Interactive Learning with Fluency Specialists
The Center for Stuttering Therapy
www.coloradostutteringtherapy.com
Boulder Office:
Mary Wallace, M.A., CCC-SLP, BCS-F
Matthew Goldman, M.A., CCC-SLP
Denver Office:
Patty Walton, M.A., CCC-SLP, BCS-F
Whitney Noven, M.S., CCC-SLP
Bethany Tileston, M.A., CCC-SLP
Kailey Sillman, M.A, CCC-SLP
Amber Rea, B.S (Graduate Intern)
Introduction
This presentation will provide key points on the topics of assessment, treatment and treatment strategies, treatment planning, addressing attitudes and emotions, writing IEP goals, measuring progress and parent and teacher counseling. Short presentations on each topic will provide the framework for breakout sessions, during which small group discussions will take place with one of the above presenters. The goal of this interactive format is to provide the attendee with optimal opportunities to ask questions and problem solve concerns with specific clients and/or aspects of assessment and treatment in general. Bring your questions!
I. Assessment
This topic section will discuss assessment guidelines for both preschool and school age children who stutter. The pro’s and cons of formal and informal assessment will be presented with a focus on how to use subjective measures to maximize obtaining important information needed for diagnosis as well planning treatment.
A. Presentation points
1. Preschool Assessment
a. danger/warning signs
b. risk factors
c. other indications of progression and increased concern
2. School-age Assessment
a. Formal Assessment Tools
1. Riley Stuttering Severity Instrument- 4 (SSI-4)
2. Test of Childhood Stuttering (TOCS)
3. Overall Assessment of the Speakers Experience with with Stuttering (OASES-S)
b. State of Colorado Rating Scale
c. Subjective measures: molecular analysis, handouts
d. Parent and teacher input
e. Qualifying considerations
B. Breakouts: This breakout will focus on issues surrounding assessment, including how to choose most appropriate formal or informal test measures, how best to qualify a child, obtaining information from parents and teachers, and how to talk to kids about stuttering.
Possible breakout topics and questions:
1. What do I do if I am getting parental reports of stuttering at home but am not seeing it in my therapy room?
2. How do I talk to a child about stuttering during our first meeting?
3. What is the most efficient way to obtain the most representative speech sample?
4. What assessment tools are best for measuring progress?
5. If I can only buy only one assessment tool, what is the best one to have?
6. How can I qualify a child for services based upon the emotional aspects of stuttering?
7. How do I assess a child who is avoiding and not talking and still be able to document stuttering?
II. Treatment and Therapy Strategies
This topic section will look at general components of stuttering therapy and will describe both fluency shaping and modification strategies, what they are when to use them, what they do, and how to best teach them.
A. Presentation points
1. General therapy components
a. implementing therapy along a hierarchy of increased length and complexity of utterance framework
b. the role of modeling in therapy
c. reinforcement (encouraging praise vs. evaluative praise)
2. Importance of combining fluency shaping and modification strategies
3. Fluency shaping strategies: speech tools which increase fluency
· stretching or easy speech
· easy voice
· soft contacts or slides
· continuous voicing
· overarticulation
4. Modification strategies: speech tools which help the child stutter more easily, avoid less, and control moments of stuttering
· bouncing (easy, voluntary repetitions)
· pull outs
· holding and tolerating
5. Case study presentation of the use of modification strategies with a preschool child.
B. Breakouts: This breakout session will focus on the practicing and learning of therapy strategies and questions related to choosing, teaching and generalizing them.
Possible breakout topics and questions:
1. How do I know which fluency shaping technique is best for my student?
2. How do I best reinforce speech tool use?
3. When do we begin to generalize speech tools outside of the therapy room?
4. When do I stop using modification strategies?
5. Do you ever need to go back and reintroduce modification strategies?
6. How do I know modification therapy is working?
7. How do I know when to move up the hierarchy?
8. What do I do if the child learns bouncing and then doesn’t want to learn fluency strategies?
9. What do I do if the child gets stuck in the bounces?
10. What do I do if the child is reluctant to use or learn bouncing?
11. How do I help kids feel more comfortable with using speech tools in the classroom?
12. What the best way to teach speech tools in reading?
13. How do I help kids who are stuttering so badly no speech tools work at the spontaneous level?
III. Treatment Planning: Other Considerations
This topic section will present additional components of therapy including education and identification. Specific focus will be on working with attitudes and emotions and parent and teacher counseling
A. Presentation points
1. Education and Identification
2. The Importance of Addressing Attitudes and Emotions
a. drawing
b. writing
c. self talk and positive affirmations
d. problem solving
e. letters to the teacher
3. Working with Parents
a. acceptance
b. reducing expectations for speech tools at home
c. educating parents
4. Working with Teachers
a. increasing communication
b. reducing stressors in the classroom
c. using the classroom for generalization
d. doing a classroom presentation (go to www.stutteringhelp.org or www.westutter.org for guidelines)
5. FRIENDS DAY! April 18th, Jefferson Academy
www.friendswhostutter.org
B. Breakouts: This breakout session will focus on issues surrounding the planning and execution of treatment, including educating the child about normal speech production and stuttering, helping the child identify moments of stuttering, how and when to address attitudes and emotions and how best to work with parents and teachers.
Possible breakout topics and questions:
1. How do I know when I need to increase the focus of therapy more attitudes and emotions?
2. How can I document progress on goals focusing on attitudes and emotions?
3. What do I do if the child has trouble identifying stuttering behaviors?
4. What do I do if the child is reluctant to talk about stuttering?
5. How much should I be in contact with parents and teachers?
6. What do I do if parents have high expectations for fluency?
7. How do I help a child be more empowered over stuttering?
8. What suggestions do you have regarding dealing with teasing?
IV. Writing IEP Goals and Measuring Progress
This topic section is designed to increase skill and efficiency in writing IEP goals for students who stutter and discuss effective ways to measure progress across all treatment goals for accountability.
A. Presentation Points
1. General examples of SMART goal writing for fluency clients:
a. Specific
address specific skills and techniques being used in therapy
and may include: increasing participation in the classroom; increase disclosure to peers/teachers; or increase use of speech tools in specific settings
b. Measurable
should involve an increase in the count/percentage of use of speech tools rather than a reduction in stuttering
c. Achievable
goals should never target 100%, and should be scaffolded to move through (a) linguistic complexity (b) spontaneous vs. imitative responses and (c) across various situations for generalization
d. Relevant
goals should be unique to the student and based on their current level of performance; should address a goal that would decrease anxiety and increase participation and positive social interaction in their learning environment.
e. Time-bound
An achievable and relevant goal should be one that can be completed in a specific time frame
2. Measuring progress and accountability
B. Breakouts: During this last breakout, Bethany, Kailey and Matthew (our therapists who also are school based) will be discussing IEP goal writing. Mary, Patty and Whitney will answer questions regarding other topics specific to the attendees.
Possible breakout topics and questions:
1. How many goals can be targeted each school year?
2. How do I know which goals to prioritize?
3. What is the best way to measure progress for children who have more covert stuttering characterized by lack of talking in the classroom and avoidance?
4. What degree of accuracy needs to be reached at each level of the linguistic hierarchy before the goal can be considered met?
5. Specific question related to goal writing
6. Specific questions regarding children on your caseload
7. Specific questions regarding assessment, treatment planning and treatment strategies
RESOURCES
Websites:
Stuttering Foundation of America www.stutteringhelp.org
Friends: The Association of Young People Who Stutter www.friendswhostutter.org
National Stuttering Association www.westutter.org
Stuttering Home Page www.stutteringhomepage.com
REFERENCES
Briggs, D. (1975). Your child's self esteem. Random House Digital, Inc.
Chmela, K. (2006). Focus on fluency. Greenville, SC: Super Duper Publications.
Chmela, K., & Reardon, N. (2001). The school-age child who stutters: Working effectively with attitudes and emotions. Memphis, TN: Stuttering Foundation of America.
DeNil & Brutten (1991). Speech-associated attitudes of stuttering and non-stuttering children. Journal of Speech and Hearing Research, 34, 60-66. (CAT)
Dell, C.W., Jr. (2000). Treating the school-age stutterer: A guide for clinicians (2nd ed.). Memphis, TN: Stuttering Foundation of America.
Faber, A. & Mazlish, E., (1980), How to Talk so Kids Will Listen & Listen so Kids Will Talk. Avon Books
Guitar, B. (2014) Stuttering: An integrated approach to it’s nature and treatment. Baltimore, MD: Lippincott, Williams and Wilkins
Logan, K. (2009) Test of childhood stuttering. Austin, TX: PRO-ED
Murphy, B. (1996). Empowering children who stutter: Reducing shame, guilt, and anxiety. Originally presented at the annual convention of the American Speech-Hearing-Language Association, Seattle, Washington, November 20-24, 1996, http://www.mnsu.edu/comdis/kuster/TherapyWWW/murphy.html.
Riley, G. (2009) Stuttering severity instrument for children and adults. Austin, TX: PRO-ED
Van Riper, C. (1973) The treatment of stuttering. Englewood Cliffs, NJ: Prentice-Hall
Wallace, M. & Walton, P (1998) Fun with fluency for the young child. Austin, TX: PRO-ED
Walton, P. (2013). Fun with fluency for the school-age child. Austin, TX: PRO-ED.
Yaruss, J.S., Coleman, C., & Quesal, R.W. (2010). Overall Assessment of the Speaker’s Experience of Stuttering: Ages 7-12 (OASES-S) Response Yaruss, J.S., & Reardon-Reeves, N. (2013). School-age stuttering therapy: A practical guide. Stuttering Therapy Resources.
Yaruss, J.S. et,al. (2014) Minimizing bullying and teasing for children who stutter: A practical guide for SLP’s. Stuttering Therapy Resources Inc.