SLHS 4210 Final Exam | Questions and Answers

SLHS 4210 Final Exam | Questions and Answers St. Louis & Schulte's __________________________ approach describes a minimum number of characteristics must be present in order to define the problem. Lowest Common Denominator What are the core traits of cluttering? - St. Louis & Schulte's LCD approach rapid &/or irregular speech rate further accompanied by one or more of the following: excessive "normal" disfluencies, excessive collapsing or deletion of syllables, & abnormal pausing/syllable stress What are the associated features for cluttering? (4) - St. Louis & Schulte -ADHD -Lack of self-monitoring -Learning disabilities -Pragmatics Most disfluencies of cluttering include: (5) -interjections -revisions -word repetitions -unfinished utterances -phrase repetitions Compared to stuttering, how is cluttering different? (8) -speaking rate increases progressively in an utterance -prevalence of pure cluttering may be about 1.1% among Dutch & German teens -average age of identification is ~8 y/o -more articulation errors -decreased utterance complexity -fewer prolongations -fewer instances of struggle compared to typical speakers & PWS; involves greater influence of language formulation, pragmatics -cognition in addition to speech motor skills According to Yairi & Seery, how does acquired neurogenic stuttering present? presents as a result of a brain lesion following a neurological event w/out previous history of child-onset stuttering Which 3 areas of the brain have been associated with neurogenic stuttering? - Yairi & Seery both hemispheres, subcortical (basal ganglia), & cerebellum True or False. There is no universal infarction site for acquired neurogenic stuttering. True Although acquired neurogenic stuttering can occur in the absence of other speech disorders, it common occurs in junction with: (4) -dysarthria -aphasia -voice disorders -cognitive language impairment How can you tell the difference between child-onset stuttering & acquired neurogenic stuttering (ANS)? (7) -background history is most helpful -secondary behaviors are less likely -stuttering may not primarily occur on initial syllables/utterances & there are several case studies that note some word-final disfluencies associated ANS -short words may be just as difficult as long words -fluency enhancing conditions are not helpful -syllable repetitions are most likely -blocks are least common According to Yairi & Seery, how does psychogenic stuttering present? presents following significant psychological trauma w/out obvious organic etiology w/out any previous history of developmental stuttering True or False. Psychogenic stuttering is significantly more common than child-onset stuttering. False Psychogenic stuttering is often associated with other psychosomatic complaints such as: (4) -headaches -backache -fainting -panic attacks What are the characteristics suggestive of psychogenic stuttering? (8) - Deal (1982) -sudden onset -onset is related to an event that caused extreme stress -fluency enhancing conditions are not helpful -there may not be any conditions that the person is completely fluent -individuals are indifferent about the disorder & claims no responsibility -no secondary traits -normal eye contact -may show same patterns of stuttering during silent reading What is quantitative assessment? numerical & statistical; disfluency counts & assessment (SSI, OASES) What is qualitative assessment? background history, risk factors, secondary behaviors, & observing family interactions Why is it important to have video recordings? so that it is easier to identify blocks & secondary behaviors What is the goal of Fluency Shaping therapy? to increase speech fluency & reduce stuttering occurrences What are the basic principles of Fluency Shaping (FS) therapy? (4) does not emphasize feelings, affective response, or dealing with fears; FS is the treatment of surface behaviors, not the individual; does not focus on the identification of stuttering, rather it is more important to use techniques to be fluent; generalization of fluency with increasing complex language/challenging situations What is the goal of Stuttering Modification therapy? to change the way someone stutters; acceptable stuttering What are the basic principles of Stuttering Modification therapy? (4) identification of disfluencies; reducing tension, avoidance behaviors, & negative feelings; becoming comfortable with the moment of stuttering & desensitizing to fears; has a counseling aspect True or False. Fluency Shaping therapy is typically more international, while Stuttering Modification therapy is more of an American idea (Van Riper). True Describe the Comprehensive Approach to stuttering therapy. a combination of Fluency Shaping and Stuttering Modification, but might be weighed more toward FS or SM What are the treatment techniques for Fluency Shaping therapy? (6) response contingencies, easy onset, prolonged speech, rate control, light articulatory contacts, & delayed auditory feedback What are the treatment techniques for Stuttering Modification therapy? voluntary stuttering, cancellations, easy stuttering, pull-out, & preparatory sets When & where was the Lidcombe Therapy program developed? University of Sydney in Australia in the 1990s What exactly is the Lidcombe Therapy program? stuttering in a singular, isolate behavior is managed with verbal response contingencies provided by parents w/ direction from an SLP What is the goal of the Lidcombe therapy program? to achieve fluency through the use of positive reinforcement for stutter-free speech & gentle correction for stuttering For the Lidcombe program, what are some examples of verbal contingencies for stutter-free speech? How should you present these responses? "that was great talking," "smooth talking," or "was that smooth?"; be sure to be enthusiastic & use inflection For the Lidcombe program, what are some examples of verbal contingencies for acknowledgement/prompts for self correction? What should you remember when presenting these responses? What happens after using a self-correction contingency? "that was a little bump" or "please say that smoothly"; use polite commands & get rid of the choice for the child by not using words like can, could, would, or should; after the contingency, the child is prompted to ask the utterance again What population of people does the Lidcombe therapy program work best for? children 6 y/o, but can be effective for children up to 12 y/o (results become less robust overtime because the brain is less plastic) What are the strengths of the Lidcombe therapy program? (3) parents are the primary clinicians, studies support efficacy solely on the measurement of fluency, & reinforces kids to be overt What are the criticisms of the Lidcombe therapy program? (5) the criteria for dismissal is no stuttering by the end of Stage II (is it excessive? is speech artificial); does not measure avoidance or secondary behaviors; some evidence suggests decreased language performance (but this can be normal); if the program is ineffective, what has the child learned regarding techniques to be more fluent/manage stuttering; most of the clinical trial subjects do not have other speech/language disorders (are the results as strong as they are because they are only evaluating PWS) Lidcombe therapy program is a _____________ treatment strategy for preschool, while PCI & RESTART-DCM are ________________ treatment strategies for preschool. direct; indirect When and where was the Parent-Child Interaction (PCI) therapy program developed? at the Michael Palin Centre for Stammering Children in the UK in the 1990s The PCI therapy program assumes that stuttering is a __________________ and must be managed as such. multifactorial disorder Which factors that may support/impact the child's fluency does the PCI model consider? (4) physiological, linguistic, environmental, & emotional factors Describe PCI's research. has been research with children 5 y/o & with controlling for spontaneous recovery by waiting until 6-months post-onset to start therapy so they reduce the amount of false positives Describe the parental role in the PCI therapy program. parents are the primary clinicians, so there is not direct prompting for self-correction (praising is an option) & they select therapy targets with support from the clinicians Describe some things to consider with PCI therapy? efficacy data adequate, but not as plentiful compared to Lidcombe; avoids direct methods (but why, if parents don't cause stuttering?); & results are slower than Lidcombe when measuring %SS Where was RESTART-Demands & Capacities Model (DCM) developed? Who is it based on? Holland, Netherlands; based on Starkweather's Demands & Capacities Model What does the Demands & Capacities Model suggest about stuttering? that stuttering occurs when the demands on fluency exceed one's capacity to produce it What is the primary goal of RESTART-DCM? to decrease demands in the child's environment with parents as primary clinicians Parents are trained to reduce demands in what 4 areas? motoric, linguistic, emotional, & cognitive How can parents reduce demands in the motoric area? decrease parent rate of speech by adding more pauses when speaking How can parents reduce demands in the linguistic area? increase latency time by not talking, using indirect question prompts, & pausing more How can parents reduce demands in the emotional area? decrease advanced notice of excitable events How can parents reduce demands in the cognitive area? focus on questions & comments within the "here & now" How is the RESTART-DCM program executed? parents give undivided attention for 15 minutes/day at least 5 days a week A 2005 Pilot Study comparing RESTART-DCM & Lidcombe over 12 weeks demonstrated what? similar decrease in %SS & severity ratings & with levels of parent satisfaction Why is RESTART-DCM daunting for some parents? because it is more comprehensive than Lidcombe What are parents encouraged to do & not do for RESTART-DCM? encouraged to acknowledge (not self-correct) moments of stuttering & praising for fluency is avoided Differences between Lidcombe & PCI & RESTART-DCM. (3) 1. Lidcombe is a direct approach where parents are encouraged to prompt their child to either evaluate or self-correct utterances. Indirect programs like PCI & RESTART-DCM do not have prompts like that. In PCI, parents may praise for fluent speech if they like, but it is not a required target. 2. The Lidcombe project views stuttering as a single isolate behavior that just has to be shaped. PCI & RESTART-DCM views stuttering more holistically. 3. Lidcombe also has the most efficacy data behind it. PCI & RESTART-DCM have ample data, but not an overwhelming amount. Why do Fluency Shaping approaches (e.g., Lidcombe) tend to have more efficacy data than other approaches? Does this mean that Fluency Shaping Approaches are a more effective method? It is easy to measure fluency because you just measure %SS before & after therapy. Other outcomes, such as tension & avoidance, are more difficult to measure (although improving) & have been more associated with stuttering modification & more holistic approaches. Although this is the case, that doesn't necessarily mean that fluency shaping is more effective. True or False. There is no FDA approved medication for exclusive use with stuttering. True What pharmacological agents for stuttering are the most often and most recently studied? dopamine antagonists What is the purpose of dopamine antagonists? decrease dopamine in the CNS