Case Studies in Fluency Disorders: Sessions

Unless noted otherwise, all sessions have an Instructional Level of Intermediate.

Fluency Disorders in Special Populations

Evaluating and Treating Children Who Exhibit Concomitant Stuttering and Speech Sound Disorders
J. Scott Yaruss, PhD, CCC-SLP, BRS-FD

Children (age 3–12) who stutter appear to be at a higher risk of exhibiting speech sound disorders, including disorders of articulation and phonology. The presence of a second communication disorder (particularly a speech sound difficulty) has significant consequences for both evaluating and treating these children. In this presentation, we'll use a generic case study to highlight issues affecting children who exhibit both stuttering and speech sound disorders, addressing diagnostic procedures and comprehensive treatment.

After completing this session, you will be able to:

  • describe the assessment procedure for children exhibiting both stuttering and speech sound disorders,
  • determine which aspects of a child's communication difficulties should be treated first,
  • identify treatment goals for improving the speech fluency and speech sound production in this population,
  • identify at least two challenges to effective therapy outcomes, and
  • create a framework for problem-solving potential therapy challenges.

Treating Acquired Neurogenic Stuttering: A Case Study
Kathrin König, PhD

Using the example of a 46-year-old client who acquired neurogenic stuttering after cerebrovascular disease, you'll gain insight into the symptomatology of neurogenic stuttering and possible types of treatment. Based on the International Classification of Functioning, Disability, and Health (ICF), we'll describe the treatment process from first contact (registration and first treatment session), to treatment completion and check-up. We'll discuss problems and constraints, as well as progress and possibilities, in neurogenic stuttering treatment. We'll analyze the criteria that constitute "success" in stuttering treatment and thus define the theoretical construct used to evaluate practical treatment outcomes.

After completing this session, you will be able to:

  • define and recognize neurogenic stuttering,
  • outline a possible ICF-based methodology of diagnostic process and therapy planning,
  • provide an overview of possible types of neurogenic stuttering treatment, and
  • discuss "success" in stuttering treatment based on the ICF.

Disfluency and Down Syndrome
Monica Bray, MPhil

Many SLPs who work with people who have fluency disorders are unsure of how to apply their knowledge to clients with Down syndrome, and many SLPs who work with clients with Down syndrome or other learning disorders are insecure about how to address their clients' fluency problems. This session aims to bring the fields together to increase the confidence of those who work with people who have Down syndrome and are also disfluent. We will discuss a psycholinguistic model for understanding both fluency and speech difficulties of people with Down syndrome, and analyze the effect of linguistic abilities on fluency in this population.

After completing this session, you will be able to:

  • describe the features of speech that lead to our perception of disfluency in people with Down syndrome,
  • make well-informed management decisions for individuals with Down syndrome who are also disfluent, and
  • give advice and guidance to parents, teachers, and others that is based on sound linguistic principles.

Helping a Person with Covert Stuttering Gain Acceptance, Speech Management, and Increased Fluency
Marybeth Allen, MA, CCC-SLP, BRS-FD

Typically, few people know that a person with covert stuttering has a fluency disorder, which makes it challenging for the SLP to "uncover the stutterer." In this program, you'll learn methods to evaluate and provide services for a person (aged 13+) who has covert stuttering. We'll examine instruments that tap into clients' reactions, feelings, and attitudes toward stuttering and assess how they see themselves as communicators. You'll learn to design a program that includes attitude-changing, homework assignments, strategies to address stuttering directly, and steps to help clients become their own clinicians. By following a case study, you'll learn to move clients from "hiding" to "acceptance" while gaining a fuller understanding of the oxymoron of "acceptance."

After completing this session, you will be able to:

  • describe the characteristics of covert stuttering,
  • plan and administer an evaluation that helps identify and explore your clients' attitudes and emotional reactions toward their stuttering,
  • create therapy tasks that support clients in confronting their fears and negative attitudes toward stuttering,
  • create therapy tasks that work toward integrating both fluency shaping and stuttering-modification skills to manage and reduce the severity and frequency of stuttering, and
  • explain how "acceptance of stuttering" can lead to stuttering management and increased fluency.

Interventions for Children With Cluttering
Kathleen Scaler Scott, PhD, CCC-SLP, BRS-FD

This session examines cluttering in children aged 8–12 years. We'll present a case study of a school-aged child with cluttering and explore symptoms, treatment techniques, outcomes, and management of cluttering along with concomitant issues.

After completing this session, you will be able to:

  • identify three symptoms that can lead to diagnosis and treatment of cluttered speech,
  • discuss three treatment techniques for school-aged children with cluttering, and
  • describe three techniques for generalization of skills to everyday speaking contexts.

Stuttering, Bilingualism, and Working Confidently Outside Your Comfort Zone
Garth Foote, MSc (A), SLP

Focus on the unique variables as well as potential roadblocks SLPs face when working with bilingual people who stutter (BWS). We'll discuss real-life challenges facing this population (age 16+); ways to approach assessment and treatment in the absence of L1 resources; and a novel, evidence-based framework to help clients make real changes in complex social and linguistic environments. We'll discuss how to chart progress when accurate stuttering measurements are unreliable or impossible. We'll also suggest ways to bolster rapport and foster meaningful change—whether working in a client's second language, the therapist's second language, or both. The strategies covered can be transferred easily and productively to other people who stutter.

After completing this session, you will be able to:

  • identify relevant variables in the assessment and treatment of BWS,
  • identify and address three roadblocks to generalization,
  • describe the difference between "goal intentions" and "implementation intentions," and
  • use implementation intentions collaboratively to bring about complex change.

Adolescents Who Stutter: A Case Study
Diane Games, MA, CCC-SLP, BRS-FD

This presentation addresses the issues that can affect the successful treatment of adolescents who stutter. We'll discuss a case study that demonstrates the process of identifying goals, selecting treatment approaches, and reporting outcomes. The variability of stuttering, past negative experiences, and situational stress will be addressed with the adolescent client.

After completing this session, you will be able to:

  • identify three significant factors in treating adolescents who stutter,
  • describe two strategies that will facilitate goal-setting with the adolescent client, and
  • discuss treatment concepts that involve problem solving and applying skills to a variety of speaking situations.

Disfluency in Autism Spectrum Disorders Case Study: A Successful Treatment of Atypical Fluency Disorder
Vivian Sisskin, MS, CCC-SLP

Treatment of fluency disorders among those with autism presents challenges: case studies have shown that disfluency patterns or diagnostic profiles of these clients don’t always resemble those typical of people who stutter, and anecdotal reports indicate that treatment approaches traditionally utilized for stuttering have not been successful. In this course, we’ll describe the current understanding of fluency disorders among those with autism, and document a case of successful remediation of final part-word repetition (atypical disfluency) in a school-age child. We’ll also present symptoms, treatment protocol, and outcome data, while speculating on the nature/function of these unusual disfluencies and the principles to guide instructional strategies.

After completing this session, you will be able to:

  • summarize literature related to fluency disorders among children and adolescents with autism spectrum disorders (ASD)
  • describe profiles representing fluency disorders (e.g., stuttering, atypical disfluency) among those with ASD
  • apply characteristics of ASD learning styles to develop teaching strategies for treating fluency disorders among individuals with autism

Treatment Approaches and Service Delivery

Treating Young Children Who Stutter: A Family-Focused Approach
Craig E. Coleman, MA, CCC-SLP, BRS-FD

In this session, you'll get a brief overview of the assessment process along with a detailed description of a family-focused treatment approach for young children (2–7 years) who stutter. You'll also learn about the risk factors associated with childhood stuttering, components of a thorough assessment, and key ingredients of effective individualized treatment. We'll discuss the assessment and treatment process through a framework that recognizes the affective, behavioral, and cognitive components of stuttering.

After completing this session, you will be able to:

  • identify the risk factors associated with childhood stuttering,
  • describe the components of a complete diagnostic evaluation for young children who stutter, and
  • identify components of an individualized treatment approach that targets the affective, behavioral, and cognitive components of treating this population.

Early Stuttering Intervention With the Lidcombe Program
Barry Guitar, PhD, CCC-SLP
Danra Kazenski, MS, CCC-SLP

In this session, you'll learn about the Lidcombe Program, an intervention strategy to help preschoolers who stutter. The program is delivered by the parent and guided by the clinician, who holds weekly meetings with the parent and child. Using a case study, we'll discuss the Lidcombe Program including assessment, skills and contingencies, follow-up treatments, and steps to ensure that the child maintains his or her fluency. We'll also examine modifications for individuals and for distance therapy, and consider data collection and evidence for the effectiveness of treatment.

After completing this session, you will be able to:

  • describe the procedures used in the Lidcombe Program,
  • identify ways the Lidcombe Program can produce long-term fluency in preschoolers who stutter, and
  • discuss extensive published evidence about this program.

Stuttering Therapy in a School Setting
Nina Reeves, MS, CCC-SLP, BRS-FD

As school-based therapists, how can we make better progress with school-age children who stutter? In this program, we'll present a case study that outlines several years of Jason's therapy process, including his transition from middle to high school. We'll outline initial case history gathering, assessment, and therapy plan decisions, while presenting concepts presented during the therapy process. Finally, we'll discuss the outcomes—including successes and challenges—and will highlight the flexible problem-solving strategies employed in this case.

After completing this session, you will be able to:

  • list the components of a multidimensional stuttering assessment and
  • describe at least three options for managing speech motor aspects of stuttering.

Using Teletherapy with Early Stuttering Intervention
Kristin A. Chmela, MA, CCC-SLP

Teletherapy may be a viable option for helping children with fluency problems across the globe. This session reviews an early intervention stuttering case that employs teletherapy to deliver the Basic Principle Problem Solving methodology. We'll discuss pre-, within-, and follow-up data, client perceptions, and future considerations for using telepractice with this population.

After completing this session, you will be able to:

  • use teletherapy service delivery to aid in early stuttering intervention,
  • apply the Basic Principle Problem Solving methodology to teletherapy intervention for early stuttering,
  • describe challenges related to early stuttering intervention and telepractice, and
  • use pre-, within-, and post-data collection methods in early stuttering teletherapy treatment.

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