Evolving Communicative Competence in School-Age Children … · 2020-02-11 · From this workshop...
Transcript of Evolving Communicative Competence in School-Age Children … · 2020-02-11 · From this workshop...
EvolvingCommunicativeCompetenceinSchool-AgeChildrenWhoStutter
KristinA.ChmelaM.A.CCC-SLPBCS-FOwner&Director,ChmelaFluencyCenter
DirectorofTraining&TherapeuticPrograms,
CampShoutOut
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KristinChmela,M.A.,CCC-SLPBCS-F,spendsthemajorityofhertimeworkingwithindividualsofallageswithfluencydisordersatherclinic,ChmelaFluencyCenter,inthesuburbanChicagoarea.Sheisarecognizedlectureronthetopicofchildhoodfluencydisordersacrosstheworld.SheisCo-FounderandCo-DirectorofCampShoutOut,atherapeuticprogramforschool-agechildrenwhostutterandahands-ontrainingopportunityforprofessionalsandgraduatestudents.KristinwasformerChairoftheAmericanBoardofFluencyandFluencyDisorders,supervisesgraduatestudentsfromacrosstheglobe,providessmallgroupintensivetrainingsathercenter,andhasservedasadjunctfacultyatNorthwesternUniversity.Throughouthercareer,KristincollaboratedextensivelywiththeStutteringFoundationontrainingvideos,conferences,andpublications.Sheisleadauthoroftwopracticaltherapymanualsandprovidesongoingconsultationservicesforseveralareaschooldistricts.Asapersonwhogrewupstuttering,Kristinhasremainedpassionateabouthelpingpeoplewhostutterandthosewhoservethem,evenafter32yearsinthefield!Kristincanbepersonallycontactedatkristin@chmelafluencycenter.comorat847-383-5589. Chmela2019/AllRightsReserved 2
DisclosureStatement:KristinChmelaM.A.CCC-SLPBCS-F• NonfinancialNonon-financialrelationshipstothecontentofthispresentationaredeclared. • Financial
-BasicPrincipleProblemSolving:WorkingwithSchool‑AgeChildrenWhoStutter;Chmela,K.&Campbell,J.(2014)SuperDuperPublications;royaltypayments-FocusonFluency;SuperDuperPublications;royaltypayments-FluencyFlips;SuperDuperPublications;royaltypayments-DirectorofTrainingandTreatmentProgram;CampShoutOut;Holton,Michigan;onsitehonorarium
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Fromthisworkshopparticipantswillbeableto:1)Assesscommunicativecompetencewithintheschool
settingforfluencycases2)DevelopDifferentialEvaluationandTreatmentplans3)Implement3strategiesacrosseachoftheFiveAreasof
FocusofCommunicativeCompetenceAswellas:-Atypicaldisfluencycases,makingdecisionsabouttherapyforpreschoolers,goalwriting,andmore
Ø School-AgeStutteringiscomplicated
WhatcanwedoNOWtomakethispresentproblemevolveinapositivemanner? 5
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-Whatcausesstuttering?(Smith&Weber2016)
“…Wearenowatapointintimewhentheanswertothisquestionnolongermustbe“wedon’tknow.”Itisnowwidelyacceptedthatstutteringisamultidimensionaldisorder.Itisalsowidelyacceptedthatstutteringisaneurodevelopmentaldisorder,whichmeansthatitarisesduringdevelopmentinchildhood…”(emphasisadded)
Ø School-AgeStutteringiscomplicated
-Canweviewstutteringasanisolatedproblem?Briley,P.M.,&Ellis,C.(2018).Thecoexistenceofdisablingconditionsinchildrenwhostutter:evidencefromtheNationalHealthInterviewSurvey.JournalofSpeech,Language,andHearingResearch.
-Presenceofatleast1moredisablingdevelopmentalconditionwasatleast5.5timeshigher-Higheroddsforintellectualorlearningdisability,ADHD,seizures,autsim/Aspergers/pervasivedevelopmentaldisorder/otherdevelopmentaldelay-Existenceofotherdifficultiesshouldbeconsideredaspartoftheoverallmanagementplan
Ø School-AgeStutteringiscomplicated
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-Dothecontributingfactorsmatter?MultifactorialDynamicPathwaysTheory(Smith&Weber,2017)
-Doestheapproachincludemorethan“speechtechniques?”Hughes,C.D.&Mahanna-Boden,S.(2017).Resultsfromastutteringclinicforschool-agechildrenwhostutter:apilotstudyusingacomprehensiveapproach.PerspectivesoftheASHASpecialInterestGroup.
Ø School-AgeStutteringiscomplicated
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Ø School-AgeStutteringServices
-Ongoingproblemsolving:referencingandinterpretingtheBasicPrinciplesaccordingtocurrentknowledge,evidence,andresearch
-Identifyingschool-basedchallengeswithin
3areas:content,process,&integration(Chmela&Johnson,2018)
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Dr.HugoGregory
Relationship
Counter-Conditioning,Desensitization
DifferentialEvaluation&Treatment
GuidedPractice
Modeling
Reinforcement-Self-Monitoring&SelfReinforcement
Generalization&Transfer
GradualDismissal&Ongoing
Maintenance
IntegrationofChild+
EnvironmentalFactors
Chmela&Campbell,2014;Gregory,1968;2003
Basic Principles help us guide the clinical process of positive change
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BeaDifferentialThinker11
Family
EnvironmentThe Big Picture
Executive Functioning
MotorSocial Emotional
SensoryLanguageCognitive
Child
What is the pattern of fluency?
What are the relevant potential contributing factors?
What are the strengths/weaknesses of the child’s overall Communication Profile?
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Fluency Evaluation Options Formal Measures Informal Measures
Motor Ø TestofChildhoodStuttering(Gillam,Logan,&Pearson,2010)Ages4-11
Ø StutteringSeverityInstrument-4(Riley&Riley2009)Ages3-up
Ø Formalarticulation,phonology,oralmotor,voice
assessmenttoolsifneeded
InformalOptions:seecontinuumnextpageØ RatingsofStutterLikeDisfluencies(Onslow&Packman,2003Ø RatingsofOtherDisfluencies/RateofInformationflowØ RatingsacrossvariousspeakingsituationsØ SystematicDisfluencyAnalysis(Campbell&Hill,2003)Ø Real-TimeAnalysis(Yaruss,1998)Ø On-line%StutteredSyllables(Onlsow&
Packman,2003)Ø Cursoryoralmotorandvoiceassessment
Contributing Factors
FormalOptions:Ø OverallAssessmentoftheSpeaker’sExperienceofStuttering(OASES)(Yaruss,Coleman,&Quesal,2010);ages7-12;13-17)Ø BehavioralAssessmentBatteryforSchool-AgeChildrenWhoStutter(BAB),(Brutten&Vanryckeghem,2006);ages6-15ANDØ Languageevaluationmeasures
Ø SinglewordReceptiveVocabularyassessmentand
Ø SinglewordexpressivevocabularyØ ShortSensoryProfile:caregiver/parent,teachers;childifageappropriateORSensoryProcessingMeasure
Ø Detaileddevelopmental,medical,andacademichistory;reportofotherconcernsordiagnoses;culturalfactors
Ø Informalanalysisofspontaneousspeakingsample
Ø Informaldialogueregardingperceptions,
feelings,andexperiencesrelatedtotheproblemaswellasadverse
Ø Pencil-PaperTasks;(Chmela&Reardon,2001)Ages8-TeensØ Parent&TeacherChecklists(Chmela&
Reardon,2001;Reardon&Yaruss,2004)
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FluencyCaseSummary
Motor Social-Emotional
Sensory Language Cognitive
FluencyPattern&PotentialContributingFactors
ModerateStuttering;blocks,prolongations;tensereactionswithheadmovements
Significantfrustrationwithinblocks;Pragmatic-peerissues
Significant
RiskFactors VeryHigh
ExecutiveFunctioningSkills&OtherDiagnoses
q Difficultiesobservedq Diagnoses:HighFunctioningAutism;ADHDq Moderateimpactofstutteringproblem
PresentStudentNeeds:q Communicationwithinsmallgroupinteractionsq Increasedself-initiatedpeerverbalinteractionsq Increasedeffectivenessofmessagescommunicatedviaeasierrelaxedapproachto
onsetofphonation,pausing;self-adjustmentsoftension;assertivenessregardingneedingincreasedtime;healthyreactionstocommentsregardingstuttering
q Ongoingcommunicationregardingstatusofself-perceptionsoffluency
Informalcasesummaryworksheet:Gage9-3
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DevelopingGOALSforStutteringTherapyØ Frequencyofcommunicationascomparedtosame-agepeersacrossacademicenvironment
-Measuredacrossratingscalescompletedbycaregiver/s,student,teacher/s,SLP-Mayleadtogoalfocuseduponincreasingcommunicationwithincertainspeakingsituations
Ø Competencyofcommunicationascomparedtosame-agepeers
-Measuredacrosscaregiver/sreport,studentreport,teacher/s,SLP-Mayleadtogoalrelatedtomodificationsofvariouscommunicativebehaviors(see5AreasofFocus)acrossvariousspeakingsituations
Ø ProgressindicatedacrossRubricsrelatedtowhatwilloccuracrossspecificsituationswherebyfrequency/competencyisbeingtargeted
-Utilizingrubricsaccountsforthevariabilityofstuttering
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• G.willdemonstratepresentengagement(self-regulatingbody,connecting,inhibitorycontrol)making2ormorerelevantcontributions(buildinguponothers’ideasorexpressinghisown)withincollaborativegroupdiscussionsasmeasuredbycorrespondingrubric(0-4RatingScale;with3asanoverallaverage)by…
• G.willcommunicatewithinsmallgroupinteractionsandself-initiatedpeercommunicationswhilecommunicatinginvarioussettingswithafrequencyof3(basedupon0-4Rubric))completedbystaffobservationsby…
• G.willdemonstrateavarietyofmodifications(Easier-RelaxedApproach-SmoothMovements-Phrasing;Pausing;Self-AdjustmentstoTension;TurntheQuestionAround)whilecommunicatinginvarioussettingswhileansweringquestionsanddemonstratingnarrativeswithafrequencyof3(basedupon0-4Rubric)asmeasuredbyacomparisonofhisself-ratingtostaffrating(75%correspondence)by...
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BriefOverviewofTreatmentStrategies:Gage9-3Attentive
Awarenessofthoughts,emotions,&body;situation
&resultantactions
AssertiveInitiating,participating;advocatingforoneself
ConfidentBodylanguage;Voicevolume&strength
EffectiveCommunicatingwith
greaterease;intelligibility,
organization,&clarity
ProactiveEngaginginsetting
oneselfupforevolvingcommunicativesuccess
q Breathawarenessq Mindfulnessq ReflectivelisteningExecutiveFunctioning:(Skillstargetedwithinacademicandhomeenvironment;reinforcedthroughoutspeechtherapy)q Self-Regulationq InhibitoryControlq Shift-Sustainq SensingTimeq CognitiveFlexibility
q SocialLanguage(Sociallanguagegoalsformulatedandarereinforcedwithinfluencytherapyandthroughouttheacademicday)
q FirsttoApproachq Talkingforyourselfq TalkingMoreq SayingAllWordsq Nonverbal-Verbal
Notingq Self-Advocacyq Educatingothers
abouthiscommunication&stuttering
q Coreseated&standingpostures
q Handshakeq Naturaleye
contactq Bodylanguageq Volume-powerof
voice
q Varyingintent&expression
q Pausingwithvariationq Phrasingwith
variationq Expressive
Organization:Completesentences;Narratives;Answeringquestions(TTQA)
q Easier-Relaxed
Approachwithvariation
q SmootherMovementsq Self-adjustmentsof
tensionq Voluntarydisfluencyq Naturalstutteringw/
ease
q CorePracticesq GuidedHierarchies
ofPracticeq AccessingOngoing
Supportq OtherDaily
PreparationBalancinginput-technology;physicalbody
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FluencyCaseSummary
Motor Social-Emotional
Sensory Language Cognitive
FluencyPattern&PotentialContributingFactors
ModerateAtypicalDisfluency(finalsoundrepetitions)
Someself-regulatoryissuesreportedathome
Significantlyaboveaverage
RiskFactors Nofamilyhistory
ExecutiveFunctioningSkills&OtherDiagnoses
q Nonereported
PresentStudentNeeds:q Communicationwithinvariouslevelsoflanguagecomplexityq Communicationwithinfamilyconversationsq Increasedeffectivenessofmessagescommunicatedviacounterconditioningoffinal
sounddisfluenciesq Education&involvementofparentsintherapy;teacher
Informalcasesummaryworksheet:Tage11-6
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BriefOverviewofTreatmentStrategies:Tage11-6Attentive
Awarenessofthoughts,emotions,&body;situation
&resultantactions
AssertiveInitiating,participating;advocatingforoneself
ConfidentBodylanguage;Voicevolume&strength
EffectiveCommunicatingwith
greaterease;intelligibility,
organization,&clarity
ProactiveEngaginginsetting
oneselfupforevolvingcommunicativesuccess
q Breathawarenessq Mindfulnessq ReflectivelisteningExecutiveFunctioning:q Self-Regulationq InhibitoryControlq Shift-Sustainq SensingTimeq CognitiveFlexibility
q SocialLanguage
q FirsttoApproachq Talkingforyourselfq TalkingMoreq SayingAllWordsq Nonverbal-Verbal
Notingq Self-Advocacyq Educatingothers
abouthiscommunication&stuttering
q Coreseated&standingpostures
q Handshakeq Naturaleye
contactq Bodylanguageq Volume-powerof
voice
q Varyingintent&expression
q Pausingwithvariationq Phrasingwith
variationq Naming&countering
atypicaldisfluency;Completesentences;Narratives;Answeringquestions(TTQA)
q Easier-Relaxed
Approachwithvariation
q SmootherMovementsq Self-adjustmentsof
tensionq Voluntarydisfluencyq Naturalstutteringw/
ease
q CorePractices:BreathAwareness;Mindfulness
q GuidedHierarchiesofPractice
q AccessingOngoingSupport:parentwillprovidefeedbackduringdaily10minutespecialcommunicationtime
q OtherDailyPreparationBalancinginput-technology;physicalbody
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TherapyGoalsforTage11-6:
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FluencyCaseSummary
Motor Social-Emotional
Sensory Language Cognitive
FluencyPattern&PotentialContributingFactors
SevereSLD;blocks,prolong;multipleinterjectionsnotedpriortoSLD
Instancesofbullying;Withdrawingfromtalkinginclassroom
Seekinginput;tactile-proprioceptive;historyofOT
Recept-Exprvocabdiscrepant
RiskFactors Veryhigh
ExecutiveFunctioningSkills&OtherDiagnoses
q Noneidentified;disorganizationathomenoted;parentconcernedaboutattention;veryimpulsive
PresentStudentNeeds:q Communicationwithteacher(frequency&competency)q Communicationwithinsmallreadinggroupsinclassroom(freq&comp)q Increasedeffectivenessofmessagescommunicatedviareducingeffortassociatedwith
stutter;desensitizationoffearrelatedofstutteringmoment;attitudes&feelingsq Education&involvementofparentsintherapy;teacherq Self-advocacywithpeersq Furtherexplorationof‘attention’concerns
Informalcasesummaryworksheet:Mage8-1
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BriefOverviewofTreatmentStrategies:Mage8-1Attentive
Awarenessofthoughts,emotions,&body;situation
&resultantactions
AssertiveInitiating,participating;advocatingforoneself
ConfidentBodylanguage;Voicevolume&strength
EffectiveCommunicatingwith
greaterease;intelligibility,
organization,&clarity
ProactiveEngaginginsetting
oneselfupforevolvingcommunicativesuccess
q Breathawarenessq Mindfulnessq ReflectivelisteningExecutiveFunctioning:q Self-Regulationq InhibitoryControlq Shift-Sustainq SensingTimeq CognitiveFlexibility
q SocialLanguage
q FirsttoApproachq Talkingforyourselfq TalkingMoreq SayingAllWordsq Nonverbal-Verbal
Notingq Self-Advocacyq Educatingothers
aboutcommunication&stuttering
q Coreseated&standingpostures
q Handshakeq Naturaleye
contactq Bodylanguageq Volume-powerof
voice
q Varyingintent&expression
q Pausingwithvariationq Phrasingwith
variationq Completesentences;
Narratives;Answeringquestions(TTQA)
q Easier-Relaxed
Approachwithvariation
q SmootherMovementsq Self-adjustmentsof
tensionq Voluntarydisfluencyq Naturalstutteringw/
ease
q CorePractices:BreathAwareness;Mindfulness
q GuidedHierarchiesofPractice
q AccessingOngoingSupport
q OtherDailyPreparationBalancinginput-technology;physicalbody
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TherapyGoalsforMage8-1:
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StutteringPersistencevs.Recovery
Preschool-1stgrade
2nd-4thgrade
5th-8thgrade
1yearpostonset: 63%recover2yearspostonset:47%recover3yearspostonset:16%recover4yearspostonset:5%recover
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Themajorityofyoungchildrenbeginstutteringbetweentheagesof2-4.75%willrecoverwithin1yeariftheonsetofstutteringispriorto3.5yearsofage.
Ø WhydoesfocusinguponoverallCommunicativeCompetencematter?
RiskFactorsAnalysisChart*PrimaryRankOrderedRiskFactors
FamilyhistorywithpersistenceGenderofchildTrendsinfluencypatternTimepersistedsinceonsetAgeatonset#andtempoofrepetitionunitsPresenceofprolongations/blocks
q Who?q Maleq FlatorIncreasedtrendinfrequencyovertimeq Continuedfor6-12monthsq After3½yearsofageq 2-3ormoreunitsofrepetition;quickertempoq PatternofSLDincludesBlocks-Prolongations
SecondaryRiskFactors
StutteringSeverityMovementsofhead,neckPhonologicalSkillsExpressiveLanguageSkills
q Post1year,remainsinseverequantityrangeq Post1year,remainfrequent&severeq Belownormalinearlyphaseofstutteringq Remainedadvancedovertime;weaknesses
OtherConsiderations
ChildReactionstoproblemChild’sTemperamentobservationsOtherParentReactionsOtherfamilyhistory
q Frustration/Withdrawal/Avoidanceq Lowersensorythreshold,higherreactivity;lower
adaptability,higherdistractibility,lowerattentionq Otherdevelopmentalissuesq Significantanxiety/negativemannerofreactingq Speech/language,learning,anxiety,mood,attentiontic
orcompulsivedisorders;autism
ChmelaFluencyCenterReferencesincludeYairi&Ambrose,2005,IllinoisPredictionCriteria;Yairi&Seery,2015;Kraft&Yairi,2011
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Ø The mindset of an Evolving Communicator Ø 5 Areas of Focus Ø Integration of speech pathology, psychology,
neuroscience, and occupational therapy Considers the integration of familiar approaches (Fluency Shaping & Stuttering Modification) and adaptations of “third-generation behavioral and cognitive therapies” (Hayes, 2004)
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Ø School-agestutteringtherapyfocusesuponevolvingCommunicativeCompetence
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Key Concept #1: ² Communicative success is defined in multiple ways and is
within reach for all of us.
-Considers “The Big Picture” (the ongoing Differential Evaluation-Differential Treatment Processes)
-Willingness to keep learning and growing
Ø School-agestutteringtherapyfocusesuponevolvingCommunicativeCompetence
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Key Concept #2 ² Communicative competency is not perfect for anyone.
("The Concept of Communicative Competence." Handbook Of Communication Competence, ed. by G. Rickheit and H. Strohner. Walter de Gruyter, 2010)
-A historical topic -3 part definition -Accounts for relevance, variability, & motivation
Ø School-agestutteringtherapyfocusesuponevolvingCommunicativeCompetence
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Key Concept #3: ² Communicative abilities thread through most of what
matters to us. -Linking what we do (actions) to what matters to us (our values) -Helps us to identify behaviors that may no longer be helpful to us -Fosters healthier communicative attitudes- behaviors
Ø School-agestutteringtherapyfocusesuponevolvingCommunicativeCompetence
5AreasofFocusof
EvolvingCommunicativeCompetence
AdaptedfurtherbyChmela,2018;three/fiveelementsdefinedoriginallybyChmela,expandedbyChmela&Campbell,2014;furtherexpandedbyChmela,Campbell,Eldridge,&Raynorthroughout
CampShoutOutcollaborationAllRightsReserved
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How aware am I? Am I aware of my breath? Am I aware of what is going on around me? Am I aware of my thoughts? My emotions? What my physical body is telling me? Am I aware of listeners’ expressions and body language? Am I tolerant of waiting? Do I notice what I do when talking is harder? Do I notice when it is easier to speak? Do I hear it, feel it? Do I know what I do when I am trying not to stutter?
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Thumb=Attentive
Counterconditioning&Awareness
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Ø Wemayfocusupon:
q Breath awareness q Mindfulness q Reflective listening q Aspects of Executive Functioning -Self-Regulation -Inhibitory Control q Aspects of Social Language Chmela2019/AllRightsReserved 34
Do I talk if I want to? Do I say every word I want to say? Do I talk enough? Do I talk for myself? Do I self-advocate around communication if need be? Am I the first to introduce myself to someone new? Is the language I am using, voice tone and loudness respectfully appropriate for the situation?
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Index=Assertive
Ø Wemayfocusupon:
q First to Approach q Talking for yourself q Talking More q Saying All Words q Nonverbal-Verbal Noting q Creating & Holding Space q Self-Advocacy q Educating others about communication &
stuttering
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Confident: Do I have a strong body core? Do I sit with dignity? Stand like a majestic mountain? Do I connect with my eyes while communicating? Do I have a firm handshake and make a connection with my eyes when introducing myself? Is my voice from the start to the end of a phrase powerful? Do I feel a sense of ease in the pause?
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ThirdFinger=Confident
Chmela2019CopyrightMaterialChmela2019/AllRightsReserved
Ø Wemayfocusupon:
q Core seated & standing postures q Handshake q Natural eye contact q Body language q Volume-power of voice
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Effective: Do I communicate moving towards what I want to say? Can I create greater ease? Are my sentences complete? Is my message organized and clear? Does the manner of my speaking allow the listener to focus upon my message?
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Fourth=Effective
Ø Wemayfocusupon:Varyingintent&expression
PausingwithvariationPhrasingwithvariationCompletesentences
TurningtheQuestionAroundExpressiveOrganization
Easier-RelaxedApproachwithvariationSmootherMovements
Self-adjustmentsoftensionVoluntarydisfluency
Voluntaryself-adjustmentsNaturalstutteringw/ease
Lessspecifictomorespecific
waysofm
odifyingspeaking
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Proactive: Do I know how to set myself up for success as a communicator ? Do I have a team? Do they know how to help me? Do I know what my goals are? Do I know how to ask for feedback? Am I working on self-feedback? Do I do Core Practices? Am I learning how to Guide my own practice?
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Pinky=Proactive
Ø ExploringAttitudesandFeelings
4CategoriesofQuestionstoAskTeens
1.Desire-Whatdoyouwant?
2.Ability-Whatispossible?
3.Reasons-Whatarethebenefits?
4.Need-Howimportantisthischange?
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Zebrowski(2018presentation)MotivationalInterviewing(Rollnicketal.,2008)
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Whatisitthatyouwant?(DesireQuestions)• Whatwouldyouliketoseedifferentaboutstuttering?• Whatmakesyouthinkyouneedtochange?• Areyouconcernedaboutyourstuttering?Areothers
concerned?• Whydoyouthinkothersareconcernedaboutyour
stuttering?• Whatideasdoyouhaveaboutwhatneedstohappen?• Whatisyourtheoryaboutwhyyoustutter?• Inwhatwaysdoyouseemeandthisprocesshelpfulin
attainingyourgoals?
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• Whatarethemostchallengingspeakingsituationsforyou(worriedyouwillstutter,avoidingtalking-stuttering;stutterthemost)?
• What-wherearethecircumstanceswhen“doingsomethingwitha
stutter”isveryhardtodo?• Howconfidentareyouinyourabilitytouseanewbehaviorand
remainengagedfollowingfailure(ona1-10RatingScale)?
• Ofthemostchallengingsituations,whichonewouldyoubewillingtotakeonfirst?Whatwouldittaketocreateapositivechangeinthatsituationalcircumstance?
• Acrossthe5AreasofFocus,wheredoyouseeyourself-yourstrengthsandareasofpossiblechangeorgrowth?
• Whatareasmatterthemosttoyoutofacilitatechange?Why?
Whatdoyouseeyourselfdoing?(Ability)
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• Whatwouldbethegoodthingsaboutchangingsomethingabout
yourstuttering?Whatwouldbenotsogoodaboutchanging?• Whatwillhappenifyoudon’tchange?• Whatwillyourlifebelikeiftomorrowyouwokeupandnever
stutteredagain?Whatwouldyoubethinking,feeling,anddoingdifferently?Whatwouldyourteachersnotice?Yourparents?Siblings?Friends?
• Howimportantismakingthischange?
Whyareyoudoingit?(Reason&NeedQuestions)
45Zebrowksi
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Ø Wemayfocusupon:
q Core Practices q Guided Hierarchies of Practice (see
next) q Meet with teacher/other
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RevisedChmela2019/CampShoutOut2015Campbell&Chmela/Campbell,2003
How many people?
Who are they? What input do I need?
Feedback What ACTIONS (Attentive, Assertive, Confident, Effective)
will I DO WHILE I am:
¨ 2-3 ¨ Peers I know ¨ Girl(s)/Boy(s)
¨ Sitting ¨ Standing ¨ Walking ¨ Other
Who will give Feedback? ¨ SLP ¨ Self ¨ Teacher ¨ Other
¨ 4-5 ¨ Peers I don’t know
¨ Girl(s)/Boy(s) ¨ Speech group
¨ Half class
¨ Whole class
¨ Authority Figures ¨ Familiar Adults ¨ Unfamiliar Adults
¨ Visually distracting
¨ Limited visual distractions
How? ¨ Whole
grade ¨ Whole
School
Other:
¨ Noisy ¨ Quiet
¨ Verbal Reminder
¨ Tactile Reminder
¨ Visual Reminder
Other:
*Allsituationsconsiderlanguagecontext,discoursestructure,andsemanticcomplexity.
Campbell,2003;Chmela&Campbell,2014
Guided Practice Chart
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RevisedChmela2019/CampShoutOut2015Campbell&Chmela/Campbell,2003
How many people?
Who are they? What input do I need?
Feedback What ACTIONS (Attentive, Assertive, Confident, Effective)
will I DO WHILE I am:
¨ 2-3 ¨ Peers I know ¨ Girl(s)/Boy(s)
¨ Sitting ¨ Standing ¨ Walking ¨ Other
Who will give Feedback? ¨ SLP ¨ Self ¨ Teacher ¨ Other
¨ 4-5 ¨ Peers I don’t know
¨ Girl(s)/Boy(s) ¨ Speech group
¨ Half class
¨ Whole class
¨ Authority Figures ¨ Familiar Adults ¨ Unfamiliar Adults
¨ Visually distracting
¨ Limited visual distractions
How? ¨ Whole
grade ¨ Whole
School
Other:
¨ Noisy ¨ Quiet
¨ Verbal Reminder
¨ Tactile Reminder
¨ Visual Reminder
Other:
*Allsituationsconsiderlanguagecontext,discoursestructure,andsemanticcomplexity.
Campbell,2003;Chmela&Campbell,2014
Guided Practice Chart
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MeetwiththeTeacherCreateanagenda&negotiatewhowilldothe
talking
1. Thingsaboutmycommunicationskills:mystrengthsacrossthe5AreasofFocus&myareasofgrowthIamworkingtowards
2. Factsaboutmystuttering3. Factsaboutstuttering4. Thingsgoingwellformeinyourclassroom5. ThingsIworryaboutornoticerelatedtomy
communication6. WhatIamworkingonthathelpsmygrowthasa
communicator7. Waysyouandmypeerscansupportme
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Thefollowingideasaresuggestionsfortheteacher,coach,orinstructorwhohasachildwhostutters
inherorhisclassroomorprogram.Stutteringisacomplex,variableproblemwithabasisinthewiringandfunctioningofthebrain.Itisnotcausedbynervesorlackofconfidence,althoughitmayincreasewithmomentsofanxiety.Stutteringwaxesandwanes,bothinquantityaswellasinseverityoftheactualmoments.Itconstantlychangesovertime.Somechildrenwhostutterhaveotherspeechand/orlanguageproblems.Somechildrenmayhaveattentionproblemsorstrugglewithanxiety.Stutteringrunsinfamilies.Eachchildwhostuttersisdifferent.
Childrenperceive,feel,andreacttostutteringdifferently.Somekeepontalkingnomatterwhat,andotherstalklessorsaylesswhentheydotalkbecausetheydonotwantotherstoseethemstutter.Somechildrenexperiencehighanxietywhenmeetingnewteachers,coaches,orpeersinschool,sports,orduringotheractivities.Othersdonot.Childrenwhostutterperceivespeakingsituationsdifferently.Somefeelgivinganoralpresentationisverychallenging,wherebyothersfeelisiseaserforthembecausetheyaretheonlyonesspeaking.Somelovetoreadaloud,andothersdreaditeverydayoftheschoolyear.
Helpfulreactionstostutteringincludewaiting,lettinghimorherfinishwhatisbeingsaid,keepingeyecontact,andifpossible,saying,“Iamnotinahurry,”or,“Ihavetimetolisten.”Ifpeersorotherschuckleorimitatethechild,itishelpfultosayverymatter-of-factly,“Wegiveeachothertimefortalkinghere,andwedonottalkabout,laugh,ormimicthewaysomeonetalks.”Ifit’snottheappropriatetimeforthechildtotalk,oryoucan’tbeavailabletolisten,it’sO.K.tosay,“Let’sholdthatideaforlater”or,“Ican’tbeagoodlistenernow.Abettertimewouldbe…”tothechild.
Letthechildknowinprivateyouhavetimetolisteniftheyfeeluncomfortableaboutanythingassociatedwithtalkinginyourenvironment.Youcanaskhimorherdirectlywhatyoushoulddowhentheyarehavingdifficulty.IthelpstoassurethemitisO.K.iftalkingiseasyanditisO.K.ifitisnot,andthatnomatterwhat,youwantthemtosharetheirideas!Sometimesspendingafewminutestalkingdailyorweeklywiththechildone-on-onecanhelphimorherbecomemoreatease.
Teachers,coaches,andotherscanhelpbyhelpingthechildfeelcomfortabletalking,demonstratezerotoleranceforbullying,andoffersupportandunderstanding.Bullyingiscommonplaceforchildrenwhostutter,andpositivecommunicativeexperiencesforthechildareessentialthroughouttheirdevelopment.Othersuggestionsarelistedonthenextpage.Ifthechildisinspeechtherapy,itmaybehelpfultoreachouttothechild’sspeech-languagepathologistforideasaswell.Othersuggestionsarelistedonthenextpage,aswellashelpfulresources.
Suggestions for Teachers, Coaches, & Others Interacting with Elementary-High School Students Who Stutter
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ü Ifyouarehavingthechildrenintroducethemselves,itmaybeeasierforthestudenttostartfirst.ü Thestudentmayprefertositinacertainspot.Sometimesclosertothefrontoftheroomiseasier.ü Delayedresponse(waitpurposelyfortwosecondsafterbeingcalledonbeforeprovidingananswer)forallstudentstopracticereducesthefeelingoftimepressureduringlargegroupdiscussionsandparticipation.ü Askallstudentstoorallycommunicateincompletesentences,;whenansweringquestionsorally,teachthemTTQA(TurntheQuestionAround)atthestartoftheiranswer.ü Createasignalfororalparticipationtohelpachildbecomemorecomfortableifwarranted(ifthechildwishestospeak,he/sheraiseshis/herhandwiththefingersinanopenposition;ifthechildknowstheanswerbutdoesnotwishtospeak,he/sheraiseshis/herhandbutkeepsitinafist. ü Offertheinitialpartofthedesiredresponseasalead-intothechild’sanswer(i.e.“Tyrone,numberfivestatesthattheboy….”).ü Askthechildmoreclosed-endedquestionswithchoices,suchas,“Didtheboyfindthetreasureorwashestillsearchingforit?”ü Physicallyapproachachildwhenhe/sheiscalledupontospeak(sothatthecommunicativeexchangeisbetweenthe2ofyou).ü Provideawarningpriortobecalledupon(Samyouanswer#1andMaxwillbe#2).ü Allowtheclasstohaveoralreadingoptions(readingalone,orreadingchorallywithapartner).ü CreateaSubstituteCard,includingthestudent’spicture,informationregardingthestudent’scommunication,aswellasthebestwaystoreact.Letthestudentknowthatiftherewillbeasubstitute,heorshewillbeabletocarrythroughwhatyouhavebeendoingtosupporthimorher.
HelpfulResourceswww.stutteringhelp.orgTheStutteringFoundationprovidesfreeonlineresources,servicesandsupporttothosewhostutterandtheirfamilies,aswellassupportforresearchintothecausesofstuttering.(educationalmaterials,professionalreferrallist,teachervideoandbooklet)www.stutteringspecialists.orgHelpsconsumersandprofessionalslocatespeech-languagepathologistswhoareBoardCertifiedSpecialistsinFluency:professionalswhohavegonebeyondthebasicclinicalcertification(CCC-SLP)awardedbytheAmericanSpeech-Language-HearingAssociation(ASHA).www.friendswhostutter.orgFRIENDSisanationalorganizationcreatedtoprovideanetworkofloveandsupportforchildrenandteenagerswhostutter,theirfamilies,andtheprofessionalswhoworkwiththem.www.westutter.orgTheNationalStutteringAssociationprovidessupport,friendship,andinformationtothestutteringcommunity.TheNSAprovidesinformationaboutstuttering,increasespublicawarenessofstuttering,servesasasupportandadvocacygroup,andisareferralorganizationforspeechtherapysourcesthroughouttheUnitedStates. Chmela2019/AllRightsReserved 51
SELECTEDREFERENCELIST:School-AgeChildren• BernsteinRatner,N.(2005).Evidenced-basedpracticeinstuttering:Somequestionstoconsider.JournalofFluencyDisorders,Vol.30,3,pp.163-188.
• Bloodstein,O.&BernsteinRatner,N.(2008).Ahandbookonstuttering,6thedition.Clifton,NY:Delmar.• Bothe,A.K.,Davidow,J.H.,Bramlett,R.E.,Franic,D.M.&Ingham,R.J.(2006).Stutteringtreatmentresearch1970-2005:II.Systematicreviewofincorporatingtrialqualityassessmentofpharmacologicalapproaches,AmericanJournalofSpeech-LanguagePathology,15,342-52.
• Brutten,G.&Vanryckeghem,M.(2007).BehaviorAssessmentBatteryforschool-agechildrenwhostutter.SanDiego,CA:PluralPublishing,Inc.
• Chang,S.E.,&Zhu,D.C.(2013).Neuralnetworkconnectivitydifferencesinchildrenwhostutter.Brain,136,3709–3726.• Chang,S.E.,Zhu,D.C.,Choo,A.L.,&Angstadt,M.(2015).Whitematterneuroanatomicaldifferencesinyoungchildrenwhostutter.Brain,138,694–711.• Campbell,J.H.(2003).Therapyforelementaryschool-agechildrenwhostutter,InH.H.Gregory(Ed.),Stutteringtherapy:rationale&procedures,(pp.217-262).Boston:Allyn&bacon.
• Chmela,K.&Johnson,L.(2018).Howcanweovercomethechallengesofprovidingschoolbasedfluencyservices?SeminarsinSpeechandLanguage,Vol.39,No4.
• Chmela,K.&Campbell,J.H.(2014).BasicPrincipleProblemSolving:Workingwithschool-agechildrenwhostutter.Greenville,SC:SuperDuper,Inc.
• Chmela,K.(2006).Self&doublecharting:Aself-monitoringstrategyforschool-agechildrenwhostutter.PresentedattheInternationalStutteringAwarenessDay(ISAD)InternetOnlineConference;October1-22,2006,http://www.mnsu.edu/comdis/isad9/papers/chmela9.html
• Chmela,K.&Reardon,N.(2001).Dealingwithschool-agechildrenwhostutter:Workingeffectivelywithattitudesandemotions.Memphis,TN:StutteringFoundationofAmerica.
• Craig,A.,Hancock,K.,Chang,E.,McCready,C.,Shepley,A.,McCaul,A.,etal.(1996).Acontrolledclinicaltrialforstutteringinpersonsaged9to14years,JournalofSpeech&HearingResearch,39(4),808-26.
• Donaher,J.,Soffer,S.,andHealey,E.C.,(2004).ADHDandchildrenwhostutter:considerationsforevaluation&treatment.PaperpresentedatAmericanSpeech-Language-HearingAssociationConvention.Philadelphia,PA.
• Faber,A.&Mazlish,E.(1999).Howtotalksokidswilllistenandlistensokidswilltalk(20thAnniversaryed.).NewYork:AvonBooks.
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• Gregory,H.H.(2003).Stutteringtherapy:rationaleandprocedures,(pp.217-262).Boston:Allyn&Bacon.• Gillam,RonaldB.;Logan,KennethJ.;Pearson,NilsA.:TestofChildhoodStuttering.http//www.proedinc.com/
Customer/productView.aspx?ID=4504• Healey,E.C.,ScottTrautman,L.,&Susca,M.,(2004).Clinicalapplicationofamultidimensionalapproachforthe
assesmentandtreatmentofstuttering,ContemporaryIssuesinCommunicationandSciencesDisorders,31,40-48.• Healey,E.C.,Reid,R.,&Donaher,J.(2005).Treatmentofthechildwhostutterswithco-existinglearning,behavioral,
andcognitivechallenges.InR.LeesandC.Stark(eds.)Treatmentoftheschool-agechildwhostutters.London:WhurrPublishersLtd.
• Herder,Howard,Nye&Vanryckehgem(2006).Effectivenessofbehavioralstutteringtreatment:Asystematicreviewandmeta-analysis.ContemporaryIssuesinCommunicationScienceandDisorders,33,61-73.
• Laiho,A.,&Klippi,A.(2007).Long-andshort-termresultsofchildren’sandadolescents’therapycoursesforstuttering.InternationalJournalofCommunicationDisorders,42,367–382.
• Langevin,M.&Hagler,P.(2004).Developmentofascaletomeasurepeerattitudestowardchildrenwhostutter,InBothe,A.K.(Eds)Evidenced-basedtreatmentofstuttering:empiricalbasesandclinicalapplications.Mahwah,NewJersey:LawrenceErlbaumAssociates.
• Murphy,W.P.,Yaruss,J.S.,&Quesal,R.(2007).Enhancingtreatmentforschool-agechildrenwhostutter:Reducingnegativereactionsthroughdesensitizationandcognitiverestructuring,JournalofFluencyDisorders,Vol.32,Number2,2007.
• Murphy,W.,Yaruss,J.S.,&Quesal,R.(2007).Enhancingtreatmentforschool-agechildrenwhostutterthroughrole-playandself-disclosure,JournalofFluencyDisorders,Vol.32,Number2,2007.
• Reardon,N.A.&Yaruss,J.S.(2014).School-AgeStutteringTherapy:Apracticalguide.StutteringTherapyResources.
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• Riley,G:SSI4:StutteringSeverityInstrument,4thEdition;www.pearsonassessments.com• RileyG.,&Riley,J.(2000).Arevisedcomponentmodelfordiagnosingandtreatingchildrenwhostutter,ContemporaryIssuesinCommunicationScienceandDisorders,27,188-199.
• Scott,L.A.(2009).DecodingIDEAeligibilityforchildrenwhostutter,aninstructionalDVDproducedbyStutteringFoundationofAmerica.Memphis,TN.
• Sisskin,V.(2002).Therapyplanningforschool-agechildrenwhostutter,SeminarsinSpeechandLanguage,23,173-179.• Smith,A.&Weber,C.(2017).HowStutteringDevelops:TheMultifactorialDynamicsPathwaysTheory.JournalofSpeech,Language,andHearingResearch•Vol.60•2483–2505•September2017•Copyright©2017AmericanSpeech-Language-HearingAssociation2483
• Whitmire,K.&Scott,L.A.(2007,July).IDEA2004andspeech-languageservices:Keyissuesforchildrenwhostutter.ASHADivision4LeadershipConference,Minneapolis,MN.
• Whitmire,K.&Reardon-Reeves,N.(2006,November).MeetingtheChallengesofStuttering:WritingIEPgoalsforschoolagechildren.ASHANationalConvention,MiamiBeach,FL.
• Yaruss,J.S.,Coleman,C.E.,&Quesal,R.W.(2010).OASESforschool-agechildrenandteens.Minneapolis,MN:Pearson.• Yaruss,J.S.,&Pelczarski,K.Evidence-BasedPracticeforSchool-AgeStuttering:BalancingExistingResearchwithClinicalPractice,EBPBriefs,2(4),pp.1-8.
• Yaruss,J.S.,&Quesal,R.W.(2004).StutteringandtheInternationalClassificationofFunctioning,Disability,andHealth(ICF):Anupdate.JournalofCommunicationDisorders,37,35–52.
OtherHelpfulReferences:BoardCertifiedSpecialistsinFluencyDisorders:www.stutteringspecialists.orgStutteringFoundation:www.stutteringhelp.org1-800-992-9392;resources,education,researchfriendswhostutter.orgFriends:(supportgroupforschool-agechildren-teensandfamilies)conventions&workshops;support;volunteeropportunityforspeechandlanguagepathologistswestutter.org–NationalStutteringAssociationconventions&workshops,support;volunteeropportunityforspeech-languagepathologistsStutteringhomepage.com–resourcesandInternationalOn-Lineconference-sectionavailableforschoolcliniciansTheMindUPCurriculum:Brain-focusedStrategiesforLiving&LearningbyTheHawnFoundationcommunity.mindfulschools.orgWillard,Christopher(2016).GrowingUpMindful:EssentialPracticestoHelpChildren,Teens,andFamiliesFindBalance,Calm,andResilience.SoundsTrue.Boulder,CO.Cheasman,C.(2013).Embraceyourdemonsandfollowyourheart:AnAcceptanceandCommitmentTherapyapproachtoworkwithpeoplewhostammer.InStammeringTherapyfromtheInside:NewPerspectivesonWorkingwithYoungPeopleandAdults.Cheasman,C.,Everard,R.,Simpson,S.,(eds.).Pp267-302.J&RPressLtd.Croydon.Harris,R.(2009)ActMadeSimple:AnEasy-To-ReadPrimeronAcceptanceandCommitmentTherapy(TheNewHarbingerMadeSimpleSeries.)Saltzman,A.(2014).AStillQuietPlace.AMindfulnessProgramforTeachingChildrenandAdolescentstoEaseStressandDifficultEmotions.NewHarbinger:Oakland,CA.Sedley,B.(2015).StuffthatSucks:ATeen’sGuidetoAcceptingWhatyouCan’tChangeandCommittingtoWhatYouCan.Robinson
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Evolving Document: Research & Evidence in Support of 5 Areas of Focus in School-Age Fluency Treatment Page 1
Attentive Assertive Confident Effective ProactiveØ ManyCWScantalkabouttheirtalkingabilitiesandthemselvesastalkers(Clarketal.,2012;Vanryckeghemetal.,2005;Vanryckeghem&Brutten,2007)Ø “Speakingisdifficult”perceptionofCWSdifferentiatesCWS-CWNS(Clarketal.,2012)Ø CWSnoticestutteringmore;increaseswithage(Ambrose&Yairi,1994)Ø Comparedtonormallyfluentpeers,school-agechildrenviewedaslesspopular,andaremorelikelytoberejectedandbullied(Davis,Howell,&Cooke,2002;Langevinetal.,1998,2003;Stewart&Turnbull,2007;Bloodetal.,2010)Ø Increasedsensitivityandhighselfexpectations(Riley&Riley,2000)
Ø Comparedtonormallyfluentpeers,school-agechildrenviewedaslesspopular,andaremorelikelytoberejectedandbullied(Davis,Howell,&Cooke,2002;Langevinetal.,1998,2003;Stewart&Turnbull,2007;Bloodetal.,,2010)Ø Negativeemotionalreactionsandavoidanceofspeakingsituations(Yaruss&Quesal,2010;Vanryckeghemetal.,2001;Stewart&Turnbull,2007)Ø Mindfulnesstechniquescanbeusefulfortreatinganxietysymptomsinschool-agechildren(Goodman,2005;Grecoetal.,2005;Semple,Reid,&Miller,2005)
Ø Comparedtonormallyfluentpeers,school-agechildrenviewedaslesspopular,andaremorelikelytoberejectedandbullied(Davis,Howell,&Cooke,2002;Langevinetal.,1998,2003;Stewart&Turnbull,2007;Bloodet.al,2010)Ø Negativethoughtsandfeelingsregardingtheircommunicationdifficulties(Andrews&Cutler,1974;DeNil&Brutten,1991)
Ø Bothe,A.K.,Davidow,J.H.,Bramlett,R.E,&Ingham,R.J.(2006):-Regulatedbreathingandairflow(deKinkelder&Boelens,1998;Ladouceur&Martineau,1982)-Formofstutteringmodification(Ryan&Ryan,1983)Ø Ratner(2010)evidencereview-prolongedspeech(fluencyshaping);GILCU(GradualLengthandComplexityofUtterances,preferablywithparentsandwitheitheraDAFdeviceoranEMGdevice(Ryan&Ryan,1983,1995)Ø Boey,(2008)SpeechLanguagemaybedelayedtypical,oradvanced;comparinglanguageasnormalCWStoCWNS:-syntactic,semanticandphonologicalprocessesdevelopslowerthanthoseofCWNS;
Ø Thewholefamilyistheclient;allareimpactedbytheproblem;Majorityofsiblingswouldliketobemoreinvolvedintherapy.CWSfeellessclosetotheirparentsandtrustthemlessthanCWNSandwerefrustratedbyhowparentsmanagedtheirstuttering(Bielby,2014)Ø Reinforcementfromother(s)impactstxsuccess(Harrison,Bruce,Shenker,&Koushik,2010;andKoushiketal.,2009;Rousseau,Packman&Onslow,2005;Koushik&Shenker,2005Lincoln,Onslow,Lewis&Wilson,1996;Rousseau,Packman&Onslow,2005;Ingham,1980;Ryan&Ryan,1983)
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Research & Evidence in Support of 5 Areas of Focus in School-Age Fluency Treatment Page 2
Attentive Assertive Confident Effective Proactive
Ø Negativethoughtsandfeelingsregardingtheircommunicationdifficulties(Andrews&Cutler,1974;DeNil&Brutten,1991)Ø Negativeemotionalreactionsandavoidanceofspeakingsituations(Yaruss&Quesal,2010;Vanryckeghemetal.,2001;Stewart&Turnbull,2007)Ø Preschoolchildren:• Higheractivitylevel(e.g.,Eggersetal.,2010;Embrechtsetal.,2000)• Negativeaffect(e.g.,Eggersetal.,2010)• Lessadaptabilitytochange(e.g.,Andersonetal.,2003)• Lowerinhibitorycontrol(e.g.,Eggersetal.,2010)• Lessabletoflexiblycontroltheirattention/shiftattention(e.g.,Karassetal.,2006)Ø Donaher(2014)CWSwith
ADHD(4-26%)
Ø CWSexhibitmore“unevenness”inthedevelopmentoflanguage,vocabulary,articulationØ (Donaher,2014)CWSwithADHD(4-26%)maydemonstratepragmaticlanguageissues;lackofawarenessoflistenerperspective;timingandquantityofspeechissues:Initiatingpriortoformulatingideas,issueswithinterrupting,monopolizing,relevancyfiltering&respondingadequatelytoconversationalpartnercues;Higher-levellanguagecomprehensionandexecutivefunctioningSequencing,organization,andcohesionoflanguagePoortopicmaintenanceFollowingthroughwithadetailedormulti-stepplanØ Alm&Risberg,2007:adultswhostutternotedhistoryaschildren;muchhigherthenthegeneralpopulation
Ø Systematictransferoffluencyacrosssettingsispartofevidenced-basedpracticeforthispopulation(Shenker,2005;Andrewsetal,1980;1983;Cordes,1998;Thomas&Howell,2001))Ø Langevin,Narasimha&Prasad(2012):positivebenefitsregardingastutteringeducationandbullyingawarenessandpreventionprogramforschool-agechildreninGrades3through6Ø Milleret.Al,(2007)ChildrenwithSPD-difficultyachieving-maintainingappropriaterangeofemotionalandattentionalresponsesØ Executivefunctioning
difficulties:lackofsituationalawareness,forethought,planning,andexecution(Ward)
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Research & Evidence in Support of 5 Areas of Focus in School-Age Fluency Treatment Page 3AttentiveØ (Jonesetal.,2014)Reactivity(arousalofemotions,motoractivity,andattentions;secondarytoanovelstimuli)-morenegativeintheiremotions/affect-moreemotionallyreactive,higheranger/frustration,andhigherinmotoractivation;Self-Regulation(theabilitytomoderatetheabovetendencies;abilitytoshiftattentionfromnovelstimuli)lessabletomaintainorshiftattentionwhenappropriate;lesseffectiveatorientingattention;-lessabletoignoreirrelevantbackgroundstimuli;lessadaptivetotheirenvironment;lessabletoSelf-RegulateemotionØ Morereactivetoenvironmentalstimuliandlesslikelytoquicklyhabituate(regulate)tothestimuli(Schwenketal.,2007)Ø Morenegativeemotion(Johnsonetal.,2010;Ntourouetal.,2013)Ø Moreextremehighthanextremelowbehavioralinhibition(Choietal.,2013);correlateswithmorestutteringØ Emotionalregulationstrategiesduringpriornon-speechtasksarepredictiveofstutteringduringsubsequentspeakingtasks(Arnold
etal.,2011;Johnsonetal.,2010;Ntourouetal.,2013)Ø Kraft,S.J.,etal.,2018:helpchildrenwhostutterwithself-regulation;strategiesthatassistwithaspectsofeffortfulcontrolare
importanttoassistwithpositivetherapeuticchange
• MindfulnessSkillshavethe“potentialtoenhancechildren’s…”-attentionandfocus,memory,self-acceptance,self-managementskills,&self-understanding(Hooker&Fodor,2008;Burke,2009)Ø Mindfulnesstechniquescanbeusefulfortreatinganxietysymptomsinschool-agechildren(Goodman,2005;Grecoetal.,2005;
Semple,Reid,&Miller,2005)Ø Someevidencesupportstheimpactofmindfulnessonqualityofattention(Rani&Rao,1996;Semple,2005)Ø Mindfulnessincreasesself-esteemandself-compassion(Saltzman,2016)Ø CognitiveBehavioralTherapy(Beck,1995)hasbeenreportedintheliterature(Zebrowski&Wolf,2011)asameanstoassistschool-
agechildrenindevelopinghealthierattitudesandfeelingsregardingcommunication
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DifferentialEvaluation-DifferentialTreatment:• Wereallcomponents(childandenvironmentalfactors)addressedduringtheevaluation?• Arethereanyotherconcernsordiagnosesoutsideofstuttering&aretheybeingmanagedsuccessfully?• Didtheevaluationincludeformalandinformalmeasures?• Aregoalsbasedupondesiresofallrelevantstakeholders?Cantheybemeasured?
Relationship• Arerelationshipsbetweenallpartiespositive?• Doesthechildlikecomingtotherapy?• Isthechild’srelationshipwithhim/herselfpositive?• Areweexploringfeelingsandvalidatingthem?Listeningandvaluing?Providinginformation?Assistingindeveloping
ormaintaininghealthyattitudeandfeelingsregardingcommunicationandstuttering?
Counterconditioning&Desensitization• Isthechildstutteringwithlesstension?• Iscommunicationfacilitatedwithmoreease?Iscommunicationmorecompetentacrossthe5AreasofFocus?• Havewedevelopedandexecutedhierarchiesoffearedordifficultspeakingsituations?• Isthechilddemonstratinglesssensitivitytospeaking?Tostuttering?• Isavoidancereducingoreliminated?• Isthechild’scommunicationpatternmoreeffective?
WhatshouldIdonow?ProblemsolvebyreflectingupontheBasicPrinciples&definingthemthroughlatest
evidencebasedresearch
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Modeling• Arewemodelingspeechthatistensefreewithpausesandincreasedlisteningtime?• Arewemodelingstutteringandwaysofchangingstutteringinacomfortablemanner?• Hasthechildtaughtotherswhatheorsheisbeingtaught?GuidedPractice• Areweguidingpracticewithintherapyactivitiesbymanipulatingvariables(length,complexity,andcontextof
languageoutput,ourmodel,reinforcement,meaningfulnessoftopic,andothersensoryinputsuchaspeoplepresent,place,andlistenerreaction)?
• Havewetaughttheconversationalpartnerwhattolookfor&howtogivefeedback?
Reinforcement• Whatarewereinforcing?• Isourreinforcementgearedtowardspositiveattitude-speechchanges?• Isallreinforcementgiveninapositivemanner?• Istherationaleofwhatisbeingreinforcedcleartothechild?• Howisthechildrespondingtothereinforcement?• Arewesystematicallyfadingthereinforcement?
Self-Monitoring&Self-Reinforcement• Areweaskingthechildtoself-evaluate?• Areweincorporatingvarioustypesoffeedback(audio&visual,audioorvisual)toassistwithself-monitoring?
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Generalization&Transfer• Areweawareofthenuancesoftheseskillsandwhatisgeneralizing?• Areothersaware,suchastheconversationalpartner,ofwhattheseskillslooklikeinrealconversations?• Areweusingaratingscaletogetfeedbackfromothers?• Arewegivingfeedbackeachsessionduringanaturalisticinteraction?• Arethegoalsoftherapyrelatedtowhatisobservableacrossdifferentconversationalinteractions(communicative
behaviorsaswellaschangeinreactionstostuttering..ie..shiftsinattitudesandfeelings)• Areweinvolvingparents,teachers,others?
GradualDismissal,FollowThrough,&Maintenance• Wasthereagradualdismissalfromtherapy?• Didwemakeaplantocheckin?• Didwetalkwiththechildandrelatedothersaboutrelapseandaplanofmaintenance?• Isthereanopportunityforongoingsupport?• Didwehelpthechildandrelatedothersknowwhenitmightbeimportanttocomebacktotreatment?• Doesthechild-othersknowthatitisnormaltopossiblyneedmoretherapyasdevelopmentoccurs?
IntegratingChild-relatedandEnvironment-RelatedVariables• Isthemannerinwhichthetherapistisconductingtherapycommensuratewiththechild’scognitiveability?• Arebehavioralcomponents,bothspeechandavoidanceofspeech,beingaddressedaspartoftherapyasappropriate?• Arenegativeattitudesandfeelingsbeingmonitoredandaddressed?• Asthechild’sdevelopmenthasensued,doestherapyreflectthosechanges?• Areenvironmentalfactorsbeingconsideredaspartofthetreatment?• Arecontributingfactorsbeingaddressedintheappropriatemanner?
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