Stuttering in school age children (9;0)

Get Started. It's Free
or sign up with your email address
Stuttering in school age children (9;0) by Mind Map: Stuttering in  school age children (9;0)

1. Management plan for Theresa with specific focus to address her motivation

1.1. Goals

1.1.1. Adaptation of Lidcombe program to promote child’s motivation (Stimuli, Rewards, feedback)

1.1.2. Promote child’s intrinsic motivation

1.1.3. Reassurance of the execution of home practice by parents

1.2. Re-calibration with parent

1.2.1. Demonstration of the LIdcombe Program in treatment session

1.3. Information counseling

1.3.1. Child

1.3.1.1. Identify the core reason of Theresa’s low motivation

1.3.1.1.1. Too demanding/ Too high expectation from parent

1.3.1.1.2. Boring activity--reading passage

1.3.1.1.3. Too many negative feedbacks and comments from parent

1.3.1.2. Promote child’s intrinsic motivation

1.3.1.2.1. Include self-evaluation of Severity Rating

1.3.1.2.2. Involvement in therapy

1.3.1.3. Adjust child expectations of stuttering treatment

1.3.1.3.1. Desensitization

1.3.2. Parent

1.3.2.1. To mediate Theresa’s and parental expectation

1.3.2.2. Adjustments to be made with parents

1.3.2.2.1. Collecting severity ratings

1.3.2.2.2. Choice of stimuli

1.3.2.2.3. Inclusion of reinforcements schedules/ tangible rewards

1.3.2.2.4. Types and frequency of feedback

1.3.2.2.5. Cognitive level of tasks

2. Causal models of stuttering: P&A 3-Factor Model ( The Packman and Attanasio 3-factor causal model of moments of stuttering) (Packman, 2012)

2.1. Deficit in neural processing

2.1.1. Deficit in neural processing underpinning spoken language, which renders the speech production system unstable and prone to perturbation

2.1.2. Both functional and structural abnormalities (e.g.deficient left hemisphere/ deficit in the myelogenesis in the white fibers )

2.2. Triggering of stuttering

2.2.1. some inherent features of spoken language that increase the motoric demands on that system

2.2.1.1. These increased demands perturb the already unstable system responsible for the production of spoken language and hence trigger moments of stuttering

2.2.2. Examples: - variable syllabic stress - linguistic complexity,

2.2.2.1. contributes to the disruptions of speech motor stability characteristic of stuttering (Kleinow & Smith, 2000)

2.3. Modulating factors determines triggering threshold

2.3.1. Physiological arousal: readiness of the body to react to stressful internal and external stimuli

2.3.2. intrinsic factors: individual experiences, anxiety, fear of negative, evaluation and stuttering severity

2.3.2.1. All depends on individual differences in emotional reactivity (Walden et al., 2012) and resilience (Craig, Blumgart, & Tran,

2.3.3. Environmental stressors : e.g. talking in group discussion

2.3.3.1. Dual- or multi-tasking where the tasks share resources can lower the threshold at which stuttering is triggered

3. Case History: - 9;00 girl - Onset of stuttering: 3;06 - Attending local primary school - Treatment @ current clinic: 3 months - Low motivation - Refuse to do homework practice

3.1. Prognosis: Fair

3.1.1. Positive prognostic factors: regularly speech therapy, good parental support

3.1.2. Negative prognostic factors: Age, child’s low motivation, parent’s high demand

3.1.3. Affected by the parent’s and child’s expectation

3.1.4. Aim at : No stutter VS rating 2-3 in SSS

4. Treatment approaches and rationale

4.1. Lidcombe program: Aim for natural fluency

4.1.1. Rationale

4.1.1.1. Evidence-based practice/ Empirical Basis: Significant evidence from Phase I & II Clinical Trials (Koushik, Shenker, Onslow, 2009; Lincoln, Onslow, Lewis & Wilson, 1996)

4.1.1.2. No extra work for home practice

4.1.1.2.1. Parents can take advantage of natural conversations anywhere throughout the day to present verbal contingencies

4.1.2. Low Treatment Effectiveness in the past 3 months

4.1.2.1. Learned helplessness’ since stuttering has persisted for years

4.1.2.2. Negative emotions from her communication difficulties (Logan &Yaruss, 1999)

4.1.2.3. No tangible reinforcement provided

4.1.2.4. Not intrinsically motivated

4.2. Goal of treatment: normal or near normal fluency, natural sounding speech