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

Transcription

1 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 Participated and directed stuttering support groups for children and adults on and off for nearly 20 years Guest lecturer at UCF, presented at NSA and for Florida Hospital Published researcher Currently publishing fictional book on stuttering with clinical guide Own a private practice that specializes in CWS for 14 years 1

2 Stuttering is the highly variable. Stuttering is a low incidence disorder. Stuttering therapy in the schools is difficult. School SLPs are crunched for time. 2

3 Stuff we need (My best coat and boots) Stuff we might have forgotten was ours (Oh my hat) Stuff we can borrow (I need gloves for recess) 3

4 Most of stuttering is under the surface Old idea (1970) Melt the surface behaviors the iceberg resurfaces. 10% above the water and 90% below papers/hicks6.html I tell people I didn t grow up stuttering, I grew up trying not to stutter.. Russ Hicks Overt stuttering = the surface stuff..pwr, Prolongations, Blocking etc. Covert stuttering = all the stuff you do to try to hide the overt stuttering. avoidance, circumlocution, substitution, interjections 4

5 Know and be willing to do everything you are asking the student to do. Know the direction of therapy you are heading. Know or have a plan on how to carryover those skills into his everyday life. If I could go into the future, what would my client say about me and about my therapy? What are they going to be able to need to do that they can t or aren t willing to do now? How might an ongoing stuttering problem effect them 5

6 Said no one ever 6

7 developments-stutter#.ux_rifzg7wi to cure stuttering. to hide stuttering. to morph overt stuttering into covert stuttering. to teach tricks to mask the effects of stuttering. to make them talk less so they stutter less. To reduce or eliminate the handicapping condition of stuttering. To help our students be the BEST communicators they can possibly be. To build knowledge in our students of the reality of their speaking and eliminate the mystery of stuttering. 7

8 Produce by Juan Reyes in 1997 as his senior project. (Same program that produced The Blair Witch Projec two years before Go Knights!) Juan is a former client of mine from the UCF clinic. Juan is now the Director of Photography for VH1. Girl is struggling Girl is in TX Girl isn t an effective communicator Girl has support system Girl is consumed by her speech Parents feel it s a mystery as well To be able to order the *&^% ice cream (The goal of communication is to get stuff) To be focused on what is important (She is chasing fluency) To not be consumed by her dysfluency (She thinks about it a lot) To be given skills to reduce her duration and severity of the stuttering moment 8

9 Help to foster the attitude of the message is the goal. Create useable tools that fit her needs and her current level of ability. Be her advocate and mentor. De-mystify the stuttering moment. Most of us don t currently or rarely ever have someone that severe. If she was, life would be easier there is so much to work on, she is so willing to work, and no one would question what the issue was. Has little awareness of his stuttering Does well in class and talks as much as the other kids Is able to use his fluency techniques in speech to the degree that you rarely hear them stutter Has friends and does ok May have comorbid educational issues 9

10 The teacher may be too overwhelmed to accurately assess their student s classroom participation. The squeaky wheel gets the grease. Described as shy Hx of separation anxiety in kindergarten Worry a lot and self conscious. Language scores in the 70 s awkward word flow of ideas SLD Diagnosis in Kindergarten Low average cognitive abilities Re-evaluated in first grade to add speech and language. CELF -4 Total Language 62 Recalling sentences 1, Formulating sentences 4 Language Sample: Incomplete sentences, revisions, one word answers. Found eligible for language services in the schools. Speech added for frontal lisp 10

11 SLD Math and Reading Speech /s/ and /z/ and Language: Objective listed to ask a question in class for one of her classes per week. everyone always works on my /s/. I got picked on for stuttering (her words not mine) since first grade My parents don t even know I stutter I m shy and want to make friends Identify behaviors that we want to change Create hierarchy of speaking situations Differentiate between avoidance and escape behaviors Give new options Foster a different attitude related to communication 11

12 Stuttering is more than PWR and prolongations..kayla Hudson is not the norm. Track classroom participation. Secondary Characteristics and Avoidance Most PWS have some covert behavior Assess the handicapping condition A disorder of word finding A disorder of nervousness A disorder of the ability to think Shyness TEACH THE PARENTS THESE SAME THINGS. Make sure you and the parent are on the same page. Make sure the parent can discuss fluency in an accurate and helpful manner. Monthly checkups are great I know, I know.time. 12

13 SLP Student.Teacher Parent.Friend All on the same page and using the same terms Focus on stuttering like you would focus on an allergy or asthma.no more no less. It is a part of the child, it is not all of the child. Understand that stuttering is more than a percentage of PWR and prolongations. You won t make them worse. You are all they have to help them with their stuttering and may be the only person to help them EVER. You are a trained, caring, competent person. You are the ONLY person who has the ability to know about stuttering, be in the child s learning environment, and has scheduled one on one time to be with them. 13

14 Anatomy Phonology Social Skills Conversation Rules Voice Counseling How to be supportive and foster carryover of skills

15 Easy Beginning Pull out Cancellation Stutter on Purpose Sound Stretch Identify old way of talking Introduce new choices Guide toward student using new choices Sell the new choices Discuss how each might have benefits and consequences 15

16 Kids want to know why they are doing this stuff Who wants to do something they don t understand? How motivated are you to do things you don t understand? Why are they fluent? Why were they fluent? What did they do to make it happen? Analogies Characters from stories and books Give him a reason and a purpose for wanting to improve. 16

17 Great Moments in Speech Therapy Mini- Stutters = Bounce Co-articulation Even Phrasing Chunking The love child of stuttering on purpose and easy beginnings. Ki kind of like that. O or like this Teaches control..reduces rate, reduces pressure. 17

18 Weallknowwhatitis butdidyou everthinkof Itinthe contextofstuttertherapy. Cluttering has been described as over coarticulation (Scaler Scott, 2013) Find a balance Another pressure reducing strategy Focus on even pressure from sound to sound. Don t discriminate every sound gets even articulatory force from beginning to end. Slows down speech rate. Can sound a little monotonous Think of it as talking s..cruise control. Creating more pauses in utterances to reduce articulatory rate and increase breath support Stops at natural occurring pause boundaries in speech. Usually last about a half to one second. 18

19 Phrasing on Steroids Can be the considered the gastric bypass of stuttering therapy. Extra pauses in NON natural, random places. Utilizes the idea that if clause or word boundaries are blurred the brain will not attack the first sound and since 90% of stuttering occurs on the first sound less stuttering. Carryover Grouping ADHD and Stuttering Cluttering Minor CWS Autism and Stuttering/AKA Rochester Syndrome Dismissal Who owns all this stuff? (SLPs) Why can I never find the important stuff? (Carryover) What happens if no one uses this stuff? (It goes unused and helps no one) 19

20 Make sure their discrimination skills are superior in their own speech. Make sure they are able to name and understand why dysfluencies happen in their speech. Tracking form one can be downloaded from the MSHA site as part of this presentation Work with your team to see how there might be a specific way the student wants to do this. Many SLPs still have difficulty modeling the techniques they are teaching even after many years of therapy and you expect a child to do it? EAT LESS EXERCISE MORE.simple and effective for 95% of people. Yet 50% of the country is obese. Unlike most problems, fluency is highly unpredictable and mysterious to most students. They have other stuff going on in their head. Metacognitively, they might not be ready. Adolescents are often the clinician's toughest cases. They cannot bear to confront their stuttering deviancy long enough to do anything about it. They resist being singled out. They want the security of peer group affiliation with an intensity which is almost overwhelming. (p. 207) (Van Riper, 1971) 20

21 One time alone with the SLP has value. Difficult to do early fluency tx with other disorders. Carryover can be achieved with high functioning language group or conversational articulation group. Fluency group is great if you have enough cases. Many PWS may have sub clinical levels of ADHD. (Aim & Risberg, 2007) Address Attention Speaker/Listener Rules Pure cluttering is rare. Co-morbid issues of ADHD/LD/Stuttering Suggestions: Slow rate Increase awareness improve clarity.self monitoring 21

22 AKA.. Rochester Syndrome Characterized by Final PWR or Rhyme Repetitions and Mid Word Interjections. Final Phrase Repetitions and final sound prolongations. Not purely related to ASD, but more prevalent in this population. Not a lot of research Experts speculate it may be an internal way for the speaker to hold the floor rather than an external one as is um and like. Visual Feedback and Rule Based Social Stories Gestalt Learning activities Every situation is unique. Fluency is different.articulation doesn t regress. Fluency is HIGHLY unpredictable. Recommended: Reduce to once a month checkins. Dismiss at time of re-eval if you must. Foster the open lines of communication. 22

23 Sometimes it may be hard to determine if it is ADHD or Cluttering, or Stuttering or Autism or Covert Stuttering, Word Finding, Shyness. Remember: The key element is how you can help the student become a better communicator. The student may exhibit a combination of these things and their behaviors may change over time. Remember the basics Remember what you already have Know where to find new information 23

24