Final Exam Fluency Flashcards
Main two questions to ask in assessment of preschoolers?
- Is it stuttering or not? Stuttering or normal child disfluency?
- Should we start treatment?
Deciding whether it is stuttering or normal disfluency lies in a combination of these five factors:
- Speech behaviors (Monosyllabic repetitions, sound prolongations, tense pauses, 2 or more iterations in repetitions, prolongations more than 1 second long OR perceptual threshold)
- Accessory or concomitant features (physical, emotional, or cognitive struggle with speech)
- Child’s feelings/attitudes (Child’s belief that speech is difficult is often diagnostic in itself)
- Parent’s feelings/beliefs (Worried parents are usually correct)
- Others signs/predictors (Family history, child is not a young girl, speech getting worse over time)
What is the main issue in decided whether to start treatment?
Spontaneous recovery- high percentage in much research
What are the % of children recovered from Yairi and Ambrose’s 2002 presentation?
- 2 years post onset 31% recovered and 47% have chance of still recovering
- 3 years post onset 63% recovered and 16% had a chance of future recovery
- 4 years post onset 74% recovered and 5% had a chance of future recovery
- 5 years post onset 79% had recovered and 0% had a chance of future recovery
What are 4 predictors of persistent stuttering?
- Later age at onset
- Male vs. female (Males recovered at a later age and showed a lower recovery rate)
- No reduction in SLDs (No reduction or no significant reduction in the 1st year or within 4 years)
- Family history of persistent stuttering
What are some issues in preschool diagnosis
- Data don’t strongly support quick complete spontaneous recovery (4.5 years sometimes)
- Should we treat a disorder that will resolve itself? (Yes its impacting their life, you don’t know if there will be spontaneous recovery, stuttering could lead to other negative life changes)
- the ghost of Johnson!
Many authorities recommend starting treatment __________ post onset
No more than 1 year
Dr. Davidow suggests starting treatment for preschoolers if….
- Parents want it
- Child is at all upset
- Speech is not obviously getting much better quickly
- Reported time post onset is at least 2-3 months
If you decide not to start treatment you should at the very least do what?
Monitor- collect data every 2 weeks or every week if possible
What is one possible definition of assessment
Answering a series of questions about a client and about that client’s speech before, during, or after treatment
What are general goals of assessment for stuttering?
- Identify and describe the speech itself
- Identify and describe all other relevant features related to the impairment, disability, and/or handicap of stuttering
- Guid management decisions including during and after treatment
What information must you have when describing stuttered speech?
Frequency, quality, and speech rate
How can you measure stuttering frequency?
%SS, %WS, % words disfluent, disfluencies per 100 words, Davidow recommends counting stutters and not disfluencies.
You get more stuttering events from which stuttering measurement?
%SS
How is naturalness measured?
1= highly natural 9= highly unnatural
How is speech quality measured?
Naturalness
How can you measure speech rate? (3 options)
- Transcribe and get out your stopwatch
- Dots and a stopwatch
- SMS type programs which also allow you to do stuttering frequency and naturalness
What are questions you would ask in a case history for a child?
Time since onset, if they are aware of stuttering, if a parent or someone in the family stutters, reactions of child to episodes of concern
What are questions you would ask in a case history for an adult?
How long have they been stuttering? When did it start? Any significant life changes? Medical history?
Why assess attitudes, emotions, and cognitions in children?
Want to see what child’s reaction is to stuttered speech. Can be used as an outcome measure. How attitudes change from situation to situation (school, etc.)
Why assess attitudes, emotions, and cognitions in adults?
- Most adults have specific situations they would like to do better in
- Counseling
- Many adults may not want or care so much about eliminating stuttering and may want to alter their feelings about stuttering.
How might you assess attitudes, cognitions, emotions for stuttering?
Likert scale
What should the goal for preschool children be?
Eliminate stuttering. Should be the only goal because it is possible.
What should the goal for a school age child be?
Control and therefore decrease stuttering or decrease concomitant behaviors
What should the goal for adults be?
Decrease or control stuttering usually NOT to eliminate
What kinds of treatment probes would you try for children?
Maybe response contingent
What kinds of treatment probes would you try for adults?
Dunno, get answer somewhere
The combination of speech data, other data, probe data should allow you to develop a data based and specific
- Description of past and present stuttering
- Label the problem
- Plan for treatment options
A good assessment will include
- Case History
- Speech measures
- Other measures
- Speech change probes
- Goal setting
List a couple of findings about clinician confidence in treating persons who stutter
- Kelly et al. (1997) found that 52% of clinicians ranked their competence at 3 or below on a 5 point scale with 5 being the most competent and 1 being the least
- Brisk et al. (1997) found that 56% of clinicians agreed or strongly agreed that they were confident in choosing treatment goals for a child who stutters
General characteristics of indirect treatment
- methods do not include speech practice per se
- goals may or may not focus on child’s speech/stuttering. Instead, might involve altering the parent’s speech pattern or asking fewer questions to that child
General characteristics of direct treatment
- Methods include speech practice
- At least one goal focuses on the child’s speech/stuttering with or without the other goals
Four things that indirect treatments do
- Do not draw attention to the unwanted behavior
- Change the environment that maintains the behavior (motor, linguistic, cognitive, social emotional aspects)
- Improve related related or prerequisite skills (motor, linguistic cognitive, social emotional aspects)
- Improved related emotions or reactions
Summarize the study by Yaruss, Coleman, and Hammer (2006)
- Tested a treatment based on the demands and capacities model
- 12 boys and 5 girls
- Before Tx 16.4% mean stuttering frequency
- After Tx 3.2% mean stuttering frequency
Limitations: No extende baseline before Tx, reliability checks were not completed for the frequency count data, —Samples we’re of at least 200 words - Stuttering frequency data were only at the end of treatment and not in follow up
Describe Palin Parent/Child interactions therapy
Goal: Achieve fluency within normal limits ( with child- a 5 minute play session where targets are worked on.
Problems with Millard, Nicholas, and Cook, and Millard, Edwards and Cook studies
- Not great data. Small sample size
List some methods for direct treatment for preschoolers
- Feedback to identify correct and incorrect responses
- Initial practice in motorically simpler units or at motorically simpler levels
- Initial practice with exaggerated or hypercorrect response
How might you give feedback to identify correct and incorrect responses?
- Just reinforcement “that was good talking”, praising a time period of fluency, praise each utterance
- Just punishment “stop” “try again” “slow down” uttered by clinician contingent on the moment of stuttering
- Punishment time out (Martin, Kuhl, and Haroldson)
- Use both punishment and reinforcement (Lidcombe)
Give some background of the Lidcombe program
- Direct treatment developed in Sydney suburb of Lidcombe by Onslow and colleagues
- Developed for children younger than 6
- Conducted by parents who provide verbal contingencies for stuttered and stutter free speech
What is the goal of the Lidcombe program stage 1?
Reduce stuttering to an insignificant level and maintain the reductions
Treatment protocol for Lidcombe stage 1
Weekly sessions 45-60 minutes
Parent and child visit the clinic each week (total 16-30 visits)
On the first visit, the parent learns to use the severity rating scale to rate the child 1= no stuttering 2= extremely mild 10= extremely severe
Clinician rates %SS
Clinician models and parent practices using the verbal contingencies
Lidcombe verbal contingencies for stutter free speech
- Acknowledgement (“That was smooth”)
- Praise (“Lovely smooth talking”)
- Request for self evaluation (“Was that smooth?”)