Pseudostuttering Assignment Of Contract

CSD 2072: Fluency Disorders
Practice Assignment #1: Stuttering in Public (Due 2/6/06)

Purpose

(1)   To give you a sense of what it would be like to be a person who stutters so you can begin to understand what your clients experience on a day-to-day basis.

(2)   To give you an opportunity to practice a primary technique used in stuttering treatment

(3)   To begin to desensitize you to stuttering so you will not react negatively to you clients’ stuttering or shy away from desensitization activities your clients may need in treatment.

Assignment

First, practice stuttering with some from the class to make sure your pseudostuttering behaviors are repre­sentative of real stuttering and to help you feel more comfortable with pseudostuttering. Next, stutter openly in public in at least 10 situations. Be sure to vary your stuttering behaviors so they appear realistic. You should do this with a partner, in part to make the assignment easier, and in part so your partner can provide feedback to you about how well you stuttered. Your partner can also watch carefully for the reactions of the people you interact with during the assignment.

Examples of situations where you can do pseudostuttering include the following:

·          ordering at a coffee bar                                                             ·       asking for directions to a building on campus
·          calling information for a phone number                               ·       buying clothing at a department store
·          buying a book at the bookstore                                             ·       ordering pizza over the phone
·          ordering lunch in a restaurant                                                  ·       calling a radio talk show

Try to make this assignment as real as possible. Don’t just stutter once during the conver­sation and then be done with it. Try to become a person who stutters so you can begin to understand what our clients face on a daily basis.

Documentation

Post a summary of your experiences under the thread created for this assignment on the Black­Board website. In your summary, be sure to answer the following questions:

·          In what situations did you pseudostutter and what types of stuttering behaviors did you exhibit (severity, secondary characteristics, etc.)?
·          What were the reactions of the people you were talking to? What were your own reactions?
·          How did stuttering affect your ability to communicate?
·          Were some situations easier or harder than others? Why do you think that was?
·          Did pseudostuttering become easier or harder as you progressed through the assignment?

Finally, you should also include in your documentation a comparison between your experiences and the experiences of two or three of the students who posted their summaries before you.

Scoring

This assignment is worth a total of 30 points, as follows: For the pseudostuttering, you will receive up to 20 points (up to 2 points for each of 10 situations): 1 pointfor entering the situation and pseudostuttering and 1 point for continuing to exhibit pseudo­stuttering throughout the entire interaction (You will need your partner to help with the scor­ing.) For the write-up, you will receive up to 10 points: up to 4 points for your description of your reaction and the reactions of others, up to 4 points for your description of how stuttering affected your communication in different situations, and up to 2 points assigned by me for excellent write-ups.


CSD 2072: Fluency Disorders:
Practice Assignment #2: Evaluating and Measuring Speech Fluency (Due 2/27/06)

Purpose

(1)   To give you experience evaluating and measuring observable aspects of speech fluency

(2)   To help you develop intra- and inter-judge reliability in identifying disfluencies

Assignment

You will work in pairs or small groups for this assignment. First, each member of your group should work individually to review a videotape of a child who stutters (available in class) and determine:

·          The frequency of disfluency
·          The types of disfluencies
·          The average duration of stuttered disfluencies
·          The overall severity of stuttering according to the SSI
·          The child’s rate of speech in syllables per second

Second, after a few days, each member of the group should again review the tape individually and complete the calculation of stuttering frequency again in order to assess intrajudge agreement.

Finally, group members should compare their individual judgments of the videotape to assess interjudge agreement. In cases where interjudge agreement is poor, you

Yaruss, J.S. (1998). Real-time analysis of speech fluency: Procedures and reliability training. American Journal of Speech-Language Pathology, 7(2), 25-37.

Yaruss, J.S. (1997). Clinical measurement of stuttering behaviors. Contemporary Issues in Communi­cation Science
and Disorders, 24,
33-44.


CSD 2072: Fluency Disorders
Practice Assignment #3:What would it be like to be in stuttering therapy? (Due 3/27/06)

Purpose

(1)   To help you practice speech and stuttering modifications commonly used in treatment.

(2)   To help you understand the difficulties clients often face when use these techniques in the real world.

Assignment I

First, practice using the primary speech modifications we discussed in class until you are able to do them comfortably and accurately. The speech modifications you should practice include:

·          Slow speech (with pausing and phrasing)                          ·       Easy Starts                               ·                                                                                                            Light Contact

Next, use these three techniques in 15 different speaking situations. Make sure you get experience with all three techniques, not just the ones you find easier to do. In order to do this, you will first have to pretend to be a person who stutters (as in Assignment #1). Try to use the modification consistently like you want your clients to do. As with Assignment #1, you should do this in pairs so your partner can provide feedback about your stuttering, your modifications, and listeners’ reactions.

Assignment – Part II

First, practice using the primary stuttering modifications we discussed in class until you are able to do them comfortably and accurately. The speech modifications you should practice include:

·          Preparatory Set                                                 ·       Cancellation                                      ·       Pull-out

Next, use these three techniques in 15 different speaking situations. Make sure you should review the tape with your group to reach consensus agreement on the behaviors in the sample.

Documentation

Each group should post a brief summary of their experience with this practice assignment on the Blackboard website. Specific questions to address include:

·          What stuttering behaviors were observed in the tape?
·          What difficulties did you run into in counting stuttering behaviors?
·          How reliable were your judgments and what factors appeared to influence that reliability?
·          How could you improve your measurements?

Scoring

This practice assignment, which consists of 3 components (frequency count, reliability check, and write-up) is worth up to 30 points. For the frequency count, you will receive up to 10 points for calculating measures of disfluency (2 points each for frequency, duration, type, speaking rate, and severity). For the reliability check, you will receive up to 10 points for achieving and demonstrating intrajudge and interjudge reliability (5 points each). For the write-up, you will receive up to 10 points (up to 2 points for each of the 4 ques­tions outlined above, plus 2 additional points for citing novel literature on stuttering measurement.)

References

There is a huge literature on the reliability of stuttering measurements. I have prepared two tutorial articles outlining procedures for measuring stuttering; however, there is more literature you may wish to consider. For starters, here are references for the two articles I have written. get experience with all three techniques, not just the ones you find easier to do. In order to do this, you will first have to pretend to be a person who stutters (as in Assignment #1). Try to use the modification consistently like you want your clients to do. As with Assignment #1, you should do this in pairs so your partner can provide feedback about your stuttering, your modifications, and listeners’ reactions.

Documentation

Post a brief summary under the thread created for your small group on the BlackBoard website. For each part of the assignment, address the following questions in your write-up:

·          What was it like to try to change your speech?
·          Did the modifications come naturally?
·          Would you like to talk this way all the time? Do you think you would be able to do so if you tried?
·          How do you think a person who stutters feels when we ask them to do use such modifications?

You should also include in your documentation a comparison between your experiences and the experiences of two or three of the students who posted their summaries before you.

Scoring

This assignment is worth a total of 40 points, as follows: For the speech modifications, you will receive up to 15 points (1 points for each of 15 situations). The same is true for the stuttering modifications (1 point for each of 15 situations). For the write-up, you will receive up to 10 points: up to 2 points for answering each of the 4 questions above, and up to 2 points assigned by me for excellent write-ups.


CSD 2072: Fluency Disorders: Group Project and Poster Presentation

(To be presented in class 4/17/06 and 4/24/06)

Purpose

(1)   To help you evaluate new information about stuttering that might arise during you career.

(2)   To support the development of specific areas of interest in stuttering.

(3)   To encourage you to develop your own opinions about various topics in stuttering.

Project

You will work in small groups for this assignment. Each group will select a topic of mutual interest and prepare a poster presentation on the topic. Examples of topics that would be appropriate include:

·          Reading several personal stories of people who stutter and presenting a comprehensive review
·          Interviewing people about their knowledge and opinions about stuttering and presenting a review of your findings, including a comparison with existing literature
·          Interviewing practicing SLPs about their knowledge and opinions about stuttering and presenting a review of your findings, including a comparison with existing literature
·          Critically reviewing online resources for stuttering
·          Actively participating in the Stutt-L listserv and critically reviewing the contents
·          Attending several NSA meetings and conducting interviews with people who stutter
·          Critically reviewing material available for SLPs from the National Stuttering Association or Stuttering Foundation of America

Groups should select their topics by March 15 and get approval for the topic before proceeding. One topic that should be avoided is “reviewing movies about stuttering or people who stutter.” (That can be done for extra credit but not as a main project.)

Presentation

The poster presentation can be created either as a single large poster (several examples are available in the halls of Forbes Tower) or as a series of pages (PowerPoint slides) that will be printed and pinned to the wall individually. Half of the groups will present their posters on 4/17 and the other half will present their posters on 4/24. Students will have the opportunity to view other posters, ask questions, and discuss the content of the posters during each class.

Posters should reflect the work and participation of all members of the group; however, it will be left up to you to determine each members’ contributions. Specific topics to be addressed in your presentation will vary depending upon your project.

Handouts

Each group should prepare a brief handout outlining the group project, summarizing the important “take home” messages from the poster, and citing the appropriate references used in the project.

Scoring

The project and presentation will be worth up to 50 points, as follows: For the Project, you will receive up to 5 points for creativity in selecting the topic and up to 15 points for successfully completing the project. For the Poster, you will receive up to 10 points for coverage of your topic and up to 10 points for the quality of your poster. For the Handout, you will receive up to 10 points for including relevant details and citing appropriate literature. A final 5 points will be assigned for particularly excellent presentations.

Fluency last test- ppt & handouts

Treatment considerations for a person who stutters
THERE IS NO ONE WAY TO CONSISTENTLY TREAT ALL PEOPLE WHO STUTTER.
When setting Short-term objectives, three guiding principles should be kept in mind:
1) Make them MEANINGFULL
2) Keep them SIMPLE and ATTAINABLE
3) Set them up to be TRANSFERABLE to out-of-therapy situations.
Short-term objectives : hierarchies follow Where..
where: therapy setting, home, group setting, playground, classroom
Short-term objectives : hierarchies follow who..
Who: slp, teacher, parents, friends, bully
Short- term objectives: hierarchies follow.. LINGUISTIC (levels of target use)
word, sentence, monologue, friendly conversations, class presentations
Short- term objectives: hierarchies follow.. Situations (conditions of target use)
on the phone, in a public place, when being hurried, when angry with bully, when nervous
hierarchies: DESENSITIZATION (targets reflecting self-acceptance)
1.Elimination of secondary behaviors
2.Broadcasting: public revelation of stuttering
3.Decreased severity tolerated in various speech situations
4.Public use of speech techniques
TREATMENT CONSIDERATIONS:
For many school-aged children, areas to focus on may include
-How they think about themselves and what they know about stuttering (cognitive).
-How they feel about themselves and stuttering (affective).
-How they formulate messages as speech demands change (linguistic).
-How they manage the speech process (motor).
-How stuttering impacts interactions with various people in various situations (social).
Cognitive component treatment activities: talk about talking
Discuss the differences between normal fluency, normal nonfluencies, and stuttering. Use voluntary stuttering to produce imitations of child's stuttering pattern. Focus on physical (Motor) and emotional feeling (Affective). Increase awareness and self monitoring of different levels of speech fluency and disfluency through reading or story retelling tasks. Help the child learn, experience, modify, and believe that speech is under his/her control.
Cognitive component treatment activities: increase knowledge of stuttering
Use books/websites about stuttering...develop a trivia contest about stuttering:
Children: Sometimes I Just Stutter (SFA)
Adolescents: A Guide for Teens (SFA)
Main website: www.stutteringhomepage.com
What does the client believe "causes" his/her stuttering?
Cognitive component treatment activities: improve understanding of the speech mechanics & stuttering
1.Focus on how physiology of speech is connected to feelings and disfluent speech. Use a diagram of speech mechanism. Teach basic anatomy and physiology of "speech helpers":
2.Lungs as bellows to drive air, vocal cords as rubber bands that are vibrated, vocal tract modifications like different bottle size resonators, tongue and lips as "sound shapers and poppers".
3.Knowing what and how sounds are made helps de-mystify the speaking process. Teach understanding of the "speech machine."
4.Focus on positive aspects of client's speech. Help client achieve a feeling that he/she can be successful. Increase focus on what client CAN DO instead of what he CAN'T DO. Reduce mental effort involved in talking.
Cognitive component treatment activities: journal
With older children, have them journal responses to certain questions, perceptions, insights, awareness. Develop question of the week for reflecting upon: clinician and/or client driven questions.
Cognitive component treatment activities:Facilitate positive perceptions and cognitive "reframing":
1.Recognize successes and reward self. Focus on positive experiences.

2.Listen to "self-talk" and change the semantics to positive lexicons.

3.Enhance positive self-talk.

4.Have others present during speaking experiences and match perceptions of the experience.

5.Record (tape or video) and review successful speaking experiences.

6.Generate daily "I did it" lists: five things that make you proud.

7.Accept mistakes...everyone makes them. Decrease assigning blame.

8.Get "hooked into" self-help organizations.
Cognitive component treatment activities: Adjust reactions to perceptions of listeners
Contrast client's impressions of a communicative event with that of others: friend's, parent's, teacher's, therapist's. Video client in structured and unstructured speaking situations and check/analyze perceptions of the communication experiences. Test perceptions of how other listeners react (or DON'T react!). Are people listening to what you say or more to how you talk? Why? Compare speech of self with others on "target" parameters (rate, voicing, articulation accuracy, word mistakes (spoonerisms, slips), simple disfluencies, etc.).
Cognitive component treatment activities: Enhance awareness, monitoring, and use of sensory feedback systems
Develop use of auditory, tactile, kinesthetic, and proprioceptive systems. Identify and modify tension sights by grading tension. Explore what may contribute to a feeling of being out of control or having a loss of control of speech. Discuss what self-monitoring involves. Connect the "feeling" with the "producing" of speech.
Cognitive component treatment activities: Modify "cognitive secondaries"
Avoidance, substitution, circumlocution, starters.

Identify tricks (starters like "uh", "well um", sucked "tch") and eliminate or find balance in their use.

Identify sound, word, situation, people fears and practice desensitization, direct confrontation, or other modification techniques to manage them.
Affective component treatment activities may include: Develop an understanding
of emotional reactions to stuttering and about stuttering. How is stuttering related to how they feel about themselves? Explore worries and anxieties about talking.
affective: Use objects to represent stuttering and labels for emotional reactions:
Create a "stutter monster." Label & draw feelings child has
about stuttering. Draw, model, or design with clay figures, balloons,
paper activities. Help them manage their creations as they manage their speech.
affective: Playing with Stuttering
Use voluntary stuttering to reduce anxiety, sensitivity, and fear of stuttering. Use fake stuttering: easy vs. hard stutters. Teach child to stutter in different ways and play with stuttering. Play stuttering games: rewards for longest, loudest, craziest stutters.
affective: Attempt to normalize
feelings, emotions, and attitudes about stuttering. Create a "safe house" for talking. Desensitization and "De-awfulizing" stuttering. For some, it's OK to stutter, it's OK to fail, it's OK to feel bad about stuttering. Counter perfectionism. Engage in pseudostuttering.
affective: Desensitization processes and activities:
-Classroom sharing: teach others to stutter and assign grades to
performances. Teach teachers, parents, other students to stutter.
-Learn about famous people who have stuttered.
-Role playing how to deal with teasing responses.
-Interviews and surveys of other school children regarding stuttering.
-Develop stutter groups to share thoughts, feelings, experiences.
-Develop internet projects to learn more or communicate with others.
Definition: a positive or negative feeling toward some attitudinal object, which exerts an influence upon behavior.
so what about the definition of attitudes/modify
whether we do it consciously or not, our behavioral decisions are frequently based upon our attitudes.

Our job is to explore with the child stutterer, the bases of attitudes about or affecting the stuttering. These bases will include not only why he has the attitudes, but how he came to hold these attitudes.

This activity requires a lot of effort from both parties. Still, we can help a child explore and analyze a belief system while he is learning a more effective way of talking.
If we wish to change the thinking upon which attitudes are based, we need to provide an environment in which change is possible
There are four processes involved in attitude change:
Attention
Comprehension
Acceptance
Retention
Attitude Change processes: Attention
the child needs to be paying attention to what the clinician is saying! Beware! You may find a lot of head nodding and agreeing, even when the client really doesn't care too much about what you're talking about. It's important to be sure that your client is listening to you.
Attitude Change process: comprehension
validate the child is understanding what you are saying. We can assess attention and comprehension by simply asking the child to summarize, put in his/her own words, or restate what has been going on in therapy. This is an interesting exercise, because it shows us that what we think we are saying is not always what our clients are hearing.
Attitude change process: acceptance
The child agrees with what you are saying. With children who stutter, this may be a stumbling block. For example, the child who is convinced that he can't ask a question in class may not accept your argument that if he gives it a try, he might be successful. A challenge, then, is for you to find a way for him to test out what will happen if he asks a question in class.
Attitude change process: retention
The child remembers your comments. Using our present example, The child should be willing to try asking a question at some point in time after you've originally presented the argument.
Another change: "Rational Emotive Behavior Therapy (REBT, Ellis) is a humanistic, action-oriented approach to emotional growth which:
emphasizes individuals' capacity for creating their emotions
the ability to change and overcome the past by focusing on the present
the power to choose and implement satisfying alternatives to current patterns."
REBT is based on the idea that
it is the view people take of things that disturbs them, not the things themselves.
The stutterer's perspective on his speech, or other things towards which he holds some attitude, is derived from his thinking processes. A change in thinking should result in a change in affect.
Ellis presents REBT as an "A-B-C-D-E" model:
A is an activating experience
B is the client's belief about A
C the upsetting emotional consequences
D is disputing of irrational ideas
E is emotional change
An example of REBT Model: A
the activating experience, could be any attitudinal object, such as responding to a teacher's question in class.
An example of REBT Model: B
the irrational belief may be the inability to speak the answer. ("I can't talk in class", "the other kids will laugh at me")
An example of REBT Model: C
the emotional consequences would be negative affect associated with the verbal response. (note two components of attitude: the object (a) and the affect associated with the object (b). The Goal of REBT is to change the irrational belief of (b) into a rational belief, allowing for a change in affect (this may have to occur several times to be a completed change)
An example of REBT Model: D
disputing, where you actively dispute the child's irrational beliefs, using logical arguments, until he cannot successfully defend old beliefs about stuttering. This step is necessary for a change in (b) to occur. A dispute might be to simply say "yes" or "no" to a teacher's Yes/No question. The successful verbal response is a change in behavior that contributes to a change in a belief system. However, there is a somewhat tenuous relationship between attitudes and behavior
An example of REBT Model: E
emotional change, moving toward a more positive affect regarding responding to teacher's questions in class. This does not necessarily mean there will be a positive affect associated with answering class questions, or even that there will be no effect associated with the experience. Often, all we are talking about is a reduction in the amount of negative affect. It must be stressed that change in a belief system is going to take time.
Linguistic: Keep it relevant
Structure therapy around topics of interest to the client. With child's input, select a topic of discussion that will support the communication interactions in therapy.
Linguistic: Use linguistic context to support speech modification skills
Across sessions, build on success but also challenge the child to managing speech at higher levels of language use. Increase the flexibility in language use as the demands of the speaking situation change. Also, increase the flexibility in language use through changes in semantic complexity and changes from contextualized speech contexts to decontextualized speaking tasks. (Systematically increase linguistic complexity: think hierarchies.) Effective programs control and modify the length and/or complexity of utterance as in ELU and GILCU. Another choice is the SDS model.
Situational-Discourse-Semantic (SDS) model definition:
The SDS model allows the clinician to manipulate many variables that may affect language and speech fluency functioning at many levels. Themes may be selected by the child, clinician, or jointly which will hold interest for the child.
SDS model- dimension: situational
The theme may be presented in a contextualized or decontextualized situational context. In either context, stimuli may be hierarchically arranged from ego-centered (talk of own experiences) to decentered (talk of observed experiences) to relational (talk of sequences, ongoing experiences, of familiar experiences) to symbolic (talk through pretend, story telling, picture descriptions [contextualized], or through reading, spontaneous talk of unfamiliar or not-present topics [decontextualized], to logical (spontaneous or suppositional speech).
SDS model- dimension: Discourse
The quality of what is to be spoken can be also hierarchically arranged from simple to complex forms. Examples may move from simple naming objects or pictures, to organizing them into labeled groups, then provide descriptions of various items, then order or sequence activities, then move to explaining phenomena, describing interactive effects, problem solving, comparing and contrasting, and finally discuss two or more ideas concurrently or taking different perspectives on thematic material
SDS model- dimension: semantics
These hierarchies move basically from short to longer utterances.
The idea is to manipulate speech fluency and/or language variables in one or more areas to enhance the child's level of success in each area. The strategy also allows a framework through which one may move a child to greater levels of communicative functioning.
**Levels
Levels of Semantics-SDS model
1.Label-"Name the different parts of the speech system"
2.Description-"Tell me what you do when you stutter"
3.Attribution-"Tell me three different ways a person can stutter"
4.Interpretation-"Why is slowing down helpful?"
5.Inference-"What might happen if you stuttered when answering a question in class?
6.Evaluation-"Why do you think it is hard to talk on the telephone?
7.Analogies-"How is stuttering like a clog in a pipe?"
Linguistics: Integrate linguistic level with other CALMS components
For example, at a given linguistic level, have child focus on self monitoring of a speech strategy while describing, interpreting, discussing, etc. while maintaining eye contact with clinician and/or different listeners. Afterwards, probe the child's feelings and emotions.
clinical decision: calms model
Traditionally, the determination to treat articulation or language problems before, during, or after treating fluency problems is often a child-by-child decision
With the CALMS model, you can treat language integratively as a component of the communication deficit
The demands for speech and/or language functioning compete with the resources available for fluency functioning. Clinical decisions regarding children with multiple impairments will be based on child's particular capacities for learning and responses to communicative demands
Motor components: the 3 D's
Discuss (explain) how fluency and stuttering are produced. Draw it and map it out. Focus on how and why techniques make talking easier. Repeat explanations often. Have child put into own words.

Demonstrate (show) what happens during fluency and stuttering.

Drill (practice) skills that promote fluency. When a stuttered moment occurs, have child explore what needs to change. Make technique sound natural
Motor components: Create speech "Tool box"
using a tool box analogy to select core set of strategies or decide which fluency shaping and/ or stuttering treatment techniques seem best for the client.
Teach fluency enhancing skills that match the disruptions in the client's speech system (e.g., easy onsets for phonatory disruptions, light contacts for tense blocks).
Teach pullouts, preparatory sets, and cancellations for those who are good at catching or feel comfortable working slowly through stuttered moments
Motor component: have child rate performance
Use 1-5 or 1-10 rating scale for evaluating success of performance. Scale muscle tension and effort - from tight to relaxed speech postures and movements. Use a scale the client can mark. Clinician and child can compare ratings.
Motor components: Contextualize, Conceptualize, Generalize:
Use diagrams, drawings, analogies to help child understand how and why each strategy helps make talking easier.
For example:
-Mountains or slide for easy onsets of phonation.
-Stretched words and hooked words for continuous phonation.
-Four wheel drive out of mud or gradual opening of clinched fist
for pullouts.
-Butterfly landing on flower or any light touch for light articulatory contacts.

Generalize strategy use to a variety of speech situations and with a variety of listeners. Vary performance of strategies, from extreme to minimal use.
SPECIFIC MOTOR COMPONENT TECHNIQUES
Respiratory Management
Many children develop aberrant breathing patterns in response to their stuttering and as a way of controlling the stuttering. One may observe shallow, quick inhalations, talking on inhalation, or talking after most air is expired (on expiratory reserve volume). Exercises can be directed to easy passive (non-speech) breathing that is gradually modified to easy breath for voice.

Sometimes teaching "belly breathing" in supine, standing, and sitting positions with variants on depth and rate of breathing is useful. Sometimes drawing wave-like lines with the breathing in and out motions increases awareness of breath control.

For older children, simple diagramming of anatomy and physiology in speech respiration may be useful.
For those with "rushes of speech" with exhaustion of airstream, breaking down utterances into smaller units is helpful. Teach "chunking" of words in phrases to facilitate appropriate inhalation and exhalation cycles. Encourage slowing down initial rate of speech in a phrase and cue child to "pause a second" to facilitate more natural breath cycles for speech
For those who seem to have laryngeal tension or tightness in the throat. The idea is to dilate the pharynx. Methods include yawn-sigh, fog-the-mirror, and "hot potato". The larynx is typically lowered during this maneuver and the client feels a great deal of "looseness" or "openness". Good technique to relax laryngeal and pharyngeal structures
This is also called "gentle voice onset" or "easy voicing/talking". The importance is to feel and make a smooth transition from air movement through the glottis to activation of the vocal folds. Images include rheostat movements, light changes from day to night and vice versa, taking off like a glider versus blasting off like a rocket ship, "unkinking" a water hose, and line-to-wave images. Good for vowels and voiced consonants
Also called "keeping the motor running", "vibrating your throat", and "smooth talking". It is the vibration and stretched out voicing across speech sounds often heard with DAF speech. The end of one sound or word is blended into the next. I encourage clients to listen to newscasters, who tend to use continuous phonation during their reporting. Technique helps keep speech forward moving and pleasant sounding. If used to excess may sound "robotic"
Light articulatory contacts
Also called "light talking" or "easy talking". Great for reducing tension and impeded airflow when consonants are produced with excessively hard pressure. Can be used to prevent a stuttered moment or as a technique to move out of a stuttered moment. Encourage very soft, light, barely made contacts of the articulators...using "soft sounds" instead of "hard sounds". Be sure contact is LIGHT and NOT ABSENT. Use of images such as "pillows between the points of contact", "floppy like a rag doll", "leaves lightly falling", or "articulators touching like a butterfly landing softly" are helpful. Requires good awareness of various forms of sensory feedback
This is simply reducing the articulatory rate or syllables per second an individual is speaking. May be aided with a metronome. May be aided with contrasting fast images (rabbit-speech, Road-runner rush, Tigger-the-tiger cadences, four-wheel drive) with slower images (turtle-speech, snail-speech, eeyore speed, bicycle coasting). Also pace of child-clinician interactions may affect speaking rate---if the clinician responds slower and with paced speech, the child may follow suit. It will affect the cadence of communicative interaction in a way that enhances fluency. Encourage LISTENING to the differences in speaking rate
This is another rate affecting technique where sounds are stretched out and gently blended from one into the next. DAF is a common form through which syllables which are stretched for up to 250 milliseconds (one-quarter of a second) are gradually shaped into normal (but slower than originally) speech rates. Degrees of differences can also be described and demonstrated from super slow motion speech to varying degrees of slow motion speech to clinician and eventually child-cued rate control with prolongations occurring when stuttering moments are anticipated and immediately felt
Modifying the stuttered moment:
the purpose is to NOT eliminate the stutter but replace it with a new form of "easier" or "more fluent" stuttering. Gives the client a sense of control of his stuttering, not elimination of it.
This is considered an "after-stuttering" modification of the stutter. After the word is stuttered, the client pauses momentarily and repeats it with an easier production, "canceling" the more severe stuttered event. There should be a pause prior to the cancellation so the client can reformulate and/or modify the word or tension with greater success. Considered to be a useful method to desensitize with regard to the stuttering as well as give opportunity to analyze and improve performance on troubling sounds and words
This is a "during-stuttering" modification of the stutter. With the self-analysis and increased awareness of the stuttered moment from cancellation, the stutterer is moved to manage the problem areas DURING the stuttered moment, releasing tension or modifying specific parameters (in respiration, phonation, and/or articulation) to release himself (pull-out of) the stuttered moment. Once pulled-out of the stutter, the client resumes with the verbal message
This is a "before-stuttering" modification of the stutter. The client may anticipate or "feel" a stuttering moment arriving and, instead of avoiding or substituting the anticipated stutter, approaches it with a smooth form of stuttering. The person pre-plans (as opposed to reacting/responding to) the stutter but incorporating a fluency inducing gesture (i.e.: easy voice onset, light contact, managed breath flow). In this way the stuttered moment is managed prior to it becoming a fully stuttered event.
Catch the stuttered moment AS IT HAPPENS and have the client hold onto the moment: freeze it. Extend the grasp of the stuttered moment then volitionally let it go. This helps catch (increase awareness) and control (modify) moments of stuttering. Also increases confidence that the client is able to manage his speech.
A simple technique of purposeful, self-directed and controlled "stuttering". The client volitionally creates disfluent moments of his/her choosing and demonstrates self-management of the speech mechanism. This helps take out some of the "scariness" of stuttering (desensitize), helps "dump out" disfluencies from their system, as well as empower the client with a sense of internal locus of control.
Social component: Dont hide stuttering
Focus of activities is on removing avoidances and fears associated with speaking in a variety of situations to a variety of people. "Broadcast" by openly acknowledging the stutter or engage in pseudostuttering.
Social component: homework assignment
Develop speech practice contract and negotiate conditions of the assignment (who, when, where, how long, topic of discussion, skills that will be practiced, etc.)
Social Component: Role play various speaking situations
Begin with school related communicative interactions and with different communicative partners (peers, teachers, school secretary, para-educators)
Social component: Take therapy on the road
conduct therapy in environments other than treatment room and/or classroom.
Social: Discuss features of effective communication
A. Being a good listener and maintaining eye contact.
B. Not interrupting someone else.
C. Contributing to the topic of discussion.
D. Being sensitive to conversational turns.
E. Being willing to talk to anyone at anytime, anywhere.

-Move systematically through easy to difficult speaking situations.
-Help the client become more comfortable using a technique in public
-Help create positive communicative interactions with the family.
-Reduce the impact of "fluency disruptors" (time pressure, people interrupting, loss of listener, etc).
social: Brainstorming solutions through semantic mapping
These are simple paper and pencil "mapping" strategies to deal with issues in any of the treatment areas discussed in the non-therapy world. The maps guide the child, through child-clinician discussion, in understanding issues related to various communicative competencies.
Semantic maps:
- children understand "how", "why", "where", and "when" issues.
-Help provide new insights, perspectives, methods of implementing change.
-Aid in transfer, generalization, and maintenance of learned skills.
social: Explore strategies that may affect social conduct:
Develop and give the child methods for dealing with issues of self-esteem, school performance, peer interactions, and others' responses. 39
Social: Situational hierarchies
-Breaking one speaking context into component parts (i.e.: required to orally read one word, vs. short phrase, vs. sentence, vs. three sentences, etc...)
-Breaking down situations from easiest to hardest for speaking in academic or nonacademic situations.
Social: Environmental manipulations
-Identifying and managing classroom demands (i.e.: giving oral reports, oral reading sequences, being called upon in class).
-Helping teachers identify/reinforce verbal attempts and successes.
-Managing distractors, increasing time for responses, managing teacher feelings and responses.
-Helping teachers manage linguistic complexity or length requirements of response requirements in class.
Education and effective communication:
-Sharing and teaching about "differences" in different people
-Teaching others about stuttering or self with regard to stuttering.
-Demonstrating and encouraging speech modification techniques.
-Keeping open acceptance of the stutter and focusing on the "what" of utterances versus the "how" of utterances.
-Initiating and ending conversation.
-Learning and following appropriate turn-taking rules.
-Using appropriate eye contact.
-Resisting time pressures...internal or external. Injecting pause time.
-Practicing strategies to "jump into" conversations.
Dealing with bullying and teasing
Forty-nine to 58% of elementary school children experience bullying at some time in school. For children who stutter, the incidence rises to 81% (Langevin, 2001).
Although the problems and intervention strategies will differ from child to child, Murphy and Quesal (2002) recommends four areas through which the School SLP may intervene
1) Desensitizing children to stuttering behavior
2) Teaching children who stutter to be assertive
3) Increasing children's self-esteem
4) Educating classmates about stuttering and bullying behaviors
"well DUH!"
"I can see you're well educated!"
"Careful! It's contagious!"
"No, no, no....you're doing it all wrong. It's done like this (demonstrating a pseudostutter with exaggeration)."
"Did you have to go to school to figure that out?"
Cooper (2000) provides a series of strategies in assertiveness training such as
self-expression, self-disclosure, deflecting and verbal repetition. Examples include teaching children to use "I" statements confidently and clearly: "I'd rather not be teased that way" or "I'd prefer you stop that".
Mighty Might responses include
repetitions of the phrase "you might be right."
Repetitive phrase might be
"So what?" or "Because I want to" or simply "SO?"
shrug the shoulders, look away, and act bored
where the child simply leaves and goes to a safe place or near adults if physical harm is feared.
where the child quips back with sarcastic kindness
Remember we need to address the interaction of:
Motor components which will be affected by Linguistic components having effects upon Affective and Cognitive components ultimately affecting Social components feeding once more back to each of the other components!
The ultimate treatment goal is to
help a child believe, feel, and talk in a way that's comfortable for him/herself. This may include anything from engaging communication regardless of stuttering, to modification of stuttering, to fluency in all contexts and conditions. But above all, it means becoming an effective communicator
Children who stutter need to see that they should not hide from their stuttering
that it's OK to stutter, and with time and effort, they can learn to talk in an easier way.
Approach therapy as a dynamic, multidimensional process. Many factors interact to maintain the disorder and multiple factors need to be addressed in therapy.

There isn't one approach that will work for all children who stutter. Tailor the therapy to the needs of the child through decision making and problem solving.
success may be one of the several possibilities:
Talking is easier & less tense ...not just fluent. Stuttering has become less severe.

Attitudes and emotions about self and stuttering have improved.

Perceptions of stuttering by client, parents, and teachers have improved.

A client understands that fluctuations in fluency will occur
but through therapy, they know WHY.

The client is able to convey message in an efficient manner, recognize listener needs, and maintain topic of discussion, and manage stuttering the best way possible.

Fluency in all communicative conditions.
Decision making in the treatment of children who stutter
decisions are not clear due to the complex nature of the disorder.
Questions to ask yourself:
1.how confident am I in treating stuttering?
2. what is the long-term goal of treatment?
3. which philosophical approach will i adopt?
4. how will i document changes
5.are there external factors that may influence treatment
6. what is a realistic short-term goal?
7.why is the child making slow progress?
8.have i been an advocate for educating others?
9. if goal has been met, have behaviors been stabilized?
10. should i dismiss child?
intervention/transfer strategies: PROLAM-GM
Treatment:
-For preschool clients- Onslow's Lidcombe Program, Starkweather's parent home prevention program
-For school age children-Ryan's monterey GILCU program
-For adolescents and adults-stutter free speech program
synergistic stuttering therapy is
an integrated approach combining short-term intensive as well as long term. evaluation of: speech/language, attitudes/feelings, and environmental factors.
disorder of stuttering must be analyzed and treated from a synergistic perspective. that is that we must isolate the individual social, cognitive, and biological factors that interact in the lives of each person who stutters and be aware of the effect of the interaction of these factors.
factors for synergistic approach:
speech-language factors, attitudinal factors, and environmental factors.
1st year: emphasize on learning and transfer of new speaking in the domains of language, learned behaviors and motor skills, exploration of the affective, and environmental features. next 3 years are devoted to maintaining these new skills. last year encourages more independent study
synergistic: components of- establishment, stabilization, transfer, maintenance
establishment- emphasis on teaching of techniques that enhance natural respiration, phonation, and articulation.
Stabilization- intensive drill and practice
transfer- 8 week phase one-hour-long session where there is therapy outside the therapy room,journaling has been successful to heighten our awareness.
maintenance-prepare clients for more independent monitoring of their speech. practice and reinforced skills.
preschool treatment model objectives:
increase fluency through gradual increase in the length and complexity of the response. slow easy speech is replaced with a natural speech pattern that matches the childs fluency.
preschool treatment model : steps in the program
1. single words, slow & easy speech
2. carrier phrase, slow & easy speech
3. aid & have child instruct adult on slow on easy speech
4.sentence responses with slow speech
5. phrase length with slightly faster speech
6. phrase length with "natural" speech
7. conversation with natural spa.
8. convo involving others
indirect vs direct therapy
DT- has evolved into the most common approach for children who show multiple signs of stuttering
IT- might be warranted for children who are borderline disfluent or are in a "watch and wait period". Best approach is both therapy.
rely heavily on experience and memory of specific events in order to understand meaning and concepts. keep activities highly contexualized then proceed to a decontexualized context. clinicians need to model slow easy talk, reinforce, slow vs fast, smooth & bumpy
sample short term goals appropriate for an elementary school age child who stutters
1. determine child's intellectual & emotional awareness
2. making changes in how child stutters or created a more fluency
3. learn about stuttering
4. focus on becoming a good communicator rather than being a fluent speaker
Helping parents manage their childs stuttering:
1.explain to parents that treatment is a process, not a product. no "fix it"
2.not easy to change the way one talks, do handwriting tasks
3. have parents journal
4.help parents get comfy with stuttering & look at positive things
5. be a good listener
6. parents should use encouraging praise
7. communication improves on: use "i" instead of "you". example: i see instead of you should & not interrupting each other
manipulating linguistic complexity
contextualization: sensorimotor
discourse complexity: lowest degree occurs when discussing disconnected events & greatest degree is required when asked to coordinate multiple subjects
MLU
suggestions for parents who have a disfluent child
1. listen & don't interrupt
2.try to make talking fun and speech is not on display
3. avoid competition to speak among family members
4. realize child will stutter more when: tired, excited, talking to strangers, asked to tell an adult something, talking to an impatient listener
5. don't suggest "to slow down" "think before u speak". only listen to what and not how its being said
6. model a slow, easy, relaxed speaking style with short simple phrases
7. its ok to talk to child as long as its a non threatening manner. its okay to make mistakes
activities for managing emotions and attitudes
1. be a good listener and don't be judgmental
2. show a chart with different types of stuttering and have child imitate stuttering patterns
3. stuttering is no ones fault
4. practice voluntary stuttering
5. describe feelings towards stuttering
6. draw stuttering monster & destroy it!
7. use play-doh and have it represent negative emotions. Smash it!
8. have child teach others how to stutter and have the child grade performance
9. talk about how to handle teasing
10. keep a journal
scaffolding strategies for providing feedback and assistance
expansion, comprehension, preparatory, cloze procedure, binary choices, relational terms, summarization questions, expectant pause
(Fluency-Initiating Gestures)
SLOW: a reduction in speech rate through prolongation technique-prolong each syllable
EASY: gentle onset phonation-yawn approach
DEEP: consciously controlled inhalation prior to initiation of phonation
LOUD: conscious and sustained increase/decrease in vocal intensity
BEAT: change in prosody of speech by randomly altering loudness, rate, pitch, stress
SMOOTH: reduction of phonatory adjustments and the use of light articulatory contacts. continuous phonation

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