Target

decreasing stuttering

Participant

12-year-old boy

Technique

The subject was given a specific amount of tokens before the sessions began. The number of tokens given to the subject was calculated by multiplying the number of minutes in each session by .5 times per minute, which is the number of times the average person stutters per minute. The subject was provided with one extra token in case he came out with the exact number of stuttered words per minute. The subject was then seated across a table from the clinician and was asked to read from a book appropriate to his reading level. If the subject had an occurrence of stuttering, a token was removed. If there were any tokens remaining at the end of session, the subject was rewarded. The acknowledgment of achievement was a note to the subject's parents or a tangible reward.

Evaluation

The researchers evaluated the number of stuttered words in a 20 minute session. They evaluated the subject at the end of each session by calculating the number of tokens remaining. The experiment lasted for 20 days. The experiment resulted in an immediate decrease in the subject's stuttering. The subject went from a mean of 1.41 stuttered words per minute to .25 in the first 11 days of the experiment. The next 9 days resulted in a decrease to .21 stuttered words per minute.

Source

Andress, M. J. , & Salend S. J. (1984). Decreasing Stuttering in an Elementary-Level Student. Languange, Speech, and Hearing in Schools, 15, 16-21.

Developer

Joshua W. Petty, ETSU


Target

improving stuttering

Participant

6 males and 2 females rangeing from 6-to-10 years old

Technique

In awareness training, the parents and subjects tried to identified each occurence of stuttering. When a stuttered word or phrase occurred, the subject or parent responded verbally or by raising their hand. This was done to bring awareness to the problem. In response training, the subject was involved in discussion and modeling of diaphragmatic breathing. The subject practiced this by sitting upright in a chair with the body supported and shoulders slightly hunched, extending his or her abdomen as he or she inhaled, and exhaling smoothly and slowly through the mouth. The subject and parent were to pay close attention to incorrect breathing by noticing movement in the shoulders or by hearing breaths. The subject was also instucted to have a good idea of what he or she was going to say before speaking. The subject then exhaled slightly and spoke through a natural exhalation of air. This was demonstated by placing the subject's fingers in front of another person's lips so he or she could feel what a slight exhale felt like. The subject then practiced until he or she could speak without stuttering. The parents were also instructed to practice this. If a stuttered word occured, the subject was instructed to stop and implement the techniques immediately. The subject practiced these steps while reading and speaking a few words in conversation. In social support, the subject's parents attend the sessions and learned all the techniques. Parents were instucted to practice the procedures with their child outside of the normal sessions. They were to also remind the child to use the techniques if a stuttered word was heard. Parents also gave their child positive reinforcement for any type of progress.

Evaluation

The subjects were evaluated by counting the number of stuttered words. There was a criteria level of less than 3% stuttered words. This was calculated by counting the number of stuttered words per minute and using simple mathmatics to figure a percentage. The initial treatment lasted about 2 hours while the following sessions lasted approximately an hour. There were three sessions each week, and they continued until the subjects were able to fall below the 3% criteria. However, if the subject and/or parent was having difficulty using the procedures the sessions may have continued. The results of the simplified treatment decreased the level of stuttered words for all eight children.. All the subjects were able to decrease stuttering below the 3% criteria thus accomplishing the expected goal.

Source

Arndorfer, R. E., Miltenberger, R. G., & Wagaman J R. (1993). Analysis of a Simplified Treatment for Stuttering in Children. Journal of Applied Behavior Analysis, 26, 53-61.

Developer

Joshua W. Petty, ETSU


Target

decrease stuttering

Participant

five year old stuttering female and parents

Technique

They took a conversational speech sample, and took percentages of stuttering frequency, syllables that were stuttered, and a speech rate. Then a treatment plan was developed by the clinicians involving mother-child, and father-child interactions separately. The clinicians would view the child with both parents seperately. They would video tape these sessions in order to learn the possible stuttering patterns the child might have based on the relationship, and comfort level the child had with the other party. Then the child's stuttering was assessed from video tapes of each interaction. This allowed the clinicians and parents to see communicative stress placed on the child, that may have caused stuttering episodes. After reviewing video-tapes of the child and her parents in separate sessions, the clinicians divided her stuttering habits into two categories. These were; effortless repetitions; and evident physical effort (i.e. "facial squeezing, head jerks, hand movements, and other body gestures"). These two styles have been referred to as primary and secondary stuttering. Primary stuttering is the stage when stuttering begins, and is begins as effortless repetitions. Secondary stuttering occurs over time as more effort is required to pronounce a word. By reviewing the previous tapes with an intent to look for signs of primary and secondary stuttering, the researchers hoped to find some correlating evidence. "Frequency of primary (%SS-Primary) and secondary (%SS-Secondary) stuttering for each segment was calculated by dividing the number of stutters, primary or secondary, in a segment by the number of syllables spoken by Judy in that segment".

Evaluation

They videotaped mother-child and father-child interactions for thirty minute sessions. After the interaction sessions, the video was viewed by the parents and clinicians. The clinicians selected various segments for the parents to view. These segments included interactions that were encouraging to fluency, as well as discouraging to fluency. After viewing the tapes the parents were encouraged to respond on both the positive and negative aspects of the session. Then the relationship of the differences in the parent/child interactions, and the percent of the syllables stuttered by the child were analyzed. The study shows a correlation with the parents behavior and approach to their daughter's stuttering greatly effects her rate of stuttering as well as whether it is primary or secondary.

Source

Guitar, B., Schaefer, H.K., Kilburg, G.D., Bond, L. (1992). Parent verbal interactions and speech rate: A case study in stuttering. Journal of Speech and Hearing Research 35, 742-745.

Developer

Allen Weems, ETSU


Target

reducing stuttering

Participant

eleven children in a control group and twelve children in experimental group

Technique

Parents of stuttering children were taught in 1-hour weekly sessions to administer the treatment to their children. Parents and clinicians were to verbally correct children for stuttered speech, and the child was to correct the stuttered word. Parents were to give praise and tangible rewards for non-stuttered speech. This occurred in 15 minute sessions, and on a daily basis.

Evaluation

Recordings were made of the child's speech and corrections and praise made by parents, by parents and clinicians, sometimes with and sometimes without the knowledge of the child. This served two purposes, to allow the clinicians to determine if the parents were following the guidelines given to them, and to count the number of syllables stuttered. This data was measured for sessions both within and beyond the clinic, and converted into a percent of the syllables stuttered. Most subjects had a percent syllables stuttered at the beginning of the treatment between 1 and 5%. At the end of the treatment, almost all subjects were at or below 1% syllables stuttered. both within and beyond the clinic.

Source

Onslow, M, Andrews, C, & Lincoln, M. (1994). A control experimental trial of an operant treatment for early stuttering. Journal of Speech and Hearing Research, 37,1244-1259.

Developer

Allison Brown, ETSU zamb40@etsu-tn.edu


Target

Reducing stuttering

Participant

Ten stuttering adults ranging from 21-56 years old.

Technique

Participants were asked to read eight different passages from two junior high school level textbooks, at either a normal or high rate of speed. Through the use of recording equipment, their speech was played back to them while they spoke. This is called auditory feedback. As a control the participants received no auditory feedback Passages were also played for them with delayed auditory feedback, DAF, a 50 ms delay, or frequency altered auditory feedback, FAF, which is a half octave down shift in tone, or a combination. This type of feedback reduces the rate of speech, which usually reduces stuttering.

Evaluation

Researches recorded these reading both on audio and visual tape. Stuttering was measured for the first 300 syllables. The study showed that an increased rate of stuttering was evident with the fast reading rate, and stuttering was reduced with the use of the feedback conditions. However, the researchers could not determine if the combination of DAF and FAF had any significant effect on stuttering vs. the single condition.

Source

Macleod, J, Kalinowski, J, Stuart, A, & Armson, J. (1995). Effect of single and combined altered auditory feedback on stuttering frequency at two speech rates. Journal of Communication Disorders, 28, 217-228

Developer

Allison Brown, ETSU zamb40@etsu-tn.edu


Target

improving attitudes about stuttering and increasing fluency

Participant

group a: 4 students; a first and second grade boy and a first and fourth grade girl; group b: 2 sixth grade boys, 2 eighth grade boys

Technique

The program used with these students was the Cooper Personalized Fluency Control Therapy Program (CPFCT-R). The students experimented with different ways to control their speech. Among these were rate and volume. They lengthened their words by lengthening syllables and increasing pauses between words, phrases, or sentences. Eventually students do not lengthen every word only those they have trouble with. The students also experimented with the loudness and softness and by learning breath control (exhaling air upon vocal onset). The students chose the technique that best helped them and used it. There were four phases in this study. At phase one, the students were pretested for an assessment of behaviors and attitudes. The parents answered a questionnaire on the child's fluency and their attitudes. In phase two, the students described their behaviors and feelings. The parents shared their concerns for their children in groups. At this time, parents and students learn they can trust group members. At phase three, the students learn to control their speech. They change patterns, rate, and volume. Their actually managing their own speech. Parents are trying to change habitual behaviors; therefore, learning how difficult it is to change. Phase four is known as transfer and maintenance of the new behavior and attitudes. Students are participating in activities that involve transferring their new skills to school, home, and other social situations. The parents part in this phase is to maintain a supportive dialogue with the child.

Evaluation

The CPFCT-R, which measures attitudinal changes, was administered prior to treatment, after treatment, and during the fourth or maintenance phase of the treatment. Results showed that only one child avoided speaking in situations when he might stutter. Students began seeing their disfluency as something they could control. A goal that was accomplished was making the students aware of the severity of their disfluency. This program works to change stuttering behavior through controls, along with changing the attitudes of the students and their parents.

Source

Berkowitz, M., Cook, H., & Haughey, M.J. (1994). A non-traditional fluency program developed for the public school setting. Language, Speech, and Hearing Services in Schools, 25, 94 - 99.

Developer

Donna Chambers, ETSU.


Target

improve fluency

Participants

one group of five stutters ranging in age from 4:6 to 6:5 and a second group ranging in age from 3:8 to 7:1

Technique

One must first define the seven fluency rules to the stutters.

1. Speak slowly - this allows time for the children to remember the fluency rules and provides time to develop self-monitoring skills. Often a metronome reminds the child of slow rate.

2. Use Speech Breathing - Explain regular and speech breathing. In speech breathing, breathe in quickly and begin speaking as one lets the breath out slowly. Remind the child to not hold their breath.

3. Touch Speech Helpers Together Lightly - Define the speech helpers (lips, tongue, and teeth). Demonstrate that when speech helpers are touched together lightly sounds are made. When they are touched together tightly the airflow will stop and sounds will not occur fluently.

4. Use Only the Speech Helpers - This is simply letting the child know that it is not necessary or helpful to use other body muscles, only speech helpers.

5. Keep Your Speech Helpers Moving - Explain to the child that fluent talkers do not "hold on to" sounds. One would need to teach the concept of short and long vowel sounds. A teaching technique would be to have two pieces of velcro. One cut long, the other short. Have the child rub the long one when saying long sounds and vise versa.

6. Keep "Mr. Voice Box" running smoothly - Show the child that "Mr. Voice Box" is in the neck. Allow the child to hum and feel their voice box vibrate. Explain that the vibration is causing the sound.

7. Say a Word Only Once - Use the example of a train. The first train has different cars. The second train's cars are all the same. This shows that the train can run smoothly with only one type of each car. The same is true in speech. Repetitions are unnecessary.

After the rules are explained and understood the stutter engages in a self-monitoring program. The teacher or clinician breaks fluency rules to allow the child to identify them. The child is tape-recorded and listens to himself, to determine the rules he has broken. Then the child is asked to identify when broken fluency rules or stuttering occur in conversational speech. The final phase if the carry-over to the classroom and home. Teachers and parents are asked to help the child to remember the rules and use them. Objects can be used as a reminder. A simple glance at the object is usually sufficient and avoids direct confrontations.

Evaluation

The first group of students were treated on the first year and monitored the second year by language pathologists, teachers, and parents. The second group began their treatment at the monitoring stage of the first. The children were evaluated at the beginning of the school year. The children were measured by the Stuttering Severity Instrument, which is a scale of three sections: frequency, duration, and secondary behaviors, while speaking. This showed a reduction in frequency of stuttered words but that remaining blocks were minimal. The stutterer's speech contained slight effects of the disorder. It was important for the participants to realize the importance of not breaking rules. "Preliminary results based on these nine children show that the Fluency Rules Program is effective in producing fluent speech and the children's speech production remained fluent for a 1 - 2 year period.

Source

Runyan, C.M., & Runyan, S.E. (1986). A fluency rules therapy program for young children in the public schools. Language, Speech, and Hearing Services in Schools, 17, 276 - 284.

Developer

Donna Chambers, ETSU


Target

To decrease the amount of stuttering

Participants

The participants were four subjects, ages 3 to 5, diagnosed with early stuttering.

Technique

The subjects' speech was assessed on three occasions for two months prior to the intervention. The subjects' speech was recorded both in the home and outside of the home by a clinician. The parents were not aware of what the speech management program entailed. The intervention consisted of two treatment procedures based on parent administered verbal feedback. The first format was called the treatment session. This was done inside the home with parent and the child engaged in conversation, which was stimulated with picture storybooks. The parent was asked to record data and comments on the child's speech. Stutter-free speech was praised while any stuttering was recorded by the parent, and the child was asked to repeat the utterance without stuttering. If the child was not successful, then the conversation was continued. However, if the child successfully corrected the stuttered utterance, then overcorrection and praise was used by the parent. Overcorrection involved the parent eliciting different versions of the corrected utterance. Each of the treatment sessions were accompanied with activities and tangible rewards. The second format was the on-line verbal stimulation, which was provided in correlation with the treatment sessions. Both of these formats are similar with the exception that the on-line treatment occurred outside of the home, conversations revolved around everyday situations, and there were no tangible rewards. After the treatments, the subjects were placed in a maintenance program where a series of assessments, which would decrease in frequency, occurred.

Evaluation

Pretreatment and posttreatment assessments occurred over a 2 month and 9 month period of time, respectively. During the intervention, the parent was asked to record data on their child's speech. After the intervention, a questionnaire was sent to the parents, asking them to evaluate their child's speech. This ranged from no stuttering at all to a severe amount of stuttering. During the pretreatment assessment and the intervention, a total of 105 tapes with speech samples were made. These tapes were evaluated by clinicians, both ones who have had no experience with stuttering management and those who have has experience. The results from this intervention show that stuttering did decrease in all four subjects.

Source

Onslow, M., Costa, L., & Rue, S. (1990). Direct early intervention with stuttering: Some preliminary data. Journal of Speech and Hearing Disorders, 55, 405 - 416.

Developer

ETSU