Bucket Analogy Purpose

1
Bucket AnalogyPurpose

• Identifies factors that maybe associated with
  stuttering
• Helps parents understandthe multifactorial
  natureof stuttering

2
Bucket AnalogyFactors

• Factors interact
• Cannot distinguish influence of individual
  factors once they are in the bucket

3
Bucket AnalogyGuidelines

• Begin at the bottomand work up
• Identify factors we havemore control over and
  factors we have lesscontrol over

4
Communication Wellness Analogy

• Purpose
• Describes structure flow of treatment
• Guidelines
• Begin at the bottom and work up
• Explain that not all all steps may be necessary

Direct Child Intervention
ParentObservation
StrategyPractice
Treatment Flow
Parent Sessions
5
Communication Wellness

• Normal fluency in conversational speech
• Easy Talking
• Conversational Level
• Direct Model to Question Model
• Sentences Phrases Words
• Model Practice
• Delayed Response
• Reduplication/Rephrasing
• Decreased Questioning
• Easy Talking
• Modify interpersonal stressors
• Chart home disfluencies
• Modify communicative stressors
• Discuss types of disfluencies
• Administer Stressor Inventory

Direct Child Intervention
ParentObservation
StrategyPractice
Treatment Flow
Parent Sessions
6
Discussing Types of Disfluencies

• Helps parents learn to distinguish between
  different disfluency types
• Helps parents understand how to view progress
  during treatment
• Reduces parental misconceptions
• stuttering is just repetition
• prolongations are better than repetitions

7
Continuum ofSpeech Disfluencies(adapted from
Gregory, Campbell, Hill, and others)

• More Typical
• Interjections
• Revisions
• Phrase repetitions
• Multisyllabic whole- word repetitions

• Crossover Behaviors
• Monosyllabic whole- word repetitions
• Part-word repetitions
• No tension/struggle
• 1 2 iterations

• Less Typical
• Part-word repetitions
• 3 or more iterations
• Prolongations
• Blocks

8
Examining Stressors

• Compare stressor inventories completed by both
  parents
• Parents may view situations differently
• Focus on interpersonal stressors first
• Establish need for additional counseling
• Discuss ways to modify stressors
• Parents take lead in finding solutions

9
Home Charting

• Increase parents awareness of
• Situational factors that affect fluency
• Their reactions to their childs stuttering
• Helps parents focus their energy on helping the
  child rather than worrying
• Gives opportunity to assess parents commitment
  to treatment early in the therapeutic process

10
Home Charting

• Guidelines
• No Aha! expected
• Provide examples of successful charting(see
  handout)
• Parents should bring completed chartto next
  treatment session

11
Provide Supporting Literature

• Reassures parents that others have had similar
  concerns and questions
• Provides concrete examples of ways parents can
  help their children
• Additional opportunity to assess parents
  commitment to treatment

12
Examples of Supporting Literature

• Stuttering Foundation of America (SFA)
• Stuttering and Your Child Questions Answers
• If Your Child Stutters A Guide for Parents
• National Stuttering Association (NSA)
• Stuttering Center Handouts
• Internet Resources
• Stuttering Home Page

13
Session 2

• Overview of FluencyEnhancing Strategies

14
Goals for Session 2

• Additional opportunity for counseling to to
  address parents concerns
• Further explore interpersonal stressors (when
  applicable)
• Begin the process of modifying communicative
  stressors
• Introduce next phase of treatment parent/child
  modeling

15
Guidelines for Session 2

• First, Review Info from Session 1
• Review results from home charting
• Answer questions about booklets and supporting
  literature
• Address parents concerns about treatment and
  childs fluency
• Continue discussion of interpersonal stressors
  and modifications

16
Fluency Enhancing Strategies

• Reducing parents speaking rates
• Reducing time pressures
• Reducing demand for talking
• Modifying questioning
• Providing supportivecommunicative environment

17
Preparing for Parent-Child Modeling Sessions
(Sessions 3-6)

• Provide overview of session flow
• Explain the need to videotape sessions (have
  parents bring tape to next session)
• Briefly introduce Easy Talking asthe first
  strategy to be addressed
• Familiarize parents with wireless microphone
  system

18
Wireless Microphone System
UseEasy Talking
WirelessXmitter (TelexTW-6)
(Easy Talking)
WirelessReceiver (TelexAAR-1)
19
Session 3

• Easy Talking

20
Goals for Session 3

• Train parents to use Easy Talking
• Slower than parents habitual rate, but not too
  slow, choppy, or robot-like
• Introduce phrased speech as a preferred way to
  reduce speaking rate
• Explain that the goal for the parents speaking
  rate is somewhere in between the rate they will
  practice in treatment and the rate they used
  before treatment

21
Guidelines for Session 3

• Set up video equipment and wireless microphone
  system before session
• Review Easy Talking handout
• Introduce phrasing as a preferred way to reduce
  speaking rate
• Explain that the goal for the parents speaking
  rate is somewhere in between the rate they will
  practice in treatment and the rate they used
  before treatment

22
Model and Practice Easy Talking

• Clinician models Easy Talking withthe child
  while parents observe
• One parent interacts with childwhile receiving
  on-line feedback
• Second parent interacts with childwhile
  receiving on-line feedback
• Discuss observations and importanceof reviewing
  videotape at home