Stuttering and concomitant disorders

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Stuttering and concomitant disorders
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Children with concomitant problems

• Research continues to suggest that children who
  stutter are at greatly elevated risk for
  concomitant articulation and language disorders
  (Arndt Healey, 2001).
• Distinguishing fluency impairment in language
  disorder from stuttering (Hall, Yamashita Aram,
  1993 Boscolo, Bernstein Ratner Rescorla, 2001)
• Setting up multiple therapy goals (Bernstein
  Ratner, 1995)
• Avoiding interference between therapy goals

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• Stuttering and concomitant impairment

• How common is it?
• How to distinguish stuttering from disfluency
  stemming from language formulation problems
• Rare cases of "stuttering" following language
  and/or phonological intervention -- are they
  equivalent to normal "developmental disfluency"
  stemming from language formulation skills in
  flux?
• from Bernstein Ratner, Nan (1995) Treating the
  child who stutters with concomitant language or
  phonological impairment. LSHSS, 26,180-186.

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• Concurrent intervention Language

• Place fluency goals and practice at the lowest
  level of linguistic demand for the child's
  current system
• Utterance length alone is not a sufficient
  criteria for determining difficulty
• Accept that some fluency failure may accompany
  some language gains
• For older children, work on handling stutters,
  not avoiding them.

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• Concurrent intervention phonology

• Interactions between phonology and fluency?
• Incidence of co-morbidity not clear (Nippold,
  2002)
• Uncertain whether dysfluencies gravitate toward
  difficult phonemes or sequences (e.g., Wolk et
  al., 2000 Ratner, 2000)
• Not clear whether concomitant phonology problem
  has effect on remission rates in fluency (e.g.,
  Paden et al., 1999 Ryan, 2001)

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• Suggestions from Conture, Louko Edwards (1993)
• avoid critical feedback to inaccurate productions
• avoid over-articulation (hard onsets) of target
  sounds
• rate and turn-taking modifications are helpful to
  both conditions

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• Other concepts

• Fluency may break down when "bridging" between
  supported, scaffolded tasks, and spontaneous
  speech.
• "Cycles" (Hodson Paden, 1991) may allow for
  interim growth of skill areas.
• The importance of parental advisement and
  feedback.
• Some disorders that depress language depress the
  cognitive and metalinguistic pre-requisites for
  some aspects of fluency therapy this makes
  therapy difficult, and is NOT YOUR FAULT.