Treatment of the young stuttering child with Mini-KIDS

Transcription

Treatment of the young
stuttering child with Mini-KIDS
1st European Symposium on
Fluency Disorders, Antwerp,
Belgium, 18 & 19 April 2008
Peter Schneider
School for Logopedics
University Hospital Aachen
Germany
Content
 Why
stuttering modification with
children?
 Mini-KIDS
 Demands on the SLT
 Problems and benefits
Peter Schneider, Aachen
2
Young children are aware of
stuttering
 Young
stuttering children estimate their
own speaking significantly worse than
peers (Vanryckeghem et al 2005)
 Preventing
singsong
 Overt
strategies e.g. whispering or
emotional reactions
3
Rationale of early intervention
Linguistic
+ motoric
fragility
Disfluency
Awareness
Struggle
Environment
Hyperfunctional
selfmonitoring
Bernstein Ratner 2008 - modified
4
Intervention has to focus on

Environmental factors
– supporting reactions towards stuttering
– Fluency facilitating communication

Child
Functional coping:
– Decrease of tension and time pressure during symptoms
– Decrease of shame or guilt
– Increase of tolerance concerning mistakes
– Increase of self-esteem as a competent speaker
Reducing risks (e.g. speech and language disorder)
5
Early intervention

prevents chronic stuttering in many cases
(Curlee 1999, Onslow & Packman 1999,
Reardon & Yaruss 2003, Yaruss et al 2006)

Short intervention in most cases
6
Stuttering Modification
Objective: optimal coping
– Short and easy symptoms
– Calm and assertive reactions to stuttering
– Self-esteem as a competent speaker
Steps
–
–
–
–
Desensitisation against stuttering and triggers
Identification of overt/covered stuttering behaviour
Modification of stuttering behaviour
Generalisation of easy assertive stuttering
7
Stuttering Modification for
children
Ch.v.Riper, 1973
C. Dell, 1979
Antwerp Model, L. Larsson, P. Zebrowki, S. Yaruss,
N. Reardon, V. Waelkens,
KIDS (P. Sandrieser & P. Schneider)
and many others apply essential elements of stuttering
modification to the treatment of young children
8
KIDS
Kinder dürfen stottern
Translation:
Children are allowed to stutter
We should show them good coping strategies
that frequently induce recovery
9
Why should children be
allowed to stutter?
It prevents dysfunctional coping strategies.
If it is not allowed to stutter
 failure if it occurs
 efforts to get out of it > struggling
 attempts to avoid it
 negative reactions of environment induce
secondary emotions shame and guilt > risk
for self-esteem
10
Why should it be allowed to
talk about stuttering?
It prevents dysfunctional coping strategies.
If it is not allowed to talk about stuttering
 taboo
 imagination and concerns about reasons and
future
 no relief and consolation
for both - child and parents
11
Disrupting
self reinforcing
processes!
Functional coping instead of
–
–
–
–
Automation of motor reactions
Psychological reactions
Irritations in the environment
Prejudices
in order to reduce the maintaining factors and to
increase the chance of recovery
12
Objective of Mini-KIDS:
Recovery
 induced
by a modified stuttering as a
step towards fluent speech
– Short and easy symptoms
– Calm and assertive reactions to stuttering
– Self-esteem as a competent speaker
 induced
by reduction of other risks
13
Side-effects in case of no
recovery:



Reduction of
– dysfunctional motor reactions
– dysfunctional psychological reactions
Ability to control the remaining tensed
stuttering events to some extent
More competence in the environment
Only effects, that persist in everyday situations
after the end of the treatment may be called
success
14
Mini-KIDS
Patricia Sandrieser &
Peter Schneider
(2002)
Assessment
 Parental
interview and questionnaires
 Spontaneous speech of the child
 Observation of general communication
and concerning stuttering
 Observation of reactions to the SLTs
stuttering and to the topic of stuttering
 Assessment of other possible risks
16
Treatment indication
Stuttering with
 motor reactions (e.g. struggling)
 cognitive and emotional reactions (e.g.
avoidance)
 concerns in the environment
 associated speech and language disorder
 other risks in the child and his environment
17
Information and agreement
 Information
of the parents about the
objectives and the proceeding of MiniKIDS and alternative approaches
 agreement
with the parents
– 1 - 2 sessions a week
– One parent takes part during the session and does the home
assignments with the child
– Both parents take part in a parental group and individual
counselling
18
Parental counselling individual and in groups








Symptomatology, epidemiology
Multifactorial causes
Maintaining factors
Reacting towards stuttering
Social environment, dealing with prejudices, bullying
Fluency facilitating behaviour
Comparison of treatment approaches
Self-help groups
19
Principles
 Good
relationship between SLT, child
and parents
 Continuous
updating of assessment
and parental interview in order to fit the
treatment plan
20
Stuttering modification
combined with an individually
planned framework treatment
of risks
 Treatment
of speech and language
disorder
 Increasing self-esteem and
assertiveness
 Improving turn-taking within the family
 Improving problem solving strategies
21
Phases
 Desensitisation
and identification
 Modification
 Generalisation
22
Agreement with the parents
and the child
 “Your
mother, you and I will play and
work together and I will show you how
you can bring out your words easily if
they get stuck and how you are less
embarrassed by the stuttering.
23
Desensitisation - principles

The therapist always stutters first.

If possible, the child determines the SLT´s stuttering

Descriptive feedback is better than judging

Go out of the practice rooms as soon as possible
24
Desensitisation - cooperation
with the parents


One parent learns the exercises
Training at home as soon as the parent is
able to
– motivate the child
– give a supporting feedback
– show a good pseudostuttering

Continuous feedback about the home
assignment to the SLT
25
Talking about
reactions of others
towards stuttering
A stuttering hedgehog rescues
the animals of the wood in spite of their
negative reactions to his stuttering
26
Teaching knowledge about
stuttering
 Repetitions
- frog words
 Detection
 Discrimination
 Production
27
Prolongations - Snake-words
Duration
28
In vivo desensitisation
Side effect:
increasing
assertiveness
29
Information at nursery school
 Child
and SLT inform the class about
stuttering
 Comparison with other children who are
“different”
 Exercise of frog words with the children
 Discussion how to react in a fair way to
stuttering
30
Blocks - Pooh - words
31
Tension
32
Identification of pseudo and
true symptoms
Playing tag
 Who
notices the stutter first?
 What type of stutter was it?
 In which word did it occur?
 How much tension was in the stutter?
33
Identification of true symptoms
34
Modification schedule
 Introduction
of block solving strategy
(bss)
 Training with pseudoblocks
 Application to true symptoms
 Usually
its not necessary to treat
accompanying motor reactions - the bss
is substituting them.
35
Introduction of bss
Pooh has got stuck in Rabbits hole, because he has eaten too
much honey.
 Pooh has to wait (freezing) in order to lose weight.
 Then a frog or a snake carefully rescues
him and pulls him out with an
easy pseudostutter.


Focus changes from the story
of Pooh to the ability of the child
to rescue him/herself.
36
Training of bss

Pseudoblocks

Freezing: magic spell, solving tension with facilitating gestures

Restarting with controlled easy pseudostuttering

Training with increasing linguistic and emotional demands

Parents may not insist on training and transfer
outside training time!
37
Transfer to true symptoms
 Training
to tag true symptoms
 Agreement with the child concerning the
assistance of the SLT
 Avoid disappointment and frustration as
a consequence of too ambitious training
 Parents may only do the training at
home under the precondition, that they
stick to the guidelines of the SLT
38
Learning how to control
tension
39
Generalisation

Implementation of bss in everyday situations

Support by parents and others

Discussion of realistic goals

Larger distances between the sessions
40
End of treatment
In case of recovery or rare and easy
stuttering-events without tension and
concerns

Preparing the child and the parents for a
possible relapse

To dos in case of a relapse (self help
booklet or video)
41
The SLT should be able to





create a positive relationship with the child
and its parents
encourage self-esteem, assertiveness and
problem-solving skills
reflect his own reactions concerning stuttering
talk about stuttering without negative feelings
and attitudes
model stuttering in everyday situations
without negative feelings and attitudes
42
Problems arise if
 both
parents (or one of them) do not
accept or understand the objective and
the proceeding
 parents are not exercising at home
 the SLT is not desensitized him/herself.
 the SLT or the parents are
overambitious in the hope for a
recovery.
43
Benefits
 frequent
recovery
 if not, easy and assertive stuttering
 parents who react understandingly and
supportingly to stuttering
 short duration of the treatment
 short duration of refreshers in case of a
relapse
44
7 years later
45
Thank you for your attention!
Peter Schneider
Lehranstalt für Logopädie am Universitätsklinikum Aachen
Pauwelsstr. 30
52074 Aachen
pschneider@ukaachen.de
www.logopaedie.ukaachen.de
Patricia Sandrieser
Katholisches Klinikum Marienhof/St. Josef gGmbH
Rudolf-Virchow-Str 7
56073 Koblenz
p.sandrieser@kk-koblenz.de
www.kk-koblenz.de
46
References
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Bernstein Ratner, N.: The Psycholingustics of Stuttering. Paper at the 1st. European Symposium on
Fluency Disorders, Antwerp, April 2008
Bloodstein, O.: A Handbook on Stuttering. Singular Publishing Ltd., San Diego, 1995
Bloodstein, O, Bernstein Ratner N..: A Handbook on Stuttering. Delmar, Clifton Park, 2008
Curlee (Ed), Stuttering and Related Disorders of Fluency (2nd ed.). New York: Thieme Medical Publishers.
Dell, C., Jr.: Treating the School Age Stutterer. A Guide for Clinicians. Stuttering Foundation of America.
Memphis, Tennessee, 1979
Franken, M.-Ch. J, Kielstra-Van der Schalk, C.J., Boelens, H.: (2005) Experimental treatment of early
stuttering: A preliminary study. Journal of Fluency Disorders 30, 189-199
McClure, J., Yaruss, S.: Stuttering survey suggests success of attitude-changing treatment. ASHA Leader,
8/3 (2003), 19
Meersman, M. & Stinders, K.: Ouders als co-therapeuten bij de behandling van hun stotternde Kind.
Logopedie, (13) 3, S. 26-33, 2000
Natke, U. Stottern: Erkenntnisse, Theorien, Behandlungsmethoden. 2. Auflage, Hans Huber, Bern 2005
Onslow, M.: Behavioral management of stuttering. Singular Publishing, San Diego, 1996
Onslow, M., & Packman, A. (1999). Treatment recovery and spontaneous recovery from early stuttering:
The need for consistent methods in collecting and interpreting data. Journal of Speech, Language and
Hearing Research, 42, 398-401.
Pape-Neumann, J., Bosshardt, H.G., Natke, U., Oertle, H.: The German program for the evaluation of
stuttering therapies (PEVOS) - Results of the test-phase. ISAD-Online conference 2003
Reardon, N., Yaruss, JS. What Do We Do With Preschool Children Who Stutter? Paper at the ASHA
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References
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Riley, G.D.: (1994) A stuttering severity instrument for children and adults. SSI-3. 3rd Edition. ProEd, Austin, 1994,
deutsch in: Sandrieser, P., Schneider, P.: Stottern im Kindesalter. 2. aktualisierte und erweiterte Auflage. Thieme,
Stuttgart, 2004
Sandrieser, P., U. Natke, R. Pietrowsky, K.T. Kalveram: Stottern Im Kindesalter - Bedeutung einer frühzeitigen
Diagnostik und Beratung. Poster auf der Jahrestagung der Deutschen Gesellschaft für Kinder- und Jugendmedizin,
Leipzig, September 2002
Sandrieser, P., Schneider, P.: Stottern im Kindesalter. 3. aktualisierte und erweiterte Auflage. Thieme, Stuttgart,
2008
Schneider, P., G. Schartmann: Was ist ein U-U-Uhu? Ein Mutmachbuch für stotternde Kinder. 2. überarb. Aufl. Ulrich
Natke Verlag Neuss 2007
Schneider, P.; Sandrieser, P. Direkte Therapie mit stotternden Kindern. Video, Demosthenes-Verlag,
Köln 2002
Schulze, C., Sandrieser, P., Schneider, P. Willmes, K. Subjective Experience of Stuttering of 4 to 6 Years old
Children. Poster at the 1st European Symposium on Fluency Disorders, Antwerp, April 2008
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preschool and kindergarten children who do and do not stutter. J. Fluency Disord. 30 (2005) 307-318
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Treatment of the young stuttering child with Mini-KIDS

Transcription

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