Lecture 7

Question 1

What is positive reinforcement?

Answer 1

Presentation of a positive stimulus (praise etc.) contingent on the occurrence of a behaviour (fluency).

Question 2

What is positive punishment?

Answer 2

Presentation of a negative stimulus (verbal interruption) contingent on the occurrence of a behaviour (stutter).
Don’t tell the child exactly what to do every time (“Stop, slow down, take a breath” etc. because they will be reliant upon someone else – skill is not generalisable

Question 3

What is negative punishment?

Answer 3

The removal of a positive stimulus (communicative interaction) contingent on the occurrence of a behaviour (stutter).
Not standard clinical practice, nbut can be effective dependent on the child’s temperament, behaviour, context etc.

Question 4

What are some examples of RCS principles specific to speech pathology?

Answer 4

RCS principles specific to stuttering treatment include:
1. Punishment – Application of aversive stimulation (drawing attention to the stutter – labeling/pick-up), asking child to repeat utterance fluently
2. Withdrawal of a reinforcing stimulant – interrupting ongoing speech, or taking away earned tokens.
Sometimes works with boys especially – thrive on competition

Question 5

What are three types of reinforcers?

Answer 5

Primary reinforcers – food, drink (need to consult with family first)
Social reinforcers – attention, approval, praise
Tangible reinforcers – tokens, tangible materials, desired activities

Question 6

What are the Principles of Reinforcement? (x3)

Answer 6

1. Reinforcer must not be available at any other time
2. Initially, the reinforcer must occur contingent to the stutter, then the reinforcement schedule varies
3. Type of reinforcer must be varied to maintain power.

Question 7

What are the two types of clients?

Answer 7

Early or acute

Question 8

What is the difference between the two types of clients?

Answer 8

In early stutterers, the stutter fluctuates in both severity and nature.
Stuttered behaviours can be eliminated or become established, depending on environmental prompts.
Generally pertains to pre-school children.

Acute:
Stuttering is established and remains chronic over time.
Generally pertains to older children, adolescents and adults.

Question 9

What are the two types of therapy?

Answer 9

Simple or complex

Question 10

Describe simple therapy

OSCPRG

Answer 10

In simple therapy, stuttering is viewed as an “OPERANT-like” behaviour that can be controlled by its context.
No SPECIFIC speech pattern is taught, but rather stuttered behaviours are met with environmental CONSEQUENCES (e.g. “careful sweetheart”, or the removal of tokens etc.).
It is is easy to train PARENTS to do this type of therapy, and it is easy to REPLICATE (i.e. for them to do at home).
The therapy is conducted in natural, everyday settings, contributing to GENERALISATION.
Examples: RCS, Time Out.

Question 11

What is complex therapy?

Answer 11

In complex therapy, the stuttered behaviour is replaced with a distorted speech pattern (which the client learns from complex instructions from the CLINICIAN).
Treatment directly MODIFIES stuttered behaviours.
2/3 relapse, systematic transfer and maintenance stages needed.
Treatment example: Prolonged Speech or Smooth Speech.

Question 12

What are two types of instruction procedure?

Answer 12

Programmed and non-programmed

Question 13

What is a ‘programmed’ instruction procedure

Answer 13

INSTRUCTIONS to teach and instate fluency, and TRANSFER skills to everyday speaking situations
SITUATIONAL HIERARCHY – start therapy with something they will have success at
SYSTEMATIC DESENSITISATION
ORCHESTRATED GENERALISATION
Individual MAINTENANCE program for durability
Example: Prolonged Speech or Smooth Speech.

Question 14

What are the FOUR main components of parent-administered therapy?

Answer 14

1. Sessions
2. Structured online therapy
3. Online therapy
4. Maintenance

Question 15

What do “sessions” consist of in parent-administered therapy?

Answer 15

Structured, orchestrated daily activities that ENGAGE the child and SIMPLIFY their linguistic output.
The aim is to ensure fluency is PRACTICED and strengthened and stuttered behaviours are DECREASED by quick and natural management
Plan activities that contain a linguistic/cognitive HIERARCHY – e.g. first session – get out shopping trolley, first eliciting single words, and then phrasing questions to get sentence responses

Question 16

What is structured online therapy? When can a child move onto structured online therapy?

Answer 16

There is less focus on structure and increased CHOICE of activities that are naturally occurring in the child’s everyday environment.
NATURAL PARENT MANAGEMENT of their child’s stuttered behaviours and fluency feedback continue.
VARYING contexts act as discriminative stimuli promoting natural generalisation.
Can move onto structured online therapy when child is at level 4-5
“While we’re (at the park/making face biscuits) let’s see if you can do some beautiful talking”

Question 17

What is online therapy?

Answer 17

In online therapy, parents provide feedback throughout the day (via a chart, noting down stimuli that may have caused an increase in stuttered behaviour - e.g. a party).
After a month of scores of 2 (with occasional 3s), can move onto Maintenance

Question 18

What is maintenance? When can a child move onto maintenance?

Answer 18

Formal appointments arranged and extended over time.

Have to gradually wean the child off therapy, as well as you as a person, and their parent’s comments and reminders

Question 19

What is time out?

Answer 19

A non-programmed, simple treatment that can also be used for complex cases. Positive reinforcements are made UNAVAILABLE to children for a specified time period (generally 1 minute per year of age)

Question 20

Who first researched TO and stuttering?

Answer 20

Haroldson, Martin and Starr (1968) – 88% reduction in stuttering for each subject.

Question 21

Who conducted the puppet study? What did they find?

Answer 21

Martin, Kuhl and Haroldson (1972) used TO and successfully GENERALISED fluency beyond laboratory.

Question 22

What did James (1981) add to the research on time out?

Answer 22

Found interruption of speech must occur IMMEDIATELY and as close to source as possible to achieve maximum treatment potency. Also found that SELF-IMPOSED time out was very effective (helped the child achieve self regulation)