Term
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Definition
| Non developmental, with onset usually in adulthood (but possible at any age) |
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Term
| Features of acquired stuttering (3) |
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Definition
Neurogenic stuttering (TBI, Stroke)
psychogenic stuttering
Malingering |
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Term
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Definition
caused by neurological injury or disease
TBI, stroke, Parkinson's, brain tumour, drug use etc..
Lesions in various areas of the brain my cause stuttering speech- right and left hemisphere
frontal parietal and temporal regions
corpus callosum, basal ganglia, brainstem, cerebellum
may be transient or chronic
true neurologenic stuttering is rare- most people with braindamage do not exhibit neurogenic stuttering, and much of the disfluent speech of individuals with brain damage cannot be regarded as stuttering. |
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Term
| differential diagnosis of neurogenic stuttering |
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Definition
a varietal of core disfluency types may be present
concomitant cognitive, language, and/or affective symptoms may or may not be present. |
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Term
| in contrast to developmental stuttering, neurogenic stuttering is: |
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Definition
less variable across situations
more evenly distributed across word types and positions
more likely to occur on highly automatic speech (eg counting)
less likely to show adaptation or consistency effects
less likely to be accompanied by secondary behaviours or anxiety and embarrassment.
wont change when singing acting talking to infants or animals etc. |
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Term
| Ax of neurogenic stuttering |
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Definition
standard case history, description of speech characteristics, conditiond/variables affecting speech, and social-emotional impact
neurological history, medical prognosis, and potential for spontaneous recovery
examination of speech, language, cognition, and memory capabilities relative to pre morbid abilities. |
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Term
| Tx of neurogenic stuttering |
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Definition
traditional stuttering treatments
medical treatments (surgery, prescription drugs, brain stimulation) |
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Term
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Definition
caused by psycho emotional trauma, with no associated organic etiology
similar dynamic to functional aphonia/dysphonia- a conversion reaction. i.e. an unconscious conflict is expressed in a more socially acceptable form.
the specific 'form' may be decided by the potential for secondary gains, or may be symbolic expression of the psychological conflict |
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Term
| differential diagnosis of psychogenic stuttering |
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Definition
a variety of core disfluency types may be present
other psychosomatic symptoms (eg headaches, chest pain, limb paralysis, panic attacks)
concomitant psychological conditions and pervious exposure to a person with a somatic disorder are common (eg depression) |
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Term
| psychogenic stuttering is often characterised by: |
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Definition
lack of variability across speaking situations and words
lack of awareness or emotional apathy
rapid remission of symptoms
(these depend on individual cases) |
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Term
| Psychogenic stuttering Ax |
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Definition
standard case history and speech evaluation
psychological history, including history of events preceding onset, and prior somatic symptoms
Psychiatric assessment and diagnosis is warranted
(important to have significant others there for Ax) |
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Term
| Psychogenic stuttering Tx |
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Definition
interdisciplinary care involving psychological counseling for holistic recovery
traditional stuttering treatments (show them they can be fluent)- improvement is based on the client's acquisition of skills and strategies, towards increased self confidence |
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Term
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Definition
instances where the presence of stuttering is fakes, for financial, legal or vocational gain
disfluency characteristics that fit the diagnostic criteria should outweigh suspicion of underlying motives.
the person who malingers wants to be identified as PWS
fake stutter is stereotypical and lacks variability (wont have norman effects such as adaptation)
the persons profile with be consistent only with what they know about stuttering
*it is hard to know whether someone is malingering or psychogenic.* |
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Term
| Why treat in the preschool years? |
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Definition
increase tractability
prevention of social impact
evidence of negative consequences from peers
some imitation, did not wait for children to finish, walked away from them |
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Term
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Definition
parent training programme
randomised control trials-evidence based practice
Ages 2-6 years for study
used for up to 12 years of age
if child has had therapy before this may lead to other choices |
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Term
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Definition
parent training programme
operant conditioning
attend to stutter free speech
maximise stutter free speech
child to achieve daily SR 1-2 scores for 3-4 weeks consistently to move into phase 2.
child to maintain at SR1-2 for 12 months to complete phase two. |
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Term
| Parent training in Lidcombe |
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Definition
measurements required
severity ratings- parent trained in scoring
types of stuttered explained
SR- score child's daily stuttering severity on chart
discuss where to put chart and when to score
aim: to get interrater reliability of 1 either side to get correct scoring.
SR chart bough each week to clinic
daily structured sessions achieving SR1-2
essential to structure childs output to achieve SR1-2
need to work out what ids a real stutter and what isnt
need to consider activities and what is going to work for that child and their interests. |
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Term
| Lidcombe session structure at home |
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Definition
10 minutes at home daily
parent aim to give verbal contingencies (feedback reinforcement) for stutter free speech
praise: "smooth talking"
request for self evaluation- any bumps? (only use on stutter free speech, dont want child to acknowledge stutters) |
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Term
| Initial Lidcombe therapy session Baseline |
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Definition
at the end of the case history- parents will be asked to record SR until next session
at start of session, therapist does baseline- research has trialled just using SR's without tru-talks
aiming for 600 syllables of child's speech- highest level to get true picture of stutter
discuss baseline with parent-then compare to week SR chart- brought in by parent |
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Term
| Initial Therapy Lidcombe session demonstration |
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Definition
therapist demonstrates 'smooth talking time'
heralds to child- 'we are going to show mum and dad how to do smooth talking time with you'
easiest to start with books and pictures
always target stutter free speech first
alert parent to ignore stutters
if appropriate- child repeating or prolonging- parent to say word over the top of them. |
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Term
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Definition
Parents aiming for daily ten mins structured smooth talking time.
high levels of praise for stutter free speech
achieving SR1-2 by structured child's output to level where they are fluent
Heirarchy: from one word level-conversational speech.
concrete-abstract (imagination, memory)
variety of books used.
need to see consistent accurate feedback before encouraging unstructured feedback outside of sessions. |
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Term
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Definition
aiming for conversational styles of interaction no matter how low level.
important to get two ways process- not just listing, would use this if very severe stuttering
aim to demonstrate way to to question and give feedback alongside- some parents need more demonstration than others.
must have turn taking in smooth talking time. |
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Term
verbal contingencies
Lidcombe |
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Definition
structured sessions- aiming for parents to use frequent stutter free contingencies during the ten mins
often need encouragement to start and maintain frequency
feedback shouldn't be constant, invasive or intense- aim for balance and frequent enough to be heard and with not feeling
at end of first demo, give choice of practising at home and demonstrating next week or having a go today. |
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Term
Regular sessions
Lidcombe
Baseline |
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Definition
baseline done in free play.
aiming for high level language to see highest SR, need to consider activities. |
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Term
Regular sessions
Lidcombe
Discussion with Mo |
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Definition
SR for baseline
record weeks SR from parents chart
discuss scores
SR achieved in sessions (SR1-2 aim)
Time of the day (earlier is better, NOT after 5pm)
How many daily sessions completed?
Which activities were used?
Time taken?
HOw did sessions go?
What feedback was used? |
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Term
Regular session
Lidcombe
Parent Demonstration |
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Definition
Child and parent turn taking
Aim for SR1-2
If parent is not giving any feedback to child, start modeling beside them
if praising child during stutters- stop them!
discuss the demo with parent. eg how does that compare with how you have been doing at home?
what Sr rating would you give? |
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Term
Use of contingencies
Lidcombe |
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Definition
In structured sessions & unstructured feedback
Aim to check in with how much the feedback is happening
Need continual checking as suddenly it can change
variety of feedback
accuracy of feedback |
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Term
Types of feedback:
For stutter free speech |
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Definition
Stutter free:
'Smooth'- acknowledgment
'Great smooth talking'- praise
'any bumps? No, So smooth'- Self evaluation |
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Term
Types of feedback:
For Stuttered speech |
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Definition
"that was bumpy'- acknowledgement (dont use?)?
'can you try ____ again?'- correction |
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Term
| Contingencies for stuttered speech |
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Definition
important that both therapist and parent agree on what stuttered behaviours are.
Some kids dont cope with correction
Some parents take time to get on top of stutter free contingencies - therefore careful consideration if they can cope with it.
some parents over correct, need to break the habit
aim to demonstrate the correction in the session
discuss witht he parent how they think the child will cope with correction
choose easy repetition to ask for request for self correction eg 'mu,mu,mum- 'try mum again'
or 'that was bumpy, say mum again?' |
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Term
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Definition
If child successful-praise- great smooth talking or very smooth
if not- can state thats a tricky one or model word back to them then move on
Part word repetition- ask for word
whole word repetition- ask for phrase
phrase rep- ask for sentence
if filler: 'um um um'- "try it without the um" |
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Term
| Correction to praise ratio |
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Definition
| 1 part correction to 5 parts praise |
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Term
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Definition
if a child chooses not to correct then you move on and discuss with parent later
IF YOU SEE ANY SIGN OF NEGATIVITY TOWARDS CORRECTION, BACK OFF!!!
Counsel parent to look for any reaction and if a problem to cease doing it |
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