SCHOOL AGE STUTTERING THERAPY

2/23/19SCHOOL AGE STUTTERINGTHERAPY:Where Do We Start?Nina Reeves, M.S. CCC-SLP BRS-FD Board Certified Specialist-Fluency sources.comFluency Specialist: Frisco ISDFluency Specialist Consultant: San Diego Unified School DistrictCo-Owner/Director Stuttering Therapy Resources, Inc.Housekeeping Handouts for all of today’s sessions areposted onwww.ninareeves.com/resources UNTIL March 31st only! Nina Reeves, 2019 www.ninareeves.com1

2/23/19Onsite-special! Our entire catalog at Stuttering Therapy Resourcesis 10% off for attendees during this presentation onlywww.StutteringTherapyResources.comUse Discount Code ONSITE at checkout AND enter a drawing for a free resourcefor educating teachers about stuttering– LIKE us on Facebook (@StutteringTherapyResources)– FOLLOW us on Twitter (@StutterResource)– POST a picture on Instagram (@stutteringtherapyresources)– Post a picture, quote, or idea from the workshop Remember to tag STR in your post. Every postearns you another entry in the drawing– I will contact you by social media if you win!Just a reminder: Many slides contain student work andlikenesses Therefore, due to HIPPA regulations, nophotographs nor recordings can be made ofthe presentation slides. Nina Reeves, 2019 www.ninareeves.com2

2/23/19 I know that I cannot possibly presenteverything you want or need to know abouthow to start stuttering treatment for schoolage who stutter in the span of 3 total hours(Parts 1 and 2) So, I will attempt to address the majorpoints of foundational knowledge and skillsWHILE Also providing you with resources for furthereducation and learning activities Nina Reeves, 2019 www.ninareeves.com3

2/23/19OF COURSE, WEREALLY START WITH A multidimensional assessmentAnd, I can’t do a presentation without the next twoslides that remind us of the “BIGGER PICTURE” ofstuttering assessment and intervention!The WHO’s (World Health Organization) ICF (International ClassificationFramework) Applied to Stuttering(adapted from Yaruss, 1998, 2007; Yaruss & Quesal, 2004, 2006) Nina Reeves, 2019 www.ninareeves.com4

2/23/19A Review of the WHO Function: Observable/surface speech behaviors Reactions:– child’s behaviors in reaction to stutters,– child’s thoughts about self and communication,– child’s feelings about self and stuttering Environment: How others’ perceive/react to stuttering Impact: Participation & Activity LimitationsAssessment-Environment Assessment of other people’sreactions to stuttering Environmental impact–Adults: Parents & Teachers–Children: Peers & Siblings Do they hold beliefs that impactprogress in therapy? Nina Reeves, 2019 www.ninareeves.com5

2/23/19Assessment-Reactions Assessment of Child’s Reactions toStuttering–Beliefs & Feelings about stuttering andself–Avoidance or tension/struggle behaviors–Affective (feelings)–Behavioral (tension, struggle, avoidance)–Cognitive (thoughts/beliefs, self-esteem,self-confidence)Assessment-Reactions (cont.) Talking together WITH the child– About the child, interests, talking & communication Talking about Talking (Williams, 85) & stuttering Normed-Referenced– Behavioral Assessment Battery (BAB) [Kiddy-Cat, CAT-R] Portfolio-Based––––Reflective writings/drawingsJournal entriesQuestionnaires/checklistsDocumentation of observations (SLP’s & others’)– Samples upcoming:For further information, See Chmela & Reardon: The School Age Child who Stutters: Working Effectively withAttitudes and Emotions, Stuttering Foundation, 2001 Nina Reeves, 2019 www.ninareeves.com6

2/23/19Assessment- Impairment/Function Assessment of speech fluency– Observable characteristics– Speech disfluencies Non-stuttered(unless produced with tension)– Phrase repetitions– Revisions– Interjections– (some) whole word repetitions Stuttered– Repetitions of words/sounds/syllables– Prolongations– Blocks VIDEO VIDEO VIDEO Just curious what do you use for assessment?Assessment-Impact Assessment of adverse impact of stuttering on child’s life–Functional communication–Quality of life–OASES (Overall Assessment of a Speaker’sExperience of Stuttering) and others –Interviews–Checklists Self-Observation–Portfolio Documentation Nina Reeves, 2019 www.ninareeves.com7

2/23/19AS WE “GET STARTED,” SOMETIMESWE CAN JUMP TOO QUICKLY INTOSPEECH HANDLING TECHNIQUESBefore we ever touch a “speechtool,” we must help our studentsto build foundational knowledgeand skills related to speaking ANDstuttering!All intervention is adjusted to Age Awareness Cognitive Abilities Level of Impact Interests Readiness Family Dynamics Communication NeedsAdapted from:Chmela &Reardon, 2001 Nina Reeves, 2019 www.ninareeves.com8

2/23/19(Some of) What we need A feeling of confidence A firm knowledge of stuttering Evidence based practice Current Best EvidenceClinicalExpertiseClient ValuesNatural language to describe what we are doingCreativity to make this stage fun!A keen eye and ear for ongoing assessment to know WHY we are doing WHAT we are doing!What we don’t need Inflexible programs of any kind ANY materials that we don’t know thetheoretical basis of Too many “special” stuttering materials–Most anything can be a stuttering therapymaterial To be afraid of making kids who stutter“worse” if we discuss speaking difficultiesin appropriate and supportive ways! Nina Reeves, 2019 www.ninareeves.com9

2/23/19Firm Knowledge of StutteringCan you discuss ? What is stuttering? /How do we look at it?What causes stuttering?What about the myths and facts?Therapy processAvoidance behaviorsPrognosis (be careful)Preparing the EnvironmentEducating & Supporting Others Caregivers & Others, in general –Summary of findings & recommendations–Understanding of speech and stuttering–Understanding of the complexities of thedisorder of stuttering–Understanding of the complexities of stutteringtherapy (ownership)–Someone to listen to their story–A sounding board, not a fixer! Nina Reeves, 2019 www.ninareeves.com10

2/23/19Some things to consider There is NO ONE way of doing ANY of this! This is NOT a program!! It is a set ofpossibilities that you may chose to include inthe initial stages of therapy, in any order or inany way you chose. Mantra: “Matter-of-fact” atmosphere oftherapyThis is truly a blending Of assessment and therapy Of knowledge and skill Of the science and the art of therapy Of moving from talking about and exploring talking to talking aboutand exploring stuttering Nina Reeves, 2019 www.ninareeves.com11

2/23/19REFLECT: WHAT’STHE PRIMARY GOALOF TREATMENTFOR SCHOOL AGEWHO STUTTER?The Bones: What we can’t livewithout in therapy! Setting up for success! Nina Reeves, 2019 www.ninareeves.com–The speech notebook!–Hierarchies–Systematic Desensitization–Manipulating Variables–Effect Circles12

2/23/19A speech notebook A wonderful example of portfolio documentation! The good news is that this can be anything youand your student want it to be! NO RULES apply! How to design a Stutter Notebook Practical ample of aspeaking hierarchyANDsystematicdesensitization A sample of discussionsof “hierarchies” in theliterature:Campbell, 2003; Guitar,1998; Heinz & Johnson,1998; Hill, 2003; Shapiro,1999; Sisskin, 2002;Yaruss & Reardon, 2003 Nina Reeves, 2019 www.ninareeves.com13

2/23/19Manipulating Variables Working to systematically alter the experience ofintervention in order to enhance “real world”growth in skills and concepts presented intherapy Examples:–length & complexity of utterances––degrees of language onally,––listenersclinician model,location of sessions,physical activitySee also:Gregory & Hill,1980See also:Campbell,The BIGGIES of “Handling” StutteringStudent wants to know: Why am I learning/doingthis?All aspects affect any combination of the followingcommunication factors: Physical TensionFrequency and Severityof Stuttering HANDLE Time Pressure Ease of Tool Use Comfort Level Decrease struggle Increase ease ofcommunication Nina Reeves, 2019 www.ninareeves.comò Feeling ofChoice/Controlò Tolerance ofCommunicativePressuresò Confidenceò Anxiety or Fearò Hiding/AvoidingStuttering14

2/23/19Effect Circles and “The Biggies” Effect CirclesAsk yourself and your studentsWHY are we doing WHAT weare doing? -Van Riper andothersWe are guiding children withquestions that help themunderstand the reasonsbehind everything they areasked to do during theprocess of therapyLet’s do some!OK I’LL SEE YOU FORPART 2In 15 minutes! Nina Reeves, 2019 www.ninareeves.com15

2/23/19Selected Resources Chmela & Reardon (2001). The School Age Child who Stutters: Working Effectively with Attitudes and Emotions, Stuttering Foundation:Memphis, TN Chmela, K. (2011). Focus on Fluency, Super Duper Inc: Greenville, SC. Gregory, H. H., & Hill, D. (1980). Stuttering therapy for children. In Seminars in Hearing (Vol. 1, No. 04, pp. 351-362). Copyright 1980 byThieme Medical Publishers, Inc. Guitar G. (2014) Stuttering: Basic Clinical Skills Memphis, TN: Stuttering Foundation. Ramig, P. R., & Bennett, E. M. (1997). Clinical management of children: Direct management strategies. Nature and treatment of stuttering:New directions, 2. Reardon-Reeves & Yaruss, 2013 School-Age Stuttering Therapy: A Practical Guide, Stuttering Therapy Resources, Inc: McKinney, TX Sheehan, J. (1970). Stuttering; research and therapy. New York: Harper & Row. Yaruss, J. S. (1998). Describing the consequences of disorders: Stuttering and the International Classification of Impairments, Disabilities,and Handicaps. Journal of Speech, Language, and Hearing Research, 41(2), 249-257. Yaruss, J. S. (2007). Application of the ICF in fluency disorders. Seminars in Speech and Language, 28(4), 312-322. Yaruss, J. S. (2010).Evaluating and treating school-aged children who stutter. Seminars in Speech and Language,31(4), 262-271. Yaruss, J. S., & Quesal, R. W. (2004). Stuttering and the International Classification of Functioning, Disability, and Health: An update.Journal of Communication Disorders, 37(1), 35-52.Organizations/ResourcesAmerican Speech-Language-Hearing AssociationPhone: 1-800-638-8255Website: www.asha.orgSIG 4 (Fluency and Fluency Disorders)The Stuttering Home Pagewww.stutteringhomepage.comStuttering Foundation (SFA)P.O. Box 117493100 Walnut Grove Road #603Specialty Board of Fluency DisordersMemphis, TN 38111www.stutteringspecialists.orgPhone: 1-800-992-9392National Stuttering Association (NSA)Website: www.stutteringhelp.org119 W. 40th Street14th FloorNew York, NY 10018Email: nsastutter@aol.comPhone: 1-800-We StutterWebsite: www.westutter.orgStutter Talk:www.stuttertalk.comInternational Fluency Association: www.ifa.orgFriends8 South Oyster Bay Rd.Syosset, NY 11791Phone: 866-866-8335Website: www.friendswhostutter.orgSAY: Stuttering Association of the YoungWebsite: www.say.orgAmerican Board for Fluency and Fluency Disorderswww.stutteringspecialists.org Nina Reeves, 2019 www.ninareeves.com16

how to start stuttering treatment for school age who stutter in the span of 3 totalhours (Parts 1 and 2) So, I will attempt to address the major . 2013 School -Age Stuttering Therapy: A Practical Guide, Stuttering Therapy Resources, Inc: McKinney, TX Sheehan, J. (1970).