Treating School-Age Children Treating School-Age Children who Stutter: Objectives and who Stutter: Objectives and

Activities Activities

Craig E. Coleman, M.A. & Rebecca L. Craig E. Coleman, M.A. & Rebecca L. Roccon, M.S.Roccon, M.S.

Children’s Hospital of PittsburghChildren’s Hospital of PittsburghAmy L. Zerhusen, M.S. Amy L. Zerhusen, M.S.

Children’s Hospital of CincinnatiChildren’s Hospital of Cincinnati

Common MisconceptionsCommon Misconceptions

Only number of disfluencies can be Only number of disfluencies can be measuredmeasured

Reduction of disfluencies is the only goalReduction of disfluencies is the only goal

Criteria used in articulation/phonology can Criteria used in articulation/phonology can be applied to stuttering (80% fluent be applied to stuttering (80% fluent speech)speech)

Affective responses will improve on their Affective responses will improve on their own, as the child’s fluency improves own, as the child’s fluency improves

Appropriate GoalsAppropriate Goals

Goals should address all aspects of the disorder, Goals should address all aspects of the disorder, not just the number of disfluenciesnot just the number of disfluencies

Goals should be geared toward increasing the Goals should be geared toward increasing the overall communication skills of the person who overall communication skills of the person who stuttersstutters– Is it better to speak freely and stutter or avoid Is it better to speak freely and stutter or avoid

situations/words that may be problematic?situations/words that may be problematic?

Target the “quantity” AND “quality” of stuttering Target the “quantity” AND “quality” of stuttering

Goals should be individualizedGoals should be individualized

Goals to Address Education Goals to Address Education

Children need to be educated about Children need to be educated about stuttering (Empowerment)stuttering (Empowerment)

Education helps the child deal with Education helps the child deal with stuttering long-term rather than getting a stuttering long-term rather than getting a “quick fix”“quick fix”

Helps the child teach others, such as their Helps the child teach others, such as their peers, about stutteringpeers, about stuttering

Goals to Address “Quality” of Goals to Address “Quality” of StutteringStuttering

These goals should target decreased These goals should target decreased physical tension during stutteringphysical tension during stutteringKids can learn that they sometimes can’t Kids can learn that they sometimes can’t control “if” they stutter, but they can control control “if” they stutter, but they can control “how” they stutter“how” they stutterGoals here should also target reduction of Goals here should also target reduction of secondary behaviorssecondary behaviorsThese are often stuttering modification These are often stuttering modification techniquestechniques

Goals to Address “Quantity” of Goals to Address “Quantity” of StutteringStuttering

These goals are speech modification techniquesThese goals are speech modification techniques

They target reduction of the number of They target reduction of the number of disfluencies disfluencies

Important to note that “quantity” and “quality” are Important to note that “quantity” and “quality” are not exclusive goals-one often ties in with the not exclusive goals-one often ties in with the otherother

Goals should be viewed in terms of reduction, Goals should be viewed in terms of reduction, not how often children can speak fluentlynot how often children can speak fluently

Goals for Targeting Overall Goals for Targeting Overall CommunicationCommunication

These are the most important goals These are the most important goals because they target communicationbecause they target communication

Helping the child become a more effective Helping the child become a more effective communicator is the primary goal of communicator is the primary goal of treatmenttreatment

Goals should heavily target avoidance or Goals should heavily target avoidance or negative reactions to stutteringnegative reactions to stuttering

Getting to know your patientGetting to know your patient

InterestsInterests

MotivationMotivation

Family dynamicsFamily dynamics

Understanding their needsUnderstanding their needs

Is fluency their Is fluency their number one priority?number one priority?

Do they have other Do they have other medical diagnosis?medical diagnosis?

Fluency Treatment ActivitiesFluency Treatment Activities

Don’t Break the IceDon’t Break the Ice

Fluency OlympicsFluency Olympics

Fluency SloganFluency Slogan

Don’t Break the iceDon’t Break the ice

Pictures taped on top Pictures taped on top of the ice cubesof the ice cubes

Take turns giving Take turns giving directionsdirections

Use fluency shaping: Use fluency shaping: Easy relaxed speechEasy relaxed speech

Use stuttering Use stuttering modification: modification: PseudostutterPseudostutter

Fluency OlympicsFluency Olympics

““Stations” around your Stations” around your therapy roomtherapy room

One station outside of One station outside of the therapy roomthe therapy room

Varying levels of Varying levels of fluency shaping and fluency shaping and stuttering modification stuttering modification taskstasks

Child leaves the room Child leaves the room to complete one stationto complete one station

Fluency SloganFluency Slogan

Adopted VISA/MASTERCARD sloganAdopted VISA/MASTERCARD slogan

““One hour of speech therapy, $130; One hour of speech therapy, $130; asking your parents to order dinner for asking your parents to order dinner for you, getting the sandwich that you you, getting the sandwich that you hate; feeling good about stuttering, hate; feeling good about stuttering, priceless.”priceless.”

Fluency SloganFluency Slogan

Brainstorm-How fluency affects the child’s Brainstorm-How fluency affects the child’s lifelife

Develop own fluency slogansDevelop own fluency slogans

Helps to desensitize, lessen negative Helps to desensitize, lessen negative thoughts about stutteringthoughts about stuttering

Around the WorldAround the World

Child is given an atlas Child is given an atlas

Child picks a locationChild picks a location

Child describes location (fact or fictional)Child describes location (fact or fictional)– ClimateClimate– GeographyGeography– Planning a trip to the locationPlanning a trip to the location

ExampleExample

JamaicaJamaica– Climate:Climate:

hot, partly cloudy (e.g. 88hot, partly cloudy (e.g. 88oo F / 31 F / 31o o C)C)

– Geography:Geography:Jamaica is dominated by mountains, mostly Jamaica is dominated by mountains, mostly covered with lush, green forests. Blue Mountain is covered with lush, green forests. Blue Mountain is the highest point, at 7,402 feet. the highest point, at 7,402 feet.

– Planning a VacationPlanning a Vacation 7 day tour of white beaches, enjoy local Reggae 7 day tour of white beaches, enjoy local Reggae music, culture, and foodmusic, culture, and food

Therapy Targets Therapy Targets

Speech ModificationSpeech Modification

– ClimateClimateEasy starts (at sentence Easy starts (at sentence level)level)

– GeographyGeographyPausing and phrasing Pausing and phrasing (e.g. There are / many (e.g. There are / many mountains/ in Colorado)mountains/ in Colorado)

– VacationVacationTarget easy starts and Target easy starts and pausing/phrasing at pausing/phrasing at conversational speech conversational speech levellevel

Stuttering Stuttering ModificationModification– ClimateClimate

Pull-outs and Pull-outs and cancellations at the cancellations at the word level (e.g. cold)word level (e.g. cold)

– GeographyGeographyTarget at sentence Target at sentence levellevel

– VacationVacationTarget at Target at conversational speech conversational speech levellevel

Other Therapy TargetsOther Therapy Targets

Purposeful StutteringPurposeful Stuttering– ClimateClimate

Prolongations Prolongations

– GeographyGeographyRepetitionsRepetitions

– VacationVacationBlocksBlocks

Movie ReviewMovie Review

Child and clinician watch stuttering Child and clinician watch stuttering movie/clipmovie/clip

Clinician provides child with movie Clinician provides child with movie review worksheetreview worksheet

Child and clinician discuss the Child and clinician discuss the worksheet following the movieworksheet following the movie

Movie ReviewMovie Review1.What did you like the most about the movie?2.What did you like the least about the movie?3.Were there any comments made by the speakers that you could relate to?4.Have you ever been teased about your stuttering? If so, what did you say in response?5.If you have never been teased about your stuttering, what might you say if you were?6.How much do you know about stuttering?

7.List 2 things you know about stuttering.8.List 2 things you would like to know about stuttering.

Therapy TargetsTherapy Targets

Questions 1 & 2 Questions 1 & 2 – Target speech modification (e.g. easy starts) Target speech modification (e.g. easy starts)

or stuttering modification (e.g. cancellations) or stuttering modification (e.g. cancellations) in responsesin responses

Questions 3, 4, & 5Questions 3, 4, & 5– Target reactions to stuttering (e.g. feelings Target reactions to stuttering (e.g. feelings

and emotions towards stuttering and and emotions towards stuttering and responses to teasing)responses to teasing)

Questions 6, 7, & 8Questions 6, 7, & 8– Target knowledge of Target knowledge of

stuttering (e.g. facts stuttering (e.g. facts and questions related and questions related to stuttering)to stuttering)

Name That CategoryName That Category

Clinician identifies category and child Clinician identifies category and child identifies members of that categoryidentifies members of that category– E.g. Things with wheelsE.g. Things with wheels

Cars, bus, motorcycle Cars, bus, motorcycle

Activity can be reversed where the Activity can be reversed where the clinician provides the members of the clinician provides the members of the category and the child then identifies the category and the child then identifies the categorycategory

ExampleExample

Things that are roundThings that are round– BallBall– WorldWorld– CDCD

Things that are softThings that are soft– PillowPillow– Stuffed animalStuffed animal– ClothingClothing

Things that are round and softThings that are round and soft– Cotton ballCotton ball– Foam ballFoam ball– Ear muffsEar muffs

Stuttering & LanguageStuttering & Language

Excellent activity for those children with Excellent activity for those children with co-occurring language deficitsco-occurring language deficits– Provides opportunities to practice stuttering Provides opportunities to practice stuttering

modification or speech modification strategies modification or speech modification strategies across all levels (e.g. word, phrase, across all levels (e.g. word, phrase, conversational)conversational)

– Provides opportunities to address word Provides opportunities to address word finding or language formulation deficitsfinding or language formulation deficits

Therapy TargetsTherapy Targets

Speech ModificationSpeech Modification– Clinician provides the Clinician provides the

members of the members of the categorycategory

– Child identifies Child identifies category, as well as, category, as well as, describes how the describes how the members are related members are related

Pausing/phrasing at the Pausing/phrasing at the phrase and/or phrase and/or conversational levelconversational level

Stuttering Stuttering ModificationModification– Child identifies Child identifies

member of the member of the categorycategory

Cancellations or pull Cancellations or pull outs at the single word outs at the single word levellevel

The Great DebateThe Great Debate

Have your students participate in debates with their peers--or with you

You can pretend that you are debating with the child to see who would make a better Class President of their school

The “winner” of the debate is decided by a points system, which rewards one point for each of the following:– appropriate eye contact– speech modification or stuttering modification

strategies (e.g., easy starts, pausing and phrasing, or even voluntarystuttering)

– the content of the response.

Each participant in the debate is given their own turn to answer questions. This gives them a chance to talk without being interrupted. In addition to allowing the child to work on several objectives in a natural context, this activity also promotes an awareness of time pressure and turn-taking

Pick Your TeamPick Your Team

Children pick five to six players from professional sports teams that they want to include on their teamThey get to select their team name and make uniformsFollowing the selection of players, the child is told to pretend that each person on his team now stutters

The child must come up with a list of team “rules” to facilitate communication on a team of players who stutter

Helps children verbalize their beliefs about stuttering

Helps them learn appropriate behavior when interacting with those who stutter

Sample Team RulesSample Team Rules

Don’t tease others who are stuttering

If someone is teasing you, tell a coach

Use your speech tools

Maintain eye contact

Say what you want, even if you stutter

Have team meetings to learn about stuttering

Help people on the team if they are being teased by someone else

Stuttering Football Stuttering Football

Helps children learn the facts about stuttering

Children can play against others who stutter or against their parents

Each player starts at the goal line and tries to make it 100 yards to the other end zone to score

Each person takes turns selecting the number of yards they want to go for.

The higher number of yards, the harder the question they are asked by their opponents!

If they get the question right, they get to move up that many yards

If they get the question wrong, they do not advance and the other team gets their turn!

You can use this activity with a group of kids by dividing them into teams

They can discuss the questions they will ask (and determine how much each question is worth)

Time to Share…Time to Share…

What are some activities that you have What are some activities that you have found helpful with children who stutter?found helpful with children who stutter?

Are there questions about specific cases?Are there questions about specific cases?