We have 2 reviews for you this week!
The first article review is brought to you by Katie Cohen, SLP at Maupin and Roosevelt-Perry Elementary schools:
Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Stuttering in School-Age Children: A Comprehensive Approach to Treatment. Lang Speech Hear Serv Sch, 43(4), 536-548.
This article is a response to an article written and published by the editor of LSHSS, Dr. Marilyn Nippold that included the following scenario:
A young SLP contacts a former professor to request help with a student, Ben, for whom she is assessing and developing a treatment plan. The former professor responds to the SLP stating there is a need for more research on treatments that specifically decrease the frequency count of stuttering events for the pediatric population.
· I have an issue with this: The former professor should have suggested another resource, maybe a colleague or practicing SLP from whom this SLP could have gotten some help on creating a treatment plan for Ben rather than broadly stating that we need more research.
In her article, Dr. Nippold formally calls for more research on treatments that decrease the frequency of stuttering.
This article responds to Dr. Nippold directly using three themes.
Theme 1. Agreement with Dr. Nippold’s call for more research.
Very straightforward. I agree we do need more research on techniques to improve speech fluency.
Theme 2. Overview of recent literature including strategies to improve speech fluency, as well as, increase acceptance and decrease negative consequences.
Suppose an SLP solely focuses on decreasing the frequency count. If students avoid certain words and respond in very short utterances, they will likely exhibit a decreased frequency count. However, this can occur with increased anxiety, fear, and lack of acceptance. On the other hand, acceptance can “lead to reduced stuttering severity, increased fluency, and improved communication.” Acceptance is an integral part of the therapy process and includes concepts that are also central to mindfulness, acceptance and commitment therapy, as well as, cognitive behavioral therapy.
Stuttering is a multi-dimensional disorder; therefore, there is not one specific treatment type to help our students with fluency impairments.
Theme 3. Several strategies to minimize the adverse academic impact of stuttering on the school age population.
The authors’ strive to make suggestions that are “consistent with common clinical practice” and “reflective of real life experiences”. Here are two long-term objectives (LTO) with short-term objectives (STO) the author’s provide.
LTO1: Ben will experience a decrease in bullying.
STO1.1: Ben will talk with the SLP about what is going on in the classroom.
STO2.1: Ben will participate in a fluency group with other students who have a fluency impairment. –Ben will gain acceptance, identify a role model, and practice self-expression in a safe environment.
STO3.1: Ben will invite a close friend/ classmate to attend a speech therapy session with him at which Ben (with the SLP) will educate the peer about stuttering.
STO4.1: Ben will create and give a presentation to his class in order to teach about stuttering.
LTO2: Ben will be able to answer questions when called upon.
STO1.2: Ben will raise his hand to participate in class at least once each day. – Ben has a sense of control over when he speaks, which decreases the anxiety, however, he is still answering a question.
STO2.2: Ben will answer questions out-loud on prearranges topics of his choice that he is most comfortable with. – This will improve his participation in the classroom, as well as, build confidence.
Comprehensive assessment: When evaluating (or in some cases re-evaluating) a student with fluency of speech needs, it is imperative to look closer at the whole picture in order to develop a treatment plan more tailored to the individual student’s needs. Factors that should not be overlooked include:
· classroom participation via observation and teacher (or instructional assistant) interview
· emotions via observation and interview (parent, teacher, self, etc.)
· fluency count via direct measure of speech sample
· avoidance behaviors via observations and interviews (parent, teacher, self, etc.)
In summary, this article claims that SLPs, when working with school-aged students with fluency impairments, should focus on decreasing the frequency count in addition to -rather than instead of- acceptance.