Lecture 9 Flashcards
Stuttering Treatments
Stuttering Modification: Van Ripers Fluency shaping Programs: BOPS -Boberg and Kellyn Therapy Method -Onslow and Packman Program -Precision Fluency Shaping (webster) -Speech processing (dahm)
Other stuttering treatment programs/a approaches
- Lidcombe Program (preschoolers/ school age)
- Family Centered Program (Indirect treatment approach towards preschoolers)
- Fluency Rules Program (preschool and early grade school children)
- Comprehensive stuttering program for school age children
- Comprehensive stuttering program for adolescents and adults
Lidcombe Program
- Direct Treatment Program- initially for preschool children
- operant conditioning approach
- developed in Australia
- therapy focus is on childs speech
- parents are integral participants: learn to conduct treatment; measure stuttering severity
- clinicians monitor treatment stuttering severity measures during clinic visits; as well as adjust parents’ treatment based upon data
what are the 2 stages for the lidcombe program?
stage 1: eliminate or reduce childs stuttering to a very low level (clinical visits regularly each week)
stage 2: maintain the stuttering reduction for a long period (systematically increasing period of time between clinic visits) `
Lidcombe program: Child Responses/Parent Responses
- Stutter-free-speech- parents acknowledges it, praises it
- Unambiguous suttering (clear stuttering)- parents acknowledge– or also child to self correct the stuttered word. (similar to cancellation or pull out)
- Non-essential child responses:
* self evaluation of stutter free speech
- self correction of stuttering (parents do this, child not required to do so)
Lidcombe program:
Parental verbal contingencies
- Acknowledgement: “those words were smooth”
- Praise: “wow, good smooth talking”
- Self evaluate: “was that smooth?” or “were there bumps?”
- Then after, parents may acknowledge: “that was a bump there”
- request child to self-correct : “Can you say orange again?”
* *Verbal contingencies are used intermittently to
- lessen invasiveness or to overwhelm child
What are the speech measures for clinicians?
- prescribe treatment goals
- assess child’s progress
- determine effectiveness so treatment can adjusted
- determine when stuttering rate and severity are below program criteria at near zero levels
- prescribe targets for stage 2
What are the speech measures for parents?
Severity Ratings (SRs)
-10 pt. scale stuttering; “2” is extremely mild stuttering; “10” is extremely severe stuttering
-each day; SR for entire day or 10 min. period
Stutters per Minute of Speaking Time (SMST)
-optional measure
-to calculate parent listens to child’s conversation; measures number of unambiguous stutters in that period
-SMST calculated by dividing # of stutters by duration of child’s speech
What are the three conversations of the lidcombe program?
- structured treatment conversations
- unstructured treatment conversation
- initiating stage 2
Lidcombe program:
Stage 1: Structured/Unstructured treatment conversation
- parent taught to engage child in structured treatment
conversation- toys that child prefers are used (toys that they are familiar with) to ensure the child enjoys the experience to promote stutter- free
responses - contingent stimulation used carefully, not excessive
- as Severity Ratings decrease, movement to unstructured treatment conversation is accomplished
Lidcombe program: Stage 2
- move to Stage 2 when stuttering ratings in clinic andoutside clinic decrease to certain levels over 3 consecutive weeks.
- goal of Stage 2 is for parents to gradually withdraw treatment while child maintains same stutter-free speech
- half hour clinic visits that gradually decrease in frequency dependent upon child meeting certain criteria
Lidcombe program: clinician and parent collaboration
- treatment in Stage #1 needs to occur everyday
- clinician needs to insure parent is using contingencies for stutter-free speech appropriately as well as praise during structured treatment to create success for stutter-free speech during unstructured treatment
Lidcombe program: Evidenced based support for program
Clinical trials have been completed- supporting “the treatment is safe- in fact fun- and that the overwhelming majority of parents in such trials will comply with it and that the overwhelming majority of children in those trials will not stutter after they have had it.” (Onslow, Andrews & Lincoln 1994; Onslow, Costa and Rue, 1990; Rousseau et a., 2005)
lidcombe program: school age child treatment
Studies have been done indicating that
this program may also be viable for school age children
- Family- centered, indirect treatment approach for preschoolers
Focuses on “making changes to a child’s environment through parent training and clinician modeling without directly overtly identifying stuttering to the child and or overtly attempting to change the child’s speech-language production”
