TREATING THE SCHOOL AGE STUTTERER

Material in this document was contributed by Peter Ramig, Patricia Ogrodnick and Pamela Stewart. Presented as a mini-session at the ASHA convention, Boston, MA, 1988. (Originally formatted for the gopher archive by Judy Kuster, with permission; formatted for WWW by Chris Upton)

Introduction

The purpose of this presentation was to provide the clinician with a clinically comprehensive, yet functional source of therapy principles, goals, and activities for use with the dysfluent school-age child. This information is drawn from a wide source of research studies and treatment programs, which reflects our overall eclectic treatment philosophy.

Our treatment philosophy represents two separate philosophical schools of thought, traditional and operant, and is heavily based upon the developmental continuum of stuttering in children. Fluency shaping therapy, based upon operant conditioning principles, first establishes fluency in a controlled stimulus situation. This fluency is reinforced and gradually modified to approximate normal conversational speech. Traditional theorists take a more holistic approach looking at the individual child and characteristics of the problem when planning treatment. More recently, traditionalists are looking at possible contributing factors to the child's dysfluency, such as physiological, cognitive, and social/emotional processes which may underlie the symptom: by strengthening these "processes," fluency is thought to be facilitated.

IN OUR EFFORT TO PROVIDE YOU WITH A COMPLETE AND COMPREHENSIVE APPROACH, KEEP IN MIND THAT THESE GOALS AND ACTIVITIES SHOULD BE USED DISCRIMINATELY - ASSESSING EACH CHILD'S INDIVIDUAL NEEDS AND CHARACTERISTICS - AS WELL AS SEVERITY, AGE AND MATURITY LEVEL. SOME GOALS AND ACTIVITIES MAY NOT BE APPROPRIATE, YET OTHERS MAY ONLY REQUIRE SMALL MODIFICATIONS FOR USE WITH SPECIFIC CHILDREN. YOU MAY FIND SOME OF THESE ACTIVITIES TO BE THE FOUNDATION FOR MANY NEW IDEAS.

A major concern with the treatment of fluency in children is *maintaining the fluency*. We feel the following approach is especially successful in this regard because we teach the children how to cope with and modify their stuttering, as well as teaching them fluency.

BASIC PRINCIPLES UNDERLYING THERAPY

1. Treatment is based upon a developmental continuum, as stuttering is a progressive disorder.
2. The client-clinician relationship is an important variable built upon trust, confidence and understanding.
3. Children and adolescents typically do not have intrinsic motivation to change their speech: therefore, it is important to make therapy enjoyable and rewarding.
4. Success with fluency is paramount and therapy activities are structured at a level at which the child is able to attain fluent speech. Single word and phrase level tasks are often continued long after the child achieves fluency at that level. Building self- confidence is important and is targeted throughout treatment by providing the child with successful speaking activities.
5. Treatment plans are highly flexible and are designed to meet each child's changing needs.
6. It is important to help the child to express and understand their feelings with regard to their stuttering. The clinician should share other children's experiences and validate embarrassment, pain and/or frustration with understanding and support. Reflect to the child what he/she may have difficulty expressing.
7. During therapy, clinicians use a slow rate of speech with increased pause and response time, and maintain appropriate eye contact during both fluent and dysfluent episodes. In addition to the above fluency enhancing behaviors, the clinician also models appropriate modification techniques, as well as easy stuttering behaviors.
8. Incorporate parental involvement in the therapy process as much as possible.

COMPONENTS

1 Establishment of fluency through increasingly long and complex linguistic stimuli

2 Regulating and controlling breathstream

3 Establishment of light articulatory contacts

4 Controlling speaking rate

5 Facilitation of oral-motor planning and coordination

6 Desensitization therapy

7 Modification of the stuttering moment

8 Reduction of (word) avoidance behaviors

9 Facilitation of development of self-awareness and self- monitoring skills, as they relate to fluency

10 Facilitation of a positive attitude toward communication,and toward himself as a communicator

11 Transfer and maintenance of fluency

12 Parental involvement