a. Stuttering is a type of fluency disorder that can affect both children and adults. According to Roth and Worthington, stuttering is characterized by a high frequency and duration of stoppages in the forward flow of speech. The core behaviors of stuttering include repetitions of sounds, prolongations of sounds and blocks of airflow during speech. Secondary characteristics tend to develop as reactions to these core behaviors. These characteristics vary from person to person and can include eye blinks, head nods and foot taps. The ASHA website states that the exact cause of stuttering is unknown, but there are many therapy techniques that can be employed to help improve the fluency of those who stutter.
b. Liam Thayer is 12 years old whose speech is characterized by part and whole word repetitions, repetitions of …show more content…
initial sounds, prolongations of initial sounds and blocks. He displays some secondary behaviors such as lip tremors, head jerking and fist clenching. A 200-syllable spontaneous speech sample was taken. Of this speech sample, 30% of syllables were disfluent. Liam’s parents report that he gets frustrated and anxious when it comes to his speech. His academic performance is normal for his age and his developmental history is unremarkable.
Part 2:
Liam will successfully employ the cancellation technique when presented with a word stimulus with 70% accuracy in trials with minimal cueing
Part 3:
Liam’s treatment will include Stuttering Modification/Management.
This strategy, also called the “stutter more fluently” approach, focuses on reducing struggle and avoidance behaviors rather than completely eradicating disfluencies. Stuttering Modification consists of teaching the client a hierarchy of three techniques, cancellations, pull-outs and preparatory sets. Cancellations are the first step in Stuttering Modification. The individual is taught to complete the word that was stuttered and pause deliberately after the word is produced. The client will then mentally rehearse a technique for producing the word more fluently, and repeat the word. Another technique used in the Stuttering Modification approach is desensitization. This is when a person who stutters voluntary stutters. Roth and Worthington states that Desensitization helps to reduce negative emotions that are associated with stuttering. Both cancellations and desensitization will be used together to help improve Liam’s fluency in this session. Reading out loud is something that Liam is frequently asked to do in his class room, so this type of activity is functionally
appropriate.
Part 4:
I will use a mad-lib game to help Liam practice his cancellation techniques. This mad-lib was found on teach-nology.com. Liam and I will fill in the mad-lib together and I will instruct him to purposefully stutter on 10 words that I have underlined and then employ the cancellation technique. Liam’s teacher uses mad-libs in class, so he is familiar with how they work and how to fill them out.
Word list:
1. Dogs
2. Snakes
3. Jump
4. Tom
5. Talking
6. People
7. Cups
8. Trash
9. Fun
10. Amazing Part 5:
a. “Today we are going to be doing a mad-lib to practice the cancellation technique we learned in the last session. That’s when, if you start to stutter and you complete the word. Then you pause and practice saying the word slower and gentler in your head. Then you say the word you stuttered on again. Remember? Great! We’re going to complete this mad-lib. Then we are going to read it out loud using our special cancellation method. So, have you ever been to the arcade? That’s what this mad-lib is all about. There will be underlined words in the mad-lib. I want you to stutter on purpose when reading those words. Then I want you to use the cancellation technique. If you stutter on a word that not underlined I still want you to use the cancellation technique. I’ll demonstrate it for you. The first sentence is ‘We are going to the a-a-a-a-arcade [pause] arcade. See how I finished the word, paused, and then said the word again in a smooth, slower way? Now it’s your turn.”
b. First, Liam will begin to read the mad-lib that we filled out. When he comes across an underlined word, her will begin to deliberately stutter. He will then employ the cancellation technique. If he neglects to use the cancellation technique for an underlined word, or if he omits a step in the technique, I will use corrective feedback to help him adjust.
Part 6:
If Liam neglects to stutter on the underlined words I will remind him to by saying “remember to stutter on the words that are underlined.” I will also provide corrective feedback regarding Liam’s use of the cancellation technique. For example, “talking” he neglected to pause and went right into the repetition of the word. After this I said, “Liam, you did great, but you forgot to pause before you repeated the word. Let’s try that one again.”
Liam: “t-t-t-t-talking [pause] talking”
Clinician: “Great job! That pause was perfect!”
Part 7:
Liam will receive verbal and non-verbal reinforcement to keep him motivated throughout the session. Verbal reinforcement will include statements such as “good cancellation,” “I liked that pause” and “nice repetition of the word. Did you hear how it was more fluent?” Non-verbal reinforcements will include head nods, smiles and high fives. Liam will receive intermittent reinforcements on a fixed ratio. For every two correct responses, Liam will get some type of reinforcement. Additionally, Liam will receive a token at the end of his session. This is a secondary reinforcement. Once Liam collects a specified number of tokens he can trade them in for a prize from the prize box.
Part 8:
CF: corrective feedback
Word +/---
Dogs ---/+ (CF)
Snakes +
Jump +
Tom +
Talking ---/+ (CF)
People +
Cups +
Trash ---/+ (CF)
Fun +
Amazing +
Liam successfully demonstrated pull-outs with 70% accuracy (in 7/10 trials) with moderate cueing. This number was calculated by taking the number of correct demonstrations, 7, and dividing them by the total number of trials, 10. 7/10 = 70% accuracy. Therefore, the 70% accuracy goal was met. The moderate cueing goal was also met.
Part 9:
Liam will successfully employ the cancellation technique when presented with a word stimulus with 70% accuracy in trials with minimal cueing was the goal. Liam was able to meet the goal in this session. Corrective feedback was used three times in the session so cueing was minimal. Therefore, the cueing goal was also met. Liam was motivated throughout the session and did a wonderful job staying on task. We will continue using the Stuttering modification method. We will work on mastering “pull-outs” next.
Works Cited
Owens, R. E., Metz, D. E., & Haas, A. (2007). Introduction to Communication Disorders: A Lifespan Perspective (3rd ed.). Boston: Pearson/Allyn and Bacon.
Roth, F. P., & Worthington, C. K. (2005). Treatment resource manual for speech-language pathology (3rd ed.). Australia: Thomson Delmar Learning.
Strategies for Fluency . (n.d.). Fluency Friday . Retrieved April 28, 2014, from http://www.fluencyfriday.org/Strategies%20revised.pdf
Welcome to TeAch-nology.com. (n.d.). Worksheets, Lesson Plans, Teacher Resources, and Rubrics from TeAch-nology.com. Retrieved May 9, 2014, from http://www.teach-nology.com/