Treatment with the preschool

1
Treatment with the preschool

• Client Issues
• Status of child
• Environmental factors
• Intervention Issues
• Indirect
• Direct

2
What is the status of the child? (Yairi, 2005)

• Who is at risk for persistent stuttering?
• Gender (Male)
• Age of onset (gt 3-3.5 years)
• Positive family history
• Positive for other speech/language problems
• Length of problem (gt14-18 mos.)
• Difficult to differentiate those who will and
  will not persist near the onset of symptoms

• What behaviors to look for?
• 2-3x total disfluencies
• 5-6x stuttering-like disfluencies (SLD)
• ? proportion of SLD/total disfluency
• ? proportion of part-word repetitions with 2
  units
• 6x disfluency clusters
• Longer disfluency clusters
• Repetitions with shorter successive interval
  between units
• 2x associated head and neck movements
• SLD part-word repetition, disrhythmic
  phonation, tense pause

3
What is the status of the child?(Ward, 2006)

• 1. Not at risk to stutter
• 2. Currently not stuttering but at risk to
  stutter
• 3. Early signs of primary stuttering
• 4. Signs of established stuttering
• 5. Signs of advanced stuttering

4
Environmental Issues
5
Intervention Issues

• Indirect
• No direct discussion of fluency
• For example, model
• easy speech
• reduced time pressure
• Direct
• Fluent speech
• Stuttered speech

6
Parent-Child Interaction Approach (PCI)

• Indirect approach
• Cognitive-based
• Assumes multi-factorial nature of stuttering

7
Assessment

• Child Assessment
• Speech/language
• Fluency
• Interview to address
• Attitudes toward communication, social situation,
  school etc
• Home and family situation
• Aspects of speech problem
• Observe for behavioral issues such as
• Separation from parents
• Cooperation
• manner of engagement
• anxiety level

8
Assessment

• Child-Parent Interaction
• Video parents with child
• Evaluate interaction style
• Observe social communication variables
• Observe stuttering behaviors and when they occur
• Parent Interview
• Effect of stuttering on family
• Health History
• Psychosocial Interview
• Development history

9
Therapy outcome from assessment

• Low stuttering risk (no intervention)
• At risk for stuttering (delay intervention for
  reasons other than stuttering)
• At risk for stuttering (initiate intervention)

10
Aspects of Intervention Program

• 6 weeks of weekly one-hour sessions
• Session 1
• Establish Special time concept
• Session 2-6
• Discussion
• Video-taped play and review
• Consolidation period of additional six weeks

11
Lidcombe Program
12
General Features

• Target Group preschoolers
• Therapy Approach
• Direct
• Operant
• Parent-Mediated
• Primary Therapy Goal
• Reduce stuttering behavior lt 1 SS

13
Program Components

• Behavioral Component
• Praise stutter-free speech
• Correct stuttering (modeling, stimulation and
  reinforcement)
• Positive reinforcement punishment ratio 51
• Measure Speech Behaviors
• Programmed Maintenance (no formal transfer)
• Problem Solving Component
• Counseling to optimally integrate program into
  family environment etc.

14
Lidcombe Randomized Clinical TrialJones et al.
(2005) BMJ 331(7518) 659
15
Integrated Approach SP3 (Chmela)

• DVD in LRC