Chapter 14 • Treatment of Older Preschool Children: Beginning Stuttering 319

As I mentioned earlier, it is crucial that the parent make the practice sessions fun for the child. It may be helpful to suggest games and activities for the sessions. Table 14.2 lists some of the activities that parents can use with the child in these practice sessions. At the end of the rst clinic visit, I review the activities and tasks the parent will be doing over the coming week and respond to any questions they have. Some parents bene t from taking notes or being given a written description of things they will be doing; others like to have a follow-up con tact from me. In all cases, I encourage them to call or e-mail me if they have any questions or concerns during the week. S TAGE 1: S UBSEQUENT C LINIC V ISITS Most subsequent clinic visits have three goals: (1) to assess the child’s stuttering, (2) to discuss the current progress, and (3) to introduce new procedures when appropriate. Each ses sion begins with the clinician and parent assessing the child’s stuttering using the SRs. is assessment is made from the child’s conversational speech when talking with the parent and the clinician with no verbal contingencies given, until a representative sample of the child’s speech has been obtained (about 300 syllables or 10 minutes). e clinician determines in their own mind what SR rating to give the child’s speech and then asks the parent for their rating of that sample. Once the parent has announced their SR rating, the clinician then shares with the parent what the clinician’s rating is. If the par ent and clinician ratings di er by more than 1 point, a dis cussion ensues that helps the parent align their ratings with those of the clinician, or, in some cases, in uences the clini cian to change their rating. In some instances, the parent may be initially rating the child’s articulation or language instead of, or in addition to, their stuttering, so this must be clari- ed. Accurate parent SRs are essential to the integrity of the treatment program. ese ratings, along with the clinician’s ratings, determine whether treatment is progressing success fully and signal when to fade practice session conversations and transition to treatment in natural conversations. ey

Figure 14.2 Linguistic hierarchy used for practice sessions at the beginning of Stage 1 in the Lidcombe Program.

linguistic hierarchy is only to ensure that the child is produc ing many uent utterances and thus receiving frequent praise for uency. ere is no need to adhere to the linguistic hierar chy in obsessive way. As long as the child is producing plenti ful uency, the goal of therapy is being achieved. One of the mistakes parents o en make when they rst begin is to use positive verbal contingencies for uent speech that are too general. ey might say, for example, “ at’s good” or “You’re doing well.” In this case, I simply restate the need for speci c praise and observe the parents doing it. Another common error is for parents to let the child make longer responses than are appropriate, thereby allowing more stuttered than uent utterances to occur. Fortunately, a little discussion and lots of modeling will usually clear this up. For those children who need to start at the one- or two-word utterance stage, speci cally praising their use of one or two words will help keep them at this level until it is appropriate for them to move to longer utterances.

TABLE 14.2 Suggested Games and Activities for Structured Treatment Conversations

Grab bag

The parent puts interesting items into a large cloth bag or pillowcase, and the child guesses what each is by reaching into the bag and feeling the item.

Picture naming Using picture books or picture cards, the child names each picture. At the one-word level, the child only names the pictured object. As longer utterances are permitted, the child can use a carrier phrase such as “That’s a _____,” or she can name the item and its color, such as “red rabbit.” Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

Reading a story

Parent and child look at a familiar book while the parent reads or tells the story. To elicit a word or phrase, the parent asks the child to complete a sentence, such as “Then Goldilocks said, ‘Somebody’s been sleeping in my _____.’”

Rhyme closing

Parent makes up a rhyme and leaves the last word blank, like “Once there was a man—he cooked his eggs in a frying _____.”

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