Lecture 7 Flashcards
phonological issues as related to childhood stuttering
- “results from the investigations that have examined the influence of phonology from a production perspective continue to indicate that disordered phonology often co-occurs with stuttering. “ ( Blood, Ridenour, Quails, and Hammer, 2003)
- “Studies that have examined the planning perspective seem to indicate that disordered phonology does not have to present for a child’s fluency to be compromised by his or her phonological system.”
phonological issues as related to childhood stuttering:“ Co-occurrence of Stuttering and Phonological Disorders” (Chapter 10)
- Arndt and Healy (2001) collected data from 241 speech-language pathologists from 10 states, and found that out of 467 children who stutter (CWS) – 56% (2o5) of the children demonstrated a concomitant language and/or phonological disorder.
- Other studies such as– Blood et. Al. (2003)– surveyed 1184 SLPs and they found that 62.8% of the “….CWS had concomitant language, speech, or nonspeech disorders.” 33.5% presented an articulation disorder– and 12.7% presented with a phonological disorder.
- Contrasting view was presented by Nippold (2004)- 127 SLPs were surveyed- and if asked if they would provide treatment to those CWS who present with concomitant disorders– 31% responded “yes”; 40% responded “no”; and 23% were unsure.
- In another study SLPs were asked to assess a 4 year old CWS – “..71% would provide treatment if the child had no other concomitant; 91% would provide treatment if the child also had a phonological disorder: 94% would provide treatement if this child had a language disorder; and 94% would provide treatment if the child had both phonological and a language disorder.”
phonological issues as related to childhood stuttering:”Review of research: “Relationship between Persistence of Stuttering and Presence of Phonological Delay”
-“ …..three interrelated studies on the relationship between the persistence of stuttering and the presence of a phonological delay are consistent with the possibility that stuttering and phonological difficulties are most likely to co-occur for those children whose stuttering persists.”
(Paden & Yairi, 1996)
-“ …CWS who continued to stutter more than 36 months post-onset exhibited significantly poorer phonological skills than age and gender matched.”
CWNS.
(Paden et al. (1999)
-“ …found that for those CWS who had deficient phonological skills near the time of onset of stuttering, their stuttering would be more likely to persist than resolve.”
phonological issues as related to childhood stuttering:“Phonological Complexity of Stuttered Word”
- Per study by Wolk, Blomgren, and Smith (2000), found “….that stuttering occurred significantly more frequently on those syllables produced with phonological errors that began with consonant clusters in comparison with those that began with consonant clusters that did not contain phonological errors.”
- Per study by Huinck, von Leishout, Peters and Hulstijn (2004) “…. both AWS and AWNS exhibited more incorrect speech productions and slower speech reaction times for homorganic (consonants produced in same manner/articulation placement e.g. /p/, /b/, and /m/) than for heterorganic clusters (consonants not produced in the same manner/articulation placement), but there was no differences between AWS and AWNS in reaction times and word durations.”
Phonological issues as related to childhood stuttering:“ Treatment issues for stuttering clients with phonological issues” :
- Working on stuttering vs. phonological issues
as with language development issues, phonological intervention needs to be “…targeted in manner that does no exacerbate the stuttering issues.”
Per Conture & Curlee (2007) Chapter 10: - Wolk (1998) along with Conture recommend a more indirect approach.
Phonological issues as related to childhood stuttering: Wolk’s 6 clinical principles
Principle 1: Indirect Approach to the Treatment of Phonological Errors: relaxed approach; modeling of phonological targets; utilize play therapy approach; no expectations, positives for correct production utilized
Principle 2: Use of a Phonological Process Approach: target different phonological processes; productions accepted; accurate productions praised
Principle 3: Use of Direct Fluency Modification Techniques: focusing on rate reduction; light articulatory contact: vowel elongation
Principle 4: Concurrent Application of Phonology and Fluency Intervention Strategies: work on phonological targets including fluency facilitation techniques; model slow, relaxed speech; no attention to errors
Principle 5: Parental Involvement: encourage parents to- reduce their speaking rate; increase pause time between conversations; casually restate child’s errors; no drill work on articulation; provide support and listen to child
Principle 6: The Use of a Group Setting: Individual as well as group settings with peers
Stuttering treatment consideration for children
Need to identify:
1.situations/environmental conditions that reduce disfluency
2.Situations/environmental conditions that increase disfluency
Do this by:
1. Parent charting
2. Parent reporting
3. Clinician’s systematic observation of childs speech
4. clinicians systematic evaluations of parents report
Treatment for young child at risk for chronic stuttering: Target information from parent and clinician observations to develop a plan to
a.Track fluent and disfluent times/activities/ people/situations
b. Note how others react: what helps/what doesn’t
c. Gather all info from parents possible:
recordings, notebooks, tracking sheets
d. Increase situations that enhance fluency
e. Decrease situations that inhibit fluency
Treatment for young child at risk for chronic stuttering: Parent Education Re: Nature of stuttering
- Stuttering is cyclical
- Variable (that they didn’t do it)
- They didn’t cause it
- Okay to talk about “rough speech”; a warm, supportive response will not make it worse
- Avoid old standards like: slow down, think about what you are saying, don’t finish sentences for child
Treatment focus for established stuttering: Treatment for Established Stuttering
- work with child to increase fluency
- help child to understand his disfluenices by using words like “bumpy and smooth” “Jumpy and gliding”
- practice slow speech (turtle, hare, or race horse)
- practice and create situations for easy speech practice
Treatment focus for established stuttering: Child needs to practice being fluent
- Praise fluency, reinforce easy effortless speech
- okay to acknowledge problems: “oh that was a difficult one. Lets do something else like…”
- model easy speech or whatever enhances fluency
- observe/modify as needed
- keep parents informed
Treatment focus for established stuttering: other treatment suggestions
- attend to the child when speaking, slow down the pace; wait between taking turns at conversation
- each child is different and may need alternate
activities to foster fluency; need to consider each child individually - frequent parent contact and reporting
- don’t ask parent to change home routines or their speech unless you have data to support this fact;
ASHA Guidelines RE: Fluency Treatment:
- Fluency– shaping approach:
- Slowed rate of speech movements
- Easy onset of voicing: slow inhalation; soft but true voice to full voice before vowel initiation; practice in order to
shorten time taken up by onset of voicing period.
- Blending or continuous voicing
- Light articulatory contacts.
- Smooth, slow speech movements - Vocal control treatment approach:
-Better vocal tone, breath support, full resonance, relaxed voice
ASHA Guidelines
- Contingency management: combined reinforcement for fluent speech;successive approximation (shaping) toward fluent speech; practice from easiest to more difficult speech situations in a hierarchy; use of fluency enhancement in clinic device; use of computer assisted devices; systematic reinforcement for natural sounding speech.
- Reduction of speech associated anxiety/excitement:Systematic desensitization to social situations; confrontation of stuttering; voluntary stuttering; with children, counsel parents to reduce/remove anxiety producing events as possible
- Training parents: speak more slowly, with normal intonation, timing,stress
- Prevention: training parents to talk less often, with simpler language,interrupt less often, ask fewer questions requiring long complex answers
