The image part with relationship ID rid3 was not found in the file. Susan Cochrane, M.A., CCC SLP, BRFS Sheryl R. Gottwald, Ph.D.

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1 The image part with relationship ID rid3 was not found in the file. Susan Cochrane, M.A., CCC SLP, BRFS Sheryl R. Gottwald, Ph.D., CCC SLP, BRFS

2 Disclosure My name is Susan Cochrane. I am here to talk about assisting parents in helping their children who stutter. I have no relevant financial relationships. Some information presented here comes from my clinical experience in my private practice: Freedom to Speak. My name is Sheryl Gottwald. I am also here to talk about assisting parents in helping their children who stutter. I have no relevant financial relationships. Some information presented here comes from my clinical experience in my private practice: Center for Speech and Language Services.

3 Objectives for the Session At the end of this seminar, you will be able to: Describe a variety of approaches for assisting families of young children who stutter Explain how to match approaches with family style, needs, and interests. Tell how to implement specific approaches to help parents develop strategies for supporting their child s fluency growth.

4 EACH FAMILY IS DIFFERENT Families come to us with different needs: Knowledge base Family make up Interaction style Learning style

5 MATCH FAMILY WITH APPROACH Identify family preferences, learning style, interaction style, and history through comprehensive interview Share information about a variety of evidenced based treatment approaches Help family to choose the approach that best fits their needs and lifestyle Remember: approaches must be used flexibly

6 SOME EVIDENCE BASED APPROACHES FOR SUPPORTING YOUNG CHILDREN WHO STUTTER Parent Child Interaction Therapy (Millard & Cook, 2008) Lidcombe Program (Jones et.al., 2005) Demands and Capacities (Gottwald, 2010) Solution Focused Brief Therapy (Quick, 2008)

7 USE APPROACHES FLEXIBLY Approaches are not canned programs. Approaches are suggestions for how to address treatment. Approaches must be implemented flexibly to provide the most effective intervention. Use selected components of an approach that directly address family needs.

8 ALWAYS INVOLVE FAMILIES 1. Families are the keys to successful treatment. 2. They know their children and they know what works best for their families. 3. In addition to parents and siblings, families may also include grandparents, extended family members, babysitters, nannies. 4. Include families in planning what to do, how to do it, and in evaluating what is done.

9 Family #1: THE ADAMS FAMILY Tyler was 3 ½ years old when his mother contacted us. He had begun to infrequently repeat whole words and on occasion parts of words. Tyler did not appear to be troubled by his repetitions and continued to talk without difficulty regardless of her fluency. Tyler s Dad stuttered. Mrs. Adams wondered if she should wait and see how things turned out or seek help now.

10 PARENT CHILD INTERACTION THERAPY We chose Parent Child Interaction Therapy for the Adams Family and here is why: Tyler was normally fluent much of the time. Tyler was not reacting to his disfluency and continued to talk without worry. Except for family history and gender, no other risk factors were present. Mrs. Adam expressed concern about whether or not she should seek help.

11 PARENT CHILD INTERACTION THERAPY Clinician collaborates with parents and empowers parents to manage their child s stuttering. Parents watch video recordings of their interactions with their child to identify helpful and less helpful behaviors. Parents select targets to address, practice targets in therapy, and then when comfortable, carry targets over to home.

12 PARENT CHILD INTERACTION THERAPY Begin with a detailed assessment to describe child s speech, language and fluency levels as well as family strengths and needs. Session 1, in clinic: feedback from assessment and special time Session 2 6, in clinic, once weekly: Review progress Review video recording of parent child play Parent selects & practices interaction targets Six week period of home consolidation follows

13 PARENT CHILD INTERACTION THERAPY Management Strategies: Help parents: 1) Manage anxiety around stuttering 2) Cope with sensitive children 3) Build child s confidence 4) Set boundaries and routines Targets Might Include: 1. Rate 2. Time between turns 3. Reducing language complexity

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15 PARENT CHILD INTERACTION THERAPY As part of PCIT, Mrs. Adams: 1. Learned about multiple factors that played a role in her child s fluency 2. Developed home management strategies such as: Quiet time activities Special time Relaxed approach to talking with Tyler In 6 weeks, Mrs. Adams reported feeling confident in flexibly addressing her son s fluency needs; maintained contact with clinic over next 6 weeks via & phone. Further intervention was not warranted.

16 Family #2: THE BROWN FAMILY Evan Brown is a 4.5 year old boy who had been stuttering with fluctuating severity for 8 months prior to treatment. The Brown s were anxious to eradicate the stuttering behaviors and move on with their busy lives. Mr. and Mrs. Brown stated there was no family history of stuttering and Evan was their only child. The family had no concerns other than stuttering for Evan.

17 THE LIDCOMBE PROGRAM We chose the Lidcombe Program for the Brown Family and here is why. this model immediately addresses the behaviors of stuttering parent s implement the treatment at home Mr. Brown was able to bring Evan to the clinic 1x/week before leaving for work as is required for training the Brown s gained satisfaction from a daily plan of documentation the parents believed on response contingency behavior training

18 THE LIDCOMBE PROGRAM Parents learn what normal fluency is Parents praise child when child uses normal fluency (e.g., That was your smooth speech! ) Parents praise at least 5 times an hour After two weeks of praise, parents ask child in a gentle way to change stuttering (e.g., That was a little bumpy; can you say it with your smooth speech? ) Parents immediately praise child for attempting to change stuttering (e.g., Great job using your smooth speech! ).

19 THE LIDCOMBE PROGRAM child and parent visit clinic 1x/week where clinician trains the parent parents implement procedures at home treatment relies on relation between parent and child attempts to achieve parental verbal contingent stimulation of various responses during everyday conversations parents use a severity rating scale daily to record the child s stuttering severity

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21 The Lidcombe Program As part of Lidcombe, Mr. and Mrs. Brown: 1. were able to work with Evan at home 2. document daily progress on the rating sheets The Browns are currently in the third month of a planned 6 month program, where they are scheduled to make twelve visits to the clinic for training.

22 Family #3: THE KELLY FAMILY Brian Kelly is a 5 year old boy who has received intervention for his stuttering at his preschool off and on for the past seven months. Mrs. Kelly reported, Brian has made no progress in therapy at all; his stuttering is still as struggled as it was when we first started therapy. The family expressed concern about not knowing how to help their son.

23 DEMANDS AND CAPACITIES We chose Demands and Capacities Therapy for the Kelly Family and here is why. This model: 1. addresses the family s need for information and support. 2. identifies environmental supports and stressors that impact the child s fluency. 3. teaches parents how to participate in and support direct fluency intervention. 4. teaches the child fluency enhancing skills

24 WORKING WITH FAMILIES: AREAS OF FOCUS THE THERAPY ENVIRONMENT 1. Focus on what the family is doing that is already helping (e.g., coming to therapy, playing at child s level, giving child talking time) 2. Support family as they choose strategies 3. Practice strategies with family 4. Help family to determine ways to evaluate strategies

25 Working with Families: Behavior Change ALTERING TIME PRESSURE 1. Speech rate 2. Conversation pace 3. Interruptions 4. Time for talking

26 Working with Families: Behavior Change ALTERING LANGUAGE DEMANDS 1. Comments for complex questions 2. Confirm intent 3. Scaffold 4. Rest time

27 Working with Families: Behavior Change ALTERING ENVIRONMENTAL STRESSORS 1. Turn taking rules 2. Special interaction times 3. Structure/routine 4. Minimize fluency stressors (fatigue, excitement)

28 Working with Families: Cognitive Change DEVELOP SUPPORTIVE REACTIONS 1. Learn how Ireact now 2. Avoid negative comments 3. Focus on child s message 4. Express acceptance, react neutrally 5. Acknowledge child s feelings

29 Working with Families: Cognitive Change LEARN ABOUT FLUENCY/STUTTERING 1. Normal fluency 2. Causes of stuttering 3. Spontaneous recovery 4. Risk factors 5. The therapy process 6. Regression, discipline

30 WORKING WITH THE CHILD FACILITATE SLOW, RELAXED TALKING 1. Use slightly exaggerated models 2. Describe in concrete terms 3. Move from structured practice to functional activities as child s skills develop

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32 WORKING WITH THE CHILD LEARN TO USE WHOLE WORD REPETITIONS 1. Use easy bounces as a normal part of talking 2. Use easy bounces to change a stutter

33 WORKING WITH THE CHILD SET UP TALKING TIME RULES 1. One person speaks at a time. 2. Use an indoor voice. 3. Learn how to get the conversation floor

34 WORKING WITH THE CHILD TALK ABOUT STUTTERING 1. Talk about all the ways we talk. 2. Talk about feelings related to talking. 3. Put child s feelings into words. 4. Provide encouragement.

35 WORKING WITH THE CHILD TALK ABOUT STUTTERING 1. Your brain is still growing and you are still learning how to talk. 2. Talking will get easier as you get bigger. 3. Sometimes talking is harder for you but you are also really good at

36 WORKING WITH THE CHILD INCREASE COMFORT LEVEL WITH STUTTERING 1. Have child teach a family member how to use bumpy speech 2. Have contests to see who can catch the most bumps. 3. Give the child points for every stutter s/he catches 4. Talk about stuttering in a matter of fact way.

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38 WORKING WITH THE CHILD HELP CHILD CHANGE THE STUTTER 1. Slide into the sticky word. 2. Stretch out the bumpy word. 3. Use an easy bounce. 4. Keep the talking motor going.

39 DEMANDS AND CAPACITIES Mr. and Mrs. Kelly were both active participants in therapy and supported each other in this process. They felt much more in control when they understood what stuttering was and how it developed. They valued learning the words they could use to talk about talking with their child. As the parents relaxed about talking, so did Brian! He enjoyed turtle talk and made sure everyone in his family used it. Within several months, Brian used primarily normal fluency.

40 Family #4: THE JONES FAMILY Jake is a four year old boy who had been receiving Lidcomb treatment and doing well until they began toilet training. Mr. and Mrs. Jones expressed frustration and disappointment regarding the sudden recurrence of the stuttering behaviors. Mr. and Mrs. Jones report, We are at a loss as to what to do.

41 SOLUTION FOCUSED BRIEF THERAPY (SFBT) We chose Solution Focused Brief Therapy for the Jones Family and here is why. This model: 1. Aids the parents in identifying what works and what does not 2. Aids parents in simplifying the problem, as well as problem solving, thus easing frustration 3. Aids client by focusing on strengths and amplifying success.

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43 SOLUTION FOCUSED BRIEF THERAPY focuses on strong therapeutic relationship clinician and parents identify the problems clinician and parents evaluate what maintains the problems clinician and parents consider what might interrupt the ongoing problems clinician and parents determine how the change might best be implemented

44 Solution Focused Brief Therapy As part of SFBT, Mr. and Mrs. Jones: 1. Identified the variables that supported fluency in the past (positive R+). 2. Identified the challenges that may have stressed the child (too much pressure for toilet training) 3. Decided to implement a positive R+ system for both fluency skills and toilet training and decreased expectations for toilet training.

45 Solution Focused Brief Therapy In a very short amount of time, the Jones family reported: 1. feeling much happier with both toilet training and the child s fluency 2. that the child s fluency returned to normal levels 3. that the child no longer protested sitting on the toilet

46 IN CONCLUSION: We have discussed four, evidence based therapy approaches for treating young children who stutter. Approaches and parts of approaches are meant to be used according to the individual needs of each family and the changes that occur during treatment. Drawing from each, allows the clinician to tailor a successful therapeutic plan for each child and their family. The information here is less than comprehensive due to time constraints. We encourage you to examine each approach more closely in order to gain more information to use in your clinical practice.

47 REFERENCES Botterill, W. & Cook, F. (2010). Tools for success: Solution focused brief therapy taster [DVD]. Memphis, TN: The Stuttering Foundation. Gottwald, S. R. (2010). Stuttering prevention and early intervention: A multidimensional approach. In B. Guitar & R. McCauley (Eds.), Treatment of stuttering: Established and emerging interventions (p ). Baltimore, MD: Lippincott, Williams & Wilkins. Millard, S.K. & Cook, F.M. (2008). Is Parent Child Interaction Therapy effective in reducing stuttering? Journal of Speech, Language, and Hearing Research, 51, Miller, B. & Guitar, B. (2009). Long term outcome of the Lidcombe Program for early stuttering intervention. American Journal of Speech Language Pathology, 18, Quick, E. (2008). Doing what works in brief therapy: A strategic solution focused approach (2nd ed).waltham, MA: Academic Press.