Clinical Decision Making in Fluency Disorders

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ISBN: 9780769301167 | 0769301169
Cover: Paperback
Copyright: 11/7/2000

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Clinical Decision Making in Fluency Disorders helps clinicians and students apply the assessment-treatment process as an exciting ongoing detective procedure. The pragmatic approach includes a discussion of humor as a therapeutic tool and offers story format examples of the decision making process. This book goes beyond dry formulas to help each reader become an artisan in treating fluency disorders. Communication Disorders / Parenting

Preface

Acknowledgments

Clinician Characteristics

(34)

Introduction

(2)

The Importance of the Clinician

(9)

Clinician Attitudes About Stuttering and People Who Stutter

(5)

Specialty Recognition in Fluency Disorders

(1)

Educational Activities

(1)

Guided Practice

(1)

How Clinicians Interpret the Disorder

(1)

Clinician Personality Attributes

(3)

Clinicina Intervention Skills

(9)

Becoming Less Inhibited as a Clinician

(2)

Avoiding Dogmatic Decisions

(1)

Opening Your Treatment Focus

(1)

Calibrating to the Client

(2)

Using Silence

(1)

Modeling Risk Taking

(1)

Challenging the Client

(2)

Humor and the Clinician

(4)

A Historical Perspective

(2)

What's So Funny?

(1)

Humor in Psychotherapy

(1)

Using Humor in Treatment

(5)

The Conceptual Shift

(1)

Distancing With Humor

(2)

Mastery and Humor

(1)

Conclusion

(1)

Study Questions

(1)

Recommended Readings

(1)

Theories of Etiology

(52)

Introduction

(3)

Attempts to Define Stuttering and Related Terms

(8)

Some Definitions of Stuttering

(7)

Theories of Etiology---A Historical Perspective

(22)

Stuttering From a Physiological Perspective

(2)

Theories of Cerebral Dominance

(4)

Evidence from Neuroimaging Techniques

(7)

Temporal-Processing Abilities

(1)

Genetic Influences

(2)

Auditory Feedback

(2)

The Covert Repair Hypothesis

(2)

Stuttering as an Emotional or Psychological Problem

(2)

Stuttering as Learned Behavior

(6)

Multifactorial Models

(7)

The Demands and Capacities Model

(3)

The Multifactorial-Dynamic Model

(3)

A Neurophysiological Model

(1)

A Summary of Models

(1)

Conclusion

(1)

Study Questions

(1)

Recommended Readings

(2)

Characteristics of Stuttering Onset and Development

(26)

Introduction

(1)

Stereotypes of Stuttering and People Who Stutter

(1)

Characteristics of Normal Fluency

(4)

When Is It Stuttering?

(2)

The Features on the Surface

(1)

Distinguishing Normal and Abnormal Surface Features

(6)

A Sequence of Development?

102

(2)

Conditions Contributing to Onset

104

(7)

Less Influential Factors

104

(1)

Physical Development

105

(1)

Illness

105

(1)

Imitation

105

(1)

Shock or Fright

105

(1)

Emotional and Communicative Conflicts

106

(1)

Socioeconomic Status of the Family

106

(1)

Nationality

106

(1)

More Influential Factors

107

(1)

Sex

107

(1)

Age

107

(1)

Genetic Factors

108

(1)

Twinning

108

(1)

Brain Injury

108

(1)

Speech and Language Development

109

(1)

Motor Coordination

110

(1)

Conclusion

111

(1)

Study Questions

111

(1)

Recommended Readings

112

(1)

Assessing Adolescents and Adults

113

(72)

Introduction

113

(1)

The Variability of Fluency

114

(1)

Surface and Intrinsic Features

115

(5)

Two Basic Principles of Assessment

120

(1)

Assessing Older Speakers

121

(1)

Severity Versus Handicap

122

(3)

The Nonrepresentative Sample of Clients

125

(2)

Assessing Intrinsic Features

127

(4)

Identifying Loss of Control

127

(2)

Testing the Link Between Control and Fluency

129

(1)

Assessing the Speaker's Decision-Making

130

(1)

Mapping the Surface Features of Stuttering

131

(7)

Frequency

131

(2)

Duration and Tension

133

(2)

Fragmentation

135

(1)

Subtle Surface Features

135

(1)

Avoidance

136

(1)

Substitution

137

(1)

Postponement

138

(1)

The Client's Self-Assessment

138

(3)

Determining the Client's Desire for Change

141

(5)

Formal Measures of Severity

146

(19)

Stuttering Severity Instrument (SSI-3)

146

(1)

Modified Erickson Scale of Communication Attitudes (S-24)

147

(2)

Perceptions of Stuttering Inventory (PSI)

149

(1)

Locus of Control of Behavior (LCB)

149

(3)

Self-Efficacy Scaling for Adult Stutterers

152

(6)

The SEA-Scale: Self-Efficacy Scaling for Adolescents Who Stutter

158

(1)

Crowe's Protocols: A Comprehensive Guide to Stuttering Assessment

158

(7)

Assessing Atypical Fluency Problems

165

(18)

Acquired Stuttering

166

(1)

Neurogenic Stuttering

166

(2)

Psychogenic Stuttering

168

(2)

Distinguishing Between Acquired Neurogenic and Psychogenic Stuttering

170

(2)

Cluttering

172

(7)

Spasmodic Dysphonia as a Fluency Disorder?

179

(4)

Conclusion

183

(1)

Study Questions

183

(1)

Recommended Readings

184

(1)

Assessing Fluency Disorders in Children

185

(32)

Preliminaries to Assessment With Children

185

(2)

Decision 1: Determining Whether or Not the Child Is Stuttering

187

(13)

Eliciting Fluency Breaks

187

(2)

The Nature of Fluency Breaks

189

(2)

Indicators of Awareness

191

(1)

Determining a Child's Level of Anxiety About Speaking

192

(1)

Parent Participation in Assessment

192

(2)

Examples of Assessment Measures

194

(1)

The Component Model: One Comprehensive Diagnostic Approach

194

(6)

Decision 2: Determining the Likelihood of Chronicity

200

(12)

Fluency Breaks That Signal Chronicity

201

(2)

Making the Decision to Intervene

203

(7)

Plan A: (Stream I children who have all five recovery factors)

210

(1)

Plan B: (Stream I children who have four of five recovery factors)

211

(1)

Plan C: (Stream II and III children with a score of seven recovery factors)

211

(1)

Pland D: (Stream II and III children with a score of six or fewer recovery factors)

212

(1)

Plan E: (Stream IV children with a score of four or fewer recovery factors)

212

(1)

Using At-Risk Registers

212

(3)

Conclusion

215

(1)

Study Questions

216

(1)

Recommended Readings

216

(1)

Facilitating the Change Process

217

(18)

Introduction

217

(1)

The Nature of Change

218

(1)

The Likelihood of Success

219

(1)

Matching Treatment to Client Stages of Change

220

(4)

Precontemplation

220

(1)

Contemplation

221

(1)

Preparation

221

(1)

Action

221

(1)

Maintenance

221

(1)

Processes of Change

222

(2)

Difficulties in Initiating and Maintaining Change

224

(2)

Leading From Behind

226

(1)

The Goals of Treatment

227

(4)

Levels of Fluency

227

(1)

Achieving Spontaneous Fluency

228

(3)

The Importance of Modeling

231

(1)

Vaiables in Choosing a Teatment

231

(2)

The Timing and Duration of Treatment

231

(1)

The Complexity of Treatment

232

(1)

The Cost of Treatment

232

(1)

The Treatment Setting

232

(1)

Conclusion

233

(1)

Study Questions

234

(1)

Recommended Readings

234

(1)

Counseling Strategies and Techniques

235

(32)

Introduction

236

(1)

Egan's Three-Stage Skilled-Helper Model

236

(4)

How to ``Do Counseling''

240

(1)

The Necessity of Counseling

241

(2)

Counseling in Psychology

243

(2)

Counseling in Communication Disorders

245

(2)

Emotions Encountered During Treatment

247

(3)

Counseling Strategies

250

(3)

Behavioral Counseling

251

(1)

Humanistic Counseling

251

(1)

Existential Counseling

251

(1)

Cognitive Counseling

252

(1)

Examples of Counseling Techniques

253

(1)

Nonverbal Behaviors of the Clinician and the Client

254

(1)

Verbal Behaviors

255

(2)

The Content Response

256

(1)

The Counterquestion Response

256

(1)

The Affect Response

256

(1)

The Refarming Response

256

(1)

The Sharing Response

256

(1)

The Affirmation Response

257

(1)

Active-Listening Techniques

257

(4)

Expressing Empathy

258

(1)

Probing the Client

259

(1)

Challenging the Client

260

(1)

Using Humor

260

(1)

Client Responsibilities

261

(1)

Metalinguistic Indicators: Changing How the Client Describes the Problem

261

(1)

Choosing a Future

262

(1)

Clinician Characteristics

263

(1)

Conclusion

264

(1)

Study Questions

265

(1)

Recommended Readings

266

(1)

Treatment for Adolescents and Adults

267

(50)

Introduction

267

(1)

The Special Case of Adolescents

268

(3)

Choosing a Treatment Strategy

271

(7)

Some Specifics of Fluency-Modification Strategies

278

(2)

Some Specifics of Stuttering-Modification Strategies

280

(10)

Identification

281

(1)

Desensitization

282

(1)

Variation

283

(1)

Modification

284

(5)

Stabilization

289

(1)

Cognitive Restructuring

290

(4)

Experimental Treatment

294

(2)

Group Treatment

296

(8)

Determining Group Membership

297

(1)

Advantages of Group Treatment

298

(2)

Potential Problems With Group Activities

300

(1)

The Effective Group Leader

301

(1)

Establishing Group Norms

302

(1)

Structuring Group Activities

302

(1)

Relaxation-Imagery Exercises

302

(1)

Role-Playing

303

(1)

Public Speaking

304

(1)

Demonstration of Client Skills and Progress

304

(1)

Treatment of Atypical Fluency Cases

304

(7)

Acquired Neurogenic Stuttering

305

(1)

Acquired Psychogenic Stuttering

305

(2)

Cluttering

307

(4)

Conclusion

311

(3)

Study Questions

314

(1)

Recommended Readings

315

(2)

Treatment for Preschool and School-Age Children

317

(50)

Introduction

317

(2)

Basic Considerations When Treating Young Children

319

(9)

Indirect and Direct Strategies

321

(2)

The Role of the Parents

323

(2)

Stages of Parent Involvement

325

(1)

Educational Counseling

325

(2)

Facilitating Communicative Interaction

327

(1)

Parents as Observers and Participants

328

(1)

Treatment Strategies and Techniques

328

(1)

Using the Demands and Capacities Model

329

(12)

Enhancing the Child's Ability to Produce Fluent Speech

332

(2)

Helping the Child to Respond to Stuttering

334

(4)

Cognitive and Affective Considerations

338

(3)

Stuttering Coexisting with Other Communication Disorders

341

(5)

Two Effects of Coexisting Problems

342

(4)

Transfer and Termination Issues

346

(1)

The Possibility of Relapse With Children

346

(2)

Suggestions for the Classroom Teacher

348

(7)

The Problem of Teasing

355

(3)

Examples of Fluency Programs

358

(4)

The Successful Stuttering Management Program (SSMP)

359

(1)

Personalized Fluency Control Therapy (PFC)

359

(1)

Extended Length of Utterance (ELU)

359

(1)

CAFET for Kids

360

(1)

Speak More Fluently, Stutter More Fluently

360

(1)

Easy Does It

360

(1)

The Fluency Development System for Young Children (TFDS)

360

(1)

The Stuttering Intervention Program (SIP)

361

(1)

The Fluency Rules Program (FRP)

361

(1)

Gradual Increase in Length and Complexity of Utterance (GILCU)

362

(1)

Systematic Fluency Training for Young Children

362

(1)

Conclusion

362

(2)

Study Questions

364

(1)

Recommended Readings

365

(2)

Indicators of Progress During Treatment

367

(48)

Introduction

367

(1)

Defining Progress

368

(10)

The Variability of Change

369

(2)

Chronic Perseverative Stuttering

371

(1)

Paper-and-Pencil Measures

371

(1)

The Locus of Control of Behavior (LCB)

372

(1)

Self-Efficacy Scaling

373

(3)

The Modified Erickson Scale of Communication Attitudes (S-24)

376

(2)

Asking the Client

378

(1)

The Multidimensional Nature of Therapeutic Change

379

(2)

Variables Influencing Progress

381

(5)

The Treatment Strategy

382

(1)

The Nature of the Fluency Disorder

382

(1)

The Age of the Client

383

(2)

The Intensity of Tretment

385

(1)

Indicators of Progress

386

(24)

Increasing the Client's Self-Monitoring Ability

386

(3)

Increasing the Client's Ability to Produce ``Open Speech''

389

(1)

Decreasing the Frequency and Duration of Motoric Fluency Breaks

389

(4)

Increasing the Frequency of Formulative Fluency Breaks

393

(1)

Increasing the Naturalness of Fluent Speech

394

(1)

Development of a Naturalness Rating Scale

395

(2)

The Effect of Feedback

397

(2)

Acoustic Features of Speech Naturalness

399

(1)

The Effect of Speaking Task

399

(1)

Audio and Video Samples

400

(2)

Metalinguistic Changes

402

(2)

Increasing Open Decision-Making

404

(1)

Decreased Avoidance

404

(1)

Increased (Speech) Assertiveness

405

(1)

Increased Risk-Taking

405

(1)

Improved Self-Concept, Improved Self-Esteem, and Role Changes

405

(3)

Increased Distancing and Objectivity Through Humor

408

(2)

Criteria for the Termination of Formal Treatment

410

(2)

Conclusion

412

(1)

Study Questions

413

(1)

Recommended Readings

413

(2)

Determining Progress Following Treatment

415

(26)

Introduction

415

(2)

Our Limited View of Change

417

(1)

Maintenance and Transfer

417

(1)

The Nature of Relapse

418

(3)

The Possibility of Relapse

419

(1)

Defining Relapse

420

(1)

Possible Causes of Relapse

421

(7)

Neurophysiological Loading

422

(1)

Continued Effort Is Required

423

(1)

Client Adjustment to a New Role

423

(1)

Listener Adjustment to a New Speaker

424

(2)

Speaking in a Nonhabitual Manner

426

(1)

Failure to Follow Maintenance Procedures

427

(1)

The Cyclical Nature of Fluency

427

(1)

Overt and Covert Measures of Long-Term Change

428

(1)

Predicting Success Following Treatment

428

(2)

The Importance of Support Groups

430

(3)

Reports of Long-Term Success

433

(1)

Transfer and Maintenance Activities

434

(3)

Conclusion

437

(1)

Study Questions

438

(1)

Recommended Readings

438

(1)

Epilogue

439

(2)

REFERENCES

441

(80)

APPENDICES

A. Annotative Listing of Assessment Procedures

483

(14)

B. Resources and Support Groups in Fluency Disorders

497

(6)

C. Useful Booklets and Videotapes for Parents, Teachers, and Spouses

503

(4)

D. Guidelines for Practice in Stuttering Treatment

507

(14)

Subject Index

521

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Clinical Decision Making in Fluency Disorders

Summary

Table of Contents

Supplemental Materials