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55 Cards in this Set

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Speech Rate
Calc'd as SPM
Why impt to measure rate?
Stuttering affects rate
Goal of trmt = speaking more normal - may want to bring rate back to normal rate (where it was at beg of trmt)
Some trmt methods slow down
Some trmts do not slow PWS down, but they do slow down on own because of trmt effects
Avoidance - 2 types

Situational Avoidance
Find out about SA from client interview (usu. adult client) by asking "do you avoid situations due to your disorder?"

Child - may want to interview child's parents and/or teacher

With avoidance, all information is qualitative
When would you use questionnaires or surveys?
To make information quantifiable

Asks questions about attitudes about speaking

Many surveys are free (on internet)
E.g., Inventory of Comm Attitudes
Uses Likert scale to rate comm
Rates how speech skills are in various situations
E.g., OASIS - provides detailed information
Another consideration to keep in mind regarding surveys
Ask "Why do I need to ask this?"
May or may not want to administer questionnaires
Some surveys are directed at children, others for adults
Word avoidance
Particular word
Must know the word to avoid
Children gen. not good at this
Adults tend to be good at doing this
Can sound funny/odd - unable to pinpoint what is wrong
Very difficult to measure - can ask, but still may need to measure
One indication = come to clinic and do not stutter
How measure WA?
Can collect speech sample
Want them to read a passage
See if difference btwn spontaneous and non-spontaneous and reading a passage = may indicate WA
Need multiple speech samples that are spontaneous & reading passages
How do we measure Attitudes about speech?
Collect 2 types of samples
Single sample (should collect more)
Speech samples should be of CONNECTED speech wherever possible
Want to measure speech as it occurs
3 Types of Connected Speech Samples to collect
1) Conversational
2) Monologue
3) Reading
Important that all samples are NOT taken in clinic
How many to collect outside of clinic?
For child = at home, at school
For Rsh = have to convince - so need more information

As clinician want to be sure that you have captured as many as will give you an idea of actual speech
Method for obtaining speech samples
Take tape recording for child, parent will be asked to record
Does reactivity of the situation matter?
Post-cohort study to see if better speech when subject knew they were being recorded - conclusion = did not matter if they knew
What to do with speech samples
Calculate frequency & speech rate
May calc other information - like 2ndy beh
Data collection includes
Obtaining speech samples
Any test
Data analysis
Is different than data collection
Conversational speech sample
In clinic = engage in conversation - may use topic cards or picture cards with younger child
* Reading = give them something to read at their grade level - but don't use same passage over again due to adaptation effect
Length of samples
Between 3-5 mins
May measure # of syllables
With child, usu. assess lang/artic as well
Two general approaches to Treatment
Stuttering Modification SM

Fluency Shaping FS
First, define terms
Complete fluency = normal

Spontaneous fluency = don't have to concentrate to speak

Controlled fluency = takes effort on part of speaker

Acceptable stuttering = ok to have some stuttering where short in duration, not as many 2ndy behs, and no increase in frequency - can be different from person to person
Goal = make it non-handicapping
Goals with FS
Preschoolers = spont fluency

Older children/adults = spont fluency or controlled fluency
Goals with SM
Preschooler = spont fluency
Older child/adults = Controlled fluency, or acceptable stuttering; reduced fears & anxiety and avoidance
SM does NOT aim for controlled fluency (only controlled or acceptable stuttering)
Names associated with SM
All methods teach to lesson severity, decrease fear, anxiety & avoidance; specific techs differ from rshr to rshr
Charles Van Riper
VR approach, includes cancellation, pull-outs & prep sets
Fluency Shaping
All approaches are BEHAVIORAL based on Operant Conditioning
Data collection is stressed bef, during and post-trmt
All have empirical evid to support their efficacy
(although not all techniques have empirical support)
Operant Conditioning with regard to FS
Main belief: All behs are controlled by their consequences
OC says all operant behs are controlled by their consequences
Can take non-operant behs & modify or change them using operant beh principles
Q: nature of language - is it operant?
Q: is stuttering an operant beh? NO - not in terms of its origin, but it can be modified by using OC
Stimulus in OC models
Sr+ = positive reinforcer
Here, the stimulus is separate from the procedure

A - B - C = antecedent, beh, consequence

When you present a stimulus, beh either increases, decreases or remains neutral
Positive reinforcer
Negative reinforcer/punisher
Stimulus can be . . . .
Presented or withdrawn
S triangle
Neutral - does nota
In FS are interested in two models
Sr+ and Sr-

Can present or withdraw in 4 different procedures
Present Sr+
Beh increases (PR)
Withdraw Sr+
Beh decreases (punishment by contingent withdrawal via RC or TO, e.g.)
Present Sr-
Behavior decreases (punishment by contingent presentation)
Withdraw Sr-
Behavior increases (NR)
Sr+ withdrawal is different than . .
Extinction - something that's maintained thru PR - not doing or giving or withdrawing; cessation of either one of procedures
Programmed Instruction PI
Based on Operant conditioning
Series of steps
In order to use PR, beh must be already in repertoire
Increase beh gradually
PI - overview
Series of steps
A (what person can do) B (what you want them to do = goal)
Success at each step required
Increased difficulty
PI - How to increase difficulty?
Removal of supportive cues/prompts (Antecedent)
Harder stimulus (Antecedent)
More complex beh/response req'd (behavior)
More intermittent consequences (consequence - e.g., change schedule)
PI - components



How to use PI
Do over and over to point where criterion met; idea is that when met, can/able to go on to next step
PI criteria?
Structure of Tx = SM v. FS
SM = Loosely structured; not based on beh principles

FS = Highly structured; beh principles followed (cons - can be boring)
Measurement of Tx success - SM v. FS
SM = indirect; client reported self-satisfaction & clinical intuition

FS = Direct; measures speech beh incl - %SS, speech rate, naturalness, etc.
Evidence of Tx efficacy - SM v. FS
SM = not much and not usu based on data

FS = Empirical studies
Example of PI - Step 1 of 3
Step 1
STIMULI - 10 pics of single syllable words w/releasing /s/ + model word, instructions & repeat
BEH = correct production of /s/ in modeled word
CONSEQ = Correct - verbal and token Sr+ (1:1)
Incorrect - Verbal feedback
CRITERIA - Pass - 9/10
Example of PI - Step 2 of 3
Step 2
STIMULI - 10 pics of single syllable words w/releasing + instrs to name pics
BEH = correct production of /s/ in pic word
CONSEQ = Correct - same as 1 - verbal and token Sr+ (1:1)
Incorrect - Verbal feedback + model word and instr to repeat (1:1)
CRITERIA - Pass - 9/10
Fail: 5 consec incorrect
Example of PI - Step 3 of 3
Step 3
STIMULI - 10 pics of single syllable words w/releasing /s/ + instrs to use in sentance
BEH = correct production of /s/ in pic word in a sentance
CONSEQ = Correct - verbal and token Sr+ (1:1)
Incorrect - Verbal feedback; + model & instr to "try again"
CRITERIA - Pass - 9/10
Fail = 5 consec incorrect
Types of FS programs
1) No altered speech & PI
2) No altered speech & no PI
3) Alt speech & PI
4) Alt speech & no PI [no known trmts fall under this category]
Stages of all FS programs
Generalization (or Transfer), and
Establishment Stage
Normal-sounding, stutter-free speech is established; at end of Estab. stage, speech is stutter-free and normal sounding
NOTE: Not ready for dismissal
Generalization or Transfer Stage
Teach to use normal-sounding, stutter-free speech in other setting
End of Gen/Transf stage = doesn't matter where you are, your speech is stutter-free
Maintenance Stage
Usually, with Cdisorder not fluency, would dismiss at this point; with fluency disorder clients, relapse is common
Where is the main difference in all treatment approaches?
At the Establishment stage - other stages are usually very similar if not the same