lec 6: school-age ax + ix Flashcards
what is the main diff bw preschool vs school-age stuttering intervention? (ie the focus)
- preschool: early intervention and recovery
- school-age: “is this the right time for therapy?” and address not growing out of stuttering
T or F: parents play a big role in school-age ax and ix
false – esp in school-based services
what kind of things are we asking in school-age ax and who? (7)
- aetiology (parent)
- primary symptoms (sample)
- affect (child)
- behaviours (PTC)
- cognitive reactions (child)
- participation/activities (PTC)
- environment (PTC)
T or F: in the school-age context, prognostic factors refer to prognosis for recovery
false – refer to candidacy for tx
what are the 4 prognostic factors?
- concomitant delays
- attitudes, anxiety, avoidance
- motivation/availability
- previous therapy
why is modelling acceptance important? (3)
- if parents and teachers model that stuttering is no big deal, it will be no big deal for the child.
- affects child’s self esteem to have a parent/teacher who thinks they are not good enough and tries to improve/fix them.
- there is no cure for stuttering.
parents often need more counselling, education and therapy than the children. what kind of resources can SLPs provide? (4)
- workshops/conferences
- brochures/booklets
- videos
- websites
what kind of samples do we need for school-age ax? (4)
- 150-200 words/syllables (~5mins)
- school/home sample (or rating scale) + clinic samples (ideally 2) from DIFFERENT TIMES
- reading and speaking
- need 2 sources: parent, teacher, clinician
what is the key diff bw how we calculate frequency for preschool vs school-age children?
- preschool: %disfluencies
- school-age: %syllables stuttered – don’t ned proportions of disfluency types, just describe types, durations, secondary behaviours, SR, and rate
name 2 resources for anxiety, attitude, and avoidance interviewing
- CAT – communication attitude test
- informal interview
what should you do if a child screens positive for anxiety disorder?
refer to psychologist / physician
what are the 4 key questions we should ask school-age children’s teacher(s)?
- describe the stuttering you see at school ( when, where, with who, how much?)
- does it affect academic and social participation?
- teasing?
- how do you react/how are you trying to help?
T or F: if a client is not following the home program during trial sessions, we should decide not to treat them at the moment
true
T or F: if a client who stutters is happy, social, doing well academically and participating, it’s not necessary to treat them at the moment
true
what is the main style of tx for school-age children: direct, indirect, or integrated?
integrated
goals of integrated program for school-age children? (5)
- reduce neg feelings
- increase confidence
- teach them to stutter more easily
- reduce developmental + environmental influences contributing to stuttering
- “acceptable stuttering”
what are the 4 key steps to integrated tx for school-age children?
- exploring (speech and stuttering)
- desensitization (talking about it, facing it, living with it)
- modification (approach > fear, transfer)
- stabilization (long-term plans)
exploring: how can we facilitate this? (5)
- learn about articulators (“speech helpers”)
- explore cause of stuttering + address myths
- explore how stuttering makes them feel
- provide labels (smooth vs bumpy) + visuals
- surf the net
desensitization: how can we facilitate this? (6)
- talk about why stuttering bothers them
- draw stuttering
- read/watch about stuttering
- voluntary stutter
- “dear teacher” letters
- CBT
modification: what are some techniques? (4)
- full breath
- pausing
- easy onset
- shoelace and bouncing ball activities
what is meant by “acceptable stuttering”? (4)
- changes should not = unnatural
- only use techniques when client wants to
- it is okay to stutter, even when using techniques
- stutter easily = communicate effectively
what is the modification hierarchy?
- single words
- phrases
- sentences
- conversation
how can we facilitate transfer/generalization? (4)
- introduce interruptions in sessions
- introduce noise in sessions
- increase speech rate / time pressure
- apply learned speech behaviours outside of clinic
maintenance: T or F – treatment should be tapered off gradually
true
what is the key tenant of CBT?
you can change your behaviour, feelings, and symptoms by changing your thoughts
what is positive self-talk?
replacing negative thinking with realistic + balanced thinking
3 parts of positive self-talk?
- Attack (ex: I am not going to miss out on this because of my stutter).
- Remind yourself of strengths (ex: I have done this before).
- Turn problems into opportunities (ex: This is an opportunity to face my fears).
how can we deal w negative automatic thoughts? (3)
- Notice them
- Apply thoughts to regulate feelings (ex: deep breaths, release tension)
- Think about the facts
T or F: positive self-talk tolerates less-than-perfect performance
true
T or F: positive self-talk is positive and action-oriented
true
what is neurogenic stuttering?
stuttering caused or exacerbated by neurological disease/damage
should SLPs treat neurogenic stuttering?
only if client has severe and persistent stuttering, is motivated, has adequate cognitive and linguistic abilities
if SLPs are treating neurogenic stuttering, what kind of techniques are used? (4)
- easy onsets, slow rate, stretched syllables etc
- pacing board, tapping
- fluency shaping > cognitive restructuring
- collaborating w neurologist, psychiatrist, PT, OT
what is psychogenic stuttering?
stuttering caused by no obvious reason besides prolonged stress or trauma
T or F: psychogenic stuttering = increased fluency when talking about emotional topics
true
T or F: psychogenic stuttering = worse stuttering when choral reading, singing, tapping
true
should SLPs treat psychogenic stuttering?
- may not work if chronic/traumatizing condition is not resolved
- usually see dramatic improvements with trial therapy
what is clutterig?
- rapid, irregular speaking rate that is difficult to understand.
- high proportion of typical disfluencies (word and phrase reps, revisions, interjections, false starts, hesitations).
- more fluent when make an effort to control.
what is mazing?
disorder of spoken language characterized by repeated false starts, hesitations and revisions that leave the listener puzzled about verbal destination
which populations is cluttering common in? (3)
- attention deficit
- learning disabilities
- ASD
cluttering assessment (5)
- rate
- typical vs atypical disfluencies
- intelligibility (estimate %)
- language standardized tests
- cluttering screeners
cluttering treatment (5)
- education
- self transcriptions + ratings
- PRAAT/metronomes
- pausing, full breath
- practice strong stress emphasis
does pharmacologic treatment of stuttering work?
often reduce anxiety which can reduce stuttering
T or F: pharmacologic agents known to reduce stuttering in some people may induce it in others
true!
how effective is delayed auditory feedback (ex: SpeechEasy devices)
33% report very helpful, 33% report somewhat helpful, 33% report not helpful
