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Stuttering in sch aged children (Restart DCM (Goals (Obtain normal fluency…

- - - - Onset of stuttering has physiological basis affects delicate, complex balance of ling and motor skill
      - At core of stuttering; organic influences eg. perceptual, acoustic, movement, timing, muscular, respiratory, ling
      - Stuttering: Social, psychological, env, behavioral, arousal
  - - - SLP identifies what factors are targeted
      - Range of strategies provided to parent based on what factors are targeted
      - Strategies: special time sessions at home to target area of difficulty
    - - Parent continues Tx at home for 6 weeks
      - SLP monitors progress, responds
      - Review session at clinic at end of 6 weeks
    - - Parents, SLP discuss progress in 6 weeks
      - See if child is ready for no clinician support
- - - - Reinforce capacities
        
        Motoric
        
        Linguistic: help them find balance in fluency, speech
        
        Emotional: help them feel secure
        
        Cognitive: dont stress on being perfect
      - Reduce Demands
        
        Motoric: parent slow down so child can follow fluent sentences
        
        Linguistic: dont ask so many qns
        
        Emotional: teach parent to react more calmly, be less demanding
        
        Cognitive demands: operate on child's lvl
  - - - 1) Family focused: modify env factors to support growth, 1 hr session. Causal factors explained, stuttering education, info provided. Parents can express concerns, instructed to try parent-child special time for 15 min per day for 5 days. Parent keep log, then later SLP practice skills to lower demands, reinforce capacities. Obsv parent playing, talking w child. Discuss progress from previous week, demo, outline changes, demo again, attempt
      - 2) direct child Tx support child dev thru direct Tx, only introduced if child X responding to fam focused. Work directly on stuttering eg. breath, slow rate, telling them to try again. Make sure Tx is fun, find ways for child to explore feelings about talking difficulties. 1) modify stuttered speech in play based manner, adjusted to child's dev lvl 2) Model, teach child to vary type of stutter. 3) Learning to use variation in rate, articulation pressure. 4) Turtle talk
      - Aim to achieve balance b/w demands on child to communicate, child's motor, ling, socio-emotional, cognitive impacts
      - Stuttering results from complex interaction b/w person's env, abilities that person brings to env.
- - - - Initiation of speech motor program for syllables is problematic
      - Disturbance of neural fn
      - Speech <--> Stuttering <--> Lang
      - Ling stress is a stuttering trigger in those with vulnerable speech motor system
  - - - Instate low level of stuttering using STS
      - Weekly clinic visits: parent, child taught to use STS thru demo, imitation at near normal speech rates, normal intonation. X speak monotone. Advised to break all speech into syllables w same duration.
      - Practise 4-6 times a day, 5-10 min intervals
      - Verbal contingencies intro during practice sessions: reinforce stutter free speech (SFS)
      - Fade out SFS as SRs improve
      - Parent continue prompting child to use STS
      - Fewer clinic when Tx delivered effectively at home
    - - Maintain low level of stuttering over long period
      - Criteria: within clinic <1%/SS, beyond clinic mean severity <2 over 3 weeks
      - Parent to withdraw STS practice but prompt STS if stutter heard