Practical Treatment Strategies for Preschool and Young School-Age Children Who Stutter: Ages 2 to 6. J. Scott Yaruss, Ph.D., CCC-SLP, ASHA Fellow

Size: px
Start display at page:

Download "Practical Treatment Strategies for Preschool and Young School-Age Children Who Stutter: Ages 2 to 6. J. Scott Yaruss, Ph.D., CCC-SLP, ASHA Fellow"

Transcription

1 Practical Treatment Strategies for Preschool and Young School-Age Children Who Stutter: Ages 2 to 6 J. Scott Yaruss, Ph.D., CCC-SLP, ASHA Fellow Board-Recognized Specialist and Mentor in Fluency Disorders Associate Professor, Communication Science & Disorders, University of Pittsburgh Director, Stuttering Center of Western Pennsylvania 4033 Forbes Tower, Pittsburgh, PA Phone: (412) Fax: (412) jsyaruss@pitt.edu / speech@yaruss.com Stuttering Center: / Presentations and Seminars: Practical Stuttering Therapy Guides: S enter tuttering Disclosures: Financial relationships with Pearson Assessments (royalties) and Stuttering Therapy Resources (royalties and ownership). Non-financial relationships with StutterTalk (advisory board) and National Stuttering Association (volunteer) C W of P estern ennsylvania I. Most Important Fact #1: You can and should treat preschool children who stutter, and YOU are the best person to do it. #1 II. Purpose A. To reduce your fears about working with very young children who stutter 1. To help you realize that you won t hurt the child or make stuttering worse through treatment 2. To help you feel confident that you are using appropriate diagnosis and treatment strategies 3. To help you respond to and minimize concerns of parents and others in a child s environment B. To discuss current strategies for helping preschool and young school-age children who stutter by 1. Improving children s speech fluency through a variety of data-based techniques 2. Reducing tension & struggle during stuttering so children can communicate freely and effortlessly 3. Minimizing the development of negative reactions (e.g., fear, concern) to stuttering by the child 4. Minimizing negative reactions of parents, teachers, peers, and others in the child s environment III. Where Do We Start? Defining Stuttering A. The first question we often need to answer is whether the child is actually stuttering 1. Many children go through a period when they exhibit an increased number of speech disruptions 2. Not all of these disruptions are instances of stuttering, but we want to look carefully to make sure we don t let kids who are at risk fall through the cracks 3. To answer this question, we need a definition of stuttering so we know what to look for 4. Unfortunately, numerous definitions have been offered over the years, and this has contributed to clinicians confusion about the diagnosis and treatment of the disorder B. What Is Stuttering? It can be defined as both a speech behavior and as a speech disorder 1. Behavior: A specific type of disruption in the forward flow of speech ( speech disfluency ) 2. Disorder: A communication problem typically (but not always) characterized by the production of certain types of speech disfluencies 3. Children can produce disfluencies without stuttering and without having a disorder (Indeed, all children are disfluent to some extent) J. Scott Yaruss 1

2 C. What Are Stuttering Behaviors?!? 1. There are many definitions of stuttering, and many opinions about what should be counted as stuttering behavior a) Stuttering typically refers to certain types of speech disfluencies (e.g., sound or syllable repetitions, prolongations, blocks) b) Note that these disfluencies typically involve disruptions within the word unit, but not all withinword disfluencies are stuttering, and not all stuttering involves within-word disfluencies c) Stuttering behaviors may also be accompanied by tension or struggle, but not always 2. Stuttering is often accompanied by a speaker s feeling that he cannot continue speaking even though he knows exactly what he wants to say a) Often referred to as a feeling of a loss of control (Perkins, 1990) b) We must recognize the speaker s perception when trying to identify stuttered events D. So Is This Child Stuttering? It is relatively easy to determine whether a preschooler is exhibiting stuttering behaviors. We do this by counting the disfluencies that the child exhibits. We also gather information from parents and others about those behaviors in other settings. IV. How do we count the stuttering behaviors? A. There are several basic measures of disfluencies: 1. Frequency of Disfluencies. How often disfluencies occur in a sample; Typically represented as the percentage (out of 100) of disfluent words or syllables. 2. Types of Disfluencies. Helps distinguish normal interruptions from stuttered interruptions; Provides indication of the development of the disorder (especially in preschool children) 3. Duration of Disfluencies. The number of seconds a repetition, prolongation, or block lasts or the number of iterations in a repetition (e.g., li-li-li-like contains 3 stuttered and 1 fluent iterations) 4. Severity of Disfluencies. Describes the physical behaviors during stuttering (e.g., tension, struggle). Severity measures combine several aspects of the behavior into a single number or score. In doing so, you lose some of the detail in the data you collected, but severity ratings are widely used. a) Often obtained through measures such as the Stuttering Severity Instrument (Riley, 1994) or Stuttering Prediction Instrument (Riley, 1981), but b) (Note that the reliability of these instruments is not ideal) B. Measurement Procedures. Measures can be collected in real-time or based on a transcript 1. Real-time analyses collect and analyze data at the same time, while the client is speaking (or offline from a videotape). These measures are fast and efficient, but limited in the amount of data that can be collected at one time 2. Transcript-based analyses require that you record data and analyze it later, often based on a detailed verbatim transcript of the client s speech. These measures are time-consuming, but allows much more detail to be considered in analyses C. Real-Time Analysis: Quickly and reliably obtain the frequency and types of disfluencies 1. Watch a speech sample (live or from a videotape) and keep track of whether each word or syllable was produced fluently or disfluently. Count the disfluencies to obtain your data. a) Make sure your sample is large enough to be representative of the client s speech J. Scott Yaruss 2

3 D. Count Sheet: To facilitate data collection, you can use a count sheet (Conture, 2001; Yaruss, 1998) 1. The sheet contains a series of blank lines representing the words or syllables produced by the client 2. A tally section is also included to facilitate tabulation of different types of disfluencies 3. Count sheets can be designed to follow the coding conventions used in any clinic) a) Use a dot or a dash to indicate a fluent word; Use abbreviations to identify the types of disfluencies that occur (using one of the various categorization schemes that were mentioned) b) This takes practice, but ultimately you will be able to identify the types of disfluencies (To begin, you can mark disfluencies with an X (or use S for stuttered and N for normal)) 4. The biggest concern about real-time analysis is keeping up with the child a) Children can speak quite quickly, and real-time analysis requires rapid judgments b) Still, stuttering reduces overall speaking rate and this actually makes it easier for you to keep up once you get good at making stuttering judgments 5. For More Information: see my CE course on stuttering measurement at E. With practice, you can learn to make reliable judgments of the overall frequency of disfluencies in a sample. Still, it is not entirely straightforward because #2 1. Stuttering Varies from situation to situation, day to day, listener to listener. Thus, we cannot base decisions on measures taken in just one speaking situation 2. Some factors that affect variability: a) Conversational tasks (Conversation, Picture description / Story Retell, Monologue, Reading) b) Conversational setting (both in and out of clinic, at home, in the classroom, on the playground) c) Conversational partners (Parents, clinician, peers, siblings, playmates, others) 3. Still, If you practice (to achieve reliability) and are cautious in interpretation (because stuttering varies), you can get a reasonable indication of whether the child is stuttering and, if so, how much F. For preschool children, the question Is this child stuttering? isn t as important as you think... #3 #4 1. The parent would not have brought the child in if she hadn t had some reason to be concerned about the child s speech, AND preschool children can still recover even if they stutter severely (and children who stutter mildly may still be at serious risk!) 2. Initial Severity Does Not Predict Chronicity G. The more important question is Is This Child Likely to Continue Stuttering? because most Preschool Children Recover from Stuttering 1. Studies show that as many as 75-80% of preschool children who stutter will recover a) The majority of these children will recover within the first 6 to 12 months b) Recovery is still observed up to 2, 3, and even 4 years post-onset 2. This recovery can be aided (with the help of treatment) or unaided (without any intervention at all) 3. This is good because we want children to recover, but it s bad because it makes our job harder (There is no single factor that we can point to that absolutely differentiates children who will recover from children who will persist) H. For very young children who stutter, the primary goal of the diagnostic evaluation is to determine whether the child is at risk for continuing to stutter 1. If the child is at high risk, then treatment is definitely indicated 2. If the child is at low risk, then we may not need to be as urgent in our intervention, though I rarely send families home empty-handed! J. Scott Yaruss 3

4 I. Recent research has sought to determine what risk factors make it more or less likely that a child will recover from stuttering. These risk factors can be divided into two broad categories: 1. What s going on within the child? (Etiologic factors that create disfluencies 2. What s going on within the child s environment? (Contributing factors that exacerbate disfluencies) J. Focusing on Etiology What Causes Stuttering? 1. Most clinical researchers now believe that stuttering arises due to multiple risk factors (genetic & environmental factors including language abilities, motor abilities, temperament) 2. Many current theories of language formulation and speech production are based upon a set of related modules where messages are built through a series of interacting processes (Speech disfluencies represent disruptions in the planning or production process) 3. What s Going On in the Child? a) What are the child s Language Skills? (You already know how to evaluate children s language) b) What are the child s Motor Skills? (You already know how to evaluate young children s speech sound production, though evaluating speech motor control may not be as easy) c) What is the child s Temperament? (You may not have used tests of temperament before, but you can assess reactivity and regulation ability through observation and parent interview) #5 4. So what are we looking for in the child? a) A mismatch between Language Skills and Motor Skills (This can be any type of mismatch -- advanced language skills & typical/lower motor skills, advanced motor skills & typical/lower language skills, or anything) b) A sensitive/reactive Temperament (1) Reactivity to what goes on within/around the child (fears, cries easily, strong reactions to noise) (2) Regulation difficulty for changing responses (Difficulty stopping crying, changing activities) c) The etiology of stuttering is within the child In other words, Stuttering Is Built-In! (it is a neurological dysfunction involving the child s language skills, motor skills, & temperament systems) K. What s Going On in the Child s Environment? #6 1. For years, people believed that stuttering was caused by the child s environment a) The diagnosogenic theory stated that parental misdiagnosis of normal disfluencies led to increased concern about the child s speech ( Stuttering begins in the ear of the listener, not the mouth of the speaker ) b) This theory was the source of the fear about drawing attention to stuttering and was the foundation for indirect treatment approaches c) But The diagnosogenic theory was WRONG! The child s environment does not cause stuttering 2. Still, this does not mean the environment plays no role in the child s stuttering a) Parents are still extremely important in the child s daily experience of the disorder and the child s experiences contribute to the disorder b) We can help parents make changes that support the development of more fluent speech (If the child weren t susceptible to some change in his environment, then no treatment would work) 3. So what are we looking for in the environment? a) A speech or language model that is too advanced (This does not cause stuttering, but it can make it harder for the child to communicate successfully) (1) Children are more likely to stutter on longer, more complicated utterances (adult language model) (2) Stuttering severity is related to dyadic speaking rate (the difference between the parent s and child s rate) b) Strong (fearful, anxious) reactions to stuttering on the part of parents or others (Again, this does not cause stuttering, but it may convey that stuttering should be feared) J. Scott Yaruss 4

5 L. What Causes Stuttering? Stuttering arises due to an interaction among several factors that are affected by both the child s genes and the child s environment 1. Language Skills for formulating messages 2. Motor Skills for producing rapid and precise speech 3. Temperament for reacting to disruptions in speech 4. An interaction among factors contributes to the likelihood that the child will produce speech disfluencies and react to them M. What Risk Factors contribute to the likelihood that a child will continue stuttering? 1. Family history of stuttering 2. Preponderance of stuttered types of disfluencies 3. Time since onset > 6 months 4. Child is aware of or concerned about disfluencies 5. Child is highly reactive to mistakes or disfluencies 6. Parental reactions are negative or fearful 7. Child has concomitant speech/language disorders 8. Others? Research is ongoing N. How does all this relate to the diagnostic evaluation? To gain an full understanding of these risk factors, our evaluation will include: 1. Parent Interview: Family history, confirmation of behaviors in other settings, temperament, development of stuttering 2. Observation of Child: Surface behaviors of stuttering in clinical setting, reactivity and regulation 3. Speech/Language/Motor/Temperament Testing: Language/Motor Mismatch, Reactive Temperament, Presence of Concomitant Disorders O. To Treat or Not To Treat There is (still) a significant debate about when to recommend therapy for preschool children 1. Many preschoolers recover on their own, so some prefer to wait and see. a) I am not comfortable with this because I don t want children to fall through the cracks 2. Because there is no simple way to determine who will outgrow stuttering a) I prefer to help families that want help, even if it seems that the stuttering might ultimately resolve b) Of course, this does not mean that all children receive full, formal therapy that s what we ll discuss next P. Summary of the Evaluation. When evaluating preschool children who stutter, remember 1. Determining whether they stutter is easy (and not particularly interesting); determining whether they are likely to continue stuttering is the question of interest, for that is what helps you decide if therapy is indicated 2. The evaluation is based on finding risk factors a) Etiologic factors (within the child) b) Contributing factors (within the environment) J. Scott Yaruss 5

6 V. What s Next? TREATMENT! #7 A. What s the Primary GOAL of Treatment for Preschool Children? To eliminate the stuttering! B. How Do We Do That? There s more than one way 1. Treating Preschool Children Who Stutter the OLD Way. Historically, treatment for preschool children who stutter has been indirect (Based on the (incorrect) diagnosogenic theory) a) No instructions were provided to the child about how to modify speech or improve speech fluency (In fact, no mention of speech was made at all, for fear that the child would get worse or become aware of his stuttering ) b) This is old news! Times have changed! 2. Treating Preschool Children Who Stutter Some NEW Ways. Over the past 10 to 15 years, researchers and clinicians have moved toward providing direct treatment for preschool stuttering a) Direct discussion of fluency-enhancing speech strategies and appropriate communication attitudes, combined with environmental modifications to minimize fluency disruptors b) Direct correction of stuttered speech and praise for fluent speech (Lidcombe program) VI. A Family-Focused Treatment Approach for Preschool Children Who Stutter Yaruss, Coleman, & Hammer (2006) Language, Speech, and Hearing Services in Schools A. For young children who stutter, the first goal of therapy is to improve their fluency B. Still, our therapy is not focused entirely or exclusively on fluency 1. We also work to ensure that children develop effective communication skills 2. We want to ensure that children develop appropriate attitudes toward their speaking and stuttering C. Fortunately, we have several effective tools to help us accomplish these broad goals! Improved Speech Fluency Effective Communication Skills Healthy Communication Attitudes Parent-Focused Treatment (Parent-Child Training Program) Child-Focused Treatment (Direct Treatment) Parent Communication Modifications Parent and Child Understanding and Acceptance of Stuttering Child Communication Modifications Easy Talking Model Increased Pause Time Reduced Demands Reflecting / Rephrasing Parent Counseling Education about Stuttering Identification of Stressors Communication Wellness Education about Speaking and Stuttering Desensitization (as appropriate) Speech Modification Stuttering Modification Communication Skills Concomitant Disorders J. Scott Yaruss 6

7 VII. Part 1: Parent-Focused Treatment A. Parent Communication Modifications: (A Fluency-Facilitating Environment). Parents can change their speech patterns to help the child achieve more fluent speech, e.g.: 1. Slower speaking rate (n o t t o o s l o w!) a) Easier interaction style. Increased pausing both within and between utterances 2. Less hurried daily pace / lifestyle (Less hectic scheduling of daily life activities, one-on-one time with child) B. Focus on the Parents Communication Style and the Child s Fluency 1. Children do not slow when parents slow, and they do not pause when the parents pause a) Improvements in fluency are not related to changes in the child s speaking style b) Children just tend to become more fluent when parents change their speaking style 2. Why? Nobody performs at their best when under pressure to act quickly C. Why Do We Do These Things? (and why should they work, if they do?) 1. The rationale is NOT because parents talk too fast or demand too much a) For years, researchers have sought a consistent difference in the parenting and communication styles of parents of children who stutter, compared to parents of children who do not b) It s just not there parents of children who stutter are no faster or slower or more demanding or whatever than parents of children who do not stutter 2. The rationale for changing the environment IS based on the finding that when parents speak more slowly, children become more fluent a) The evidence for this is thin, and more research is needed so, why do we do it? 3. I think the key variable is time pressure a) Slower rate, increased pausing, reduced activity these aren t as important as giving the child the time he needs to plan and produce speech b) As we minimize time pressure, we increase communication success #8 4. The Bucket Analogy identifies multiple factors involved in stuttering and helps parents understand the rationale for parent-focused aspects of treatment a) Water in the bucket represents risk factors contributing to the child s stuttering b) Treatment aimed at modifying the communication environment addresses those aspects of the child s water bucket that can be modified (1) We can t easily change the genetic component of stuttering, temperament, family conflicts, etc (2) We can help the parents reduce time pressures the child experiences in key situations c) The rationale for parent-focused treatment is simply to lower the water level where you can d) In therapy, we change the things we can change! D. How Can We Help Parents Do All These Things?? (and do them consistently) 1. Rule #1: SHOW, not tell You can t just tell parents to slow down a) They ll try, but they can t do it without help b) And if they can t, they ll feel (even more) guilty 2. You need to train them about how to slow down, when to slow down, and what to expect when they do slow down a) The same is true for all the other strategies we re going to help the parents use in order to support their children s speech development J. Scott Yaruss 7

8 VIII. Helping Parents Learn to Facilitate Children s Speech Fluency ( Parent-Child Training Program ) A. Goal is to help parents learn and use strategies for facilitating fluency at home and in other settings B. Based on current evidence about factors that affect children s speech fluency: 1. Modifying aspects of daily interactions can help child achieve fluency in specific situations (even if the child does not directly change his own communication patterns) 2. The more time a child spends communicating successfully, the less likely he is to develop severe stuttering C. Approx. 6-to-8 session treatment program 1. 2 to 4 parent-only sessions for counseling/education about stuttering and communication in general 2. 3 parent-child sessions when parents learn and practice fluency-facilitating communication modifications 3. 1 to 2 review and problem-solving sessions where the need for further treatment is assessed 4. Training is administered by itself or prior to more direct intervention with child or family 5. Focus (for now) is on parent behaviors we will discuss child-focused treatment next D. Communication Wellness Analogy: Describes flow of treatment so parents will understand the treatment structure (this and other handouts at IX. Parent Session 1: Overview and Identification of Stressors Parent Observation Direct Child Intervention Parent Sessions Strategy Practice A. Goals of Session 1: 1. Help parents understand the nature of stuttering and the factors that may affect their child s speech 2. Provide an overview of the treatment process 3. Begin identifying interpersonal stressors B. Step 1: Stressor Inventory. Provides background about factors that may affect child s speech and helps parents understand What s Going On in the Child and in the Environment 1. Prior to any discussion about modifications, both parents complete a stressor inventory a) Provides background about factors that may contribute to the child s stuttering b) Examines stressors within the child and within the environment c) Allows parents to see how they compare with one another in their views about the child 2. Possible Stressors in the Child a) Is sensitive e) Demonstrates performance anxiety/fears b) Tends to be perfectionist f) Tends to become more disfluent when tired c) Has an intense personality g) Tends to become more disfluent when ill d) Is competitive h) Has other speech/language problems NOTE THAT THESE DO NOT CAUSE STUTTERING BUT THEY MAY CONTRIBUTE TO DISFLUENCY 3. Possible Stressors in the Environment a) Hectic daily routines are commonplace e) Stressful situations have been present b) Sibling rivalry is intense f) Family members/relatives who stutter c) Limited free time or quiet time g) High expectations are imposed by others d) Others at home talk fast/interrupt frequently NOTE THAT THESE DO NOT CAUSE STUTTERING BUT THEY MAY CONTRIBUTE TO DISFLUENCY (Stressor Inventories are attached to the end of the handout) J. Scott Yaruss 8

9 4. Interpreting Stressor Inventories a) Help parents understand that the goal is not to change the child s personality, but rather, to identify those factors that are contributing to the child s overall communication difficulty b) Keep in mind some parents may be reluctant to identify stressors in the environment c) Have both parents complete the inventories separately then compare them d) Give parents the chance to brainstorm ways to minimize personal and environmental stressors C. Step 2: Help Parents Understand Different Types of Disfluencies (See Disfluency Chart) 1. Helps parents distinguish between disfluency types and understand progress during treatment 2. Reduces misconceptions about disfluency types (prolongations are not better than repetitions) D. Step 3: Home Charting Exercise 1. Increase parents awareness of: a) Situational factors that affect fluency b) Their reactions and the child s reactions to stuttering 2. Helps parents focus their energy on helping the child rather than worrying 3. Gives opportunity to assess commitment to treatment early in the therapeutic process (Parents bring completed chart to next session) 4. The purpose is NOT for parents to keep track of how many times the child stutters E. Step 4: Provide Supportive Literature 1. Support helps parents deal with stuttering, and this helps them help their child 2. Reassures parents that others have had similar concerns, questions, and feelings 3. Provides concrete examples of ways parents can help their children 4. Examples: Booklets and brochures from SFA, NSA, Friends, Stuttering Home Page, etc. a) Beware PIO (Parental Information Overload) b) Keep in mind that counseling is not the same as teaching F. Summary of Session 1 1. Provides an overview of the process of treatment (Communication Wellness Analogy) 2. Helps parents understand the nature of stuttering (Stressor Inventories, Bucket Analogy) 3. Gives parents the opportunity to discuss their concerns in a supportive atmosphere 4. Gives clinician the opportunity to assess commitment and plan further treatment X. Parent Session 2: Overview of Fluency-Enhancing Strategies A. Primary Goals of Session 2 1. Review topics from Session 1 2. Prepare parents for communication modification sessions a) Describe structure of modeling sessions b) Explain wireless microphone system (if available) c) Introduce Communication Modifications J. Scott Yaruss 9

10 B. Step 1: Review Session 1 1. Begin by giving parents an opportunity to continue discussions from Session 1. Many parents will have thought about the stressors and have questions. Now is the time to address those issues 2. Some families may need more time on these aspects of treatment. If so, additional parent counseling sessions are scheduled prior to initiating communication modifications sessions C. Step 2: Describe Structure of Modeling Sessions 1. Communication Modification Sessions are designed to teach parents how to use skills a) Clinician first models the target strategy with the child while the parents observe b) Next, one parent interacts with child while receiving on-line feedback through wireless microphone c) Next, the other parent interacts with child while receiving feedback d) The session is videotaped so parents can review the session at home and observe the changes in detail D. Step 3: Describe the wireless microphone system (if available) Use Easy Talking Wireless Xmitter (Telex TW-6) Wireless Receiver (Telex AAR-1) (Easy Talking) E. Step 4: Introduce Communication Modifications. Make sure parents understand the rationale for the communication modifications 1. Reinforce that the goal is not to correct parental behaviors that cause stuttering, but to make the changes we can make to minimize time pressure on the child s speech (review bucket analogy) 2. Also, reinforce the importance of providing a supportive communication environment 3. Help parents reduce their concerns about the child s stuttering so they can model appropriate reactions XI. Parent and Child Sessions 3, 4, and 5: Fluency-Enhancing Strategies A. Several strategies can be introduced as necessary to enhance child s fluency if these factors are judged to affect a child s speech 1. Reducing parents speaking rates (Easy Talking) 3. Reducing demand for talking (if demand is high) 2. Reducing time pressures (Delaying response) 4. Modifying questioning (if and only if necessary) (Note: Providing a supportive environment is important no matter what other tools are being used) B. Easy Talking: Smooth, slightly slower speech that provides a model of a speaking style the child can use while reducing time pressure 1. Slower than parents habitual rate, but not too slow, choppy, or robot-like 2. Introduce phrased speech as a preferred way to reduce speaking rate 3. The goal for the parents speaking rate is in between the rate they practice in treatment and the rate they used before treatment C. Modifying Questioning: IF a parent uses frequent, rapid questions, and IF this cause problems for the child, the parent can learn to COMMENT rather than QUESTION 1. I wonder 3. I bet 5. Maybe 2. I think 4. I guess 6. It looks like Parents should not just eliminate all questioning J. Scott Yaruss 10

11 D. Reduplication / Rephrasing. Gives child opportunity to hear what he or she said in an easier, more relaxed way (easy speech) 1. Also gives parents the opportunity to provide an appropriate language/articulation model 2. Child knows that parents heard what s/he said 3. Similar to the active listening strategy that clinicians use in counseling interaction 4. Listener reflects and expands upon speaker s utterance, but adds modeling of easy talking XII. Parent and Child Session 6: Review and Evaluation A. Help parents incorporate all strategies 1. Discuss need for home practice and follow-up plan 2. Discuss plan for future treatment as necessary B. A Refresher handout can facilitate generalization (available at 1. Use Easy Talking at slowed rate with phrasing 2. Delay Responding to reduce time pressure 3. Modify Questions. I wonder Maybe I think 4. Repeat and Rephrase both fluent and disfluent speech to provide a good communication model XIII. How Can I Do All that Stuff Where I Work? ( Adapting the Parent-Child Training Program to Other Settings) A. Common Adaptations: Scheduling 1. Many clinicians have difficulty meeting with parents on a regular basis in school settings a) Still, this is somewhat easier to do in many Early Intervention or Preschool settings b) Note that the program is designed to minimize contact between clinician and parent (6 sessions) while maximizing parents treatment of children 2. We typically schedule sessions every other week to give parents the opportunity to try strategies at home before they learn new ones B. Common Adaptations: Observation/Modeling 1. We have found success using the wireless microphone to provide feedback in real-time a) The system is relatively inexpensive and easy to implement in most settings b) Does not require an observation room, since you can sit in the corner of the room and speak quietly into the mic to provide feedback 2. If you don t have access to such a system, you can still provide feedback off-line (after a parent practice session) or while watching videotape J. Scott Yaruss 11

12 XIV. What about Talking to Kids about Stuttering? (Focusing on Parent and Child Acceptance) A. Is it REALLY okay to talk about stuttering? YES! It really is okay to talk about stuttering. 1. Talking about stuttering (in a supportive way) will not make stuttering worse a) The Lidcombe Program even encourages parents to point out a child s disfluencies and ask them to say the words again without bumps (more about that later) 2. It s even okay to say the S word! B. Parent-Child Focused Treatment: Maintaining Healthy Attitudes 1. Concern: Children who stutter are at risk for developing negative communication attitudes 2. Solution: Help parents learn to... a) Model appropriate attitudes and reactions b) Listen to children s concerns about speaking c) Talk to children about stuttering 3. The goal is for the child to accept disfluencies as a normal part of learning to speak C. Talking about Stuttering 1. Concern: Child and parents do not have a way to discuss stuttering 2. Solution: Introduce a vocabulary accessible to child and parents for discussing stuttering 3. Use analogies for talking about disfluencies a) Repetition: going over railroad b) Prolongation: going over a bridge c) Block: hitting a brick wall 4. Goal: Child and parents will be able to discuss stuttering in a matter-of-fact, accepting way D. When Do We Talk About Stuttering with Preschoolers? If the child is Not Aware / Not Concerned Aware but Not concerned Aware and Concerned Parent Counseling Education about Stuttering Identification of Stressors Communication Wellness Parent and Child Understanding and Acceptance of Stuttering Then will we talk about stuttering? No Maybe Yes! Education about Speaking and Stuttering Desensitization (as appropriate) XV. Summary of Parent-Focused Components of Treatment A. A short course of therapy designed to teach parents strategies they can use to facilitate children s fluency at home and in other settings B. Recall that this is not the entire treatment it is just one component, the component that addresses parental communication patterns C. Still, some children require no more that this many children recover following only these parent-focused aspects of treatment D. Next, we decide if more treatment is needed! Parent Communication Modifications Easy Talking Model Increased Pause Time Reduced Demands Reflecting / Rephrasing Parent-Focused Treatment (Parent-Child Training Program) Parent Counseling Education about Stuttering Identification of Stressors Communication Wellness Parent and Child Understanding and Acceptance of Stuttering Education about Speaking and Stuttering Desensitization (as appropriate) J. Scott Yaruss 12

13 XVI. Direct Follow-Up A. Follow-up is critical, not only because it is a basic responsibility of clinicians using any treatment 1. Although many children recover following only the parent-focused treatment, not all do a) Some children need more direct, child-focused treatment after the parent/child training program b) Follow-up is the only way to know if the child has improved you can t rely on parent report only 2. Because success is based on the parents use of techniques, you can t just teach the strategies and assume this will be enough. You must check! #9 B. The key decision is how long to try this stuff before giving up and trying something else? 1. If Indirect Therapy Is Going to Work, It Will Work Quickly 2. Don t Wait Too Long I rarely stay only with parent-focused treatment for more than 3 months (6 sessions, every other week) If the child isn t better by then, move on! XVII. Part II: Child-Focused Treatment A. Improving Fluency Directly 1. If the child continues to stutter following the parent-focused treatment, then it s time to begin direct child-focused treatment Parent and Child Understanding and Acceptance of Stuttering Child-Focused Treatment (Direct Treatment) Child Communication Modifications 2. Now, the goals of treatment are the same as they would be for older children who stutter Education about Speaking and Stuttering Desensitization (as appropriate) a) To improve the child s fluency through direct modification of the child s communication skills b) To ensure that the child develops and maintains appropriate communication attitudes Speech Modification Stuttering Modification Communication Skills Concomitant Disorders B. Communication Modifications 1. Many techniques for improving fluency have been discussed; most focus on changing timing or tension 2. Changing Timing: Reducing Speaking Rate, Pausing and Phrasing, Reducing Pace, Easy Starts 3. Changing Tension: Light Contact, Easy Starts / Easing In, Pull-out / Easing Out, Cancellation C. Changing Timing: Speaking Rate 1. One of the most common techniques for improving fluency is reducing speaking rate 2. Turtle speech can help children slow their rate to facilitate fluency 3. I strongly prefer a more natural styles of slower speech (easy talking) 4. Guidelines for Reducing Speaking Rate a) Practice using slow rate before you teach it get a feel for too slow and not slow enough b) Use natural intonation and rhythm c) Do not use choppy or robot speech or s t r e t c h out all the words d) Slower (but still natural) speaking rates can be incorporated into all activities as a positive model for the child, but don t go too slow! D. Changing Timing: Pausing 1. Increase pause time -- the length of time between words and phrases 2. Pauses should occur at natural locations, e.g., between sentences and phrases 3. Pauses should not be so long that the child feels uncomfortable with the silence (~1 sec) 4. It may take some practice for the child (and you) to develop comfort with silence J. Scott Yaruss 13

14 E. Changing Time: PACE 1. Rather than encouraging children to slow down or pause, I teach them to manage their pace a) If their pace is too high to maintain control, they can try slowing or pausing b) Sometimes, they will need to manage their pace; Other times, they won t 2. Again, the goal is successful and effective communication F. Changing Physical Tension 1. Physical tension is a learned reaction to stuttering (or the anticipation of stuttering) (It is the child s attempt to not stutter, but it rapidly becomes part of the stuttering pattern) 2. Most of what you see on the surface is the child s reaction to stuttering (The real core of stuttering is under the surface; Children must become desensitized to that core if they are reduce their reactions) 3. We can blend desensitization with tension reduction to help children stutter more easily 4. Children can learn to change tension by exploring different ways of speaking and stuttering a) Pseudostuttering (easy bouncing or stretching) helps the child understand what happens when he gets stuck in his speech b) The child can explore using more tension and less tension to learn to change his stutters 5. These activities are fun and desensitizing and they prepare the child for advanced techniques like easing in, easing out, and cancellation G. Exploring Stuttering. To help children change stuttering, we help them learn what they are doing when they stutter by staying in and exploring stuttering 1. First, they need to learn about their speech machine 2. Next, they learn about how their articulators move during both stuttered and fluent speech 3. By staying in the block, they can explore how to move their articulators to change stuttering 4. This also helps to develop necessary self-monitoring skills and desensitizes children to stuttering H. Easy Stuttering 1. Easy stuttering helps children learn that they can change the way they stutter ( Bouncing and gliding or stretching are forms of pseudostuttering without tension) 2. Also reduces tendency to hide stuttering a) The more children try to hide stuttering, the more likely they are to stutter more b) If children are comfortable with stuttering, they can use voluntary stuttering to release tension in their muscles and prevent bigger blocks I. Helping the Child Develop Healthy Communication Attitudes 1. Desensitization is just one part of therapy that supports the development of healthy attitudes 2. Viewing stuttering in an open, matter-of-fact manner, in which the child is praised for his communication success (not just his fluency), is another way to ensure that the child learns that what he has to say is valuable and worthy even if it sometimes comes out bumpy 3. Parents must come to terms with stuttering if they are going to be able to do this effectively J. Can Little Kids Do All this Stuff? SURE! But, you may need to take your time. J. Scott Yaruss 14

15 XVIII. Brief Summary of Family-Focused Treatment A. The Family-Focused Treatment Approach is designed to help preschool children achieve and maintain normal speech fluency B. Treatment involves parent-focused and child-focused strategies that are designed to: 1. Help parents make communication modifications to indirectly facilitate children s fluent speech 2. Help parents and children develop and maintain healthy, appropriate communication attitudes 3. Help children make communication modifications to directly improve their speech fluency XIX. Next What is the Lidcombe Program? (Onslow and colleagues) A. Overview 1. An operant treatment program in which parents reinforce fluent speech and (gently) correct stuttered speech a) In Stage I, parents engage in daily treatment sessions at home (and attend treatment in a clinic once a week) until the child reaches a set criterion level for fluent speech b) In Stage 2, parents reduce the frequency of sessions, while maintaining feedback for at least a year 2. Parents also provide regular judgments of the child s stuttering severity, so ample data are kept B. Proceed with Caution! 1. More and more, I hear of clinicians who say they use a modified Lidcombe approach 2. If you are seeking to apply the principles of evidence-based practice, this cannot be done a) As soon as you modify the Lidcombe program, you re no longer operating within the evidence b) I am deeply troubled when I hear of children who are on Lidcombe for 9 months or a year (or more) that s not how it was designed to be used 3. Don t try to combine it with indirect therapy! C. Use As Directed 1. If you re interested in using the Lidcombe Program, that s fine, of course 2. But I encourage you to get the proper training and then use it as it was designed (and tested) 3. For More Information, go to: XX. So Which Approach Should I Use? A. Consider the evidence: Lidcombe has lots 1. Ample evidence supports the Lidcombe program, with many publications over the past 20 years a) Many children receiving the full Lidcombe program do indeed improve their speech fluency 2. We know absolutely nothing about children who receive only part of the Lidcombe program a) Commenting on children s speech does not make them more concerned about their speech b) Recovery rates for children receiving Lidcombe are higher than those for children not receiving treatment, and recover time is faster than natural recovery J. Scott Yaruss 15

16 XXI. Summary B. Consider the evidence: Other therapy has less 1. Although it has been widely used, very few studies have examined the effects of pure indirect therapy a) There may be no formal studies of indirect therapy 2. There is a wealth of anecdotal evidence, but nothing (yet) with the rigor of the Lidcombe research a) Starkweather reported high success rates for indirect treatment C. Note that what we re doing isn t only indirect we directly address attitudes and speech fluency a) Rustin and colleagues have written books showing success from a family-centered approach (indirect and direct) D. Still Times Are Changing. Yaruss et al. (2006) present preliminary data from the family-focused treatment program described in this presentation 1. All 17 of the first 17 children enrolled in this program showed significant gains in fluency (and all but one reached normal fluency by the end of treatment) 2. Fluency improvements were maintained throughout long-term follow-up of more than 2 years 3. Many children (2/3) required only the parent-focused components of treatment 4. The other children also received some child-focused treatment (ranging from 3 sessions to a full year for one child) E. And the data are promising (there s more than one way to skin a cat) 1. Success rates from Yaruss et al. (2006) are very similar to those reported for Lidcombe a) Further, the mean duration of treatment (12 sessions) was identical to that reported for Lidcombe (and 75% of participants required 11 sessions or less) 2. Franken et al. (2005) presented the first direct comparison of the Lidcombe program and traditional indirect/direct therapy a) Every comparison revealed identical results from the two treatment approaches A. When working with preschool children who stutter, the primary goal is to help them eliminate their stuttering 1. There are at least two research-supported approaches to treatment that help children do this 2. In addition to addressing fluency, treatment should ensure that the child develops appropriate communication attitudes. a) This will minimize the likelihood that he will struggle with his speech b) It will prepare him for the future in case he does keep stuttering and needs more advanced treatment #10 B. Most Important Fact #10a: You CAN Help Preschoolers Who Stutter C. Most Important Fact #10b: YOU Can Help Preschoolers Who Stutter XXII. And if it doesn t work remember the Most Important Facts for children who continue to stutter: Stuttering Is More Than Just Stuttering, and Treatment for Stuttering Is More Than Just Treatment for Stuttering J. Scott Yaruss 16

17 XXIII. Key Stuttering Organizations and Resources A. Stuttering Foundation of America (SFA) (800) Publishes many helpful booklets and videotapes for clinicians, people who stutter, and their families 3. Provides numerous CE workshops for SLPs B. National Stuttering Association (NSA) (800) We Stutter ( ) 2. Publishes helpful booklets for children who stutter and their families 3. Supports more than 80 local chapters for adults who stutter, as well as several new local chapters for children and families nationwide 4. Provides CE workshops for SLPs as well as workshops for people who stutter and their families 5. Hosts an annual conference with 3-day youth program C. Friends: Association for Young People Who Stutter Hosts an annual conference bringing together people who stutter from around the country D. Our Time Nonprofit organization helping children who stutter through the arts E. Specialty Board on Fluency Disorders Recognizes specialists in fluency disorders; provides information to consumers and professionals F. The Stuttering Home Page Contains a tremendous amount of helpful information about stuttering, including essays about stuttering, course syllabi, and links to other stuttering pages G. Stuttering Therapy Resources, Inc A publishing company (owned by the presenter and colleague Nina (Reardon) Reeves) dedicated to providing high-quality, affordable books and resources to help speech-language pathologists help people who stutter J. Scott Yaruss 17

18 I. Understanding Stuttering Some of the Presenter s Recent Papers on Stuttering Yaruss, J.S. (1998). Describing the consequences of disorders: Stuttering and the International Classification of Impairments, Disabilities, and Handicaps. Journal of Speech, Language, and Hearing Research, 49, Yaruss, J.S., & Quesal, R.W. (2004). Stuttering and the International Classification of Functioning, Disability, and Health (ICF): An update. Journal of Communication Disorders, 37, II. Assessment and Diagnosis Yaruss, J.S. (1997). Clinical measurement of stuttering behaviors. Contemporary Issues in Comm. Science & Dis., 24, Yaruss, J.S., LaSalle, L.R., & Conture, E.G. (1998). Evaluating stuttering in young children: Diagnostic data. American Journal of Speech-Language Pathology, 7(4), Yaruss, J.S. (1998). Real-time analysis of speech fluency: Procedures and reliability training. American Journal of Speech- Language Pathology, 7(2), III. Treatment Preschool and School-age Children Logan, K.J., & Yaruss, J.S. (1999). Helping parents address attitudinal and emotional factors with young children who stutter. Contemporary Issues in Communication Science and Disorders, 26, Murphy, W., Yaruss, J.S., & Quesal, R.W. (2007). Enhancing treatment for school-age children who stutter I: Reducing negative reactions through desensitization and cognitive restructuring. Journal of Fluency Disorders, 32, Murphy, W., Yaruss, J.S., & Quesal, R.W. (2007). Enhancing treatment for school-age children who stutter II: Reducing bullying through role-playing and self-disclosure. Journal of Fluency Disorders, 32, Reardon-Reeves, N., & Yaruss, J.S. (2013). School-Age stuttering therapy: A practical guide. McKinney, Tx: Stuttering Therapy Resources. Yaruss, J.S. (2010). Evaluating and Treating School-Age Children Who Stutter. Seminars in Speech and Language, 31, Yaruss, J.S., & Reardon, N.A., (2003). Fostering generalization and maintenance in school settings. Seminars in Speech and Language, 24, Yaruss, J.S. (2004). Documenting Individual Treatment Outcomes in Stuttering Therapy. Contemporary Issues in Communication Science and Disorders, 31, Murphy, W.P., Quesal, R.W., & Reardon-Reeves, N., & Yaruss, J.S. (2013). Minimizing Bullying for Children Who Stutter. McKinney, Tx: Stuttering Therapy Resources, Inc. Yaruss, J.S., Quesal, R.W., & Reeves, P.L. (2007). Self-Help and Mutual Aid Groups as an Adjunct to Stuttering Therapy. In E.G. Conture & R.F. Curlee (Eds.). Stuttering and related disorders of fluency (3 rd ed.) (pp ). New York: Thieme. Yaruss, J.S., Quesal, R.W., & Pelczarski, K. (2010). School-age children who stutter: Treating the entire disorder. In B. Guitar & R. McCauley, Treatment of stuttering: Conventional & controversial interventions. Baltimore: Lippincott Williams & Wilkins. Yaruss, J.S., & Quesal, R.W. (2010). Overall Assessment of the Speaker s Experience of Stuttering (OASES). Bloomington, MN: Pearson Assessments. Other Helpful Resources (Note: This is just a selection. There are many resources available to help clinicians improve their confidence in helping people who stutter) Bloodstein, O., & Bernstein Ratner, N. (2008). A Handbook for Stuttering (6 th ed.) New York: Thompson-Delmar Publishing. Chmela, K. & Reardon, N. (2001). The school-age child who stutters: working effectively with attitudes and emotions. Memphis, TN: Stuttering Foundation of America. Conture, E.G. (2001). Stuttering: Its Nature, Assessment and Treatment. Needham Heights, MA: Allyn & Bacon. Conture, E.G., & Curlee, R.F. (Ed.) (2007). Stuttering and related disorders of fluency (3 nd ed.). NY: Thieme Medical Pubs. Curlee, R.F., & Siegel, G. (Eds.), (1997) Nature and treatment of stuttering: New directions (2 nd ed.). Needham Heights: Allyn & Bacon. Gregory, H.H. (2003). Stuttering therapy: Rationale and procedures. Boston, MA: Allyn & Bacon. Guitar, B. (2006). Stuttering: An integrated approach to its nature and treatment (3 rd ed.) Baltimore: Williams & Wilkins. Manning, W.H. (2010). Clinical decision making in fluency disorders. (3 rd ed.). New York: Delmar-Cengage. Shapiro, D.A. (2011). Stuttering Intervention: A collaborative journey to fluency freedom (2 nd ed.). Austin, TX: Pro-Ed. Yairi, E., & Seery, E. (2011). Stuttering: Foundations and clinical applications. Needham Heights, MA: Allyn & Bacon. J. Scott Yaruss 18

19 Factors Potentially Associated with Childhood Stuttering S T U T T E R I N G Original version published in: Yaruss, J.S., Coleman, C., & Hammer, D. (2006). Treating preschool children who stutter: Description and preliminary evaluation of a family-focused treatment approach. Language, Speech, and Hearing Services in Schools, 37, Revised March, Copyright All Rights Reserved. The Stuttering Center of Western Pennsylvania. S tuttering C enter of estern ennsylvania W P A joint venture of Children's Hospital of Pittsburgh and the Department of Communication Science and Disorders at the University of Pittsburgh

20 "Non-Stuttered" Disfluencies Hesitations (pause) Interjections (um, uh, er) Revisions ("I want-i need that") Repetitions of phrases ("I want- I want that") Disfluencies occur more frequently Understanding Different Types of Speech Disfluencies Repetitions of multisyllabic whole words ( mommymommy-mommy let s go. ) Reactions to disfluencies increase Repetitions of monosyllabic whole words ( I-I-I want to go. ) Tension or struggle increases Tension during "nonstuttered" disfluencies Duration (length) of disfluencies increases NOTE: "Non-stuttered" disfluencies can be used to avoid or postpone stuttering (e.g., I um, you know, uh I want to um, g-g-g-o with you. ) Secondary characteristics (eye blinks, head movements, etc.) From Yaruss & Reardon (2010), Young Children Who Stutter: Information and Support for Parents. New York: National Stuttering Association (NSA). "Stuttered" Disfluencies Repetitions of sounds or syllables ("li-li-like this") Prolongations ("llllllike this") Blocks ("l---ike this")

21 Speech Disfluency Count Sheet 2/ 15/ 2003 Name: Overall Frequency / Severity: DOB: DOE: Age: Stuttered Disfl. %: Types: Situation: Clinician: Non-stutt. Disfl. %: Types: Type # Type # I I Rv Rv Rp Rp Rw Rw Rs Rs P P B B O O % % Type # Type # I I Rv Rv Rp Rp Rw Rw Rs Rs P P B B O O % % Notes: "Nonstutt." Disfl. "Stuttered" Disfl. # NonStutt Stutt I Interjection Rw Word rep. 1 Rv Revision Rs Sound/syllable rep. 2 Rp Phrase rep. P Prolongation 3 O Other (Specif B Block 4

Early Childhood Stuttering Therapy: A Practical Approach

Early Childhood Stuttering Therapy: A Practical Approach Early Childhood Stuttering Therapy: A Practical Approach J. Scott Yaruss, PhD, CCC-SLP, BCS-F, F-ASHA Professor, Communicative Sciences and Disorders, Michigan State University President, Stuttering Therapy

More information

Early Childhood Stuttering Therapy: A Practical Approach (3-hour version - Missouri)

Early Childhood Stuttering Therapy: A Practical Approach (3-hour version - Missouri) Early Childhood Stuttering Therapy: A Practical Approach (3-hour version - Missouri) J. Scott Yaruss, PhD, CCC-SLP, BCS-F, F-ASHA Professor, Communicative Sciences and Disorders, Michigan State University

More information

School-Age Stuttering: A Practical Approach

School-Age Stuttering: A Practical Approach School-Age Stuttering: A Practical Approach (3-hour version) J. Scott Yaruss, Ph.D., CCC-SLP, BRS-FD, ASHA Fellow speech@yaruss.com / www.yaruss.com www.stutteringtherapyresources.com Disclosures: Financial:

More information

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.

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. 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 Disclosure My name is Susan Cochrane. I am here to talk

More information

School-Age Stuttering Therapy: A Practical Approach

School-Age Stuttering Therapy: A Practical Approach School-Age Stuttering Therapy: A Practical Approach J. Scott Yaruss, Ph.D., CCC-SLP, BCS-F, F-ASHA speech@yaruss.com / www.yaruss.com www.stutteringtherapyresources.com Disclosures: Financial: Stuttering

More information

Therapy for Preschool and School Age Children who Stutter

Therapy for Preschool and School Age Children who Stutter Therapy for Preschool and School Age Children who Stutter Thank you! kleinjf@appstate.edu 828-262-2620 Goals for Today Seriously Participants will be able to: 1. List three factors that make children more

More information

Essential Speech Skills for School-Age Children Who Stutter

Essential Speech Skills for School-Age Children Who Stutter Essential Speech Skills for School-Age Children Who Stutter Presented by: Mark Allen, Ph.D. CCC-SLP Center for Stuttering Therapy 820 Gaffield Place Evanston, IL 60201 email: markallen@cfst.com internet:

More information

Stuttering. Risk factors that predict a chronic problem rather than spontaneous recovery include:

Stuttering. Risk factors that predict a chronic problem rather than spontaneous recovery include: Stuttering PREVALENCE, INCIDENCE, AND RISK FACTORS FOR CHRONICITY About 5% of all children go through a period of stuttering that lasts six months or more. Three- quarters of those who begin to stutter

More information

12/20/14. Nina Reeves, A bit of housekeeping. Assessment of Stuttering: Disclosures

12/20/14. Nina Reeves, A bit of housekeeping. Assessment of Stuttering: Disclosures Assessment of Stuttering: Nina Reeves, M.S. CCC-SLP BRS-FD Board Certified Specialist-Fluency Disorders www.ninareeves.com www.stutteringtherapyresources.com Fluency Specialist: Frisco ISD Fluency Specialist

More information

copyrighted material by PRO-ED, Inc.

copyrighted material by PRO-ED, Inc. Preface As a stutterer, as a speech language pathologist, and as a listener, I have grown to understand that stuttering is the absolute worst thing in this world... if we do not talk about it. When I speak

More information

Innovative Tools for Treating Stuttering

Innovative Tools for Treating Stuttering Innovative Tools for Treating Stuttering Elyse Lambeth, M.S., CCC-SLP October 9, 2015 Fluency Lanes Ideally clients have the opportunity to choose between various options for managing their stuttering

More information

Practical Counseling Strategies for Speech-Language Pathologists (3-hour version)

Practical Counseling Strategies for Speech-Language Pathologists (3-hour version) Practical Counseling Strategies for Speech-Language Pathologists (3-hour version) Phone: (412) 383-6538 J. Scott Yaruss, Ph.D., CCC-SLP Associate Professor, University of Pittsburgh 4033 Forbes Tower,

More information

Sheryl R. Gottwald, Ph.D., CCC-SLP University of New Hampshire Charlie Osborne, M.A., CCC-SLP University of Wisconsin

Sheryl R. Gottwald, Ph.D., CCC-SLP University of New Hampshire Charlie Osborne, M.A., CCC-SLP University of Wisconsin Sheryl R. Gottwald, Ph.D., CCC-SLP University of New Hampshire Charlie Osborne, M.A., CCC-SLP University of Wisconsin Personal Construct Theory A Brief Introduction Personal Constructs Humans create their

More information

The Pre-School Child Who Stutters

The Pre-School Child Who Stutters The Pre-School Child Who Stutters Patricia Zebrowski, Ph.D. University of Iowa CONSIDER STUTTERING WITHIN THE CONTEXT OF FLUENCY AND DISFLUENCY FLUENCY: The smooth transitioning between sounds, syllables,

More information

Helping Stutterers. who stutters, you understand

Helping Stutterers. who stutters, you understand Helping Stutterers By Lisa Scott From NJEA Review IF you've ever worked with a student who stutters, you understand that feeling of helplessness. How do you talk to the child about his or her speech? Should

More information

Treating Preschool Children Who Stutter: Description and Preliminary Evaluation of a Family-Focused Treatment Approach

Treating Preschool Children Who Stutter: Description and Preliminary Evaluation of a Family-Focused Treatment Approach LSHSS Treating Preschool Children Who Stutter: Description and Preliminary Evaluation of a Family-Focused Treatment Approach J. Scott Yaruss Stuttering Center of Western Pennsylvania, Pittsburgh University

More information

Stuttering Management Treatment Ideas for Preschoolers to Adults. Tom Gurrister MS-CCC SLP, BRFS Maria Gurrister MS-CCC SLP

Stuttering Management Treatment Ideas for Preschoolers to Adults. Tom Gurrister MS-CCC SLP, BRFS Maria Gurrister MS-CCC SLP Stuttering Management Treatment Ideas for Preschoolers to Adults Tom Gurrister MS-CCC SLP, BRFS Maria Gurrister MS-CCC SLP 1. Learner Outcomes Will learn a variety of stuttering management strategies in

More information

Robert W. Quesal. J. Scott Yaruss. Bill Murphy. Purdue. Western Illinois. University of Pittsburgh. University. University

Robert W. Quesal. J. Scott Yaruss. Bill Murphy. Purdue. Western Illinois. University of Pittsburgh. University. University Bill Murphy Purdue University Robert W. Quesal Western Illinois University J. Scott Yaruss University of Pittsburgh Required Disclaimer Forgive us, ASHA, for we have sinned The presenters have financial

More information

Case presentation Body Function and Structures:

Case presentation Body Function and Structures: Case presentation: o 14-year-old male adolescent (Sam) presents with an 11-year history of stuttering. increased speech disfluencies (repetitions, prolongations, blocks) avoidance of words/speaking situations

More information

Documenting Individual Treatment Outcomes in Stuttering Therapy

Documenting Individual Treatment Outcomes in Stuttering Therapy J. Scott Yaruss University of Pittsburgh, PA Documenting Individual Treatment Outcomes in Stuttering Therapy Of all of the communication disorders that are treated by speech-language pathologists, stuttering

More information

Theories, Treatment, and Ways to Promote Fluency of Speech at Home

Theories, Treatment, and Ways to Promote Fluency of Speech at Home Theories, Treatment, and Ways to Promote Fluency of Speech at Home Definition of Suttering: DSM 5 Disturbance in the normal fluency and time patterning of speech Inappropriate for the individual's age

More information

Assessment of the Child s Experience of Stuttering (ACES) (DRAFT VERSION September 27, 2006)

Assessment of the Child s Experience of Stuttering (ACES) (DRAFT VERSION September 27, 2006) Assessment of the Child s Experience of Stuttering (ACES) (DRAFT VERSION September 27, 2006) Name: Age/Grade: Sex: M F Date: Instructions. This form includes four sets of questions that ask about your

More information

Children under 6 who have Dysfluent Speech (Stammering/Stuttering).

Children under 6 who have Dysfluent Speech (Stammering/Stuttering). Patient Information Leaflet Children under 6 who have Dysfluent Speech (Stammering/Stuttering). Information for parents, teachers and carers For more information, please contact Speech & Language Therapy

More information

9/29/2017. Stuttering Therapy Workshop. Objectives today: Holistic Treatment. Data collection

9/29/2017. Stuttering Therapy Workshop. Objectives today: Holistic Treatment. Data collection Stuttering Therapy Workshop Ashlen Thomason, Ph.D., CCC-SLP Objectives today: Fluency Shaping Stuttering Modification Counseling components Goal-writing Data collection Ideas for therapy activities Holistic

More information

Primary School Children who have Dysfluent Speech (Stammering/Stuttering).

Primary School Children who have Dysfluent Speech (Stammering/Stuttering). Patient Information Leaflet Primary School Children who have Dysfluent Speech (Stammering/Stuttering). Information for parents, teachers and carers For more information, please contact Speech & Language

More information

Stuttering therapy based on what PWS say they want

Stuttering therapy based on what PWS say they want John A. Tetnowski, Ph.D., CCC-SLP, BRS/M-FD University of Louisiana-Lafayette & Charlie Osborne, M.A., CCC-SLP University of Wisconsin, Steven s Point Stuttering therapy based on what PWS say they want

More information

AFSP SURVIVOR OUTREACH PROGRAM VOLUNTEER TRAINING HANDOUT

AFSP SURVIVOR OUTREACH PROGRAM VOLUNTEER TRAINING HANDOUT AFSP SURVIVOR OUTREACH PROGRAM VOLUNTEER TRAINING HANDOUT Goals of the AFSP Survivor Outreach Program Suggested Answers To Frequently Asked Questions on Visits Roadblocks to Communication During Visits

More information

**Do not cite without authors permission** Beliefs and attitudes of children and adults who stutter regarding their ability to overcome stuttering

**Do not cite without authors permission** Beliefs and attitudes of children and adults who stutter regarding their ability to overcome stuttering **Do not cite without authors permission** Beliefs and attitudes of children and adults who stutter regarding their ability to overcome stuttering Kenneth S. Melnick, Ph.D., CCC-SLP, BRS-FD 1 & Merlo,

More information

Using Children s Stories in Stuttering Treatment. Craig E. Coleman, M.A. CCC-SLP, BRS-FD Mary E. Weidner, M.S. CCC-SLP

Using Children s Stories in Stuttering Treatment. Craig E. Coleman, M.A. CCC-SLP, BRS-FD Mary E. Weidner, M.S. CCC-SLP Using Children s Stories in Stuttering Treatment Craig E. Coleman, M.A. CCC-SLP, BRS-FD Mary E. Weidner, M.S. CCC-SLP ABC Model of Treatment Affective: feelings and emotions related to stuttering Behavioral:

More information

School Age Stuttering Therapy:

School Age Stuttering Therapy: School Age Stuttering Therapy: Where Do We Start? Nina Reeves, M.S. CCC- SLP BRS- FD Board CerIfied Specialist- Fluency Disorders www.ninareeves.com www.stuneringtherapyresources.com Fluency Specialist:

More information

CONCEPTS GUIDE. Improving Personal Effectiveness With Versatility

CONCEPTS GUIDE. Improving Personal Effectiveness With Versatility CONCEPTS GUIDE Improving Personal Effectiveness With Versatility TABLE OF CONTENTS PAGE Introduction...1 The SOCIAL STYLE MODEL TM...1 Where Did Your Style Come From?...1 SOCIAL STYLE and Versatility Work...

More information

The Control Illusion. By Barbara Dahm

The Control Illusion. By Barbara Dahm 1 The Control Illusion By Barbara Dahm 2 THE CONTROL ILLUSION Have you thought to yourself, If only I could control my speech, I would be able to speak fluently? Maybe a well-meaning SLP told you to work

More information

This is an edited transcript of a telephone interview recorded in March 2010.

This is an edited transcript of a telephone interview recorded in March 2010. Sound Advice This is an edited transcript of a telephone interview recorded in March 2010. Dr. Patricia Manning-Courtney is a developmental pediatrician and is director of the Kelly O Leary Center for

More information

Insurance Fact Sheet: Fluency

Insurance Fact Sheet: Fluency Department of Speech Pathology 513-636-4341 (phone) 513-636-3965 (fax) What is Stuttering? Insurance Fact Sheet: Fluency Fluency can be described as the natural flow or forward movement of speech which

More information

(p) (f) Echolalia. What is it, and how to help your child with Echolalia?

(p) (f) Echolalia. What is it, and how to help your child with Echolalia? (p) 406-690-6996 (f) 406-206-5262 info@advancedtherapyclinic.com Echolalia What is it, and how to help your child with Echolalia? Echolalia is repeating or echoing what another person has said. Children

More information

This is a large part of coaching presence as it helps create a special and strong bond between coach and client.

This is a large part of coaching presence as it helps create a special and strong bond between coach and client. Page 1 Confidence People have presence when their outer behavior and appearance conveys confidence and authenticity and is in sync with their intent. It is about being comfortable and confident with who

More information

Stages of Change The Cognitive Factors Underlying Readiness to Manage Stuttering:Evidence from Adolescents. What Do We Mean by Motivation?

Stages of Change The Cognitive Factors Underlying Readiness to Manage Stuttering:Evidence from Adolescents. What Do We Mean by Motivation? The Cognitive Factors Underlying Readiness to Manage Stuttering:Evidence from Adolescents Patricia Zebrowski, Ph.D., CCC-SLP University of Iowa, USA European Symposium on Fluency Disorders 2018 1 What

More information

Syllabus ASLS Stuttering Disorders

Syllabus ASLS Stuttering Disorders Syllabus ASLS 664-900 Stuttering Disorders Instructor: Patty A. Walton, M.A. CCC-SLP, BCS-F Patty.walton@unco.edu Course Description: This class will address advanced topics relating to the assessment

More information

Introduction 11/24/09. Objectives of this presentation. Troubleshooting with the Lidcombe Program for Stuttering ASHA Convention 2009 New Orleans, USA

Introduction 11/24/09. Objectives of this presentation. Troubleshooting with the Lidcombe Program for Stuttering ASHA Convention 2009 New Orleans, USA Troubleshooting with the Lidcombe Program for Stuttering ASHA Convention 2009 New Orleans, USA Melissa Bruce, M.S. University of Houston Kristin Chmela, M.A. Chmela Fluency Centre Barry Guitar, Ph.D. University

More information

Choosing Life: Empowerment, Action, Results! CLEAR Menu Sessions. Substance Use Risk 5: Drugs, Alcohol, and HIV

Choosing Life: Empowerment, Action, Results! CLEAR Menu Sessions. Substance Use Risk 5: Drugs, Alcohol, and HIV Choosing Life: Empowerment, Action, Results! CLEAR Menu Sessions Substance Use Risk 5: This page intentionally left blank. Session Aims: (70 Minutes) To understand the health consequences of drugs and

More information

Interviewing, or MI. Bear in mind that this is an introductory training. As

Interviewing, or MI. Bear in mind that this is an introductory training. As Motivational Interviewing Module 2 Slide Transcript Slide 1 In this module, you will be introduced to the basics of Motivational Interviewing, or MI. Bear in mind that this is an introductory training.

More information

Motivational Strategies for Challenging Situations

Motivational Strategies for Challenging Situations Motivational Strategies for Challenging Situations Mandy Fauble, PhD, LCSW Executive Director, Safe Harbor Behavioral Health of UPMC Hamot James, Wyler, MA, CPRP Scenario When I talked to her about my

More information

Choosing Life: empowerment, Action, Results! CLEAR Menu Sessions. Adherence 1: Understanding My Medications and Adherence

Choosing Life: empowerment, Action, Results! CLEAR Menu Sessions. Adherence 1: Understanding My Medications and Adherence Choosing Life: empowerment, Action, Results! CLEAR Menu Sessions Adherence 1: Understanding My Medications and Adherence This page intentionally left blank. Understanding My Medications and Adherence Session

More information

How to Work with the Patterns That Sustain Depression

How to Work with the Patterns That Sustain Depression How to Work with the Patterns That Sustain Depression Module 5.2 - Transcript - pg. 1 How to Work with the Patterns That Sustain Depression How the Grieving Mind Fights Depression with Marsha Linehan,

More information

section 6: transitioning away from mental illness

section 6: transitioning away from mental illness section 6: transitioning away from mental illness Throughout this resource, we have emphasized the importance of a recovery perspective. One of the main achievements of the recovery model is its emphasis

More information

Objectives. My information: 3/7/18. Strategies for Children Who Stutter

Objectives. My information: 3/7/18. Strategies for Children Who Stutter Strategies for Children Who Stutter EMBRY BURRUS, MCD, CCC/SLP My information: A. Embry Burrus, MCD, CCC/SLP Clinical Supervisor Auburn University (334) 332-9985 aeburrus397@gmail.com burruae@auburn.edu

More information

Good Communication Starts at Home

Good Communication Starts at Home Good Communication Starts at Home It is important to remember the primary and most valuable thing you can do for your deaf or hard of hearing baby at home is to communicate at every available opportunity,

More information

Managing conversations around mental health. Blue Light Programme mind.org.uk/bluelight

Managing conversations around mental health. Blue Light Programme mind.org.uk/bluelight Managing conversations around mental health Blue Light Programme 1 Managing conversations around mental health Managing conversations about mental wellbeing Find a quiet place with an informal atmosphere,

More information

UNDERSTANDING MEMORY

UNDERSTANDING MEMORY Communication Chain UNDERSTANDING MEMORY HEARING EXPRESSION thoughts/ ideas ATTENTION select words to use speech production FEEDBACK Hello, how are you? Communication Chain The Communication Chain picture

More information

Differential Treatment Of School- Age Children Who Stutter

Differential Treatment Of School- Age Children Who Stutter Differential Treatment Of School- Age Children Who Stutter Presenter: Megan Scott Dacus, M.S., CCC-SLP Moderated by: Amy Hansen, M.A., CCC-SLP, Managing Editor, SpeechPathology.com SpeechPathology.com

More information

Stuttering Behaviors in a Virtual Job Interview

Stuttering Behaviors in a Virtual Job Interview Stuttering Behaviors in a Virtual Job Interview Shelley Brundage The George Washington University Ken Graap Virtually Better, Inc Funding Provided by NIDCD # R41 DC-006970 INTRODUCTION Stuttering is an

More information

1. Before starting the second session, quickly examine total on short form BDI; note

1. Before starting the second session, quickly examine total on short form BDI; note SESSION #2: 10 1. Before starting the second session, quickly examine total on short form BDI; note increase or decrease. Recall that rating a core complaint was discussed earlier. For the purpose of continuity,

More information

Improving Personal Effectiveness With Versatility

Improving Personal Effectiveness With Versatility CONCEPTS GUIDE TRACOM Sneak Peek Excerpts from Improving Personal Effectiveness With Versatility Concepts Guide TABLE OF CONTENTS PAGE Introduction...1 The SOCIAL STYLE MODEL TM...1 Where Did Your Style

More information

Motivational Interviewing in Healthcare. Presented by: Christy Dauner, OTR

Motivational Interviewing in Healthcare. Presented by: Christy Dauner, OTR Motivational Interviewing in Healthcare Presented by: Christy Dauner, OTR The Spirit of MI Create an atmosphere of acceptance, trust, compassion and respect Find something you like or respect about every

More information

Speak Out! Sam Trychin, Ph.D. Copyright 1990, Revised Edition, Another Book in the Living With Hearing Loss series

Speak Out! Sam Trychin, Ph.D. Copyright 1990, Revised Edition, Another Book in the Living With Hearing Loss series Speak Out! By Sam Trychin, Ph.D. Another Book in the Living With Hearing Loss series Copyright 1990, Revised Edition, 2004 Table of Contents Introduction...1 Target audience for this book... 2 Background

More information

IntentionalLiving C E N T E R

IntentionalLiving C E N T E R IntentionalLiving C E N T E R HEAD HEART HAND ASSESSMENT Welcome to your self-discovery tool Are you a thinker, feeler or doer? Ephesians 5:10 from The Message says, Figure out what will please Christ,

More information

The Truth About Fitness, Weight Loss and Improving Athletic Performance by Kevin Quinlan

The Truth About Fitness, Weight Loss and Improving Athletic Performance by Kevin Quinlan The Truth About Fitness, Weight Loss and Improving Athletic Performance by Kevin Quinlan First of all, let me set your mind at ease I m NOT trying to sell you anything here! The purpose of this report

More information

TRACOM Sneak Peek Excerpts from. Self-Perception Guide

TRACOM Sneak Peek Excerpts from. Self-Perception Guide TRACOM Sneak Peek Excerpts from Self-Perception Guide Self-perception GUIDE Table of Contents Introduction...1 The SOCIAL STYLE MODEL TM............................................. 1 Where Did Your Style

More information

UNDERSTANDING CAPACITY & DECISION-MAKING VIDEO TRANSCRIPT

UNDERSTANDING CAPACITY & DECISION-MAKING VIDEO TRANSCRIPT I m Paul Bourque, President and CEO of the Investment Funds Institute of Canada. IFIC is preparing materials to assist advisors and firms in managing effective and productive relationships with their aging

More information

Presented for the National Stuttering Association Annual Convention 2008! Diane C. Games, M.A. CCC-SLP Board Recognized Specialist Fluency Disorders

Presented for the National Stuttering Association Annual Convention 2008! Diane C. Games, M.A. CCC-SLP Board Recognized Specialist Fluency Disorders Presented for the National Stuttering Association Annual Convention 2008! Diane C. Games, M.A. CCC-SLP Board Recognized Specialist Fluency Disorders Fluency Friday Plus Themes/Ideas Teaching Parents Bringing

More information

How to Help Your Patients Overcome Anxiety with Mindfulness

How to Help Your Patients Overcome Anxiety with Mindfulness How to Help Your Patients Overcome Anxiety with Mindfulness Video 5 - Transcript - pg. 1 How to Help Your Patients Overcome Anxiety with Mindfulness How to Work with the Roots of Anxiety with Ron Siegel,

More information

35 th Anniversary of Diagnosis as a PWS 20 th year in the schools as a clinician 4 years as a clinical supervisor at the University of Central

35 th Anniversary of Diagnosis as a PWS 20 th year in the schools as a clinician 4 years as a clinical supervisor at the University of Central 35 th Anniversary of Diagnosis as a PWS 20 th year in the schools as a clinician 4 years as a clinical supervisor at the University of Central Florida Attended Stuttering Foundation Workshop for Specialists

More information

BASIC VOLUME. Elements of Drug Dependence Treatment

BASIC VOLUME. Elements of Drug Dependence Treatment BASIC VOLUME Elements of Drug Dependence Treatment Module 2 Motivating clients for treatment and addressing resistance Basic counselling skills for drug dependence treatment Special considerations when

More information

Choosing Life: Empowerment, Action, Results! CLEAR Menu Sessions. Substance Use Risk 2: What Are My External Drug and Alcohol Triggers?

Choosing Life: Empowerment, Action, Results! CLEAR Menu Sessions. Substance Use Risk 2: What Are My External Drug and Alcohol Triggers? Choosing Life: Empowerment, Action, Results! CLEAR Menu Sessions Substance Use Risk 2: What Are My External Drug and Alcohol Triggers? This page intentionally left blank. What Are My External Drug and

More information

Ending Stigma with Recovery Messaging

Ending Stigma with Recovery Messaging Ending Stigma with Recovery Messaging Welcome to the RecoveryU module on Ending Stigma with Recovery Messaging: How to share your story to reduce the stigma of Addiction and Recovery. By the end of this

More information

COPING WITH A CANCER DIAGNOSIS. Tips for Dealing with What Comes Next

COPING WITH A CANCER DIAGNOSIS. Tips for Dealing with What Comes Next COPING WITH A CANCER DIAGNOSIS Tips for Dealing with What Comes Next Copyright 2012 Alliance Health Networks www.alliancehealth.com About half of all men and a third of all women in the United States will

More information

Catching Our Stutters

Catching Our Stutters Catching Our Stutters Desensitization Strategies Hard versus Easy Contacts Hard-Easy-Regular Negative Practice Three-Way Contrast Drills (Triads) Reduction of Avoidance Behaviors My Pet Rock Drawing your

More information

Tips on How to Better Serve Customers with Various Disabilities

Tips on How to Better Serve Customers with Various Disabilities FREDERICTON AGE-FRIENDLY COMMUNITY ADVISORY COMMITTEE Tips on How to Better Serve Customers with Various Disabilities Fredericton - A Community for All Ages How To Welcome Customers With Disabilities People

More information

Therapy for Young Stuttering Children with Cognitive and Emotional Problems

Therapy for Young Stuttering Children with Cognitive and Emotional Problems Therapy for Young Stuttering Children with Cognitive and Emotional Problems Mies Bezemer the Netherlands mbezemer@zeelandnet.nl www.stottercentrumzeeland.nl 1 , the Netherlands Middelburg, Goes, Zierikzee

More information

The older school aged child

The older school aged child Speech and language therapy Stammering information The older school aged child Information for parents / carers Follow Follow us us on on Twitter Twitter @NHSaaa @NHSaaa Find Find us us on on Facebook

More information

Choosing Life: Empowerment, Action, Results! CLEAR Menu Sessions. Health Care 3: Partnering In My Care and Treatment

Choosing Life: Empowerment, Action, Results! CLEAR Menu Sessions. Health Care 3: Partnering In My Care and Treatment Choosing Life: Empowerment, Action, Results! CLEAR Menu Sessions Health Care 3: Partnering In My Care and Treatment This page intentionally left blank. Session Aims: Partnering In My Care and Treatment

More information

How to Manage Seemingly Contradictory Facet Results on the MBTI Step II Assessment

How to Manage Seemingly Contradictory Facet Results on the MBTI Step II Assessment How to Manage Seemingly Contradictory Facet Results on the MBTI Step II Assessment CONTENTS 3 Introduction 5 Extraversion with Intimate and Expressive 8 Introversion with Expressive and Receiving 11 Sensing

More information

4/3/2014. Dame Cicely Sanders : Born in England Nursing Degree Social Work Degree Doctor Opened 1 st Stand Alone Hospice 1967

4/3/2014. Dame Cicely Sanders : Born in England Nursing Degree Social Work Degree Doctor Opened 1 st Stand Alone Hospice 1967 Catherine Hausenfluke Independent Consultant 512-966-4955 Know More about Dying and Grief Come to Terms with Your Own Morality Understand Grief and What are the Rules Understand the Dying Process Relating

More information

Problem Situation Form for Parents

Problem Situation Form for Parents Problem Situation Form for Parents Please complete a form for each situation you notice causes your child social anxiety. 1. WHAT WAS THE SITUATION? Please describe what happened. Provide enough information

More information

Beattie Learning Disabilities Continued Part 2 - Transcript

Beattie Learning Disabilities Continued Part 2 - Transcript Beattie Learning Disabilities Continued Part 2 - Transcript In class Tuesday we introduced learning disabilities and looked at a couple of different activities that are consistent and representative of

More information

Feedback from You: Objectives. Purpose 3/17/2014. Informal surveys of my area team: What do you want to hear about during my stuttering presentation?

Feedback from You: Objectives. Purpose 3/17/2014. Informal surveys of my area team: What do you want to hear about during my stuttering presentation? Rob Dellinger March 5, 2014 Disclosure I am here to talk primarily about treating schoolage children who stutter and also secondary children who stutter. Much does not apply to preschool kids who stutter.

More information

MANUAL FOR THE LIDCOMBE PROGRAM OF EARLY STUTTERING INTERVENTION 2008 CONTENTS

MANUAL FOR THE LIDCOMBE PROGRAM OF EARLY STUTTERING INTERVENTION 2008 CONTENTS MANUAL FOR THE LIDCOMBE PROGRAM OF EARLY STUTTERING INTERVENTION 2008 CONTENTS PART ONE: OVERVIEW OF THE LIDCOMBE PROGRAM... 2 PART TWO: ESSENTIAL COMPONENTS OF THE LIDCOMBE PROGRAM... 3 Parental Verbal

More information

Establishing long-term fluency goals when working with adults who stutter

Establishing long-term fluency goals when working with adults who stutter Establishing long-term fluency goals when working with adults who stutter Dr. Kim R. Bauerly Northeast Hearing and Speech, Portland, Maine Dr. Robert Kroll The Speech and Stuttering Institute, Toronto,

More information

Attention and Concentration Problems Following Traumatic Brain Injury. Patient Information Booklet. Talis Consulting Limited

Attention and Concentration Problems Following Traumatic Brain Injury. Patient Information Booklet. Talis Consulting Limited Attention and Concentration Problems Following Traumatic Brain Injury Patient Information Booklet Talis Consulting Limited What are Attention and Concentration? Attention and concentration are two skills

More information

A Guide To Stuttering

A Guide To Stuttering Chicago Speech Therapy Presents: A Guide To Stuttering For Parents An illus trated guide t o unders t anding your child s speech f luency AVAILABLE ON: www.chicagospeechtherapy.com Copyright 2017 by Karen

More information

IT S A WONDER WE UNDERSTAND EACH OTHER AT ALL!

IT S A WONDER WE UNDERSTAND EACH OTHER AT ALL! It s a Wonder we Understand Each Other at All! Pre-Reading 1 Discuss the following questions before reading the text. 1. Do you think people from different cultures have different communication styles?

More information

ROADMAP FREEDOM FROM STUTTERING. Copyright 2017 Life Quality, Inc. All Rights Reserved

ROADMAP FREEDOM FROM STUTTERING. Copyright 2017 Life Quality, Inc. All Rights Reserved ROADMAP TO FREEDOM FROM STUTTERING Copyright 2017 Life Quality, Inc. All Rights Reserved Contents Why freedom from stuttering 3 What is it?.. 4 The path.. 5 Three massive mistakes on the way...6 Automated

More information

How to Foster Post-Traumatic Growth

How to Foster Post-Traumatic Growth How to Foster Post-Traumatic Growth Module 7, Part 2 - Transcript - pg. 1 How to Foster Post-Traumatic Growth Two Ways to Ignite Accelerated Growth Part 2: How Your Choice of Language Can Transform an

More information

Chapter 14 Support for parents and caregivers

Chapter 14 Support for parents and caregivers 179 Chapter 14 Support for parents and caregivers All over the world, parents and other family members work very hard caring for their young children. And when a family has a child who cannot hear, there

More information

MA 1 Notes. Deaf vs deaf p. 3 MA1 F 13

MA 1 Notes. Deaf vs deaf p. 3 MA1 F 13 Name Period MA 1 Notes Fingerspelling Consider frngerspelling to be like your handwriting. Being clear is vital to being understood, be confident enough not to worry, whether each letter is exactly right,

More information

COPING WITH SCLERODERMA

COPING WITH SCLERODERMA COPING WITH SCLERODERMA Any chronic disease is life changing. Symptoms demand your attention. You have to adjust your schedule to accommodate medications, doctors appointments and treatments of various

More information

Learning to use a sign language

Learning to use a sign language 85 Chapter 8 Learning to use a sign language It is easy for a young child to learn a complete sign language. A child will first begin to understand the signs that others use, especially for people and

More information

CONFLICT RESOLUTION: REAL SKILLS FOR THE REAL WORLD. BWSR Academy 2015

CONFLICT RESOLUTION: REAL SKILLS FOR THE REAL WORLD. BWSR Academy 2015 CONFLICT RESOLUTION: REAL SKILLS FOR THE REAL WORLD BWSR Academy 2015 MINNESOTA STATE OFFICE FOR COLLABORATION AND DISPUTE RESOLUTION Serving as a statewide catalyst to advance: Sustainable resolution

More information

Using Essays in Therapy

Using Essays in Therapy The Journal of Stuttering Therapy, Advocacy & Research Using Essays in Therapy Dale F. Williams, Ph.D., CCC-SLP Florida Atlantic University Abstract Using essays in speech therapy is an effective way to

More information

DEAF CHILDREN WITH ADHD AND LEARNING DIFFICULTIES

DEAF CHILDREN WITH ADHD AND LEARNING DIFFICULTIES DEAF CHILDREN WITH ADHD AND LEARNING DIFFICULTIES Scott R. Smith, MD, MPH Developmental-Behavioral Pediatrician University of Rochester Medical Center Common Complaints about Children with Problems Your

More information

Meeting someone with disabilities etiquette

Meeting someone with disabilities etiquette Meeting someone with disabilities etiquette Many people unsure how to go about meeting someone with a disability because they don t want to say or do the wrong thing. Here are a few tips to keep in mind

More information

Suggested topics to review with your students

Suggested topics to review with your students Working with Students: Building Blocks for Motivational Interviewing and Brief Intervention Strategies Jason R. Kilmer, Ph.D. University of Washington Associate Professor Psychiatry & Behavioral Sciences

More information

BASIC VOLUME. Elements of Drug Dependence Treatment

BASIC VOLUME. Elements of Drug Dependence Treatment BASIC VOLUME Elements of Drug Dependence Treatment BASIC VOLUME MODULE 1 Drug dependence concept and principles of drug treatment MODULE 2 Motivating clients for treatment and addressing resistance MODULE

More information

The Power of Feedback

The Power of Feedback The Power of Feedback 35 Principles for Turning Feedback from Others into Personal and Professional Change By Joseph R. Folkman The Big Idea The process of review and feedback is common in most organizations.

More information

BOOKLET ONE. Introduction to Behavioural Activation for Depression

BOOKLET ONE. Introduction to Behavioural Activation for Depression BEHAVIOURAL ACTIVATION FOR DEPRESSION BOOKLET ONE Introduction to Behavioural Activation for Depression Contents Missing sources of wellbeing 2-3 Sources of misery 4-5 What we do when we feel down 6-7

More information

The older school aged child

The older school aged child Speech and language therapy Stammering information The older school aged child Information for teachers Follow Follow us us on on Twitter Twitter @NHSaaa @NHSaaa Find Find us us on on Facebook Facebook

More information

CONTINUING EDUCATION

CONTINUING EDUCATION CONTINUING EDUCATION for Speech-Language Pathologists SCHOOL-AGE STUTTERING: ASSESSMENT AND TREATMENT PDH Academy Course #1809 (3 CE HOURS) Course Abstract This intermediate level course walks learners

More information

Working in the Classroom with Young Children Who Stutter

Working in the Classroom with Young Children Who Stutter Working in the Classroom with Young Children Who Stutter James Panico, Derek E. Daniels, and M. Susan Claflin 1, 2 Young children develop the skills necessary for communication in infancy. Interactions

More information

b. often a result of ineffective or neutral interventions c. when the client deeply ponders the helper s intervention*

b. often a result of ineffective or neutral interventions c. when the client deeply ponders the helper s intervention* CHAPTER 8: STEPS FOR WORKING WITH FOUR TYPES OF ACTION Multiple-Choice Questions 8.01. Circling is all of the following except: a. staying at the same level b. often a result of ineffective or neutral

More information