Preschool Assessment

Question 1

Nature of Stuttering (3 forces)

Answer 1

Results from interaction of 3 forces:
Constitutional
Developmental
Environmental

Question 2

Clinical Methods (3)

Answer 2

1. educate (e.g. slower speech)
2. counsel
3. collect data

Question 3

Clinical Procedures: Indirect Tx (Integrated Approach)

Answer 3

Clinican counsels parents
Clinician models facilitating interaction
Parents practice facilitating interaction at home (important stage)

Question 4

Severity Ratings

Baseline Measures

Answer 4

Lidcombe Severity Rating Scale (1-10 Scale) reporting daily severity (parents usually)
Clinicians record 1st 10-15 min and note child’s SR, comparing it with parents

Question 5

One-on-One Time w/ Child

Answer 5

Parent try for 10-15 min/ day one-on-one
Done at same time each day
Child-directed, parent attending, good listening

Question 6

Other Aspects of Parent-Child Interaction

Answer 6

• Clinician observe at beginning of each session
• Observe speech rate, stressful interactions
• Watch vids with parents and brainstorm what might be stressful

Question 7

Typical interaction patterns that may stress a vulnerable child:

Answer 7

• high rate of speech
• rapid fire conversational pace
• interruptions
• open-ended questions
• critical or corrective
• lack of listening to child
• advanced vocab & syntax

Question 8

Maintenance

Answer 8

Support family so anxiety decreases
Gradually fade contact after fluency achieved
Prepare parents for possible return of stuttering under stress
Help family gain confidence in problem solving skills

Question 9

Older Preschool Children: Beginning Stuttering

Answer 9

• 3.5 - 6 years old
• Stuttering at least 9 months
• Repetitions w/ tension, tense prolongations, some blocks
• Escape behaviours, some avoidances
• Frustration and embarassment

Question 10

Lidcombe Program Overview

Answer 10

-Parent delivered in-home operant program, praise every 5th utterance
-Gentle correction for unambiguous stutters (5:1 ration)
-Parent guided by weekly clinic visits
Initially in structured sessions, then unstructured

Data guides:
Daily Severity Ratings (SRs)
Clinician collects %SS or SRs at clinic visits
-Systematic maintenance program for 1 year after fluency

Question 11

Lidcombe Stage 1: 1st Clinic Visit

Answer 11

• SLP ax child’s %ss or SR in 300 syllables of convo speech
• teaches parents about SRs on 1-10 scale daily
• Calibrate parent if needed
• Teaches parent to conduct daily tx conversation for 10-15 min each morning (should be fun)
• Specific praise after 5 fluent utterances
• After 5 praises, 1 acknowledgement of bumpy (non-negative tone), 1 week later can use requests for self-correction

Question 12

Stage 1: Introducing Unstructured Tx Conversations

Answer 12

• If SRs & %SS reduced, unstructured convos introduced

- Use of praise, acknowledgement of stutters, requests for correction in everyday situations

Question 13

Stage 2: Maintenance

Answer 13

If child meets criteria for 3 WEEKS in a row

• %SS in clinic BELOW 1%
• Week’s SRs are all 1 or 2 (w/ at least 4 days of 1)
• If criteria met, 30 min clinic visits (2, 4, 8 week intervals each have 2 visits, 1 visit at 16 week)
• If criteria not met, increase clinic visits, may reinstate structured or unstructured clinic visits