Clinical Decision Making in Fluency Disorders

by Manning, Walter H.

• ISBN13: 9780769301167
• ISBN10: 0769301169
• Edition: 2nd
• Format: Paperback
• Copyright: 2000-11-07
• Publisher: Cengage Learning

Summary

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

Table of Contents

Preface
Acknowledgments
Clinician Characteristics	1	(34)
Introduction	1	(2)
The Importance of the Clinician	3	(9)
Clinician Attitudes About Stuttering and People Who Stutter	4	(5)
Specialty Recognition in Fluency Disorders	9	(1)
Educational Activities	10	(1)
Guided Practice	10	(1)
How Clinicians Interpret the Disorder	11	(1)
Clinician Personality Attributes	12	(3)
Clinicina Intervention Skills	15	(9)
Becoming Less Inhibited as a Clinician	15	(2)
Avoiding Dogmatic Decisions	17	(1)
Opening Your Treatment Focus	18	(1)
Calibrating to the Client	19	(2)
Using Silence	21	(1)
Modeling Risk Taking	21	(1)
Challenging the Client	22	(2)
Humor and the Clinician	24	(4)
A Historical Perspective	24	(2)
What's So Funny?	26	(1)
Humor in Psychotherapy	27	(1)
Using Humor in Treatment	28	(5)
The Conceptual Shift	29	(1)
Distancing With Humor	30	(2)
Mastery and Humor	32	(1)
Conclusion	33	(1)
Study Questions	34	(1)
Recommended Readings	34	(1)
Theories of Etiology	35	(52)
Introduction	35	(3)
Attempts to Define Stuttering and Related Terms	38	(8)
Some Definitions of Stuttering	39	(7)
Theories of Etiology---A Historical Perspective	46	(22)
Stuttering From a Physiological Perspective	48	(2)
Theories of Cerebral Dominance	50	(4)
Evidence from Neuroimaging Techniques	54	(7)
Temporal-Processing Abilities	61	(1)
Genetic Influences	62	(2)
Auditory Feedback	64	(2)
The Covert Repair Hypothesis	66	(2)
Stuttering as an Emotional or Psychological Problem	68	(2)
Stuttering as Learned Behavior	70	(6)
Multifactorial Models	76	(7)
The Demands and Capacities Model	77	(3)
The Multifactorial-Dynamic Model	80	(3)
A Neurophysiological Model	83	(1)
A Summary of Models	83	(1)
Conclusion	84	(1)
Study Questions	85	(1)
Recommended Readings	85	(2)
Characteristics of Stuttering Onset and Development	87	(26)
Introduction	87	(1)
Stereotypes of Stuttering and People Who Stutter	88	(1)
Characteristics of Normal Fluency	89	(4)
When Is It Stuttering?	93	(2)
The Features on the Surface	95	(1)
Distinguishing Normal and Abnormal Surface Features	96	(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