Week Eight Flashcards
What are some characteristics of school age and adults who stutter?
- More likely to continue to stutter
- More at risk for experiencing negative emotions
- Increasing independence from caregivers
- Increasing dependence on peers
What is the overarching goal of treating school aged/adults who stutter?
- Person can speak freely and effectively, whether or not stuttered disfluencies are produced
What three areas are targeted in treatment for a school aged child who stutters?
- Stuttered disfluencies or sensation of being stuck
- Child’s reactions and avoidances
- The environment’s reactions
What are some goals and potential intervention approaches to target stuttered disfluencies/sensation of being stuck?
Goals:
- Help children identify and navigate the sensation of being stuck
- Child will understand what they are doing in a moment of stuttering
- Child will be able to identify moments of stuttering in their own speech
Intervention approaches:
- Talk about the speech mechanism
- Count the stutters in their own speech/SLT’s pseudo stutters
- Stuttering modification
- Speech modification
What are some goals and potential intervention approaches to target the child’s reactions and avoidance’s?
Goal: achieve more neutral reactions to stuttering and speaking
Intervention: Desensitization, cognitive therapy, stutter in supportive environment
Goal: Child will demonstrate reduced negative reactions to stuttering
Intervention: Exposure therapy, desensitization e.g., naturally occurring stuttering in supportive environment, voluntary stuttering/pseudostuttering
Goal: Child will demonstrate reduced physical tension during moments of stuttering
Intervention: Easy onset speech modification techniques
Goal: Child will engage in situations and activities that are currently avoided
Intervention: desensitization to list of situations
What are some goals and potential intervention approaches to target the environment’s reactions?
Goals:
- Educate people in the child’s environment about stuttering
- Child will discuss basic facts about stuttering with family, teachers and friends
- Child will acknowledge stuttering openly when talking to a friend
Intervention:
- Talk about stuttering openly, connect child and family with support organisation
- Self disclosure
What are some general considerations regarding treatment?
- Generalisation to real-world environment needs to be integrated throughout Tx
- Create expectations that stuttering may require some type of intervention at various points across the lifespan
True/false: Speech is the largest obstacle when it comes to treating adults who stutter
False. Due to the duration of experience with stuttering, the negative reactions and social and emotional consequences may be larger obstacles to well-being than speech disfluencies themselves
True/false: Client readiness is not that important to take into account with therapy
false. Client readiness is a crucial component to therapy outcomes (accounting for 40%). Therefore, crucial to take into account with goals and intervention.
What are three themes for approaching intervention with adults?
- Learn to use speech and stuttering modification techniques to make talking easier
- Change negative thoughts and feelings about stuttering
- Approach talking with less avoidance of words, sounds or situations
What approaches can be used to make talking easier for adults?
Normal Talking Process
- Increase awareness of spontaneously fluent speech
Fluency Shaping (client changes entire speaking pattern to produce controlled, stutter-free speech)
- Slow rate: pausing & phrasing, prolonged vowels/syllables, longer turn-switching pauses
- Decrease muscle tension: Slow relaxed phonation onset, light articulatory contacts
- Rhythmic speech: Westmead
- Prolonged speech: Naturalness/Camperdown
Stuttering Modification
- identification, desensitization, modification, stabilization
Which clients suit fluency shaping techniques?
- For whom fluency is highly important
- Those with severe stuttering who want to experience forward moving speech
- who can make controlled fluency feel and sound natural
- Who can cope with negative thoughts and emotions or approach talking without avoidance
What is involved in the stuttering modification technique?
Identification
- Improve the client’s knowledge about stutters so they can learn to efficiently correct them
- Identification itself can lead to reduction in overt stuttering
- Increased awareness and attention may also lead to increase in stuttering
Rationale:
- Reveal behaviours to target for modification
- Require client to take an active role in Tx
- contributes to desensitisation
Modification
1. Cancellation
= Post-block modification
- Finish word, pause, examine, plan change, re-say
- Pull out
= in-block modification
- while saying word examine, plan change, finish word in an easier way - Preparatory set
= Pre-block modification
- Before saying the word examine, plan change & produce word more easily throughout
Which clients suit stuttering modification techniques?
- Clients with a high degree of emotional reactivity
- Clients who frequently avoid sounds, situations, words, or situations
- Clients who produce high frequency of inaudible prolongations or long blocks
- Clients who do not want to change whole speech pattern through controlled fluency
What approaches can be used to change negative thought and feeling about stuttering for adults?
- Cognitive behavioural therapy (CBT)
- Mindfulness
- Acceptance and commitment therapy (ACT)
- Self help and support organisations
- Rational-emotive therapy (RET)
= express thoughts and actively take charge of them
= focus on positive self-talk
