Q

CSP-SC Steps

A
  • Establish fluency skills in continuous speech (systematically increasing rates) & training parents
  • Ongoing cognitive-behavioural skills training
  • Preparation for transfer
  • Transfer
  • Prep for maintenance
  • Maintenance
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9
Q

Acquisition

A

Speech processes
Fluency Enhancing skills
Training Each skill
Cycle Through skill sessions

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10
Q

Acquisition: Speech Processes

A

Discuss speech processes
Discuss how speech is normally produced
Respiratory System Phonatory System Articulatory System
Discuss where stutters (i.e., bumps and sticks) occur – they identify their own
Discuss and demonstrate FS that replace the bumps and sticks (see in class handout)

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11
Q

Acquisition: Fluency Enhancing Skills

A

Tension Modification
Prolongation (Stretch): Slow to slight stretch Easy Breathing (EB)
Gentle Starts (GS)
Smooth Blending (SB) (or Hooking/Linking)
Light Touches (LT)
Self-Corrections (SC) (or Fixes): Re-breathe
3T’s: Think, Take a Breath/Thumbs up, Talk
Rate Changes (or Changes)
Calm & Cool

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12
Q

Clinical Strategies Critical to Client Success

A 
Feedback
Careful sequencing (80% success)
Continuous prolongation
Instructions
Effective use of time
Maintain client individuality
Fostering responsibility
Involving family and friends
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13
Q

Tension Modification

A

Practice audible prolongation of “T” in “Tim

Hold, slow release
Hold at level 10 tension, slow release
Hold at level 5 tension, slow release

TM in preparation for self-corrections and to help child cue in to tension and how to release it

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14
Q

Prolongation (Stretch) Rates

A

Slow Stretch: 40-60 SPM (1-4 syllables per breath group) Welcome/ to Canada

Medium Stretch: 60-90 SPM (4-6 syllables per breath group) Welcome to Canada/ We hope you enjoy/ your visit here.

Slight Stretch: 90-120 SPM (6-8 syllables per breath group) Welcome to Canada/ We hope you enjoy your visit here.

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15
Q

Easy Breathing (EB)

A 
Comfortable diaphragmatic inspiration 
Comfortable expiration
Breath through mouth
Monitor abdomen (or not)
Individualize
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16
Q

Gentle Starts (GS)

A

Glide voice on
Pre-voice expiration – older children only and only if need to specifically train it
Gradual increase in loudness
Applies to all sounds at the beginning of a word (or word in a phrase) regardless of place or manner of articulation

17
Q

Light Touches (LT) & Smooth Blending (SB)

A

LT – soft contacts…or normal amounts of tension on consonants within words…stops are not fricitivized

SB – sounds within words and phrases (breath groups)
are linked together

Individualize
May not teach LT – embed in SB
May teach LT in the beginning if needed but drop after SB well established

18
Q

Fixes (Self-corrections)

A

Re-breath
Pullout
Individualize

19
Q

Changes

A

Child taught to gear rate down to prevent or recover from stutters (taught at medium stretch)

20
Q

3 “Ts”

A

3 Ts used to resist time pressure and facilitate language organization if needed

Think…Take a breath…Talk using FS

21
Q

Calm & Cool

A

Incorporates 3 T’s, self regulation in terms of mind and body
– Calm and Cool Body
– Calm and Cool Mind – knows what he/she wants to say
– Calm and Cool Talking

22
Q

Self- and parent – Monitoring/Evaluation

A 
Fosters awareness
• Use selfevaluation frequently
• Types
-Rating FS
-Tally paper - tally counter
-Thumbs up/down
-“Give me five” – evaluate 5 in a row
-Tally “Remembers” vs. “Forgets”
23
Q

Acquisition:

Cycle Through Skills Sessions

A
  • each of the skills have been learned at word and phrase level, -begin to cycle through the skills that are relevant to the child (group)
  • systematically increasing the length and complexity of utterance
  • teach parents to lead session
  • individualize
24
Q

Slow:
Medium:
Light:

A

Slow: Stretch, EB, GS, SB, LT, Fixes
Medium: Stretch, EB, GS, SB, LT, All skills, Fixes, 3T’s, Rate Changes
Slight: Stretch, EB, GS, SB, LT, All Skills, Fixes, 3T’s, Rate Changes

25
Q

Acquisition: Criterion Checks at the end of each stretch rate

A
  • To check consistency/stability
  • Use criterion checks before completing each skill session and before moving up to next stretch rate
  • May need to decrease language level slightly in criterion check
  • May check 2 sets of 5 breath groups: 80%accuracy is generally required
  • Individualize
26
Q

Levels

A
  • Words,phrases
  • Sentences (oral, reading)
  • Carrier phrases
  • Simple Q/A
  • Picture descriptions
  • Monologue
  • Paragraph reading
  • Topic Maintenance Q/A
  • Conversation
  • Presentations
  • Debates (if appropriate)
27
Q

Max level for slow

A

Picture descriptions

28
Q

Max level for medium

A

Topic maintenance Q & A

29
Q

Max level for slight

A

Presentations

30
Q

Acquisition: Incorporating Lidcombe components toward the end of acquisition

A
  • Parents learn to deliver specific reinforcement for naturally occurring fluent speech (i.e., speech that is fluent with or without use of FS)
  • Used along with skill and rate practice if appropriate for client
31
Q

Transfers

A
  • Use skills and rate control in real life situations applicable to them
  • Manipulate difficulty level
  • Parents taught how to guide
  • Start w/ pre-transfers (in clinic)
  • Create transfer hierarchy
32
Q

Transfer: Components

A

Plan
Do Transfer
Evaluate (play back recording)

33
Q

Maintenance: Home Practice

A 
Fluency Skill practice:
• Warm ups
• Daily for 10-15 minutes
• Target each rate and skill up to sentence level
• Ongoing Practice
• Planned Transfers
• Severity Ratings (SR)

Attitudinal Emotional Issues:
• Ongoing discussion as appropriate

34
Q

Treatment Outcomes: Kully and Boberg, 1991

A

Percent syllables stuttered (%SS) and parent report

Stuttering reductions
• 79-98% within-clinic at 8 to 18 months
• 65-100% outside-clinic

Stuttering is a relapse-prone condition
• Need for ongoing maintenance

35
Q

CSP-SC: Treatment Formats

A

Intensive 4 week program (until 2010)

Intensive program (3 weeks 2011 to present)
• 2 weeks individual intensive therapy (2 hours/day) followed by a 4 day transfer and consolidation camp

Extended therapy (1x per week; individual or group)

Semi-intensive therapy (2 to 3 days followed by extended; individual or group)

Telehealth delivery of treatment

36
Q

Teen/Adult CSP - Components

A

Integrates
• Fluency Shaping, Stuttering Modification, and Strategies to Manage the Psycho-emotional and social consequences of stuttering

Developed over more than 30 years

Evidence-based

37
Q

CSP Evidence Base

A

Between 71- 86% of participants maintaining reduced stuttering at 1, 2, 5 or 10 years post- treatment.
• self-report data clinically significant improvements in communication attitudes, perceptions of stuttering, and confidence in approaching speech situations.
• CSP is efficacious in helping adolescents and adults achieve reductions in stuttering with speech naturalness being within normal ranges for typically fluent speakers.

38
Q

Treatment Phases

A

Establishment (Week 1 & 2)
Transfer/Prep for maintenance: real world use of fluency and CBT skills (Week 3)
Maintenance: After clinic

39
Q

Difference b/t children & teens/adults

A

Controlled rate/rate changes

Fluency (10 decks)

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