Chapter 14 • Treatment of Older Preschool Children: Beginning Stuttering

reader should consult Chapter 10 in the textbook, Assessment of Preschool Children who Stutter , for the components of an evaluation. e latest editions of Clinical Evaluation of Lan guage Fundamentals Preschool , 5th edition (Wiig et al., 2013), and Goldman-Fristoe Test of Articulation , 3rd edition (Gold man & Fristoe, 2015), should be used to assess aspects of lan guage and phonology. Treatment Treatment of children with stuttering and concomitant prob lems must focus both on stuttering as well as one or more concomitant issues. But how do you decide which to focus on? First one and then the other? Where do you start? e lit erature in this area suggests that there are three possible ways to organize treatment: sequential, concurrent, and cyclic. Sequential Model e sequential approach begins with identifying the child’s most pressing problem and treating that until a certain degree of mastery has been achieved. en, the next most prominent problem is dealt with. A weakness of the sequential approach is that if the rst problem treated requires a long time to master, other problems may be neglected even though their prime time for treatment may be passing. An example of a sequential approach is how clinicians using the Lidcombe Program usually deal with concomitant problems (Unicomb et al., 2013). When using Lidcombe, it is imperative that only stuttering be treated during Stage 1, during which the parent and child are highly involved in working on uency. Typically, the Lidcombe Program from the beginning to the end of Stage 1 is conducted rst, and then, any other speech or language problem is treated. In some cases, however, when another problem is particularly severe, such as when a phonological problem is so severe that most of what the child says cannot be understood, pho nological treatment is conducted until the child’s speech is intelligible. en, Stage 1 of Lidcombe can be implemented, and treatment of the other problem(s) can be resumed when Stage 1 is nished. During treatment using the Lidcombe Program, it is crucial that parents understand that the focus is on uency only, so that their SRs are not a ected by the other disorder(s). Placing the priority on the treatment of stuttering is recommended because of its greater likelihood of chronicity and exacerbation as children grow older. is contrasts with most other developmental problems that tend to improve a little or at least not worsen appreciably if treat ment for them is delayed. Concurrent Model Clinician-researchers using other approaches—not the Lid combe Program—have recommended a variety of ways of responding to other concomitant speech and language

Ntourou et al., 2011). However, there is a tendency in gradu ate programs to focus students’ training in uency disorders on individuals whose only problem is stuttering. Once these newly trained clinicians graduate, they take positions in the real world and nd that their caseloads are brimming with children who not only stutter but also have concomitant problems. I hope this section will help clinicians develop strategies to help these children. Treatment for stuttering plus other issues must be well-planned and exible to be suc cessful with both de cits. It is also important that evaluation of these children identi es concomitant problems because the co-occurrence of stuttering with language and/or pho nological problems can suggest that natural recovery from stuttering without treatment is unlikely (Leech et al., 2017, 2019; Sasisekaran, 2014). e co-occurring de cits indicate that clinicians should treat these children as soon as possible rather than adopt a “wait and see” approach. When concomitant problems are found, the challenge is to plan how best to work with these other problems along with treatment of stuttering. A very useful resource for work ing with both stuttering and two of these concomitant de cits is the chapter by Hall, Garbarino, and Bernstein Ratner titled “Language and Phonological Considerations” in Zebrowski et al. (2022). Many of the suggestions I give in this section come from this chapter. One of their principles is that treatment must ensure that the linguistic and phonological demands of the therapy activities do not stress speech production capa bilities. For example, trying to teach a child to use easy onsets while speaking long and complex sentences may be too chal lenging. Similarly, asking a child to stay in a moment of stut tering while reading sentences with phonological elements that the child has not mastered may lead to failure. Evaluation A preschool child being considered for stuttering therapy should be assessed not only for stuttering but also for aspects of language and phonology as well. e article by Brundage et al. (2021) provided a detailed description of a thorough evaluation of a preschool child who stutters. Moreover, the aforementioned chapter by Hall et al. (2022) not only gives a rationale for an in-depth evaluation but also provides a case example of such an assessment, in Box 13.1. In addition, the TABLE 14.3 Modifying the Speech and Language of Family Members 1. Use a speech rate that more closely matches the child’s. 2. Pause between conversation turns.

3. Eliminate questions requiring long, complex answers. 4. Respond to the content of the child’s message with positive comments regardless of fluency. 5. Acknowledge struggled stutters by using meaningful words, such as “That’s okay.” Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

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