direct treatment for preschoolers

Question 1

direct treatments for unwanted behavior (3)

Answer 1

1. feedback to identify correct and incorrect responses
2. initial practice in motorically simpler units or at motorically simpler levels
3. initial practice with exaggerated or “hypercorrect” response

Question 2

feedback to identify correct and incorrect responses (reinforcement)

Answer 2

-just reinforcement
-“that was good talking”
-praise a time period of fluency
-praise each utterance
(shaw and shrum, 1972)

Question 3

feedback to identify correct and incorrect responses (punishment)

Answer 3

• just punishment
• “stop, try again, slow down”
• these are uttered by the clinician contingent on a moment of stutter (after)
• RCTO
• puppet study
• don’t have to punish everytime

Question 4

feedback to identify correct and incorrect responses (both punishment and reinforcement)

Answer 4

• BOTH
• lidcombe program
• most effective for preschoolers

Question 5

lidcombe program (background)

Answer 5

DIRECT treatment

• developed in Sydney (Onslow and colleagues)
• conducted by parents who provide verbal contingencies for stuttered and stutter-free speech
• research shows treatment itself is helping not just spontaneous recovery

Question 6

LP- stage 1 goal

Answer 6

reduce stuttering to “insignificant” level aka ZERO and maintain reductions

Question 7

LP stage 1 procedures

Answer 7

• weekly sessions (45-60mins)
• parent and child visit clinic each week (16-30 visits)
• first visit parent learns to use severity rating
• clinician rates %ss, models, and parents practices contingencies in structured treatments

Question 8

LP verbal contingencies for stutter free speech

Answer 8

• acknoledgement (that was smooth)
• praise ( great no bumps!)
• request for self-eval (was that smooth?)

Question 9

LP verbal contingencies for stuttered speech

Answer 9

• acknowledgement (there was a little bump there)
• request for self correction (you had a bumpy word, try it again)
• not saying anything negative
• provide contingency as close to stutter as possible

should be 5:1 ratio between stutter free and stuttered speech contingencies

Question 10

LP rest of stage 1

Answer 10

• decrease in severity usually occurs in first 4 weeks
• when it decreases, clinician encourages parent to use contingencies in unstructured convos (eating dinner, driving to school
• structured convos become less frequent

Question 11

LP stage 2

Answer 11

SHOULD BE ALL UNSTRUCTURED CONVOS
-to enter stage 2, child needs 3 consecutive weeks of
(1) clinician giving SR of 1 or 2 for whole visit
(2) parents SR for the previous week are all 1 or 2, at least 4 being 1
GOAL= maintain speech performance needed at stage 2

demand close to perfect fluency increases success

Question 12

LP stage 2 clinic visits

Answer 12

child and parent attend clinic less frequently if stuttering criteria are met
-reduction in verbal contingencies so child does not become reliable on them

Question 13

extended length of utterance (ELU) goal

Answer 13

facilitate children’s spontaneous and automatic use of natural sounding, stutter free speech under all talking conditions, with all speakers

Question 14

ELU treatment

Answer 14

-begin with production of monosyllabic words and progress to 6 syllable utterances, various monologue lengths, and finishing in 5 min monologues and 5 mins of convo

Question 15

ELU positive reinforcers

Answer 15

• social and token
• provided for each fluent response
• punisher is provided during every moment of stuttering
• faded during later stages

Question 16

GILCU positives

Answer 16

• experimentally evaluated
• transfer activités can be incorporated into treatment from the beginning
• older children have comparable results to younger children

Question 17

GILCU criticisms

Answer 17

• limited long term beyond clinic data
• subject attrition
• data hard to understand and find

Question 18

prolonged speech with children

Answer 18

-childrens programs usually incorporate individual elements of prolonged speech

"turtle speech"
"satin ribbon"
"feathers"
"easy mouth"
"keep the motor running"