Comprehensive Stuttering Program for School-Aged Children (7-11/12 years) Flashcards
Considerations of Choosing a Tx
- evidence base
- known predictors of tx outcome
- child and parent reactions of therapy
- experience of SLP
Comprehensive stuttering program for school-aged children (CSP-CS)
Integrated approach that addresses both stuttering behaviours, psychological, emotional and social consequences of stuttering.
CSP-SC Treatment Goals & 3 phases
- speech related goals
- attitudinal/emotional goals
- self-management goals
- environmental goals
Phases: acquisition, transfer, maintenance
Environmental Goals
- 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
Self-management goals
- Develop problem solving skills
- Self-monitoring/evaluation/reinforcement
- Manage environment
- Plan practice activities
Family Involvement
- heavy
- a lot of reinforcement, monitoring, decision making
CSD-SC Speech-Related Goals
- 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)
CSP-SC Steps
- Establish fluency skills in continuous speech (systematically increasing rates) & training parents
- Ongoing cognitive-behavioural skills training
- Preparation for transfer
- Transfer
- Prep for maintenance
- Maintenance
Acquisition
Speech processes
Fluency Enhancing skills
Training Each skill
Cycle Through skill sessions
Acquisition: Speech Processes
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)
Acquisition: Fluency Enhancing Skills
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
Clinical Strategies Critical to Client Success
Feedback Careful sequencing (80% success) Continuous prolongation Instructions Effective use of time Maintain client individuality Fostering responsibility Involving family and friends
Tension Modification
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
Prolongation (Stretch) Rates
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.
Easy Breathing (EB)
Comfortable diaphragmatic inspiration Comfortable expiration Breath through mouth Monitor abdomen (or not) Individualize
Gentle Starts (GS)
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
Light Touches (LT) & Smooth Blending (SB)
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
Fixes (Self-corrections)
Re-breath
Pullout
Individualize
Changes
Child taught to gear rate down to prevent or recover from stutters (taught at medium stretch)
3 “Ts”
3 Ts used to resist time pressure and facilitate language organization if needed
Think…Take a breath…Talk using FS
Calm & Cool
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
Self- and parent – Monitoring/Evaluation
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”
Acquisition:
Cycle Through Skills Sessions
- 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
Slow:
Medium:
Light:
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
Acquisition: Criterion Checks at the end of each stretch rate
- 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
Levels
- Words,phrases
- Sentences (oral, reading)
- Carrier phrases
- Simple Q/A
- Picture descriptions
- Monologue
- Paragraph reading
- Topic Maintenance Q/A
- Conversation
- Presentations
- Debates (if appropriate)
Max level for slow
Picture descriptions
Max level for medium
Topic maintenance Q & A
Max level for slight
Presentations
Acquisition: Incorporating Lidcombe components toward the end of acquisition
- 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
Transfers
- 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
Transfer: Components
Plan
Do Transfer
Evaluate (play back recording)
Maintenance: Home Practice
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
Treatment Outcomes: Kully and Boberg, 1991
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
CSP-SC: Treatment Formats
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
Teen/Adult CSP - Components
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
CSP Evidence Base
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.
Treatment Phases
Establishment (Week 1 & 2)
Transfer/Prep for maintenance: real world use of fluency and CBT skills (Week 3)
Maintenance: After clinic
Difference b/t children & teens/adults
Controlled rate/rate changes
