Treatment of the young stuttering child with Mini-KIDS - · PDF fileTreatment of the young stuttering child with Mini-KIDS 1st European Symposium on Fluency Disorders, Antwerp,

Treatment of the youngstuttering child with Mini-KIDS

1st European Symposium onFluency Disorders, Antwerp,Belgium, 18 & 19 April 2008

Peter SchneiderSchool for LogopedicsUniversity Hospital AachenGermany

Peter Schneider, Aachen 2

Content

Why stuttering modification withchildren?

Mini-KIDS Demands on the SLT Problems and benefits


Young children are aware ofstuttering Young stuttering children estimate their

own speaking significantly worse thanpeers (Vanryckeghem et al 2005)

Preventing strategies e.g. whispering orsingsong

Overt emotional reactions


Rationale of early intervention

Hyperfunctionalselfmonitoring

AwarenessStruggle

Disfluency

Linguistic+ motoricfragility

Environm

ent

Bernstein Ratner 2008 - modified


Intervention has to focus on

Environmental factors– supporting reactions towards stuttering– Fluency facilitating communication

ChildFunctional coping:– Decrease of tension and time pressure during symptoms– Decrease of shame or guilt– Increase of tolerance concerning mistakes– Increase of self-esteem as a competent speaker

Reducing risks (e.g. speech and language disorder)


Early intervention

prevents chronic stuttering in many cases(Curlee 1999, Onslow & Packman 1999,Reardon & Yaruss 2003, Yaruss et al 2006)

Short intervention in most cases


Stuttering Modification

Objective: optimal coping– Short and easy symptoms– Calm and assertive reactions to stuttering– Self-esteem as a competent speaker

Steps– Desensitisation against stuttering and triggers– Identification of overt/covered stuttering behaviour– Modification of stuttering behaviour– Generalisation of easy assertive stuttering


Stuttering Modification forchildren

Ch.v.Riper, 1973

C. Dell, 1979

Antwerp Model, L. Larsson, P. Zebrowki, S. Yaruss,N. Reardon, V. Waelkens,KIDS (P. Sandrieser & P. Schneider)

and many others apply essential elements of stutteringmodification to the treatment of young children


KIDSKinder dürfen stottern

Translation:

Children are allowed to stutter

We should show them good coping strategiesthat frequently induce recovery


Why should children beallowed to stutter?

It prevents dysfunctional coping strategies.

If it is not allowed to stutter failure if it occurs efforts to get out of it > struggling attempts to avoid it negative reactions of environment induce

secondary emotions shame and guilt > riskfor self-esteem


Why should it be allowed totalk about stuttering?It prevents dysfunctional coping strategies.

If it is not allowed to talk about stuttering taboo imagination and concerns about reasons and

future no relief and consolation

for both - child and parents


Disruptingself reinforcingprocesses!Functional coping instead of

– Automation of motor reactions– Psychological reactions– Irritations in the environment– Prejudices

in order to reduce the maintaining factors and toincrease the chance of recovery


Objective of Mini-KIDS:Recovery induced by a modified stuttering as a

step towards fluent speech

– Short and easy symptoms– Calm and assertive reactions to stuttering– Self-esteem as a competent speaker

induced by reduction of other risks


Side-effects in case of norecovery:

Reduction of– dysfunctional motor reactions– dysfunctional psychological reactions

Ability to control the remaining tensedstuttering events to some extent

More competence in the environment

Only effects, that persist in everyday situationsafter the end of the treatment may be calledsuccess

Mini-KIDS

Patricia Sandrieser &Peter Schneider(2002)


Assessment

Parental interview and questionnaires Spontaneous speech of the child Observation of general communication

and concerning stuttering Observation of reactions to the SLTs

stuttering and to the topic of stuttering Assessment of other possible risks


Treatment indication

Stuttering with motor reactions (e.g. struggling) cognitive and emotional reactions (e.g.

avoidance) concerns in the environment associated speech and language disorder other risks in the child and his environment


Information and agreement

Information of the parents about theobjectives and the proceeding of Mini-KIDS and alternative approaches

agreement with the parents– 1 - 2 sessions a week– One parent takes part during the session and does the home

assignments with the child– Both parents take part in a parental group and individual

counselling


Parental counselling -individual and in groups Symptomatology, epidemiology Multifactorial causes Maintaining factors Reacting towards stuttering Social environment, dealing with prejudices, bullying Fluency facilitating behaviour Comparison of treatment approaches Self-help groups


Principles

Good relationship between SLT, childand parents

Continuous updating of assessmentand parental interview in order to fit thetreatment plan


Stuttering modificationcombined with an individuallyplanned framework treatmentof risks Treatment of speech and language

disorder Increasing self-esteem and

assertiveness Improving turn-taking within the family Improving problem solving strategies


Phases

Desensitisation and identification

Modification

Generalisation


Agreement with the parentsand the child

“Your mother, you and I will play andwork together and I will show you howyou can bring out your words easily ifthey get stuck and how you are lessembarrassed by the stuttering.


Desensitisation - principles

The therapist always stutters first.

If possible, the child determines the SLT´s stuttering

Descriptive feedback is better than judging

Go out of the practice rooms as soon as possible


Desensitisation - cooperationwith the parents One parent learns the exercises Training at home as soon as the parent is

able to– motivate the child– give a supporting feedback– show a good pseudostuttering

Continuous feedback about the homeassignment to the SLT


Talking aboutreactions of otherstowards stuttering

A stuttering hedgehog rescuesthe animals of the wood in spite of theirnegative reactions to his stuttering


Teaching knowledge aboutstuttering Repetitions - frog words

Detection Discrimination Production


Prolongations - Snake-words

Duration


In vivo desensitisation

Side effect:increasingassertiveness


Information at nursery school

Child and SLT inform the class aboutstuttering

Comparison with other children who are“different”

Exercise of frog words with the children Discussion how to react in a fair way to

stuttering


Blocks - Pooh - words


Tension


Identification of pseudo andtrue symptomsPlaying tag

Who notices the stutter first? What type of stutter was it? In which word did it occur? How much tension was in the stutter?


Identification of true symptoms


Modification schedule

Introduction of block solving strategy(bss)

Training with pseudoblocks Application to true symptoms

Usually its not necessary to treataccompanying motor reactions - the bssis substituting them.


Introduction of bss

Pooh has got stuck in Rabbits hole, because he has eaten toomuch honey.

Pooh has to wait (freezing) in order to lose weight. Then a frog or a snake carefully rescues him and pulls him out with an

easy pseudostutter.

Focus changes from the storyof Pooh to the ability of the childto rescue him/herself.


Training of bss Pseudoblocks

Freezing: magic spell, solving tension with facilitating gestures

Restarting with controlled easy pseudostuttering

Training with increasing linguistic and emotional demands

Parents may not insist on training and transferoutside training time!


Transfer to true symptoms

Training to tag true symptoms Agreement with the child concerning the

assistance of the SLT Avoid disappointment and frustration as

a consequence of too ambitious training Parents may only do the training at

home under the precondition, that theystick to the guidelines of the SLT


Learning how to controltension


Generalisation

Implementation of bss in everyday situations

Support by parents and others

Discussion of realistic goals

Larger distances between the sessions


In case of recovery or rare and easystuttering-events without tension andconcerns

Preparing the child and the parents for apossible relapse

To dos in case of a relapse (self helpbooklet or video)

End of treatment


The SLT should be able to

create a positive relationship with the childand its parents

encourage self-esteem, assertiveness andproblem-solving skills

reflect his own reactions concerning stuttering talk about stuttering without negative feelings

and attitudes model stuttering in everyday situations

without negative feelings and attitudes


Problems arise if

both parents (or one of them) do notaccept or understand the objective andthe proceeding

parents are not exercising at home the SLT is not desensitized him/herself. the SLT or the parents are

overambitious in the hope for arecovery.


Benefits frequent recovery if not, easy and assertive stuttering parents who react understandingly and

supportingly to stuttering short duration of the treatment short duration of refreshers in case of a

relapse


7 years later


Peter SchneiderLehranstalt für Logopädie am Universitätsklinikum AachenPauwelsstr. 3052074 [email protected]

Patricia SandrieserKatholisches Klinikum Marienhof/St. Josef gGmbHRudolf-Virchow-Str 756073 [email protected]

Thank you for your attention!


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References Riley, G.D.: (1994) A stuttering severity instrument for children and adults. SSI-3. 3rd Edition. ProEd, Austin, 1994,

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Treatment of the young stuttering child with Mini-KIDS - · PDF fileTreatment of the young stuttering child with Mini-KIDS 1st European Symposium on Fluency Disorders, Antwerp,