Chapter 14 • Treatment of Older Preschool Children: Beginning Stuttering 331

SUGGESTED PROJECTS 1. Develop a hierarchy based on length and complexity of utter ances that could be used by a clinician who is working with beginning stuttering and wants to move from single words to conversational speech. 2. Develop a hierarchy, based on increasing social complexity, for a child with beginning stuttering. Design it for use by a typical, two-parent family with older and younger siblings and grand parents who visit frequently. In other words, design a series of interactions that a parent could take a child through that would have the child practice uency in more and more challenging social situations with the family members listed. 3. Interview the family of a child with beginning stuttering who was treated successfully. Find out what they perceived to be the most helpful aspects of treatment and what advice they would give to other families just beginning treatment. SUGGESTED READINGS Bernstein-Ratner, N. (1995). Treating the child who stutters with concomitant language and phonological impairment. Language, Speech, and Hearing Services in Schools , 26 , 180–186. In this insightful overview of the treatment of children with con comitant disorders, Bernstein Ratner identi es several models that have evolved. Guitar, B., & McCauley, R. (2010b). Treatment of stuttering: Estab lished and emerging interventions . Lippincott Williams & Wilkins. Several interventions described in this book are applicable to older preschool children, and each is accompanied by video clips illus trating treatment. Of particular importance to the current chap ter is the chapter by Harrison and Onslow about the Lidcombe Program. Packman, A., Onslow, M., Webber, M., Harrison, E., Arnott, S., Bridgman, K., …, Lloyd, W. (2016). e Lidcombe Program treat ment guide . Available under Research and Publications using the link for Speech Language Pathologists at http://www.lid is manual gives detailed information about the procedures that clinicians use in administering the Lidcombe Program. e man ual is frequently updated as new information is obtained about how to make the program e ective. Shapiro, D. (2011). Stuttering intervention: A collaborative journey to uency freedom (2nd ed.). Pro-Ed. e section on direct intervention in the chapter on intervention with preschool children has many excellent suggestions for treat ment, including ideas for building up resistance to uency disrup tors and encouraging expression of emotion. In addition, there is an excellent section on working with children who stutter and have concomitant disorders. Zebrowski, P. M., & Kelly, E. (2002). Manual of stuttering interven tion . Singular. e chapter on treatment of the preschool child, particularly treatment of those children who are likely to persist in stuttering,

■ Some children may not be suited for the Lidcombe Program. A stuttering modi cation approach for these children includes helping the family create a uency supporting environment, having the clinician model easy stutters and, if needed, then gradually getting the child to identify easy stutters and then imitate them and gradually change their own harder stutters into easier ones. ■ Another clinician, Sheryl Gottwald, uses an approach based on the “demands and capacities” concept and treats both the family and the child. Gottwald uses an individualized treatment in which the clinician gets to know each family and each child so that their needs can be met in a way that plays to their strengths and supports their challenges. ■ It is important to help children who have concomitant problems (like phonological or language challenges) work on them in a way that takes into account the in uence of stuttering on these issues and vice versa. Many clinician-researchers have described approaches that do just that; they include sequential, concurrent, and cyclic treatments. 1. Describe Stage 1 and Stage 2 of the Lid combe Program for the beginning stutterer. What is the goal of each phase? 2. Describe practice sessions and natural con versations in the Lidcombe Program. 3. Describe the two major ways of collect ing data on the child’s progress in the Lid combe Program. 4. Describe how data are used to guide the child’s progress in the Lidcombe Program. 5. What is a major difference between the Lidcombe Program and Stuttering Modifi cation? 6. Compare the Lidcombe Program and Stuttering Modification with Gottwald’s approach. In what ways are they similar, and in what ways are they different? 7. Describe Gottwald’s use of “easy bounces” and “bouncy speech” to change a child’s more tense stutters. 8. Describe how the treatment of beginning stuttering and concomitant phonological and language disorders can be managed. STUDY QUESTIONS

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