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School aged children stuttering (Things to consider in Ax (Why they are…
School aged children stuttering
Steps Ax
Case history
Samples (Conversation, reading): 1) assess severity 2) freq % SS, 3) communication rate syllables per min
Sample outside clinic
Severity ratings
A-19 scale: child's view of themselves as communicator
Hierarchy of speech sounds (rank 10)
Assess impact of stuttering on person's life
Attitudes, feelings of PWS
Anxiety
higher risk of dev. anxiety related to stuttering although NOT EVERY child is like this
-ve communication attitudes, X like the way they sound, X think they are effective communicators
Bullying: SLP must be aware of this, bcos of not solved, this might set child up for unhelpful thinking
-ve peer perception
R/s difficulties
Occupational under achievement: X have high goals for long term career
Long term effects: X think they are good at anything to do w communication
Level of anxiety NOT directly proportional to severity of stutter: some not bothered by it, accept that this is the way they talk
Ax
OASES
Communication Attitude Test (CAT)
Teacher assessment of student's communicative competence (TASCC)
Reducing fear, avoidance
Help child in accepting that feeling fear, making mistakes is ok
No one is perfect, being perfect is not realistic
Reduce stigma around stuttering being "bad"
Reinforcing +ve experiences w fluency
Graded exposure: slowly expose to feared words, sounds, situations
Open discussions about feelings, challenging unhelpful thoughts around themselves as communicators.
Older children: CBT, Solution focused brief therapy-guide person thru stuttering journey
EBP approaches
Ax, Tx: baseline, goal setting, Tx decisions, patterns
Accountability: show progress or not, compare w benchmarks
Feedback: common lang, quantitative measures=objective, enable self-support.
Research purposes: impt to have measures of outcomes, inter-intra rater reliability>validity
Fewer clinical trials, no RCT evidence
Self-imposed time out Tx
Tx option for school-aged children 6;0-13;0 who have insight into their stuttering
May not always be suitable Tx for children w higher lvls anxiety--> not comfortable--> try another Tx
Works well w those w predominant blocking: children can feel it. Can also be prolongations, repetitions etc
Steps
Apply PVC for stuttering
Signal to stop talking can be verbal/non-verbal
Start w SLP/parent imposed time out
Progress to self
Neurological POV: we are trying to send messages to your brain saying "We don't want the stutter to come thru", so when we stop it, it's telling your brain that we don't want it to happen anymore
Notes
Can start w 5 seconds. BUT X stop at every stutter. Just majority
Length of time out reduces as person starts to feel stutter pass more quickly thru practice
Child must stop talking to let stutter pass
X need to make a big deal of request to stop
Can start off w memory game: 1 word--> 2 words--> phrase--> sentences
Considerations
X work if high lvls anxiety present
Can still speak in natural pattern
Works well w more severe cases
Internal motivation, insight from child best
Minimal parent invl needed
Factors to consider in choosing Tx
Child's age
Response to Tx trials: ask parents if they want to try another program if they have done Lidcombe
Available evidence
Negotiation w parent, child-what do they feel is comfortable?
Slower in response, more plateaus, less variability
How is implementation of Lidcombe program different in school aged vs. preschool?
Can be used for 6;0-10;0
Good starting point
Ideal for children who have some awareness (can start to self-correct), can have some anxiety but no word avoidance (WATCH OUT!)
Concepts are same
Stage 1 might take longer bcos rigidness of brain
Activities
Tailored to child's interests (guides choice of resources), cognitive lvl
Child completes own SR (decides what their speech looked like in sch), parents give own SR
PVCs can be tailored
Focus on praise for child's own self-correction
Rewards (only during STAND OUT MOMENTS- smooth sentence): verbal, non verbal, token eg. lego pieces to build car
Characteristics of PWS
Decreasing response to Tx (tractability)
Contextual, personal, cognitive differences (memory, reasoning, problem solving, self control, self monitoring, anticipatory skills, able to manipulate env more w lang, choices), greater unds, insight
Families are busier, school more demanding, less time for Tx
School presentations, leadership, speeches: scary experience, assessed on confidence lvl
Brain less neuroplasticity as child ages: more diff as brain becomes fixed, can give them early Tx but more likely for stutter to worsen. More about managing > eliminating stutter (although still an option)
Transition from child to adult
R/s w parents
Highly impacted by peers
Reaching puberty- could have sudden onset of stutter
Taking a lot of info
In env where right or wrong is focus
Things to consider in Ax
Why they are referred, motivations to receive Tx
Stuttering history, why they started stuttering eg. stress triggered
Stuttering severity in various situations
Tx history
Presence of -ve social conseq: bullying, anyone who commented on your speech, impt to use neutral lang
Who can assist w Tx
Expectations in Tx
Openness about Tx
What to use?
Subjective units of distress scale (SUDS), unhelpful thoughts and beliefs about stuttering (UTBAS), overall asessment of stutterer's experience (OASES)
Tx: syllable timed speech
Can use picture cues to help child maintain use of STS during conversations
Metronome, practice 5-10 min, 4 to 6 times a day
Considerations
Mass practice required
Might be unnatural
Can be helpful if LP plateaus
No instruction needed
6;0-13;0
Tx: speech restructuring
What?
Stuttering has primary neurophysiologic cause that can become more complex w age bcos social, psychological factors
Improve brain capacity to process speech by improving coordination of respiratory, supralaryngeal, laryngeal systems
Reduce demands associated w speaking eg. slow down speech, increased airflow
Reduce motor dysfunction: reduced muscle tension-speech articulators to touch gently
Principles
Significantly reduced by fluency shaping strategies:smooth speech, prolonged speech
Tx designed to sustain long term change
Goals
Significantly reduce stuttering, increase speech rate to fnal lvls
Gain understanding of speech mechanism
Produce natural-sounding speech
Improve psychosocial skills-emotions, attitudes
Considerations
Ideal for older sch aged children only bcos it's complex
Works best w children who can self-evaluate, insight into stuttering
Parent invl not always required but good to have
Long term commitment
Can be effective in controlling stuttering over long time
If Tx X work think
Is it too boring?
Is child internally motivated to change behaviour?
Is this irrelevant to communication situations, demands?
Not enough practice?
Child too self conscious about how fluent speech sounds
No active participation of parents
Overenthu parents leap to next stage too fast
Anxiety, poor self esteem?