Chapter 14 • Treatment of Older Preschool Children: Beginning Stuttering 317

provides a gentle acknowledgment of the stutter (“ at was a little bumpy”) or a gentle request for self-correction (eg, “Say ‘truck’ again.”). Although in an operant framework, these latter comments are seen as mild punishments, I think that many parents and children will experience them as pretty innocuous. Table 14.1 lists verbal contingencies for uency and stuttering. e ratio of verbal contingencies for uency to verbal contingencies for stuttering is kept very high to make the program a positive experience for the child. In other words, the parent responds to the child’s stuttering only a er the parent has given an appropriate number of praises for u ency. e ratio is determined by the parent and clinician as they observe how the child responds to both kinds of con tingencies. As the child’s stuttering decreases during practice sessions, contingencies are also given during the natural con versations each day. e parent continues to provide verbal contingencies for uency and stuttering, but in more casual way, in natural situations of daily life, such as when the parent is talking with the child in the car, in the kitchen, or at a store. Once the child meets the established criteria for uent speech

developers continue to identify improvements through their research, the essentials of the interventions have not changed signi cantly, making these resources of continuing value. O VERVIEW e Lidcombe Program uses operant conditioning proce dures (ie, verbal response contingencies), which are admin istered by a parent in the home during brief one-on-one practice sessions and natural conversations each day and are guided by weekly meetings with the clinician. Treat ment begins in structured conversations—practice sessions designed to elicit a maximum of uent speech by the child so that the child receives mostly positive reinforcement. At the beginning of treatment, it is important to provide frequent praise, su cient to let the child know that they are uent (eg, “ at was really smooth talking!”), acknowledgment of uency (eg, a very low-key “ at was smooth”), or request for self-evaluation (eg, “Was that smooth?”), which is used only a er a uent utterance. A er the child becomes used to praise for uency, the parent begins to comment infrequently on the child’s stuttering. When the child stutters, the parent

TABLE 14.1 Verbal Contingencies for Fluent Speech and Unambiguous Stuttering

Examples of Verbal Contingencies

Fluent speech

■ Comments should be specific to speech (ie, “nice” or “very good” is too general, but “that was nice, smooth talking” is right on). ■ Always give at least as many praises for fluency before a contingency for stuttering. ■ Adjust the types of praise to those that the child seems to enjoy. Here are some examples: “That was smooth.” “Great, your words are smooth!” “Nice smooth talking!” “No bumps there, excellent.” “I didn’t hear any bumps.” “Wow, that whole story was totally smooth.” “Was that smooth?” (The answer should always be “yes” and followed up with another instance of praise.) ■ Also praise for spontaneous self-evaluation (ie, if the child says “I was really smooth today” or remarks on his own smooth or bumpy talking). ■ Use low-key friendly delivery and move quickly to a praise. ■ Use one request for correction after several praises. ■ Some children become so smooth during a session they do not need any contingencies for stuttering. This is okay because the goal is practicing stutter-free speech. ■ In early responses to stutters, some Lidcombe clinicians merely comment acceptingly on stutters rather than asking the child to re-do them: “Oops, I heard a little bump.” “That was a little bumpy.” “There was a bump.” “You got a little stuck there.” “You only need to say _____ once.” “Say _____ again.” (Use if child is comfortable with repeating stuttered word.) Remember only to praise smooth speech; it’s important not to praise bumps! However, praising the child’s willingness to continue talking after a bumpy patch supports communication and therefore warrants consideration.

Unambiguous stuttering

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