Fluency - Exam 3 Flashcards
Six treatment targets
1st Target
Reduce Frequency
- All ages/contexts
- Uses operant conditioning to reward fluency (positive reinforcers and mild punishers)
- DO NOT create other behaviors that reduce naturaless
- When working with pre-k with beginning/borderline stuttering it is reasonable to set therapy target as reduction of stuttering to zero, but for everyone else it should be to reduce stuttering to whatever is possible
Six treatment targets
2nd Target
Reduce Abnormality
- By countering the classically conditioned tension from fear and loss of control by reducing fear and increasing control of stutter
- Goal involves arriving at easier and shorter stuttering events
Six treatment targets
3rd Target
Reduce Negative Feelings and Attitudes
- key to reducing severity and associated characteristics
- Improve clients thoughts about stuttering, as well as their attitude, emotions and decision
- Negative attitudes lead to reverbberant interactions that cause increased muscular tension
- Goal involves desensitization and building wins
Six treatment targets
4th Target
Reduce Avoidance
- Avoidance can prevent progress on other treatment targets
- Reduce fear by voluntarily stuttering
- Reduce conditioning by replacing contingencies (e.g. preparatory set or “downshifting” rate before stutter)
- Increase comfort and control by confronting stutter across approach hierarchy
Six treatment targets
5th Target
Increase Freedom
- Client gets to speak freely without limitations
- Stutter may have dampened pragmatic skills so you may need to teach client…….
- how to deal with social inputs/outputs/codes
- prosody (normal speech rhythms)
- narratives because of escape/avoidance behaviors
Six treatment targets
6th Target
Increasing Environmental Facilitators
- Decreasing negative pressure and increasing positive aspects of speech
- Increasing praise
- Reducing rate
- Active listening
- Openly discuss stuttering allowing for PWS to perform self advocacy
How do reinforcers and punishers work in the 1st treatment target?
In the first treatment target you’re using positive reinforcers and mild punishers as a form of operant conditioning to encourage fluency - sort of reprograms brain to seek rewarding situation (event that resulted in reinforcer)
What is going on with classical conditioning in the 2nd treatment target?
By achieving easier and shorter stuttering events (reducing abnormality), you are countering classical conditioning (tension) from the previous fear and feelings of loss of control by REDUCING fear and INCREASING control over the stutter.
Why would we persue the 3rd and 5th treatment targets? Any big problems they are set up to solve?
- Both targets focus on aspects of the “whole” person
- Reducing tension associated with negative classical conditioning associations
- Allows the client to connect with the world easier by being able to speak on their own terms without fear of judgement
Which clients, in what type of context would be best suited for the 4th and 6th treatment targets?
- School-aged children in the school setting
- Greater teacher/peer involvement in providing a fluency enhancing environment, the greater success for the CWS within the classroom
- Encouraging the CWS to “face their fears” and to stop utilizing avoidances in the classroom or with peers, inhibiting the ability to peform well or create friendships
One treatment identified by Kenneth O. St. Luis
Increase client’s knowledge and awareness of cluttering (i.e. using a recording)
What is the mystery/controvesry behind perceived speech rate in cluttering?
- the controversy considers whether or not PWC have a faster speech rate or if it is just perceived as faster because of the irregular pauses and collapsing phrases
- studies report that PWC speech rate and disfluency event frequency NOT necessarily higher than control group
Conclusions from the ICA forum
- Low level of awareness of cluttering
- Limited number of competent professionals
- Cluttering is complex
- Lack of evidence based treatments
- Presence of biological and psychological factors in the etiology
Conclusions from the ICA forum
- Low level of awareness of cluttering
- Limited number of competent professionals
- Cluttering is complex
- Lack of evidence based treatments
- Presence of biological and psychological factors in the etiology
Joseph Dewey’s list of approaches that he wished SLPs would try and why?
- Self monitoring
- Focused (on one central point)
- Underlying music (changing the “mofified monotone”)
- Identifying mazes
- SLPs used techniques with him that were exhausting and unrealistic “it relieves the pain but it doesn’t fix the problem”
Decision flows associated with younger clients
- Indirect approach (6th target)
- Slighly more direct
- Direct
Decision flows for younger clients
Indirect approach
- educating parents/caregivers on how to create a relaxed, non judgemental environment
- providing models to parents on how to increase environmental facilitators
- working with family directly, but child might be unaware of why SLP is there
- about 4-6 weeks
Decision flows for younger clients
Slightly more direct approach
- continue indirect method
- direct interactions with child without stress/judgements
- For mild cases parents praise fluency and ignore stutter
- For severe cases clinician begins stutter awareness with child through modeling and intentional stuttering, client can catch SLP stutters and then child “plays” with stuttering to desensitive frustration in the process
- Child imitations of models is reinforced
