Integrated Treatment of Intermediate Stuttering

1
Integrated Treatment of Intermediate Stuttering

• Characteristics of Intermediate Stutterers
• Blocks are most frequent core, also exhibit
  repetitions and prolongations
• Escape behaviors
• Avoidance behaviors
• Fear is most dominant emotion at this level. Also
  experience shame and embarrassment.
• Typically between 6-13 years of age

2
Basic features of integrated approach with
intermediate stutterer

• Targets stuttered and fluent speech
• Fluency goals
• Spontaneous fluency
• Controlled fluency
• Acceptable stuttering
• Addresses negative feelings/attitudes
• Inspired by Charles Van Riper and Julie Reville
  (workbook, Easy Talker)
• Includes direct treatment of child, with
  involvement of parents and teacher

3
Exploring stuttering in therapy

• Exploring the goals of therapy
• Exploring beliefs about stuttering
• Stuttering Straight Talk for Teens
  http//www.stutteringhelp.org/Default.aspx?tabid4
  91
• Stuttering Straight Talk for Teachers
• Exploring the core behaviors of stuttering
• Exploring secondary behaviors
• Exploring feelings and attitudes

4
Fluency skills for intermediate stutterers

• Flexible (slowed) rate
• Easy onset (ee-oos in Easy Talker)
• Light contact
• Proprioception
• Superfluency combining all four of the above

5
Transfer of Superfluency

• Determine with the client a hierarchy of speaking
  situations, from least difficult to most
  difficult, then begin to work on each level. Use
  the technique of scaffolding during transfer.
  Breaking down a task into smaller, easier units,
  with additional cues or prompts.

6
Desensitization

• Identify fluency disruptors for that child
• Practice using fluency skills in the presence of
  fluency disruptors

7
Reducing fear and avoidance behaviors

• Provide for repeated exposure to feared
  situations, in the presence of pleasant
  surroundings, with positive reinforcement.
• Deal with teasing by using acceptance I know I
  stutter, Im working on it, will take the fun
  out teasing.
• Be open about stuttering.

8
Maintenance

• Most intermediate stutterers will require a
  series of check-ups over a 2 year period.
• If their fluency regresses, put them back into
  therapy for a month and repeat the maintenance
  period.

9
Working with parents

• Explain the program and their role
• Discuss causes of stuttering
• Identify/reduce fluency disruptors
• Identify/increase fluency-enhancing situations
• Eliminate teasing
• http//www.nsastutter.org/

10
Working with teachers

• Four goals
• Explain the treatment program
• Facilitate openness between student and teacher
  regarding stuttering
• Establish classroom participation expectations
  for student and teacher
• Help teacher to eliminate teasing
• Stuttering Straight Talk for Teachers

11
Therapy with the intermediate stutterer other
clinicians

• Carl Dell
• A stuttering modification approach to therapy.
• Therapy described in SFA book, Treating the
  School Age Stutterer A Guide for Clinicians.
• 8 phases of treatment
• 1 - saying a word 3 ways
• 2 - locating tension
• 3 canceling
• 4 changing stutters to a milder form
  (pull-outs)
• 5 insert easy stuttering into real speech
• 6 changing hard stutters during real speech
  (pull-outs)
• 7 building fluency (desensitizing to fluency
  disruptors)
• 8 building independence (maintenance)

12
Bruce Ryan Delayed Auditory Feedback

• A fluency shaping approach.
• Three phases
• Establishment 26 steps (Table 11-1)
• Transfer Programmed (Table 11-2)
• Maintenance 22 month period (Table 11-3)

13
Gregory and Campbell

• An integrated approach.
• Fluency-enhancing behaviors (FEBs)
• Easy relaxed approach with smooth movements
  (ERA-SM)
• Slowed rate
• Continuous voicing
• Residual stutters are modified through pull-out
  techniques
• Deals with negative attitudes and emotions
• Includes parents and teacher in program