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Stuttering management and treatment is a complex process that does not have one approach that will cure all problems (Guitar 7). Stuttering is a common speech impediment or neural processing of speech that starts during the first three years of life and can impact up to 10% of children (O’Brian and Onslow d3742). Contributors to the condition range from educational to mental health issues, which points to the need to manage to stutter as early as possible to prevent further complications.
The assessment implemented for Jane, a nine-year-old female, prior to the introduction of the program combined several techniques. First, the Fluency Case History Form was filed to identify the range of concerns associated with the stuttering patterns of the girl. Parent Observation Checklist of Fluency Concerns and Teacher Observation of Fluency Concerns were completed by Jane’s mother and her school teacher to identify their perspectives on the issue and the definition of existing strategies that have already been implemented. Stuttering Severity Instrument-3 (SSI-3) was also necessary for measuring the severity of stuttering of the child.
During the session, it became apparent that Jane’s stutter is far from severe and might be primarily psychologically induced. From her own and her mother’s account of the disorder, it seems like she only stutters in highly stressful situations. It should be noted, however, that the definition of a stressful situation is arbitrary: the most mundane and normal occurrences can be frustrating for a stutterer. Most of all, Jane is shy in the presence of strangers; she is also afraid of giving presentations and answering phone calls. However, when the girl is around her family and friends, she does not feel constrained and barely struggles with being fluent.
Goals and Objectives
Five management goals have been identified for defining the purpose of a treatment plan for managing Jane’s stuttering. First, it is expected to reduce the frequency of stuttering that disrupts her normal speech. The rationale for this goal is linked to the need to identify the rate at which the girl experiences discomfort linked to stuttering. Second, the reduction of severity, duration, and stuttering abnormality to the level of resembling normal discontinuities in speech is expected to occur. This is explained by the necessity to reduce the negative influence of stuttering patterns. Third, the plan aims to reduce the occurrence of defensive behaviors that are used for avoiding, preventing and escaping from adverse events. The rationale is linked to the benefits of addressing Jane’s mental influences on stuttering. Fourth, it is expected to remove or reduce processes associated with creating and maintaining stuttering behaviors. This is necessary for monitoring listeners’ reactions, denial, and parents’ reactions. Fifth, the program aims to help Jane to make positive decisions to handle speech limitations. The rationale for this goal is linked to the need to install a sense of independence in the decision-making after the completion of the program.
Strategies intended for accomplishing the goal of treating Jane will be implemented through the use of a team approach to treatment planning, in which the priorities of the child and her family drive the methods and the goals of the treatment. According to Healey, an interactive and team-based approach to stuttering management represents one of the most cohesive and multi-dimensional approaches to addressing the condition (2). It also implies a combination of technological and traditional methods. The team approach is seen as beneficial because it implies the collaboration between multiple players in the process and requires the sharing of ideas, perspectives, and opinions that will suit Jane’s situation the most.
Since Jane seems to have already developed preventive and avoiding behaviors, it is critical to breaking the mold early enough before it solidifies. Anxiety is a common concomitant in stutterers, and when untreated, it has the potential of creating a vicious circle. First, stutter gives rise to feelings of uneasiness, and later, the created anxiety aggravates stutter. To stop this from happening, Jane will be prescribed exposure therapy. This therapeutic strategy was found beneficial for people with a stutter who reported an improvement in their affective, behavioral, and cognitive experiences (Scheurich 29). Jane is expected to participate in situations that she finds stressful to desensitize her and make her reactions milder.
Practices and Activities
Procedures for therapy will include the reduction of avoidance by reinforcing stuttering. Since Jane often struggles with school presentations, it is recommended that she tells the audience that she might stutter to relieve stress. A significant part of the frustration in stutterers comes from the unwillingness to let others know about their disorder. Stating it as a fact can be empowering and establish a sense of confidence in her and the capability to speak regardless of the challenges associated with stuttering. Jane will be reinforced for communication even in cases when fluency is severely limited.
Gradual exposure to stressors will help Jane to face her fears and harness feelings of distress. A speech therapist might encourage her to call her family and friends more. The next step would be short calls to retrieve some information. The first few times can be scripted: she can actually write down what she wants to say and use her notes as a point of reference. Once she feels freer, she can afford to be more spontaneous. It is critical that Jane is praised along the way and her accomplishments are acknowledged. At the same time, her parents should not focus on her disorder excessively; otherwise, this manageable trait might start to define her.
Regular assessments through observation and testing will be implemented, thus the progress and the efficacy of the implemented program will be assessed. A parent rating procedure can be introduced, so Jane’s progress is tracked. It is easy to use and subjective, requiring not many resources, which means that quick results can be achieved. Using parent rating can be a source of the progress’s confirmation (or lack thereof) observed by program implementors. Such assessments can also be effective in the case of breaks in treatment in order to identify significant changes that should be addressed as soon as possible.
When it comes to the dismissal, it is recommended that a therapist dismisses Jane in the case when she is no longer experiencing the negative impact that was present previously. It is essential to note that benchmarks for stuttering should not only be based on frequency but also the severity of disfluencies, their length, the degree of secondary behaviors, and the temperament of the child. When a level of comfort is developed, and when both the girl and her parents notice significant improvements in the degree of stuttering, dismissal may be administered. However, it is essential to monitor Jane from time to time to identify any changes for the worse in order to address them immediately through additional training and interventional programs.
In summary, the program implemented for managing stuttering will adapt to the needs of the subject, Jane, given the implementation of the team approach that implies close collaboration between the participants of the process. One of the key objectives of the program is ensuring that she understands that speech complications are not rare and happen to everybody. The elimination of fear of stuttering is possible once the girl realizes that struggle is common and that it is important to look beyond it.
Guitar, Barry. Stuttering: An Integrated Approach to Its Nature and Treatment. LWW, 2013.
Healey, Charles. “Clinical Applications of a Multidimensional Approach for the Assessment and Treatment of Stuttering.” Semanticscholar, Web.
O’Brian, Susan, and Mark Onslow. “Clinical Management of Stuttering in Children and Adults.” BMJ, vol. 342, 2011, d3742.
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Scheurich, Jennifer A., et al. “Exposure Therapy for Social Anxiety Disorder in People Who Stutter: An Exploratory Multiple Baseline Design.” Journal of Fluency Disorders, vol. 59, 2019, pp. 21-32.