Treatment of the young stuttering child with Mini-KIDS

Treatment of the young stuttering child with Mini-KIDS

1st European Symposium on Fluency Disorders, Antwerp, Belgium, 18 & 19 April 2008 Peter Schneider School for Logopedics University Hospital Aachen Germany

Content  Why

stuttering modification with children?  Mini-KIDS  Demands on the SLT  Problems and benefits

Peter Schneider, Aachen

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Young children are aware of stuttering  Young

stuttering children estimate their own speaking significantly worse than peers (Vanryckeghem et al 2005)

 Preventing

singsong

 Overt

strategies e.g. whispering or

emotional reactions Peter Schneider, Aachen

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Rationale of early intervention

Linguistic + motoric fragility

Disfluency

Awareness Struggle

Environment

Hyperfunctional selfmonitoring

Bernstein Ratner 2008 - modified Peter Schneider, Aachen

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Intervention has to focus on 

Environmental factors – supporting reactions towards stuttering – Fluency facilitating communication



Child Functional 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) Peter Schneider, Aachen

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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


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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


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Stuttering Modification for children 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 stuttering modification to the treatment of young children Peter Schneider, Aachen

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KIDS Kinder dürfen stottern Translation:

Children are allowed to stutter We should show them good coping strategies that frequently induce recovery Peter Schneider, Aachen

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Why should children be allowed 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 > risk for self-esteem Peter Schneider, Aachen

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Why should it be allowed to talk 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 Peter Schneider, Aachen

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Disrupting self reinforcing processes! Functional coping instead of – – – –

Automation of motor reactions Psychological reactions Irritations in the environment Prejudices

in order to reduce the maintaining factors and to increase the chance of recovery Peter Schneider, Aachen

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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 Peter Schneider, Aachen

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Side-effects in case of no recovery: 

 

Reduction of – dysfunctional motor reactions – dysfunctional psychological reactions Ability to control the remaining tensed stuttering events to some extent More competence in the environment

Only effects, that persist in everyday situations after the end of the treatment may be called success Peter Schneider, Aachen 14

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 Peter Schneider, Aachen

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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 Peter Schneider, Aachen

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Information and agreement  Information

of the parents about the objectives and the proceeding of MiniKIDS 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 Peter Schneider, Aachen

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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


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Principles  Good

relationship between SLT, child and parents

 Continuous

updating of assessment and parental interview in order to fit the treatment plan


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Stuttering modification combined with an individually planned framework treatment of risks  Treatment

of speech and language

disorder  Increasing self-esteem and assertiveness  Improving turn-taking within the family  Improving problem solving strategies Peter Schneider, Aachen

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Phases  Desensitisation

and identification

 Modification  Generalisation


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Agreement with the parents and the child  “Your

mother, you and I will play and work together and I will show you how you can bring out your words easily if they get stuck and how you are less embarrassed by the stuttering. Peter Schneider, Aachen

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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


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Desensitisation - cooperation with 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 home assignment to the SLT


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Talking about reactions of others towards stuttering

A stuttering hedgehog rescues the animals of the wood in spite of their negative reactions to his stuttering Peter Schneider, Aachen

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Teaching knowledge about stuttering  Repetitions

- frog words

 Detection  Discrimination  Production Peter Schneider, Aachen

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Prolongations - Snake-words Duration


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In vivo desensitisation Side effect: increasing assertiveness


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Information at nursery school  Child

and SLT inform the class about stuttering  Comparison with other children who are “different”  Exercise of frog words with the children  Discussion how to react in a fair way to stuttering Peter Schneider, Aachen

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Blocks - Pooh - words


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Tension


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Identification of pseudo and true symptoms Playing 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? Peter Schneider, Aachen

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Identification of true symptoms


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Modification schedule  Introduction

of block solving strategy

(bss)  Training with pseudoblocks  Application to true symptoms  Usually

its not necessary to treat accompanying motor reactions - the bss is substituting them. Peter Schneider, Aachen

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Introduction of bss Pooh has got stuck in Rabbits hole, because he has eaten too much 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 story of Pooh to the ability of the child to rescue him/herself. Peter Schneider, Aachen

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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 transfer outside training time! Peter Schneider, Aachen

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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 they stick to the guidelines of the SLT Peter Schneider, Aachen

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Learning how to control tension


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Generalisation 

Implementation of bss in everyday situations



Support by parents and others



Discussion of realistic goals



Larger distances between the sessions Peter Schneider, Aachen

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End of treatment In case of recovery or rare and easy stuttering-events without tension and concerns 

Preparing the child and the parents for a possible relapse



To dos in case of a relapse (self help booklet or video) Peter Schneider, Aachen

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The SLT should be able to     

create a positive relationship with the child and its parents encourage self-esteem, assertiveness and problem-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 Peter Schneider, Aachen

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Problems arise if  both

parents (or one of them) do not accept or understand the objective and the 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 a recovery. Peter Schneider, Aachen

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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 Peter Schneider, Aachen

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7 years later


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Thank you for your attention! Peter Schneider Lehranstalt für Logopädie am Universitätsklinikum Aachen Pauwelsstr. 30 52074 Aachen [email protected] www.logopaedie.ukaachen.de Patricia Sandrieser Katholisches Klinikum Marienhof/St. Josef gGmbH Rudolf-Virchow-Str 7 56073 Koblenz [email protected] www.kk-koblenz.de Peter Schneider, Aachen

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References           

 

Bernstein Ratner, N.: The Psycholingustics of Stuttering. Paper at the 1st. European Symposium on Fluency Disorders, Antwerp, April 2008 Bloodstein, O.: A Handbook on Stuttering. Singular Publishing Ltd., San Diego, 1995 Bloodstein, O, Bernstein Ratner N..: A Handbook on Stuttering. Delmar, Clifton Park, 2008 Curlee (Ed), Stuttering and Related Disorders of Fluency (2nd ed.). New York: Thieme Medical Publishers. Dell, C., Jr.: Treating the School Age Stutterer. A Guide for Clinicians. Stuttering Foundation of America. Memphis, Tennessee, 1979 Franken, M.-Ch. J, Kielstra-Van der Schalk, C.J., Boelens, H.: (2005) Experimental treatment of early stuttering: A preliminary study. Journal of Fluency Disorders 30, 189-199 McClure, J., Yaruss, S.: Stuttering survey suggests success of attitude-changing treatment. ASHA Leader, 8/3 (2003), 19 Meersman, M. & Stinders, K.: Ouders als co-therapeuten bij de behandling van hun stotternde Kind. Logopedie, (13) 3, S. 26-33, 2000 Natke, U. Stottern: Erkenntnisse, Theorien, Behandlungsmethoden. 2. Auflage, Hans Huber, Bern 2005 Onslow, M.: Behavioral management of stuttering. Singular Publishing, San Diego, 1996 Onslow, M., & Packman, A. (1999). Treatment recovery and spontaneous recovery from early stuttering: The need for consistent methods in collecting and interpreting data. Journal of Speech, Language and Hearing Research, 42, 398-401. Pape-Neumann, J., Bosshardt, H.G., Natke, U., Oertle, H.: The German program for the evaluation of stuttering therapies (PEVOS) - Results of the test-phase. ISAD-Online conference 2003 Reardon, N., Yaruss, JS. What Do We Do With Preschool Children Who Stutter? Paper at the ASHA Convention. Chicago, November 2003 Peter Schneider, Aachen

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References 

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             

Riley, G.D.: (1994) A stuttering severity instrument for children and adults. SSI-3. 3rd Edition. ProEd, Austin, 1994, deutsch in: Sandrieser, P., Schneider, P.: Stottern im Kindesalter. 2. aktualisierte und erweiterte Auflage. Thieme, Stuttgart, 2004 Sandrieser, P., U. Natke, R. Pietrowsky, K.T. Kalveram: Stottern Im Kindesalter - Bedeutung einer frühzeitigen Diagnostik und Beratung. Poster auf der Jahrestagung der Deutschen Gesellschaft für Kinder- und Jugendmedizin, Leipzig, September 2002 Sandrieser, P., Schneider, P.: Stottern im Kindesalter. 3. aktualisierte und erweiterte Auflage. Thieme, Stuttgart, 2008 Schneider, P., G. Schartmann: Was ist ein U-U-Uhu? Ein Mutmachbuch für stotternde Kinder. 2. überarb. Aufl. Ulrich Natke Verlag Neuss 2007 Schneider, P.; Sandrieser, P. Direkte Therapie mit stotternden Kindern. Video, Demosthenes-Verlag, Köln 2002 Schulze, C., Sandrieser, P., Schneider, P. Willmes, K. Subjective Experience of Stuttering of 4 to 6 Years old Children. Poster at the 1st European Symposium on Fluency Disorders, Antwerp, April 2008 Starkweather, C.W.: Fluency and Stuttering. Englewood Cliffs, N.J., Prentice Hall, 1987 Starkweather, C.W., J. Givens-Ackerman: Stuttering. ProEd, Austin, Texas, 1997 Stes, R., R. Boey: D.I.S. Detectie Instrument voor Stotteren. CIOOS, Antwerpen, 1998 Stes, R., Boey, R.: Modification of the behavioral models of parents in reaction upon the stuttering of their young children. A training program for parents. dbl-Jahrestagung in Münster, 1993 Van Riper, C: The treatment of stuttering. Englewood Cliffs, N.J., Prentice Hall 1973. Vanryckeghem, M., Brutten, G., Hernandez, L.: A comparative investigation of the speech-associated attitude of preschool and kindergarten children who do and do not stutter. J. Fluency Disord. 30 (2005) 307-318 Yairi, E., N. Ambrose : Early Childhood Stuttering. Pro-ed, Austin, Texas 2005 Wieser, E.: „Ich bin wegen dem genauso wertvoll wie andere!“ Zur Bedeutung von Scham bei stotternden Menschen. Dissertation. Leopold-Franzens-Universität Innsbruck 2002 Yaruss, JS., Coleman, C., Hammer, D. Treating Preschool Children Who Stutter: Description and Preliminary Evaluation of a Family Focused Treatment Approach. Lang., Speech Hear. Services in Schools 37 (2006) 118-136 Zebrowski, P.: Therapy of Childhood Stuttering. Vortrag des CIOOS-Kongresses in Antwerpen, 21.05.2003.


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Treatment of the young stuttering child with Mini-KIDS

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