Stuttering Treatment

Question 1

Goals of Treatment for Younger Preschoolers

Answer 1

• decrease stress
• decrease family concern
• trying to understand their feelings
• helping them change selected aspects of the family-child interactions

Question 2

T/F: During indirect treatment of younger preschoolers, none of the child’s speech behaviors are specifically targeted for direct change.

Answer 2

TRUE!

Question 3

Indirect Treatment Target for Younger Preschoolers

Answer 3

the family’s interaction styles (both speech and

nonspeech behaviors)

Question 4

When does direct treatment begin for younger preschoolers?

Answer 4

After 6 weeks with no gains from indirect treatment

Question 5

Direct Treatment for Younger Preschoolers

Answer 5

Begin by praising fluent speech.

Have child catch you having a longer block.

Question 6

T/F: Treatments are more successful with increased duration and less frequency.

Answer 6

FALSE! Treatments are most successful at higher frequency and shorter duration.

Question 7

Palin Centre Parent-Child Interaction

Answer 7

Focuses on changing interactions between parent and child base on the principle that in changing these behaviors, it gives “the child more time to plan and execute speech.”

Question 8

Goals of Treatment for Older Preschoolers (3.5-6 years)

Answer 8

Gain or regain spontaneous, normal fluency.
Children have little or no recollection of having stuttered and will not have to monitor their speech or work at being fluent.”

Question 9

Lidcombe Program, Stage 1 Components

Answer 9

Assessing child’s severity.
Explain severity ratings to parent.
Parents document daily.
Teach the parent to conduct daily treatment conversations.
Progress from all structured conversations to unstructured conversations.

Question 10

When does the Lidcombe Program progress from stage 1 to stage 2?

Answer 10

when “(1) the parent’s SRs for three weeks in a row are all 1s and 2s, with at least four of the ratings being 1, and (2) the clinician’s SRs for the entire clinic visit are 1s or 2s for the same three weeks.

Question 11

Lidcombe Program, Stage 2 Components

Answer 11

Verbal contingencies remain but are reduced in
frequency.
Meetings with clinician drop from weekly to two visits/two weeks, two visits/four weeks, two visits/eight weeks, and then one visit 16 weeks later.
Same level of fluency as above must be maintained in order to graduate from this maintenance phase.
Takes approximately 1 year to complete.

Question 12

What can go wrong with the Lidcombe Program?

Answer 12

1. parents are less attentive to praising fluent speech regularly so that fewer positive reinforcements are made than requests for corrections
2. parents become lax about the consistency of structured treatment conversations so that many days are missed
3. other family members, while trying to be helpful, make mistakes in providing verbal contingencies because they have not been trained.
4. the child is overly sensitive to verbal contingencies and asks parents to stop using them.
5. some children who stutter severely at the beginning of treatment have trouble generating adequate fluency in structured sessions.

Question 13

Modifying the Speech and Language of Family Members

Answer 13

Use a speech rate that more closely matches the child’s.
Pause between conversation turns.
Eliminate questions requiring long, complex answers.
Respond to the content of the child’s message regardless of fluency.
Acknowledge struggled stutters using meaningful words.

Question 14

Direct modification of child’s speech is accomplished when the clinician:

Answer 14

“talks and plays games in a very fluency-enhancing setting. This situation includes the clinician talking slowly in a relaxed way with plenty of pauses and silences. Then the clinician teaches the child to talk in a slow, relaxed way”

Question 15

Begin with ________ demands ( ________ phrases) and then ________ demands ( ________ phrases)

Answer 15

smaller; shorter

increase; longer

Question 16

Gotwald tries to make stuttering “looser and looser” accomplished by ________ (________) or ________ ( ________ ________ )

Answer 16

bouncing; repeating

stretching; intentional prolongations

Question 17

The goal of direct treatment for older preschoolers is met when…

Answer 17

stresses in environment have diminished;
family understands the relationship between environment and stuttering; AND
“child’s stuttering has decreased to the point at which she is normally disfluent, with an occasional mild instance of stuttering”.

Question 18

Direct Treatment for School-Age Children Components

Answer 18

1) Explore stuttering to desensitize

2) Use superfluency

Question 19

Superfluency

Answer 19

a style of speaking that incorporates fluency-shaping components such as slow speech rate and gentle onset of phonation.

Question 20

What is controlled fluency?

Answer 20

Speaking with a preparatory set

Question 21

What is controlled stuttering?

Answer 21

Speaking with cancellations or pull-outs

Question 22

Fear and avoidance are addressed by a child becoming

knowledgeable about their stuttering and then ____________________________ ?

Answer 22

learning new responses to old cues

Question 23

Therapy to deal with the cycle of struggle and reward must use a two-pronged approach:

Answer 23

(1) reducing the negative emotions and rewarding the easier speech that results, and
(2) teaching the child to use controlled fluency (“superfluency”) instead of stuttering.

Question 24

The exploring phase of treatment involves…

Answer 24

Exploring beliefs about stuttering.
The child exploring his/her own stuttering.
Learning about the speech mechanism.
Practicing fake stuttering.
Identifying clinician stuttering.
Self-identifying stuttering.
Exploring what avoidance behaviors are used.

Question 25

Because there is much involvement beyond just the observable behaviors, treatment needs to address each affected area:

Answer 25

Behaviors resulting from stuttering
Emotions about stuttering
Thoughts about stuttering

Question 26

When residual stuttering is present, Guitar advocates for 3 goals:

Answer 26

1) Use controlled fluency
2) When controlled fluency isn’t working, produce easy forms of stuttering
3) When they feel it is sufficient, produce mild, “acceptable” stuttering

Question 27

Guitar’s hierarchy of treatment is:

Answer 27

1) Exploring behaviors, cognitions, and emotions
2) Teach fluency skills
3) Assist with maintenance

Question 28

Successful outcome of treatment depends, in part, on…

Answer 28

Increasing approach behaviors and reducing avoidance.

Question 29

How do you determine goals in beginning therapy for adults?

Answer 29

Inform client about spontaneous fluency, controlled fluency, and acceptable stuttering.

Question 30

Stuttering Modification

Answer 30

Essentially, this means to stutter more fluently or with less struggle.

Question 31

Operant Conditioning

Answer 31

Reward or punishment in order to enhance or weaken a

voluntary behavior.

Question 32

What are the 4 phases of Stuttering Modification?

Answer 32

1. Identification.
2. Desensitization.
3. Modification.
4. Stabilization.

Question 33

Stuttering Modification - Identification

Answer 33

The person who stutters identifies their own symptoms associated with their stuttering.

Question 34

Stuttering Modification - Desensitzation

Answer 34

The person who stutters works towards lessening anxiety associated with stuttering or situations that may bring about stuttering.

Question 35

Stuttering Modification - Modification

Answer 35

Cancellation.
Pull-outs.
Preparatory sets.

Question 36

Cancellation

Answer 36

Upon completing a stuttered word, pause deliberately and then say it again before going on.

Question 37

Pull-Out

Answer 37

Recognize a moment of stuttering and use a prolongation to overcome that moment.

Question 38

Preparatory Set

Answer 38

Uses the same prolongations used during pull-outs, but the plan to do so is initiated before a speech gesture is made.

Question 39

Stuttering Modification - Stabilization

Answer 39

Instead of cancelling words, whole phrases and sentences are cancelled.
Make automatic those motor plans that allow for fluent speech.

Question 40

Hierarchy of Controlled Fluency

Answer 40

(Only on words that are anticipated to be produced fluently.)
1) Single syllables at the beginnings of sentences.
2) Various syllables in other sentence positions.
(Replacing stuttering with controlled fluency.)

3) In the treatment room use controlled fluency when she anticipates stuttering and before she finds herself stuck in a block.

Question 41

T/F: Stuttering while speaking with prolongations is highly unlikely.

Answer 41

TRUE!

Question 42

What is the active ingredient of carry-over fluency?

Answer 42

Extreme prolongations

Question 43

What are the two primary purposes of extreme prolongations?

Answer 43

1. To establish a fluent modality.
2. The creation of carry-over fluency through the
   generation and nurturing of proper neural networks.