Despite the strides made by the current stuttering research, much confusion and misconceptions exist with respect to the treatment of stuttering in preschoolers. Many clinicians still continue to recommend that the parents ignore the child’s stuttering or use indirect environment modification approaches in the hopes that the child’s stuttering goes away. Further complicating this issue is that oftentimes many preschool children DO spontaneously recover from their stuttering several months post onset.

While oftentimes, it may be prudent to wait a few months to see how the onset of stuttering progresses, waiting too long may be quite problematic.  This is especially true for those children who become increasingly frustrated with their stuttering or those who begin to develop secondary stuttering characteristics (reactions to stuttering such as gaze avoidance, facial grimaces, extraneous body movements, words avoidance, etc).

When it comes to preschool children one intervention approach which has been highly successful to date is The Lidcombe Program. Developed in Australia, the Lidcombe Program is a fluency shaping program, which is highly effective for children 2-6 years of age who stutter.

It’s goal is to eliminate stuttering.  The program focuses on behavioral feedback provided in response to a child’s fluent speech.  However, it’s not the therapist who provides the treatment but the PARENTS. The researchers who developed the program firmly believe that the intervention has to take place in natural environments, and there’s nothing natural regarding the therapist’s office!

Based on theories of operant conditioning, the premise of the program is simple: parents praise stutter free speech and request for correction of stuttered speech.  The Lidcombe focuses on raising the child’s awareness of stuttering and encourages verbal reactions to stutter free speech.

To start, child and parent/s attend therapy sessions once a week.  The therapist teaches the parents the types of verbiage to use with their child in treatment as well as  how to rate their child’s weekly stuttering incidence on a 10-point stuttering severity scale in order to obtain a percent of stuttered syllables (%SS). Parents and therapist compare severity ratings (SR) and discuss discrepancies, if any. Therapist then supervises as parent administers treatment in session. For the rest of the week parents administered treatment in structured home setting in short increments (10 to 15 minutes each) 1 to 2 times per day.  As child’s awareness improves, parents’ switch from structured to unstructured settings in an effort to initiate generalization.

For more information about whether the Lidcombe Program is right for your child, visit their website or contact the speech language professionals specializing in this approach in your area.

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One alternative assessment method, which has been gaining popularity in recent years is the Dynamic Assessment Approach

The method is simple:

Test –Teach-Retest  (concepts such as grammar, vocabulary, narratives, etc)

This method allows the clinician to:

For more information see ASHA’s Dynamic Assessment Resources @ www.asha.org/practice/multicultural/issues/additional.htm

As a speech language pathologist working in  psychiatric setting I see children act out all the time displaying a number of maladaptive behaviors ranging from aggression and avoidance to withdrawal and elopement.  However, working with this population have taught me over the years not to jump to the obvious conclusions  but to dig a little deeper.

One question I often find myself asking these days is: ”Is it behavior or is it sensory?”

Many times after doing a bit of detective work,  the answer does surprise me.

For those parents and professionals who are currently dealing with a first time onslaught of difficult behaviors and are not so certain how to recognize which one is which,  I recommend the following screening  instrument:

The Listening Inventory (2005) Academic Therapy Publications developed by Donna Geffner, PhD and Deborah Ross-Swain, EdD

1. Presentation Title:     Behavior Management Strategies for School Based Speech Language Pathologists

Time:                         Thursday, April 19                8:15 AM - 10:15 AM

Summary: In recent years more and more school based speech-language pathologists have to work with children who present with behavioral deficits in conjunction to speech-language delays/impairments. A significant portion of work with these children in therapy sessions involves successful management of inappropriate behaviors such as excessive inattention, hyperactivity, aggression, opposition/non-compliance and/or apathy, which interferes with successful objective completion and goal attainment. This workshop will explain what type of common challenging behaviors can manifest in children with select communication, psychiatric, and neurological disorders.  It will outline behavior management strategy hierarchy from most to least intrusive methods for students with differing levels of cognitive functioning (high-average IQ to varying levels of MR). It will list positive proactive behavior management strategies to: prevent inappropriate behaviors from occurring, increase students’ session participation as well as improve compliance and cooperation during therapy sessions.

2. Presentation Title:     Social Pragmatic Assessment of Children Diagnosed with Emotional/Psychiatric Disturbances in the Schools

Time:                         Thursday, April 19              10:45 AM - 12:45 PM

Summary:  The number of children who present with non-spectrum emotional, behavioral, and psychiatric disturbances (oppositional defiant disorder, reactive attachment disorder, mood disorder, etc) has been steadily increasing in recent years. Many of these children attend district schools and due to high incidence of communication issues associated with these conditions, speech language pathologists are frequently included on the team of professionals who treat them.   This workshop is aimed at increasing the participants knowledge regarding aspects of social pragmatic language.  —By the end of the workshop participants will be able to list common pediatric psychiatric diagnoses, explain the impact of psychiatric disturbances on language development of children, summarize the role of SLP in assessment of pragmatic language and social cognitive abilities of school-age children, as well as utilize formal and informal assessment instruments to assess pragmatic language and social cognitive abilities of school age children.

Summary:  The article introduces the concept of multisensory stimulation and explains its benefits for internationally adopted children of all ages.  It also provides suggestions for parents and professionals on how to implement multisensory strategies in a variety of educational activities in order to stimulate interest, increase task participation as well as facilitate concept retention.

References:

Doman, G & Wilkinson, R (1993) The effects of intense multi-sensory stimulation on coma arousal and recovery. Neuropsychological Rehabilitation. 3 (2): 203-212.

Johnson, D. E et al (1992) The health of children adopted from Romania. Journal of the American Medical Association. 268(24): 3446-3450

Ti, K, Shin YH, & White-Traut, RC (2003), Multisensory intervention improves physical growth and illness rates in Korean orphaned newborn infants. Research in Nursing Health.  26 (6): 424-33.

Milev et al (2008) Multisensory Stimulation for Elderly With Dementia: A 24-Week Single-Blind Randomized Controlled Pilot Study. American Journal of Alzheimer’s Disease and Other Dementias. 23 (4): 372-376.

Tarullo, A & Gunnar, M (2006). Child Maltreatment and Developing HPA Axis. Hormones and Behavior 50, 632-639.

White Traut (1999) Developmental Intervention for Preterm Infants Diagnosed with Periventricular Leukomalacia. Research in Nursing Health.  22: 131-143.

White Traut et al (2009) Salivary Cortisol and Behavioral State Responses of Healthy Newborn Infants to Tactile-Only and Multisensory Interventions. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 38(1): 22–34

 Resources:

• American Occupational Therapy Association (AOTA) http://www.aota.org/
• American Speech-Language-Hearing Association (ASHA) http://www.asha.org/
• Anatomy Arcade: http://www.anatomyarcade.com/
• Cannon, Janell (2000) Crickwing. Harcourt Children’s Press.
• DLTK Printable Crafts for Kids www.dltk-kids.com
• Enchanted Learning: http://www.enchantedlearning.com/crafts/halloween/pastaskeleton/ How to make a pasta skeleton;
• Enchanted Learning:  http://www.enchantedlearning.com/crafts/edible/ Edible Crafts
• Percival Touch ‘n’ Feel Book (2005). Bendon Publishing International
• Sensory Processing Disorders Foundation Website http://www.sinetwork.org/index.html
• Sensory Processing Disorder Blog http://www.sensory-processing-disorder.com/index.html
• Wendy Z Learning Resources. 5 recycled multisensory learning games. Retrieved October 30^th 2011.  (http://wendyzshandsonlearning.blogspot.com/2009/06/5-recycled-multisensory-learning-games.html)

Date; January 25th 2012

By the end of the workshop participants will be able to:

•Identify skills and knowledge necessary to qualify a practitioner to be called a bilingual SLP

•Identify and describe cultural and linguistic variables that may impact speech-language pathology services to bilingual/bicultural children

•Explain typical language development for monolingual and bilingual  speakers

•Explain the process of second language acquisition in children.

•Contrast communication differences and communication disorders in bilingual children

•Discuss research driven evidence based practice (EBP) assessment strategies for bilingual clients with communication disorders.

•Illustrate potential limitations of standardized tests

•Explain how to use alternative, non standardized methods to reduce assessment bias

•Describe research driven evidence based practice (EBP) treatment techniques for bilingual children with speech-language disorders.