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1、温州都市报【PPT课件】 Fluency Treatmentfor Big KidsLynne ShieldsFontbonneUniversityDepartment ofCommunication Disorders&Deaf EducationWhats yourfort level?Choice A:I LOVEworking withbig kidswho stutter!Choice B:Im abit apprehensiveabout working with a big kid who stutters.Choice C:I dont wantto seeabig kidwh
2、o stutters walkthrough mydoor!What canI dofor you?Goals fortoday:Group A:A fewnew ideas and/or resourcesB&C:Increase levelof fortby givingyou sometoolsDefinition of“BigKids”Children betweenthe agesof9-18.OR,anyone whois inthe pre-adolescent oradolescent stageof maturation.Assessment forThose BigKids
3、 Components:1)Thorough casehistory/interview withparents/teacher/child2)Evaluate speech&language abilities3)Good descriptionof featuresof childs stuttering4)Evaluation ofawareness andattitudes ofabout stuttering5)Find outchilds interests/goals1)Interview?Interview child,parent,teacher(s)?Good templa
4、tesfor questionnaireforms inGuitar (1998)“Stuttering:An integratedapproach toits natureand treatment”Teacher Questionnairesamplequestionsfrom Chmela&Reardon (xx)Some thingsI havenoticed aboutthis childs municationareWhen thischild answersquestions inclass he/sheWhen thischild speaksto meat mydeskWhe
5、n thischild readsaloudMy knowledgeabout stutteringisMost importantly,right nowI needto knowParent Questionnaire(from Chmela&Reardon,xx)My greatestconcerns regardingmy childs speechproblem areI feelmy childis/is notconcerned abouthis/her speechproblem becauseWhen mychild stutters,I feelWhen mychild s
6、tutters,I say/doMy knowledgeabout stutteringisFrom previoustherapy,if any,I learned2)Evaluate Speech&Language Abilities?Children whostutter aremore likelyto haveco-ourring speechand/or languageproblems?Be sureto checkfor thisthrough casehistory&screen for these areas?Evaluate in-depth asneeded3)Desc
7、ription ofStuttering?Types ofdisfluenciesPresence ofstruggle behaviorse.g.effort whilespeaking,tensionPresence ofavoidance behaviorse.g.word substitutions,avoiding speakingsituations?4)Evaluation ofAwareness/Attitudes?Do not assume thata childis notbothered byhis/her speechbased on their verbalrepor
8、t.?Older childrenand teensare proo givenon-specific answers.?Give attitudescales/have themevaluate scenarios/etc.5)Determine Childs Goals?Ask yourbigkidwhat bothersthem themost abouttheir speech.?Ask themwhat they are interestedin orwilling towork on.?Just asimportantly,ask whattheyarenot willingor
9、interestedin workingon.?Compare childs answersto parentalwishes/expectationsTreating Stuttering?Fluency-Shaping=train childto altermode of speaking toproduce speech that is100%fluent.?Stuttering Modification=focus onshaping stutteringto moreeasy,less disruptiveform;focus onfeelings/attitudes?Best Be
10、t=Combination ofboth,tailored tofit child.Canned programsfit aboutas wellas thoseone-size-fits allgarments!Goals ofFluency Therapyfor Children(Manning,xx)A.Gain understandingof speechmechanismB.Enhance speechfluencyC.Manage stuttering that oursD.Deal withemotions andattitudesE.Address relapseA.Under
11、stand theSpeech Mechanism?How itworks fornormal speaking.What happensto mewhen Iget stuckon words.Learn about stuttering:what itis,whostutters,reasons why,etc.*Dontassumethat anolder childalready knowsall ofthis!?B.Help childchoose toolsthat enhancespeech fluencyGoal=speechthatis smooth,produced wit
12、houteffortTypical tools:-gradual andrelaxed useof vocalfolds(easy onset)-slower rateofspeaking(stretching)-gradual,smooth transitionssound-to-sound-light articulatorycontacts(light touch)-keeping anopen vocaltractChoosing FluencyTools(continued)When selectingtools besure that:?The tool(s)are fortabl
13、eforthechild.?The tool(s)is/are usedin sucha waythat speechsounds asnatural aspossible.This willhelp tremendouslywith generalization.C.Help childmanage theirstutteringGoal:Learn tochange theform of stutteringthatours,modify?Learn termsand explainconcepts.?May wantto havechild trynew waysofstuttering
14、.?Voluntary stutteringasatool.D.Help childdeal withemotions andattitudes related to stutteringThisarea frequentlyneeds tobe addressed.Some ways to dothis:Desensitization ActivitiesFocusontheMessageProblem-solvingDesensitization Activities?Voluntary stuttering-have acontest?Water balloons,water pisto
15、ls(Bill Murphy)?Art work?Journaling?Writing stories?Interviewing about stutteringBE CREATIVE!Message Therapy(Cooperman&Bloom,xx)What makesa goodmessage?-good content-clear presentation-good eyecontact-saying whatyou wantto sayGetaway fromover-focus onfluency.This therapywas designedfor youngerchildr
16、en,but Ifind theideas veryuseful,even withadults.Engage childin problem-solvingChild canlearn tosolve their own problemsrelatedtospeech,e.g.,teasing,oral presentations,etc.-classroom presentationaboutstuttering,paper-writing lettersto teachers-figuring outwaystotell peoplenot tointerruptnot toplete sentencesE.Address theissue ofrelapse?For olderchildren,relapse isa likelypossibility.?help childand parentsdevelop planfor howthey willhandle,if ours.Lear
