1. General Treatment Approaches to Change Speech/Stuttering Behaviors
Stephen M. Tasko

2. Broad Frameworks for Intervention: “Alphabet Soup”
ABC Principle (Various)
A (affective)
B (behavioral)
C (cognitive)
CALMS Model (Healey)
C (cognitive)
A (affective)
L (linguistic)
M (motor)
S (social)
Stephen M. Tasko

3. Stephen M. Tasko

4. CALMS Profile
Stephen M. Tasko

5. Traditional Dimensions of Stuttering Therapy
Establishment of techniques/fluency
Transfer of techniques/fluency
Maintenance of techniques/fluency
Stephen M. Tasko

6. Behavioral Approaches to Stuttering Therapy
Stuttering Modification (stutter more fluently)
vs.
Fluency Shaping (speak more fluently)
Stephen M. Tasko

7. Stuttering Modification
General therapeutic goals:
is not fluency
is easy stuttering
focuses on making changes to the stuttering behaviors themselves
Addressing fear and avoidance is an integral part of the behavioral changes
Stephen M. Tasko

8. Stuttering Modification
Theoretical underpinnings:
More closely allied an anticipatory struggle viewpoint of stuttering
However, is not inconsistent with other perspectives
Stephen M. Tasko

9. Fluency Shaping General therapeutic goals: is to speak fluently
Stuttering behaviors are not directly addressed
Improved fluency is achieved by
Reinforcing “natural” fluency in a highly structured response contingent program
Systematically building a new pattern of speech production that is gradually “normalized”
Addressing fear and avoidance behaviors is not integral to the actual fluency shaping procedures, but are often part of an overall program.
Stephen M. Tasko

10. Fluency Shaping Theoretical underpinnings:
Speech/stuttering is a behavior under operant control
Stuttering is a speech motor control problem that is best controlled by
Using a more motorically stable form of speaking
re-coordinating the speech motor subsystems (i.e. respiration, phonation, articulation)
Stephen M. Tasko

11. Stuttering Modification
How to change stuttering
Stephen M. Tasko

12. Stuttering Modification
Highly interactive and client specific
Focus on mastery and control of stuttering
Heavy focus on proprioception
Establishment and transfer are intermingled
Typically makes use of voluntary stuttering
Stephen M. Tasko

13. Stuttering Modification
Role of voluntary stuttering
Helps reduce fear and avoidance
Helps reinforce a sense that the PWS has voluntary control over fluent and stuttered speech
Provides a context for practice of techniques
Stephen M. Tasko

14. Stuttering Modification
Therapeutic approaches
Post-block* modification (cancellation)
Within-block modification (pull-out)
Pre-block modification (altering preparatory set)
*In this context a block refers to any stuttering moment
Stephen M. Tasko

15. Cancellation What is a cancellation? A ‘do-over’ of a stuttered word
The ‘do-over’ word is then produced in an easy, tension-free, continuous manner
Stephen M. Tasko

16. Cancellation: Variant 1
Sequence: When stuttering has occurred
Complete the moment of stuttering.
STOP. DO NOT proceed to the next word
Pause (2-3 seconds)
Pantomime the stuttering moment*
Silently repeat the word in a highly conscious manner*
Whisper the word*
Repeat the word loudly, slowly with a high degree of control
*variations abound regarding which of these include
Stephen M. Tasko

17. Cancellation: Variant 2
Sequence: When stuttering has occurred
Complete the moment of stuttering.
STOP. DO NOT proceed to the next word
Pause (2-3 seconds)
Replicate the stuttering block as realistically as possible but with ease and lack of tension.
Repeat the word loudly, slowly with a high degree of control
Stephen M. Tasko

18. Cancellation Goals of the Cancellation (according to Van Riper)
Confront the disfluency (don’t run away from it)
Practice for “fluent or easy stuttering” or pull-out behavior
Desensitization: reduce emotional panic and struggle
“Punishment” for stuttering
*Many clinicians advocate only using the cancellation within the clinical setting
Stephen M. Tasko

19. The Pull-Out What is a pull-out?
A gradual shift out of the stuttering block toward fluency
Conditions that typically necessitate a pull-out
Excessive air pressure or lack of airflow
Lack of movement
Tight adductor laryngeal tension
Inappropriate articulator posturing
These motoric parameters must be altered to pull out of the block
Stephen M. Tasko

20. The Pull-Out Typical pull-out sequence:
Stop (“freeze”) while in the block
Reduce inappropriate tension levels
Initiate air
Initiate voice
Initiate gradual movement
Stephen M. Tasko

21. Altering Preparatory Set
What is a “preparatory set”?
Van Riper’s term for what happens to a PWSjust prior to uttering a difficult word
Components of a PWS’ preparatory set
Elevates muscle tension
Says first sound with a fixed articulatory posture (isolating first sound from the rest of the word)
“Preforming” the first sound well ahead of uttering it
Stephen M. Tasko

22. Altering Preparatory Set
Replacing the “old” preparatory set with a “new” preparatory set relies upon good ability to anticipate problem
PWS may have difficulty with anticipation, particularly early in therapy
What is the “new” preparatory set?
Articulators are in a state of rest (lack of tension)
Initiate continuous movement from initial to following sound
Immediately initiate airflow and sound
Stephen M. Tasko

23. Fluency Shaping
How to become fluent
Stephen M. Tasko

24. Fluency Shaping Some common features of fluency shaping approaches
Uses a strict hierarchy of task difficulty
E.g. words – phrases – sentences – connected speech
Total fluency is required before changing task difficulty (highly behavioral)
Practice, practice, practice
Focus on mastery of fluency
Due to clear objective (total fluency), such treatment design lends itself to objective measurement
Stephen M. Tasko

25. Fluency Shaping
Natural fluency can be used in a highly structured response contingent (positive reinforcement) environment
Fluency reinforced without discussion of how to speak
Progress to next level contingent upon meeting strict fluency criterion
If client “stalls” at a level, then specific strategies may be introduced
Use of natural fluency more common with young children
Stephen M. Tasko

26. Fluency Shaping
More commonly, fluency shaping targets are introduced and integrated into the speech patterns of the client
Client moves through hierarchy of task difficulty as well as individual target “degree”
Establishment and transfer are often separated more in time
Stephen M. Tasko

27. Common Fluency Shaping Targets
Phonatory-based targets
Easy voice onset
Continuous voicing
Respiration-based targets
Full breath
Abdominal breathing
Pre-phonatory airflow
Continuous airflow
Stephen M. Tasko

28. Common Fluency Shaping Targets
Articulation-based targets
Easy/soft/light articulatory contact
Full articulatory movements (proprioception)
Higher-order targets
Modified rate
Rhythmic speaking
Phrasing and pausing
Blending
Stephen M. Tasko