Stuttering

314 Section III • Treatment of Stuttering

Case Example

Katherine

child may experience as the result of moving, the birth of a sibling, or other life events. In some children, beginning stuttering emerges gradu ally a er they have gone through a period of borderline stuttering as younger preschool children. As these children get older and if stuttering continues, they begin to respond to negative experiences of repetitive dis uencies with increased tension. However, in some children, beginning stuttering appears suddenly, close to the onset of stutter ing. ey may be easily frustrated or highly distressed when many of their speech attempts result in repetitions or pro longations that feel out of their control. As these children respond, at rst nonconsciously, to these core behaviors, they increase tension and develop a variety of escape behav iors that are reinforced. eir eyeblinks, head nods, and pitch increases are rewarded because they o en result in the release of stutters. Gradually, classical conditioning in u ences when and where the child’s stuttering occurs. Spe ci cally, negative emotional experiences that are associated Seven years after therapy had been completed, we contacted Katherine and her parents to assess her status. She had been completely fluent ever since treatment ended and was highly verbal with only dim memories of ever having stuttered. Her parents have become a valuable resource for other parents of children who are beginning to stutter as they contemplate treatment. stuttering and then using verbal contingencies for stuttering and for fluency during natural conversa tions throughout the day. After several weeks went by, we saw notable im provement in Katherine’s stuttering, shown by both our weekly measures of her stuttering frequency in the clinic and her mother’s daily ratings of the se verity (SRs) of Katherine’s stuttering at home. The steady decline in Katherine’s stuttering continued, interrupted by an occasional spike upward when a stressful event occurred, such as a visit by relatives or a family trip. At one point, Katherine’s stuttering shot up for several days, and we worked with Katherine’s mother to figure out the source of the problem. We discovered that Katherine’s father, in his eagerness to help, began to use verbal contingencies without training when he was alone with Katherine and over dosed her with several hours of contingencies each day. Once that was resolved and Katherine’s father was trained to use contingencies judiciously, her stut tering continued to decline steadily. Katherine be came fluent after about 6 months of treatment. Over the following year, the clinicians continued to stay in touch, but Katherine and her mother came in to the clinic less and less frequently.

Katherine’s therapy began when she was 3 years old and stuttering severely—on 21% of her spoken syllables. As you may remember from our description of her stuttering in Chap ter 1, Katherine’s pattern was characterized by rep etitions, prolongations, and

Author’s Beliefs Nature of Stuttering As I’ve described in chapters in the “Nature of Stuttering” part of this book, I believe that beginning stuttering arises when children’s neurodevelopmental sensorimotor di cul ties related to speech production interact with their tempera ment and other developmental and environmental in uences to produce or exacerbate repetitions, prolongations, and blocks. is is essentially the position taken by C. S. Blue mel in his book e Riddle of Stuttering (1957). It was further articulated by Johnson and colleagues (1959), who suggested that the problem of stuttering arises as a result of interac tions among (1) the amount of the child’s dis uency, (2) the reaction of his listeners to the dis uency, and (3) the child’s sensitivity to his own dis uency and to listeners’ reactions. I would add to Johnson’s list of interacting factors any pres sures that a child may feel internally (eg, to speak quickly and in long, relatively complex sentences) and any anxieties the At the time she came in for an evaluation, two other clinicians and I had recently been trained in the Lidcombe approach—a treatment described in this chapter. Several weeks after the evaluation, we began Katherine’s therapy by training her mother in using verbal contingencies (praise) for Katherine’s fluent speech during daily, 15-minute practice ses sions at home. We also trained Katherine’s mother in making daily ratings of the severity of Katherine’s stuttering. During our weekly clinic meetings with Katherine and her mother, we measured the fre quency of Katherine’s stuttering in conversation at the beginning of each session. The rest of each ses sion was spent on problem solving any issues that came up during practice sessions and training Kath erine’s mother in the next steps of treatment. These next steps included using verbal contingencies for blocks, with a predominance of blocks with much struggle behavior. She had changed from bubbly and talkative to withdrawn and reluctant to engage in conversation.

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