CSP-CS + Down Syndrome

Question 1

Current use of fluency skills for preschoolers

Answer 1

Stretch
Gross easy start
Smooth blending

Question 2

Published prevalence estimates of stuttering among children w/ DS

Answer 2

21-48%

Question 3

When polled, SLPs reported use of _____ to treat stuttering in DS

Answer 3

Direct fluency shaping and behavioural contingencies

Question 4

Sarah’s response to using fluency skills was:

Answer 4

Improvement consistent w/ typically developing SWS reported on earlier CSP-SC studies

Question 5

Essential components of Sarah’s tx program (3):

Answer 5

1. Prolongation & fluency skills
2. Parent contingencies
3. Modify school/home environments

Question 6

At follow up, results showed:

Answer 6

Reductions in stuttering reflected 89% improvement and greater participation, self-confidence and self-esteem improved

Question 7

Models for Treating CWS w/ co-existing disorders

Answer 7

• sequential
• concurrent intervention
• blended (blended and blended lagged)

Question 8

1. Establishment

7 sessions/4 weeks

Answer 8

• prolongation: slow stretch (40-60 spm)
• EB, GS, SB, LT, self corrections
• mother made daily severity readings
• daily home practice

Question 9

2. Intensive fluency skill practice

5 one-hour session in one week

Answer 9

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

Question 10

3. Transfer (7 sessions/13 weeks)

Answer 10

• 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

Question 11

4. Consolidation of Fluency Skills an Training of Classroom Support Staff (16 2x monthly sessions/28 weeks)

Answer 11

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

Question 12

5. Refinement of Fluency Skills and Home Programming (6 - 1hr sessions/29 weeks)

Answer 12

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

Question 13

6. Maintenance and Follow up (no sessions / 20 weeks)

Answer 13

• Praise for stretched or smooth speech withdrawn
• Sarah used fluency skills as she needed
• Support given to parent when needed

Question 14

Challenge 1: Difficulty achieving fluency beyond single words

Answer 14

– Taught parent to model fluency skills

– Completed a “stretch warm-up” prior to smooth talking activities (STAs)

Question 15

Challenge 2: Difficulty understanding relevant concepts

Answer 15

– Taught concepts of “bumpy” and “smooth”
• Sorted bumpy and smooth objects
• Identified smooth and bumpy speech

Question 16

Challenge 3: Receptive and Expressive Language Delays

Answer 16

– 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

Question 17

Challenge 4: Family Schedule Constraints

Answer 17

– 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

Question 18

Challenge 5: Parent burn-out

Answer 18

– Provided additional parent education / counseling
– Facilitated parent-driven goal setting, data collection, and progress tracking
– Encouraged parental incentives

Question 19

Challenge 6: Child Therapy Fatigue

Answer 19

– 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