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2/23/19
© Nina Reeves www.NinaReeves.com 1
SCHOOL AGE STUTTERING THERAPY:
Where Do We Start? PART 2
Nina Reeves, M.S. CCC-SLP BRS-FD Board Certified Specialist-Fluency Disorders www.ninareeves.comwww.stutteringtherapyresources.comFluency Specialist: Frisco ISD Fluency Specialist Consultant: San Diego Unified School DistrictCo-Owner/Director Stuttering Therapy Resources, Inc.
Housekeeping
■ Handouts for all of today’s sessions are posted on www.ninareeves.com/resources■ UNTIL March 31st!!
■ Join my mailing list at ninareeves.com/SLPSignupfor more resources
2/23/19
© Nina Reeves www.NinaReeves.com 2
Just a reminder:
■Many slides contain student work and likenesses
■ Therefore, due to HIPPA regulations, no photographs nor recordings can be made of the presentation slides.
2/23/19
© Nina Reeves www.NinaReeves.com 3
Onsite-special!■ Our entire catalog at Stuttering Therapy Resources
is 10% off for attendees during this presentation only
www.StutteringTherapyResources.com
Use Discount Code ONSITE at checkout
■ AND…enter a drawing for a free resourcefor educating teachers about stuttering
– LIKE us on Facebook (@StutteringTherapyResources)– FOLLOW us on Twitter (@StutterResource)– POST a picture on Instagram (@stutteringtherapyresources)– Post a picture, quote, or idea from the workshop
■ Remember to tag STR in your post. Every postearns you another entry in the drawing
– I will contact you by social media if you win!
■ I know that I cannot possibly present everything you want or need to know about how to start stuttering treatment for school age who stutter in the span of 3 total hours (Parts 1 and 2)
■ So, I will attempt to address the major points of foundational knowledge and skills
WHILE ■ Also providing you with resources for further
education and learning activities
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© Nina Reeves www.NinaReeves.com 4
FOUNDATIONAL KNOWLEDGE AND SKILLS
How to Start Therapy: Part 2
Foundational Knowledge/Skills (overview 1)
■ Learning about SPEECH– Explore the “speech machine” – Tuning into speech/communication of
self & others– Playing with speech (ways our voices
work) – “Catch mes” (different voices) – Tight & loose big muscles– Relaxation: What it is and what it isn’t
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© Nina Reeves www.NinaReeves.com 5
The “Speech Man” (Ramig & Bennett, 97)
■ Why are we learning this? – It is the“underlying map” for everything else we do
– Discover the process of speech
– Increase proprioceptive awareness of the “speech works”
■ What are the steps? – Develop visual “Speech Man” by playing with speech and
having child make discoveries
– Discuss each part of the speech mechanism and how it helps to create speech
Talking about Talking (Dean Williams)
■ Speech Machine and how it works (Ramig & Bennett and others)
■ “Ways our voice works” (playing with talking)
■ Tight vs loose muscles (play with speech) ■ “Catch me” games (Dell and others)
– Including“Ways Our Voice Works”
Exploration of Speech (con’t)
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© Nina Reeves www.NinaReeves.com 6
More Foundational Knowledge & Skills
■ Learning about STUTTERING -101■ What is stuttering?
– Facts/Myths – Famous people who
stutter– Types of stutters– Teaching others about
stuttering
Let’s get to know stuttering!
■ Have fun with this!
■ Facts and myths
– Dispel and learn
■ Famous people who stutter
■ Using the terminology
– The “S” word
– Types of stutters
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© Nina Reeves www.NinaReeves.com 7
Even More Foundational Knowledge & Skills■ Learning about STUTTERING -202
■ Self-Monitoring– Tight & Loose speech muscles– “Catch mes” (with stutters now)– “Speech Detective” – Stay in the moment – Freeze & release
Remember…■ The student is becoming an “expert”
(Murphy) at knowing about talking, stuttering, and communication.
■ Therefore, the student can and should be starting the process of becoming his/her own advocate
■ This can be done by having the student teach others about talking and stuttering
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Introducing Speech Handling Strategies (and why I no longer call them “tools”
Guiding Principles – NO HARD AND FAST RULESUse your knowledge of the child and your clinical judgment to make determinations!
“Techniques”: Consider the Following..1. Start with foundational knowledge and skills that the student has not learned or does not remember!
Students need to understand how speech is made. They also need to know and understand the disorder of stuttering (to the extent they can given their age, level of awareness, cognitive abilities and readiness/impact).
2. Map out the array of speech handling techniques
Not every child needs every tool (or at least not all at once), but it is imperative that they understand the breadth of the possibilities for handling speech in the long term.
3. Always integrate “types” of tools, as needed.
This means stuttering modification, fluency enhancing, and communication skill techniques are ALL a part of the process.
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© Nina Reeves www.NinaReeves.com 9
“Strategies:” Consider the Following…(cont)4. Integration takes clinical intuition and common sense True integration includes not feeling the need to do “all stuttering modification,” and then moving to “all fluency enhancing tools.” It also means that we don’t need to wait until a child has mastery of a specific skill before “weaving in” another technique. 5. Techniques are learned and explored at word/phrase levels and then introduced and practiced at increasing levels of linguistic complexity; along with increasing levels of difficulty in the child’s created situational hierarchies.
Types of Techniques: These are INTEGRATED in the process of therapy
Stuttering Modification
*For children who “stutter enough” that they could (eventually) identify a moment of stuttering as it is occurring.
*For children who are sensitive to and/or avoid stuttering
* These techniques are practiced with “fake stuttering” at first, and then practiced in real instances of stuttering, as the child increases his ability to identify his own stuttering moments.
Fluency Enhancing
*For children who don’t avoid stuttering and are not overly sensitive to stuttered moments
*Also for children who exhibit only mild stuttering behaviors and little to no struggle and/or no avoidance behaviors
Communication Skills
* Not every child will need help in this area. However, it is important to understand that enhancing communication skills such as eye contact, turn taking, initiating conversations, and handling time pressure can be helpful to children who stutter
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© Nina Reeves www.NinaReeves.com 10
FOR THOSE OF YOU LEAVING US…
Otherwise, See you after lunch forStuttering and Concomitant Issues Parts 1 and 2
Selected Resources■ Chmela & Reardon (2001). The School Age Child who Stutters: Working Effectively with Attitudes and
Emotions, Stuttering Foundation: Memphis, TN
■ Chmela, K. (2011). Focus on Fluency, Super Duper Inc: Greenville, SC.
■ Gregory, H. H., & Hill, D. (1980). Stuttering therapy for children. In Seminars in Hearing (Vol. 1, No. 04, pp. 351-362). Copyright© 1980 by Thieme Medical Publishers, Inc.
■ Guitar G. (2014) Stuttering: Basic Clinical Skills Memphis, TN: Stuttering Foundation.
■ Ramig, P. R., & Bennett, E. M. (1997). Clinical management of children: Direct management strategies. Nature and treatment of stuttering: New directions, 2.
■ Reardon-Reeves & Yaruss, 2013 School-Age Stuttering Therapy: A Practical Guide, Stuttering Therapy Resources, Inc: McKinney, TX
■ Sheehan, J. (1970). Stuttering; research and therapy. New York: Harper & Row.
■ Yaruss, J. S. (1998). Describing the consequences of disorders: Stuttering and the International Classification of Impairments, Disabilities, and Handicaps. Journal of Speech, Language, and Hearing Research, 41(2), 249-257.
■ Yaruss, J. S. (2007). Application of the ICF in fluency disorders. Seminars in Speech and Language, 28(4), 312-322. Yaruss, J. S. (2010). Evaluating and treating school-aged children who stutter. Seminars in Speech and Language,31(4), 262-271.
■ Yaruss, J. S., & Quesal, R. W. (2004). Stuttering and the International Classification of Functioning, Disability, and Health: An update. Journal of Communication Disorders, 37(1), 35-52.
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Organizations/ResourcesAmerican Speech-Language-Hearing Association
Phone: 1-800-638-8255
Website: www.asha.org
SIG 4 (Fluency and Fluency Disorders)
Specialty Board of Fluency Disorders
www.stutteringspecialists.org
National Stuttering Association (NSA)
119 W. 40th Street
14th Floor
New York, NY 10018
Email: [email protected]
Phone: 1-800-We Stutter
Website: www.westutter.org
Stutter Talk: www.stuttertalk.com
International Fluency Association: www.ifa.org
The Stuttering Home Page
www.stutteringhomepage.com
Stuttering Foundation (SFA)
P.O. Box 11749
3100 Walnut Grove Road #603
Memphis, TN 38111
Phone: 1-800-992-9392
Website: www.stutteringhelp.orgFriends
8 South Oyster Bay Rd.
Syosset, NY 11791
Phone: 866-866-8335
Website: www.friendswhostutter.org
SAY: Stuttering Association of the Young
Website: www.say.org
American Board for Fluency and Fluency Disorders
www.stutteringspecialists.org