CSP-CS + Down Syndrome Flashcards
Current use of fluency skills for preschoolers
Stretch
Gross easy start
Smooth blending
Published prevalence estimates of stuttering among children w/ DS
21-48%
When polled, SLPs reported use of _____ to treat stuttering in DS
Direct fluency shaping and behavioural contingencies
Sarah’s response to using fluency skills was:
Improvement consistent w/ typically developing SWS reported on earlier CSP-SC studies
Essential components of Sarah’s tx program (3):
- Prolongation & fluency skills
- Parent contingencies
- Modify school/home environments
At follow up, results showed:
Reductions in stuttering reflected 89% improvement and greater participation, self-confidence and self-esteem improved
Models for Treating CWS w/ co-existing disorders
- sequential
- concurrent intervention
- blended (blended and blended lagged)
- Establishment
7 sessions/4 weeks
- prolongation: slow stretch (40-60 spm)
- EB, GS, SB, LT, self corrections
- mother made daily severity readings
- daily home practice
- Intensive fluency skill practice
5 one-hour session in one week
Prolongation – medium stretch
• 3T’s
• Mother modeled fluency skills in in-clinic sessions
• Home practice of fluency skills
• Requests for correction of stutters during home practice added: 10 praises to 1 ask for correction
• Praise for naturally occurring smooth speech added
- Transfer (7 sessions/13 weeks)
- Prolongation – slight stretch (90 – 120 spm)
- Scavenger hunts, surveys, mock school sessions
- Teasing and Bullying discussions
- Daily home practice
- Praise for fluent speech used with or without fluency skills
- Asks for correction: 5- praises to 1 ask for correction
- Consolidation of Fluency Skills an Training of Classroom Support Staff (16 2x monthly sessions/28 weeks)
Family support continued
• Fluency skill practice, praise and asks for correction continued at home
• Consultative support given to teacher
• Calm and cool
• Praise for 3T’s use outside of home
• Adults in Sarah’s environment modeled a slower speech, calm body, and showed that they were thinking first
- Refinement of Fluency Skills and Home Programming (6 - 1hr sessions/29 weeks)
In – clinic fluency skill practice
• Practice in more highly functional situations (presentations, reading aloud, answering questions)
• Strategies to support emerging language skills given to parent
• Parents continued with transfers
- Maintenance and Follow up (no sessions / 20 weeks)
- Praise for stretched or smooth speech withdrawn
- Sarah used fluency skills as she needed
- Support given to parent when needed
Challenge 1: Difficulty achieving fluency beyond single words
– Taught parent to model fluency skills
– Completed a “stretch warm-up” prior to smooth talking activities (STAs)
Challenge 2: Difficulty understanding relevant concepts
– Taught concepts of “bumpy” and “smooth”
• Sorted bumpy and smooth objects
• Identified smooth and bumpy speech
Challenge 3: Receptive and Expressive Language Delays
– Smooth talking activities structured to remain at lower language levels
– Vocabulary / sentence structures were pre-taught
– Visuals were used to facilitate understanding
– Smooth talking activities during familiar routines were completed throughout the day
Challenge 4: Family Schedule Constraints
– Tracked relationship between lack of sleep and increased stuttering
– Minimized the demands of their busy schedule
– Instituted a regular routine for meals, naps, and bedtime
Challenge 5: Parent burn-out
– Provided additional parent education / counseling
– Facilitated parent-driven goal setting, data collection, and progress tracking
– Encouraged parental incentives
Challenge 6: Child Therapy Fatigue
– Used a variety of smooth talking incentive programs
• For example, high fives, checkmarks, stickers, stamps, points on event counter, pennies, tokens, and points towards desired prize (e.g., book, dollar store toy) tallied on visually appealing incentive charts
