Fluency Final - OUHSC

Stage 2 of Lidcombe - Maintenance

o Family begins stage 2 when child meets criteria for three weeks in a row o Stage 2 consists of 30-minute clinic visits scheduled at systematically increasing intervals as long as criteria are met: o If criteria are not met, parent and clinician jointly decide among several possible options: § Clinic visits increased in frequency compared to previous level § Weekly clinic visits § Reinstating either structured or unstructured clinic visits or both o Sometimes contingencies need to be adjusted

Stage 1 of Lidcombe

o First clinic visit o Clinician teaches parent to conduct daily treatment conversation at home for 10-15 minutes each morning o Once parent is comfortable with using praise, gentle corrections are introduced o When structured conversations have been going well and the child's SRs and %SS show a reduction, UNSTRUCTURED conversations are introduced

Interaction strategies

o Following the child's lead in play o Letting child solve problems o Use of pausing

Family strategies

o Openness about stuttering o Building confidence o Dealing with feelings

Child strategies

o Rate reduction o Pausing to think o Easy onset

What are some stressful communication interaction patterns?

· High rates of speech · Interruptions · Inadequate or inconsistent listening to what the child says

What are some helpful communication interaction patterns?

· Positive comments · Listening time · Frequent open-ended questions · Slow rate

What are the primary therapy goals of Palin PCI?

"A child who is communicating as fluently and effectively as possible with confidence and pleasure." "Parents who feel less anxious and more knowledgeable and confident to support their child."

What are the main behavioral manifestations/common signs of cluttering?

-Rapid irregular rate of speech -Pausing at inappropriate times -Repeating words or phrases -Leaving words unfinished -Collapsing words -Omitting words -Excessive interjections -Can sound slurred -Sloppy handwriting

*Be able to match techniques/tools with whether their goal is fluency or modifying the moment of stuttering*

...

*From HSTalks... what are some strengths and limitations of the stuttering modification approaches?*

...

*What is voluntary stuttering?*

...

Know the slide that maps therapy goals and the ICF model

...

See "does the child stutter chart" in notes

...

Why do SLPs ask when the child began stuttering?

...

What is the consolidation period at Palin PCI, how long does it last, and what do parents do during the consolidation period?

6 weeks with NO clinic visits Parents continue Special Times and complete sheets Continue to praise and complete Praise Log Continue other family strategies e.g. turn taking, bedtimes, behavior management Parents send in completed sheets to therapist Therapist monitors and makes contact as necessary Predict possible relapse Parents encouraged to contact therapist if fluency gets worse Review appointment arranged at end of 6 weeks

Challenging unhelpful thinking patterns

Can you give a specific example? Who? What? Why? Where? How did you feel? What did you do? How is this a problem for you? What do you mean when you say...? What is the evidence that ...is/is not true? What is the worst thing that could happen if it is true? If it did happen, what then? What does this mean about how the other person thinks or feels about you? What would you tell a friend in a similar situation?

What are the questions on the readiness ruler?

a. (What changes are you considering?) b. How IMPORTANT is it for you to make this change? c. How CONFIDENT are you that you can make this change? d. How READY are you to make this change?

What are 3 treatment goals in the indirect therapy (see slides from "indirect therapy" and indirect components of Palin PCI and Family-Focused Therapy)?

1. Educate the parents · GOAL: Parents will (continue to) receive provide information and support as they learn about stuttering and how they can help their child · PROCEDURE: The parents and clinician will.. 1. Continue discussions started at the initial contact or diagnostic evaluation so the parents will have a greater understanding of stuttering 2. Discuss information as needed so the parents are ready to assume the role of "home clinician" i. Remember that counseling = informing, so watch out for too much informing ii. We do need to provide information, but don't bowl them over with too many facts and try not to be too directive in treatment 2. Identify fluency stressors · GOAL: The parents will identify factors (fluency stressors) that make it more difficult for their child to maintain fluency · PROCEDURE: The parents will... 1. Learn about the "bucket analogy" so they can understand the role of stressors 2. Complete "stressor inventories" so they will see what "adds water to the bucket" i. The bucket analogy helps parents understand that many factors affect stuttering and that we cannot distinguish the influence of individual factors once they are in the bucket ii. The stressor inventories help parents identify factors that might add water to the child's bucket 3. Introduce the concept of a "fluency facilitating environment" · GOAL: Parents will understand the value of making changes in their own communication style (a "fluency-facilitating environment") to help their child speak more fluently · PROCEDURE: Parents and clinicians will... 1. Review "stressor-inventories" and bucket analogy to see what stressors can be diminished 2. Consider changes to the parents' communication style that may enhance child's fluency i. Parents can change their speech patterns to help the child achieve more fluent speech, e.g.: 1. Slower speaking rate (not too slow) 2. Easier interaction style (increased pausing both within and between utterances) 3. Less hurried daily pace/lifestyle (be careful with this one) (less hectic scheduling of daily activities; one-on-one time with the child) 4. Teach the parents to provide a "fluency facilitating environment" · GOAL: Parents will learn how to provide a fluency-facilitating environment for their child · PROCEDURE: The clinician will... 1. Model communication changes for the parents 2. Give parents the opportunity to practice, both in the therapy room and outside the therapy room · Examples of communication modifications: 1. Reducing parents' speaking rates slightly 2. Reducing time pressures (also called "delaying response" or "pausing") 3. Reducing demand for talking (if demand is high) 4. Modifying questioning (if and only if necessary) 5. Providing a supportive environment for both fluent and stuttered communication

How can parents identify fluency stressors in the family-focused treatment approach?

1. Learn about the "bucket analogy" so they can understand the role of stressors 2. Complete "stressor inventories" so they will see what "adds water to the bucket" i. The bucket analogy helps parents understand that many factors affect stuttering and that we cannot distinguish the influence of individual factors once they are in the bucket (communitive stressors, interpersonal stressors, child factors) ii. The stressor inventories help parents identify factors that might add water to the child's bucket

What are the "7 tips for talking with your child" presented by the Stuttering Foundation?

1. Reduce the pace 2. Full listening 3. Asking questions 4. Turn taking 5. Building confidence 6. Special times 7. Normal rules apply

What are the 3 "philosophical points" of Palin PCI?

1. The children and their parents are the experts 2. It is not the parents' fault 3. Children and parents are already doing helpful things

What are "Special Times" in Palin PCI?

A caregiver plays with her child for five minutes, giving the child her undivided attention and focusing on what he is saying rather than how he is saying it Parent should try to arrange 5 minutes per day of one-on-one time with child to practice parent-child interaction changes When the time is up, the caregiver writes about her Special Time on the task sheet, making a note of what she did, and how she felt it went

What are the advantages/disadvantages of telehealth?

Advantages: Goals can be met Unconditional positive regard can be met More convenient More comfortable setting Disadvantages: Lower attendance rates for some Connection issues Privacy concerns Need to prep clients for technical difficulties

What is indirect treatment?

Aimed at CHANGING THE ENVIRONMENT (usually for 2 years to 3.5 years) Involves alleviating stresses that the child might be experiencing in communication at home and in other situations

What is direct treatment?

Aimed at having children learn to CHANGE THEIR SPEECH Works directly on the child's speech by having him speak more fluently, stutter more easily, or both

What are unhelpful thinking patterns and how can they be challenged?

All or nothing thinking Catastrophizing/fortune telling Mind reading Over-generalization Mental filter/magnification/discounting positives "Should" statement Personalization and blame Labelling

What are 2 national organizations that run support groups?

American Institute for Stuttering The National Stuttering Association

What are some informal ways to assess school-age children's emotions about stuttering and their reactions to stuttering?

Asking them to draw what their stuttering feels like What's True for You Assessment????

SSI-4 (Stuttering Severity Instrument)

Assesses stuttering severity in children and adults; frequency, duration, physical concomitants, naturalness of speech

From HSTalks...When assessing bilingual children what do you need to know about the type of stuttered disfluencies?

Bilingual children in the process of learning another language may present with pseudo-stuttering characteristics related to word retrieval rather than true stuttering; may not ACTUALLY be a stuttered disfluency

Temperament Characteristics Scale

Birth to 4 - characteristics that describe children; two spectrums along each question regarding "staying close vs. separating from parent" and other questions

What is the basic premise of CBT?

CBT focuses on the role of cognitions or "self talk" because changing thoughts can lead to changes in feelings Perceptions of events strongly influence how we feel and act Fundamental to CBT is the view that it is our interpretation of the world that affects how we feel and behave o It is not the event that causes emotional problems per se but the meanings we give the event o So, for example one person might think of a listener's lack of eye contact as embarrassment while another might think of it as rudeness. Its emphasis is on changing unhelpful thoughts and replacing them with more helpful ones o It is more concerned with how problems are maintained than on how they are caused and wherever possible the focus of therapy is in the present rather than the past CBT helps people make links between thoughts, emotions, physiological reactions, and behaviors

How is "time" addressed in different speech tools/techniques?

Changing timing increases opportunities for PLANNING language and PRODUCING speech Talk more SLOWLY by: o Pausing as needed BEFORE starting to speak (e.g., pausing before taking a turn in conversation) o Pausing as needed DURING ongoing speech (e.g., pausing between word ----> phrases ------> sentences) o Slightly reducing speaking rate Pausing between words and phrases maintains naturalness and gives more time for planning Pausing between words and phrases maintains naturalness and gives more time for planning Pauses should occur at appropriate locations, e.g., between sentences and phrases o 1. Pauses should not be so long that the child feels uncomfortable with the silence (~1 sec) o 2. It will take practice for the child (and you) to develop comfort with silence o 3. Focusing on pausing is easier (and more effective) than thinking about slowing speech

What are the main differences between cluttering and stuttering?

Cluttering -Prosody (rhythm and melody of speech) affected -Much less likely to recognize their cluttering -Begins their thought knowing what they want to say but gets derailed in the mid sentence - could be related to language/ thought organization -Commonly phrase repetitions, interjections, and revisions (disfluencies considered "typical" -May exhibit slurring of speech Stuttering -Not associated with prosody issues -More awareness of their stutter -Knows what they want to say but struggles with speech execution -Common disfluencies include repetitions, prolongations, and blocks -No slurring of speech unless it is associated with a co-occurring condition -Secondary behaviors that reveal physical struggle of speaking

KiddyCAT

Communication Attitude Test for Preschool and Kindergarten Children who Stutter - yes or no questionnaire given to the child; "is talking hard for you?"

From HSTalks...What is covert stuttering? What are the physical and psychological differences between overt and covert stuttering?

Covert stuttering occurs when someone tries to hide their stutter; people don't know they have one Covert stutterers - hide in the "closet" and the person experiences a lower quality of life, increased health risks and exhausting maintenance behaviors - panic attacks, headaches, stomach ulcers Overt stutter - there is a pivotal moment that leads them to empowerment; stuttering freely

What does DAF and FAF stand for? How do they work?

Delayed Auditory Feedback - device that allows speakers to hear their own voice with a slight time delay (less than .25 second); powerful method for reducing disfluencies in people who stutter Frequency Altered Feedback - much newer than DAF; form of AAF where the frequency range of the speech is shifted up or down leading to changes in pitch which results in a shift in the entire speech spectrum -FAF paradigm: it is perceived by speakers as an error in their vocal pitch production, upon exposure to FAF, speakers have the tendency to compensate

Termination stage

End Therapist's response: No therapy needed

*What are some factors that the SLP need to take into account when deciding whether to recommend therapy or not?*

Extreme views: No child should receive direct therapy vs. Every child should be treated as soon as possible A third view: Therapy should be offered selectively, primarily to those at high risk for developing stuttering; other children should be monitored during a waiting period Waiting period: i. 6 months from the time of onset before initial intervention ii. 9 to 12 months (Yairi and Ambrose, 2005) to observe a shift toward recovery; at that point in time, those who will recover become more identifiable

*What are the two main goals of the stuttering modification/"stutter more fluently" approaches?*

Generalization and agency???

Family-focused treatment approach

Help preschool children achieve and maintain normal speech fluency; treatment involves parent-focused and child-focused that are designed to: 1. Help parents make communication modifications to indirectly facilitate children's fluent speech 2. Help parents and children develop and maintain healthy, appropriate communication attitudes 3. Help children make communication modifications to directly improve their speech fluency

How is "tension" addressed in different speech tools/techniques?

Helps the child move his articulators more smoothly and easily; when a child's muscles are too tense, it is harder to speak 1. Tension is a reaction to the underlying feeling of loss of control; it is part of what he is doing to interfere with speech 2. The child will be able to speak more easily if: a. He can prevent tension from building up b. He can minimize tension after it's already there

What questions would you ask your client's teacher (preschool and school-age) and why?

How does his stuttering impact his classroom participation, academic performance, and overall progress? Is the child experiencing any teasing? If so, to what extent and how does he handle it? How does the teacher feel about the child's stuttering and how does it affect the classroom? Make an alliance with the teacher Find out about child's communication in class, if stuttering interferes with communication, how teacher responds to child's stuttering, and if other children tease child about his stuttering What information might you want to give the teacher about stuttering? Classroom observation -Arrange a time with teacher to unobtrusively observe student when he may be talking in class -Note how much he talks, to what extent he avoids, and how others react to his stuttering *Teacher Questionnaire (Stuttering Foundation of America (SFA), 2008)* *Teacher's Rating Scale (Las Cruces Public Schools, Kuster Website)* Ask these questions because the classroom is the main spot where social interactions are experienced. It is a place where students attempt to interact with one another, therefore it allows you to view a variety of interactions and discover any fear or anxiety related to the stutter

When is direct treatment introduced in the family-focused treatment approach?

If the child continues to stutter following the use of the parent-focused treatment (and attitudinal work), then it is time to begin direct child-focused treatment At this point, the goal of treatment is actually the same as it is for older children who stutter To improve the child's fluency through direct modification of the child's communication skills. To ensure that the child develops and maintains healthy, appropriate communication attitudes

From HSTalks...Is bilingualism a risk factor for stuttering?

It is NOT a risk factor for stuttering; some believe this but there is no data

*What are the common factors in therapy and what is their relative contribution to treatment outcomes (at least in psychotherapy)?*

It is the SIMILARITIES, rather than the differences, between approaches that account for the observation that all psychotherapeutic approaches are, in general, effective TECHNIQUE: factors or 'strategies' unique to different therapy approaches (e.g. "easy onset," "voluntary stuttering") EXTRATHERAPEUTIC CHANGE: characteristics of the client and his/her environment (e.g. temperament, social support) HOPE OR EXPECTANCY: "placebo" - a more positive treatment outcome is likely to be predicated on the client's hopefulness, but also on the clinician's hope and expectation that the client has the ability to change, and that they will be able to help the client bring about such change Therapeutic relationship??? A more positive treatment outcome is likely to be predicated on the client's hopefulness, but also on the clinician's hope and expectation that the client has the ability to change, and that they will be able to help the client bring about such change

What is the main difference between Lidcombe and Palin PCI?

Lidcombe program uses OPERANT CONDITIONING - reinforcement for everything? Palin PCI is FACILITATIVE rather than instructive

Assessment goals for school-age children who stutter

MORE ABOUT THEM (they experience more fear, embarrassment, situational avoidances, and are able to anticipate a stuttering moment) A longer time since onset of stuttering has elapsed for school-age children than for preschool children In terms of secondary behaviors, they may be exhibiting escape, starting, and avoidance behaviors They are also experiencing frustration, embarrassment, and the beginning of fear related to their stuttering While becoming increasingly independent from parents, school-age children are becoming increasingly dependent on their peers for their social, emotional, and academic development They have a definite concept of themselves as a person who stutters Pre-assessment questions What are characteristics of student's stuttering? What are student's feelings and attitudes about speaking? How does stuttering affect him/her at school and home? Is he eligible for services, according to state regulations? Goals of stuttering assessment -Establish rapport with the client -Older kids - it is very likely you are not going to be the first person they've seen for therapy -REALLY listen to their needs -Obtain background and case history information -Describe the client's speech characteristics -Understand the client's home and social environment -Identify condition and variables affecting the client's speech -Understand the impact of the communication disorder on the individual's life -Provide information about the nature of fluency/stuttering and its treatment -Recommend a plan of action for the client

Maintenance stage - "I still am"

Maintaining the change? Therapist's response: Use of toolbox Relapse prevention plan If relapses occur, encourage early recognition and rapid responses, discuss coping with relapse and potentially go back to using skills for preparation and action stages

What are NATs and how can they be challenged?

Negative automatic thoughts about stuttering Notice your mood and identify the HOT negative automatic thought or NAT (the one that is really influencing how you are feeling) Look for any evidence that unquestionably supports your NAT; also notice anything that seems like evidence but which could actually be interpreted in different ways Look for evidence that suggests things may not be as you first thought or assumed (e.g. someone isn't acting as you thought, or someone is responding positively or neutrally towards you) Decide whether you're using any unhelpful thinking patterns and, if so, recognize this and try to say something more helpful to yourself Decide whether you need to do any problem solving, o i.e., if the evidence suggests there is a problem, decide what your options are

What is the dodo effect?

Numerous studies have compared the effectiveness of different therapeutic approaches for depression, anxiety, schizophrenia, etc. With rare exceptions, research has uncovered little significant differences among different psychotherapeutic approaches This observation has been described as "the dodo effect" (e.g. Tallman & Bohart, 2004); "Everybody has won and all must have prizes." (Lewis Carroll) A possible explanation for the dodo effect is that there are COMMON FACTORS throughout all therapies that facilitate change or progress "Results support the claim that intervention for stuttering results in an overall positive effect. Additionally, the data show that no one treatment approach for stuttering demonstrates significantly greater effects over another treatment approach." (Herder, Howard, Nye & Vanryckeghem, 2006)

Assessment goals for preschool-age children who stutter

PARENT-BASED Does the child stutter? Is the child likely to recover or persist? What does stuttering affect the child and his/her family? Recommendations/plan of action Parent Time since onset Family history of stuttering Description of child's stuttering and its trajectory Child's temperament Knowledge about stuttering Awareness, reactions, and emotions of child to stuttering Reactions and emotions of parents to child's stuttering Child Stuttering frequency and severity, disfluency type and duration, physical tension, concomitant behaviors Speech and language abilities Emotions/attitudes

Palin PCI

Palin PCI (Kelman and Nicholas, 2008) is a therapy program conducted at the Michael Palin Centre for children up to 7 years of age that uses play=based sessions with parent-child pairs, video feedback, and facilitated discussion to help parents support and increase their child's natural fluency It is a facilitative rather an instructive approach · A SUCCESSFUL OUTCOME o "A child who is communicating as fluently and effectively as possible with confidence and pleasure." o "Parents who feel less anxious and more knowledgeable and confident to support their child."

What is the difference between parent education, parent counseling, and parent training?

Parent education - clinician provides information and explanations Parent counseling - clinician listens, eases concerns, shows understanding Parent training - clinician shows and teaches how to interact with child

Palin Parent Rating Scales

Parent questionnaire to rate from 1-10 the impact of stuttering on their child, severity of stuttering and parent concerns, and parent's knowledge and confidence managing the stuttering; "does your child speak less because of stuttering (1-10) 1 is normally always, 10 is never

What are the stages of change?

Pre-contemplation Contemplation Preparation Maintenance Termination

What kind of contingencies are used in Lidcombe?

Reinforcement for fluency speech o E.g. "That was smooth." "Nice smooth talking!" o "I didn't hear any bumps." Mild punishment for stuttering o E.g. "Oops, I heard a little bump." "That is a little bumpy." "You only need to say _____ once." "Say ____ again."

*What factors influence a client's readiness for change?*

Self-efficacy (confidence they can do it) Motivational states are not binary - with clients either motivated or not motivated; rather, readiness exists along a continuum of steps or stages and can vary rapidly, sometimes from day to day

What is the ideal fluency-related goal when working with preschool-age children who stutter? Spontaneous fluency or controlled fluency using speech tools?

Spontaneous fluency

Contemplation stage - "I may"

Stage of change in which people are considering changing behavior Therapist's response: Help clients concretize reasons for changing Help clients articulate a vision of what they want Recognize ambivalence Give time and encourage evaluation of pros and cons of behavior change

Preparation stage - "I will"

Stage of change in which people are getting ready to make a change Therapist's response: Help clients concretize plans for change Help clients brainstorm small steps they can begin to take Discuss potential roadblocks and help them develop strategies in advance

Precontemplation stage - "I won't/can't"

Stage of change in which people are unwilling to change their behavior Therapist's response: Empathy, active listening, give information, provide choices, give hope, remove barriers or change, validate lack of readiness

What is a decisional balance worksheet?

Start with - "What do you like about drinking/using___?" Then - "What do you not like about drinking/using___?" End with - Summary of pros and cons Use patient's terms to reflect back what they said Start with pros, end with cons • Do not add your own cons

From HSTalks... what are some strengths and limitations of the fluency shaping approaches?

Strengths: being a programmed, systematic, clear, step-by-step approach, a "safer" technique for clinicians, and one that has a more objective outcome Limitations: that it pays little attention to attitude or feelings, it doesn't address covert aspects of stutter, and requires commitment

What are 2 websites that you would refer parents, children, and teachers for more information about stuttering?

Stuttering Foundation & National Stuttering Association

How is parent and child understanding and acceptance of stuttering achieved in the family-focused treatment approach?

Talking about stuttering (in a supportive way) will not make stuttering worse; one treatment approach (the Lidcombe Programme) even teaches parents to point out disfluencies in a child's speech and ask them to say the words again smoothly, without "bumps" It's even okay to say the "s" word: "always use the proper name for things; fear of a name increases fear of the thing itself" Parents will model appropriate attitudes toward the child's speaking abilities Parents will listen to child's concerns

TOCS

Test of Childhood Stuttering; assesses speech fluency skills and stuttering-related behaviors in children; it helps identify children who stutter, determines the severity of the stuttering, and document changes in speech fluency over time Standardized fluency measure - rapid picture naming, modeled sentences, structured convo, narration Observational rating scales Supplemental clinical assessment

TOCS ORS

Test of Early Childhood Stuttering Observational Rating Scale - parents rate the frequency of child's disfluencies and effects; "how often does your child repeat a word before completing a sentence"

OASES

The Overall Assessment of the Speaker's Experience of Stuttering (OASES) examines the entirety of the stuttering disorder from the perspective of the person who stutters Contains four sections: A. General information about the speaker's perception of stuttering B. The speaker's affective, behavioral, and cognitive reactions to stuttering C. The impact of stuttering on the speaker's functional communication abilities in key situations D. The impact of stuttering on the speaker's overall quality of life The OASES-E (for adults 18 and over) was published in English and Spanish by Pearson Assessments The OASES-S (for school-age children 7-12) and OASES-T (for teenagers 13-17) have also been published

How can you assess your patient's readiness for change?

The readiness ruler or a decisional balance worksheet

What is the main goal of fluency shaping approaches?

The ultimate goal is for the child to be able to COMMUNICATE whatever he/she wants, whenever he/she wants, with whomever he/she wants, using whatever reasonable manner he/she wants Why? o A completely fluent child may still avoid situations, rendering the newly fluent speech unless o We talk to COMMUNICATE not to be fluent

Know the CBT cycle and be able to give examples for stuttering and categorize examples given to you.

Thoughts, emotions/feelings, behaviors, physiological *see notes for cognitive model of the vicious cycle*

Preschool-age assessment: What information do SLPs usually gather from parents during the interview and why? For example, why do SLPs ask when the child started stuttering?

Time since onset Family history of stuttering Description of child's stuttering and its trajectory Child's temperament Knowledge about stuttering Awareness, reactions, and emotions of child to stuttering Reactions and emotions of parents to child's stuttering Does your child have more or less trouble talking when excited/pressured/rushed/angry/upset/fearful? Does your child have more or less trouble talking with peers/family/adults/strangers/in groups/one-on-one? What situations are the most difficult? Least difficult? (e.g. pre-school/day care/mother's day out, church, peer interactions) How do you respond to your child's disfluencies? What seems to help your child when he/she is stuttering? Has your child ever been teased about stuttering? What do you think might have caused your child's stuttering? Has your child ever expressed any concern/awareness about stuttering? VERY IMPORTANT Is there anything else you would like me to know? What do you hope to learn from this evaluation? At the end of the evaluation, please let me know if your child's speech during this evaluation is typical of the speech you hear at home.

What are the 2 aspects in the speech production that most direct therapy techniques try to modify?

Timing and tension

What are the main reasons adults join stuttering support groups?

To meet others who stutter To practice speech therapy techniques To share feelings, thoughts, experiences To talk in a safe space To learn and understand more about stuttering To help others feel better about themselves

What is URICA?

University of Rhode Island Change Assessment Score each of the following on a scale from 1 to 5 with 1 = 1 strongly disagree; 2 = disagree; 3 = undecided; 4 = agree; 5 = strongly agree There are 32 items in total with 8 for each of 4 stages of change: Precontemplation: e.g. as far as I'm concerned, I don't have any problems that need changing Contemplation: e.g. it might be worthwhile to work on my problem Action: e.g. I am actively working on my problem Maintenance: e.g. I have been successful in working on my problem but I am not sure I can keep up the effort on my own Scores for each subscale range from 8 to 40, with higher scores indicating greater endorsement of the relative stage of change

What does ... "Palin PCI is a facilitative rather than an instructive approach" mean?

Works with parents to facilitate a fluency enhancing environment; no instruction for the child given directly through the clinician

From HSTalks...Is there a risk to misdiagnose a bilingual child when doing a fluency assessment? If so is it false positive or false negative?

Yes - it is typically a false-positive 42 Speech-Language Pathologists out of 207 surveyed believe that bilingualism is a risk factor for the persistence of stuttering, even though there is no data to support this conclusion This mislabel may lead bilingual speakers to experience linguistic uncertainty, which may then lead to an actual increase in disfluencies.

What are some parent communication modifications in the family-focused treatment approach?

a. Educate the parents; Parents and clinician will i. Continue discussions started at the initial contact or diagnostic evaluation so the parents will have a greater understanding of stuttering. ii. Discuss information as needed so the parents are ready to assume the role of "home clinician." 1. Remember that counseling ≠ informing, so watch out for too much informing 2. We do need to provide information, but don't bowl them over with too many facts and try not to be too directive in treatment