spch chapter 8

The Lidcombe Program

-can reduce stuttering to zero or near-zero levels in children younger than age 6 -involves parent administered verbal contingencies for stutter-free speech and stuttering, as well as requests for self correction. -verbal contingencies are first administered daily during structured play, then during unstructured interactions. -weekly visits with the SLP involve direct measurement of stuttering and ensure the program is implemented correctly by the parent. -parents provide a weekly stuttering rating

effects of stuttering through the lifespan

-current evidence suggests that stuttering affects the ability to communicate and participate in life from an early age -stuttering can also have a negative impact in the workplace, and is vocationally disabling condition because employers view it as a disorder that decreases employability and opportunities for promotion. -individuals who stutter are more prone to anxiety, depression, and negative impact.

direct treatment

-explicit and direct attempts to modify child's speech and speech-related behaviors -children are taught to identify "hard" and "easy" speech produced by the SLP first, and then in their own speech. -then the SLP teaches strategies to increase easy speech and change from hard to easy speech when required

indirect treatment

-focus on child, parents, and child's environment -SLP shares info and teaches parents to provide slow, relaxed speech model for child -play-oriented activities that encourage slow and relaxed speech are a central component -no explicit discussion about child's fluent or stuttering speaking behaviors -goal is to facilitate fluency through environmental manipulation and is often effective for younger preschool children over a period of 1-2 months

efficacy of intervention with preschool-age children

-indirect and direct treatment approaches for this group have both been found to be effective, and might be more effective when combined -those in a parent-conducted program maintained their fluent speech in long-term clinical follow-up studies

treatment of stuttering in Older children and adults

-involve family members and significant others in the treatment process; and encouraging the individual who stutters to increase social connection with others may be more beneficial in the treatment of stuttering than just teaching the individual to modify his/her speech -teaching older children to be more open about their stuttering and acknowledging their stuttering in a casual manner can be effective -self disclosure of stuttering can be used

efficacy of intervention with adolescents and adults

-positive client-clinician relationships have been shown to contribute to successful treatment -studies suggest a 60-80% improvement rate, regardless of therapeutic technique

efficacy of intervention with school age children

-various treatment approaches and techniques for this age group are effective in establishing fluent speech, but the child's ability to use these techniques in various settings and maintain improvements is problematic -it is important to address the psychosocial aspects of stuttering.

10;100

If the SLP determines more than _____ disfluencies per _______ words spoken, it may indicate that the child has a fluency problem.

delayed auditory feedback

a speaker hears their speech after an instrumental delay; when a person speaks under this, his or her speech is slowed involuntarily.

70%

approximately what percent of children will recover from stuttering within the first 2 years after its onset?

2

at what age are whole-word repetitions, interjections, and syllable repetitions common?

3

at what age do revisions become the dominant disfluency type?

stuttering

characterized by involuntary repetitions of sounds and syllables, sound prolongations, and blocks

gradual increase in length and complexity of utterance program

effective in reducing or eliminating stuttering, particularly in school-age children

prolonged speech

fluency shaping technique that reduces speech rate; one of the most powerful ways to reduce or eliminate stuttering.

pausing/phrasing

lengthens naturally occurring pauses and adds pauses

clustered disfluencies

more than one disfluency in a word are common in young children who stutter and may indicate incipient stuttering

stuttering

more than two repetitions of an interjection

normal disfluency

one or two repetitions of an interjection

response-contingent stimulation

originated from operant conditioning paradigms

diagnosogenic theory

overly concerned parents react negatively to a child's normal speech hesitations and repetitions, causing anxiety in the child and increased stuttering

light articulatory contacts

reduces speech rate and physical tension before and during occurrences of stuttering, promoting smooth speech. Reduced tension is believed to prevent prolonged articulatory postures that interfere with smooth articulatory transitions.

response-contingent time-out from speaking

requires pausing briefly after stuttering; -pause serves as the consequence for stuttering -research shows reduced stuttering frequency to zero or near-zero levels -adolescents and adults who stutter have been taught to self-administer a time-out from speaking immediately after a self-identified instance of stuttering.

selecting intervention techniques

selection of a management technique depends on severity, the motivation and specific needs of the person who stutters and the SLP's knowledge of the available techniques.

demands and capacities model

stuttering develops when the demands to produce fluent speech exceed the child's physical and learned capacities. Fluency depends on motor skills, language production, maturity, and cognitive development. Children who stutter presumably lack one or more of these capacities. The DCM is a tool for understanding the forces that contribute to stuttering.

covert repair hypothesis

stuttering is a reaction to a flaw in the speech production plan. Poorly developed phonological encoding skills cause errors in the speech plan. Stuttering is a "normal" repair reaction to an abnormal phonetic plan.

cancellation phase

stuttering modification in which the individual completes the stuttered word and then pauses deliberately for a minimum of 3 seconds and produce a stuttered word slowly.

pull-out phase

stuttering modification in which the individual modifies the stuttered word during the actual occurrence of stuttering and involves slowing down the sequential movements of the syllable or word

The Packman and Attanasio 3-factor model

suggests that there are three factors that cause moments of stuttering: a deficit in the neural processing of language and inherent instability of the speech production system; triggers, or certain features of spoken language that are associated with greater speech motor demands that negatively affect an already unstable speech production system; and modulating factors, such as physiological arousal in an individual that can alter the threshold at which a stuttering moment occurs. Computer stimulation models have been programmed to stimulate stuttering, providing evidence for a disrupted speech motor control system in individuals who stutter.

fluent speech

the consistent ability to move the speech production apparatus in an effortless, smooth, and rapid manner resulting in a continuous, uninterrupted, forward flow of speech.

preparatory sets

the individual prepares to use fluency producing strategies before attempting the word and the goal is to initiate the word in a more fluent manner.

developmental stuttering

the most common form of stuttering; begins in the preschool years

decrease

the slowing of speech rate is accompanied by a substantial ___________ in stuttering.

gentle voicing onsets

the tension free onsets of voicing that gradually build in intensity

neurogenic stuttering

typically associated with neurological disease or trauma and is acquired after childhood

organic, behavioral, psychological

what are the three etiological theories of stuttering?

natural recovery

what are these behaviors generally associated with in stuttering treatment? -decrease in stuttering behaviors during the 12 months after initial onset -female children -no family history of stuttering or relatives who stuttered have fully recovered -receptive and expressive language and phonological skills are typical for the child's age -cognitive abilities are within the typical range for the child's age -the child has an outgoing, carefree personality and is therefore less sensitive to potential stressors in his/her environment.

Direct therapeutic techniques

what are these following examples of? -fluency shaping -stuttering modification

observation of the child speaking and a detailed parental interview

what are two important components of the evaluation of a child suspected of stuttering?

younger preschool years

what developmental framework is this: -periods of stuttering are followed by periods of relative fluency -the child will stutter most when upset of excited, or under pressure -sound and syllable repetitions are the dominant feature -stuttering occurs at the beginning of sentences, clauses, and phrases on both content and function words -most children are unaware or are not bothered by disfluencies and do not exhibit secondary behaviors

older preschool years

what developmental framework is this: -stuttering may begin to sound rapid and irregular -blocks may begin to appear, and increased tension of the speech mechanism may be observed -stuttering is more widely dispersed throughout the child's utterances. -secondary behaviors may appear; the child has conscious awareness of his/her stuttering and may become frustrated.

stuttering modification techniques

what direct therapeutic technique teaches the person to react to stuttering calmly, without unnecessary effort or struggle?

fear and anxiety about speaking

what do people who have developmental stuttering frequently exhibit?

secondary behaviors

what is eye blinking, facial grimacing or tension, and exaggerated movements of the head, shoulders, and arms?

stuttering moment

what is more than two repetitions of a sound or word considered?

detailed analysis

what is the primary component of the child's speech behavior in the evaluation of stuttering?

fluent

what kind of speakers repeat whole multisyllable words, interject a word or phrase, repeat phrases, or revise sentences?

neurogenic stuttering

what kind of stuttering can be more widely dispersed throughout the utterance?

developmental stuttering

what kind of stuttering usually occurs on content words?

neurogenic stuttering

what kind of stuttering usually occurs on function words?

stuttered

what speech involves certain core behaviors, including repetitions of sounds, syllables or one-syllable words, prolongations of sounds, or blocks, where an inappropriate stop in the flow of air or voice occurs during speech production?

psychological

what theory: -contends stuttering as a neurotic symptom, treated most appropriately by psychotherapy -has yet to provide a satisfactory explanation for the underlying cause of stuttering or its onset and development

school age

what type of developmental framework is: -fear and avoidance of stuttering begin to emerge -stuttering seems to be in response to specific situations -certain words are regarded more difficult than others and such words may be avoided -blocks are more common than repetitions and prolongations, and characterized by excessive muscular tension.

older teens and adults

what type of developmental framework is: -stuttering is in its most advanced form -the individual has developed a self-concept as a person who stutters -a primary characteristic is vivid and fearful anticipation of stuttering -certain sounds, words, and speaking situations are feared and avoided -longer, tense blocks are the most frequent core stuttering behavior, repetitions still occur but they are more rapid and irregular and may co-occur with blocks -secondary behaviors and circumlocution continue -evidence of embarrassment, helplessness, fear and shame are present

3&3

when is there an increase in disfluent speech?

organic theory

which theory : -proposes an actual physical cause for stuttering -may have been proposed, but all have failed to explain stuttering satisfactorily -there is renewed interest in the theory of cerebral dominance due to findings of structural and functional differences in the brains of adults with chronic developmental stuttering

behavioral stuttering

which theory: -asserts that stuttering is a learned response to conditions external to the individual -diagnosogenic theory

developmental stuttering

which type of stuttering occurs on the initial syllables of words?