stuttering therapy: building communicative competence

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Stuttering Therapy: Building Communicative Competence Across the Common Core

Kristin A. Chmela M.A.

CCC-SLP BCS-F

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Disclosure Statement

• Nonfinancial

-Lead/Cooperating Author; Books and Videotapes published by the Stuttering Foundation

• Financial

-Honorarium: ISHA Convention

-Text and Products: Super Duper

-Camp Shout Out; intellectual property rights

-Director of Training and Treatment Program at Camp Shout Out; Michigan; Onsite honorarium

-Chmela Fluency Center; intellectual property rights

Chmela/All RIghts Reserved/2018 3

Agenda

• Assess Communicative Competence across the Common Core

• Document IEP Goals & Objectives for 3 Cases

• Implement 3 Strategies for each of the 5 Areas of Focus of Communicative Competence


Why focus upon communicative competence?


Childhood Stuttering –Where are we and Where are we going?

–

“What causes stuttering? We are now at a point in time when the answer to this question no longer must be “we don’t know.” It is now widely accepted that stuttering is a multidimensional disorder. It is also widely accepted that stuttering is a neurodevelopmental disorder, which means that it arises during development in childhood.”


The majority of young children begin stuttering between the ages of 2-4. 75% will recover within 1 year if the onset of stuttering is prior to 3.5 years of age. The later the onset and the longer the problem persists, the less likely it will completely resolve.

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Stuttering Persistence vs. Recovery

Preschool

-1st grade

2nd-4th

grade

5th-8th

grade

1 year post onset: 63% recover2 years post onset: 47% recover3 years post onset: 16% recover 4 years post onset: 5% recover


Multifactorial Dynamic Pathways TheorySmith & Weber, 2017

➢ Fluency problems are multidimensional (non-linear, dynamic)

➢ Pathways to recovery or persistence are different for each child

9www.merriam-webster.com/dictionary/differential (emphasis added)

1dif·fer·en·tial adjective \ˌ

di-fə-ˈren(t)-shəl\

:relating to or based on a difference:

treating some people or groups differently from others

:of showing, or depending on a difference; differing or varying according to circumstances or relevant factors

Differential thinkers

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Differential thinkers consider the BIG PICTURE

Family

Environment

Executive Functioning

MotorSocial Emotional

SensoryLanguageCognitive

Child

Specific Domains of Development

General Domain of Development

Revised/Chmela & Campbell, 2014


Gathering Data (Informal and Formal)

• Communication Competency Informal Rating Scale (teachers/other school professionals)

• Information from Caregiver (caregiver/s)

• Formal/informal measures related to cognitive-affective aspects and impact of the problem

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Language & Other

Impacts of the

Problem

FluencyPattern

Reactions to the

problem

Formal & Informal Measures


➢ What is the pattern of fluency?➢ What are the relevant potential

contributing factors?

➢ What are the strengths/weaknesses of the child’s overall Communication Profile?

EBP

Focusing on Communicative Competence

➢ The mindset of an Evolving Communicator

➢ 5 Areas of Focus

Considers the integration of familiar approaches (Fluency Shaping & Stuttering Modification) and adaptations of “third-generation behavioral and cognitive therapies”

(Hayes, 2004)

-Cognitive Behavioral Therapy

-Acceptance Commitment Therapy

-Mindfulness

Chmela/All RIghts Reserved/201815


Evolving Communicator Mindset

Key Concept #1:

Communicative Success is defined in multiple ways and is within reach for all of us.

-Considers “The Big Picture” (the ongoing Differential

Evaluation-Differential Treatment Processes)

-Willingness to keep learning and growing


Key Concept #2

Communicative Competency is not perfect for anyone. ("The Concept of Communicative Competence." Handbook Of Communication Competence, ed. by G. Rickheit and H. Strohner. Walter de Gruyter, 2010)

-A historical topic

-3 part definition

-Accounts for relevance, variability, & motivation




Key Concept #3:

Communicative abilities thread through most of what matters to us.

-Linking what we do (actions) to what matters to us

(our values)

-Helps us to identify behaviors that may no longer be

helpful to us

-Fosters healthier communicative attitudes-

behaviors

5 Areas of Focus of

Communicative Competence

Adapted further by Chmela, 2018; three/five elements defined originally by Chmela, expanded

by Chmela & Campbell, 2014; further expanded by Chmela, Campbell, Eldridge,& Raynor throughout

Camp Shout Out collaborationAll Rights Reserved


Attentive: Am I aware of what is going on around me? Am I aware of my thoughts? My emotions? What my physical body is telling me? Am I aware of listeners’ expressions and body language? Am I tolerant of waiting? Do I know what I do when talking is harder? Do I notice when it is easier? Do I hear it, feel it?


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➢ “Speaking is difficult” perception of CWS differentiates CWS-CWNS (Clark et al., 2012)

➢ CWS notice stuttering more; increases with age (Ambrose & Yairi, 1994)

➢ Compared to normally fluent peers, school-age childrenviewed as less popular, and are more likely to be rejected and bullied (Davis, Howell, & Cooke, 2002; Langevin et al.,1998, 2003; Stewart & Turnbull, 2007; Blood et al., 2010)

➢ Increased sensitivity and high self expectations (Riley & Riley, 2000)


➢Negative thoughts and feelings regarding their communication difficulties (Andrews & Cutler, 1974; De Nil & Brutten, 1991)

➢Negative emotional reactions and avoidance of speaking situations (Yaruss & Quesal, 2010; Vanryckeghem et al., 2001; Stewart & Turnbull, 2007)

➢ Cognitive Behavioral Therapy (Beck, 1995) has been reported in the literature (Zebrowski & Wolf, 2011) as a means to assist school-age children in developing healthier attitudes and feelings regarding communication

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➢Research on Temperament:

Preschool children have been found to have:

• Higher activity levels (e.g., Eggers et al., 2010; Embrechtset al., 2000)

• Negative affect (e.g., Eggers et al., 2010)

• Less adaptability to change (e.g., Anderson et al., 2003; Jones et al., 2014)

• Less able to flexibly control their attention/shift attention (e.g., Karass et al., 2006; Jones et al., 2014)

• Lower inhibitory control (e.g., Eggers et al., 2010)

• Less able to self-regulate emotions (Jones et al., 2014)

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➢More reactive to environmental stimuli and less likely to quickly habituate (regulate) to the stimuli (Schwenk et al., 2007)

➢More extreme high than extreme low behavioral inhibition(Choi et al., 2013); correlates with more stuttering

➢Emotional regulation strategies during prior non-speech tasks are predictive of stuttering during subsequent speaking tasks (Arnold et al., 2011; Johnson et al., 2010; Ntourou et al., 2013)

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➢Mindfulness Skills -Have the “potential to enhance children’s…” -attention and focus, memory, self-acceptance, self-management skills, & self-understanding (Hooker & Fodor, 2008; Burke, 2009)

-Useful for treating anxiety symptoms in school-age children (Goodman, 2005; Greco et al., 2005; Semple, Reid, & Miller, 2005)

-Some evidence supports the impact of mindfulness on quality of attention (Rani & Rao, 1996; Semple, 2005)

-Increases self-esteem and self-compassion (Saltzman, 2016)

Assertive: Do I talk if I want to? Do I talk enough? Do I talk for myself? Do I self-advocate around communication if need be? Am I the first to introduce myself to someone new? Is the language I am using, voice tone and loudness appropriate for the situation?


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➢Many CWS can talk about their talking abilities and themselves as talkers (Clark et al., 2012; Vanryckeghem et al., 2005; Vanryckeghem & Brutten, 2007)

➢Compared to normally fluent peers, school-age children viewed as less popular, and are more likely to be rejected and bullied (Davis, Howell, & Cooke, 2002; Langevin et al.,1998, 2003; Stewart & Turnbull, 2007; Blood et al., , 2010)

➢Negative emotional reactions and avoidance of speaking situations (Yaruss & Quesal, 2010; Vanryckeghem et al., 2001; Stewart & Turnbull, 2007)

➢ Langevin, Narasimha & Prasad (2012): positive benefits regarding a stuttering education and bullying awareness and prevention program for school-age children in Grades 3 through 6

Confident: Do I have a strong body core? Do I sit with dignity? Stand like a majestic mountain? Do I connect with my eyes while communicating? Do I have a firm handshake and make a connection with my eyes when introducing myself? Is my voice from the start to the end of a phrase powerful? Do I feel a sense of ease in the pause?


(The next finger)


➢Compared to normally fluent peers, school-age children viewed as less popular, and are more likely to be rejected and bullied (Davis, Howell, & Cooke, 2002; Langevin et al.,1998, 2003; Stewart & Turnbull, 2007; Blood et.al, 2010)

➢Negative thoughts and feelings regarding their communication difficulties (Andrews & Cutler, 1974; De Nil & Brutten, 1991)

Effective: Do I communicate moving towards instead of away from the movement of talking? Can I create greater ease? Are my sentences complete? Is my message organized and clear? Does the manner of my speaking allow the listener to focus upon my message?



➢Bothe, A. K., Davidow, J. H., Bramlett, R. E, & Ingham, R. J. (2006):

-Regulated breathing and airflow (de Kinkelder & Boelens,1998; Ladouceur & Martineau,1982)

-Form of stuttering modification (Ryan & Ryan, 1983)

➢ Ratner (2010) evidence review-prolonged speech (fluency shaping); GILCU (Gradual Length and Complexity of Utterances, preferably with parents and with either a DAF device or an EMG device (Ryan & Ryan, 1983, 1995)


➢(Boey, 2008)Language may be delayed typical, or advanced; comparing language as normal CWS to CWNS: -syntactic, semantic and phonological processes develop slower than those of CWNS

➢Donaher (2014) CWS with ADHD (4-26%)

➢Alm & Risberg, (2007) adults who stutter noted

history as children; much higher then the general population

Proactive: Do I know how to set myself up for success as a communicator ? Who is on my team? Do they knowhow to help me? Do I knowwhat my goals are? Do I knowhow to ask for feedback?Am I working on self-feedback? Do I do Core Practices?



➢CWS feel less close to their parents and trust them less than CWNS and were frustrated by how parents managed their stuttering (Bielby, 2014)

➢Reinforcement from other (s) impacts tx success (Harrison, Bruce, Shenker, & Koushik, 2010; and Koushik et al., 2009; Rousseau, Packman & Onslow, 2005; Koushik & Shenker, 2005 Lincoln, Onslow, Lewis & Wilson, 1996; Rousseau, Packman & Onslow, 2005; Ingham, 1980; Ryan & Ryan, 1983)

➢Systematic transfer of fluency across settings is part of evidenced-based practice for this population (Shenker, 2005; Andrews et al, 1980; 1983; Cordes, 1998; Thomas & Howell, 2001)


Informal Rating ScaleCOMMUNICATION COMPETENCE WITHIN EDUCATIONAL ENVIRONMENT p. 1

Date:Name of Student:Name of Teacher/Person Completing Form:

Please provide your observations utilizing the following informal rating scale regarding this student’s communication skills within his/her educational environment. Please feel free to comment after any item if you have more information to share.

Across grade-level standards for speaking and listening in your classroom, how often do you observe this student:

1=never 2=seldom 3=less than peers 4=comparable to peers 5=exceeding peers

Communicating in your classroom ________

Speaking with you one-on-one ________

Approaching communication with peers/adults ____/___

Volunteering speak in small group ________

Volunteering to speak in front of the entire class ________

Sharing ideas of various lengths in front of the entire class ________

Comments:


Informal Rating Scale p.2Based upon how frequently this student communicates, how often do you observe this student:

1=never 2=seldom 3=less than peers 4=comparable to peers 5=exceeding peers

Interrupt others _________

Appear lost or respond with “I don’t know” when called upon _________

Revise ideas or having difficulty explaining things _________

Demonstrate interjections (“uhm, uh, like,” “so,” or “you know”) _________

Repeat entire words or phrases while speaking _________

Repeat sounds or syllables of a word _________

Begin a sound with a block, or effort to produce it _________

Prolong a sound _________

Appear to begin to say a word and then switching it for another the word ________

Speak in a way that impacts his/her intelligibility (clarity) of speech ________

Lose eye contact when communicating ________

Take a noticeable length of time to communicate ________

Talk with you about his/her communication skills ________

Use lack of eye contact with you-others ________

Use a voice volume hard to hear by others ________


Communicative Competency

Writing Goals & Objectives

In what circumstances (frequency-manner or both) is this problem impacting the child the most right now in school?




What areas of Focus related to Communicative Competency can assist this child in making a positive change across those identified circumstances?

Case #1:

• S. is female; 5th grade; age 11-9 was adopted from a Chinese

orphanage at age 9 months; lives with her parents; all speak

only English; there are no siblings

• No information available regarding birth history; S. received OT,

PT, and speech-language services upon arrival home for slight

developmental delays until the age of 4

• Onset of Stuttering: age 3 when language development

increased; regained normal fluency after 4 months

• Age 5 stuttering re-emerged; parents noticed decrease in

verbalization overall with refusal to speak in certain social

situations; pediatrician informed parents she would “outgrow

the problem.”


• Academic performance is strong; comfortable with a few

select peers who share similar interests; Teachers reported

no stuttering in school until now

• S. attended full time day care prior to school and now attends

an afterschool program until 5:00pm daily

• Parents ask her to slow down and try to say the word again if

she stutters; parents report stuttering frequency and severity

has increased to a moderate to severe level both at home

and at school

• S. approached her mother and asked for help with her speech


• Test of Childhood Stuttering revealed severe stuttering; loss of

eye contact frequently noted; simple, short responses were

utilized whenever possible; some bilabial lip tension and

prolongations of up to 8-10 seconds; stuttering frequency noted

similar across all tasks of the TOCS

• Articulation-voice within normal limits

• Executive Functioning: No concerns reported in this area

• Social-Emotional: Has small group of friends; appears highly

anxious to parents about performance in golf, school, life in

general; parents feel she is less mature than her peers


• Language: PPVT-4: 127 SS; EVT-2: 105 SS;

• CELF-5 All subtests and scores within the high average range,

except for Semantic Relationships (Scaled Score 8)

• Cognitive: OASES-S revealed a Moderate Impact of the

disorder; S. reported avoidance of speaking situations,

including talking with a teacher if she needed help with a

problem, talking to unfamiliar peers, and talking with adults

of authority; S. expressed great concerns regarding

upcoming presentations in her class; Academic performance

was above average; no concerns regarding her grades


Teacher Rating Form

• S. seldom communicated in classroom and spoke to

teacher one-on-one; never volunteered to speak in front of

class; volunteered to speak in small group less than peers

• S. appeares lost when called upon, demonstrated

interjections, prolonging sounds, and blocking exceeding

peers; used low voice volume exceeding peers

CCSS.ELA-LITERACY.SL.5.1Engage effectively in a range of collaborative discussions (one-on-one, in groups, and teacher-led) with diverse partners on grade 5 topics and texts, building on others' ideas and expressing their own clearly.


Long Term Goal:

By (one year), (S.) will work on making progress towards (becoming more assertive as a communicator) as measured by (speaking one-on-one with teacher and during large group discussions 3-5) with no prompt or cue.

How will we get there?

Case #2

Family & Environment

N. is a male, age 7-10; lives with his 2 biological, monolingual

English-speaking parents and sister age 4; highly verbal sibling

with lots of interrupting reported; family has “hurried

communication pattern” and reports stress during transitions;;

familial reactions to stuttering include saying “it’s O.K. to pause

and take your time.” Excitement and language formulation noted

to increase stuttering.

Birth, Developmental, and Medical; Other:

Born prematurely by C-section at 25 weeks at 1 pound, 15

ounces; hospitalization for three months after birth; breathing and

feeding problems were indicated; required intubation for a period

of approximately 2 months, and re-intubation was necessary

multiple times during that time period; good health at present;

normal hearing and vision; allergies medicated; exercise induced

asthma45

.

Speech and language delayed; short sentences emerging at 3

years;

Saw psychologist from ages 5-6 for behavior issues like “fast

listening and dealing with transitions; very sensitive temperament;

difficulty letting go of bad experiences; cries often; mom noted his

reactions (positive or negative) are very intense; voice appears

hoarse

N. had physical therapy through early intervention; early OT; oral

motor and articulation within normal limits

Onset of Stuttering: 7 years, 3 months

Teacher notes consistent stuttering in the classroom, although

N. continues to participate; lots of distractibility noted in the

classroom; more stuttering in school when explaining something

more complex; increased difficulty when asking teacher

questions in front of the large group; greatly reduced

participation in small reading group 46

Family History: Mother has a brief memory of stuttering when

very young; maternal side history of anxiety and depression

Motor: Moderate stuttering (TOCS); mostly PWR and whole word

reps; some prolongations at beginning of utterances;

Executive Functioning: Parents note shifting attention away

from something is difficult; hyper-focusing once the task has

begun; difficulty following systematic rules or routines; becoming

easily distracted “from things he does not want to do”

Social-Emotional: Interacts well with his peers at school,

church, and choir, as well as with baby sitter and on play dates;

some comments made on the playground about his talking;

teacher noted he is “more emotional” than his peers; reaction from

him to his increased stuttering has been very sensitive; he wants

to know why he can’t talk very well

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Sensory: OT early on; constant movement during evaluation;

mom notes he does gymnastics 3 times per week

Language: Mom concerned with receptive language, particularly

with following directions, writing that he “understands but doesn’t

always follow directions quickly.”PPVT-4: 107 SS; EVT-2: 105 SS;

TNL: Narrative Language Ability Index-84; CELF-5 overall

average range with no significant discrepancies



What factors in this case catch your attention?

What areas of Communicative Competence might you focus upon?

What situations would be relevant to consider within the educational environment?

Case #3

L. (8th grader) transferred to his present school from another

state; he resides with his bilingual parents who speak English

and Polish; he is proficient both receptively and expressively in

both languages for spoken as well as written modalities;

• 2 older female siblings (16,17); very verbal household; frequent

family gatherings with multiple attendees; interrupting and face-

paced speaking noted at gatherings; mother reports they don’t

talk about stuttering with L., although have attended the school

IEP meetings

• Parents feel he has not transitioned easily to his new school ;

concerned about his behavior (lack of follow through), although

they noted this was typical at his previous school as well


• Normal pregnancy and delivery, although jaundice at birth;

milestones were achieved within normal limits; No medical

concerns reported; no medications

• L. was diagnosed with ADHD at age 8, although parents are not

sure it was an “accurate diagnosis” because L. could “choose to

focus if he wanted to do so.” No treatment for the ADHD was

initiated.

• Onset of Stuttering: Age 3; has attended therapy ever since;

parents feel progress was made in grammar school, although

since the 7th grade L.’s stuttering has persisted at a more

intense level

• Parents feel stuttering is most prevalent when L. tries to explain

something complex; they feel he is bright although they are

worried about his ability to get along with peers, noting his

spends most of his free time alone playing video games;

teachers are concerned about his attention in the classroom51

• Family History: Stuttering reported and has persisted for

father, paternal grandfather, and maternal aunt

• Motor: The SSI-4 indicated mild stuttering, including infrequent

subtle blocking; during conversation, multiple interjections and

revisions were noted; stuttering reported at home by parents

within the moderate range

• Executive Functioning: Parents note L. has difficulty

managing his time; often completes assignments late or forgets

to turn them in after he finishes them; his belongings are

disorganized and he loses things frequently; parents feel he

does not always “think before he speaks” and often says things

that are not appropriate

• Social-Emotional: When asked about talking, L. indicated he

did not want to talk about it and that “all was fine with his

speech; When asked to complete the OASES-T, L. requested to

not fill it out52

• No previous OT reported; parents note L. is very inactive and

spends most of his free time (at least 2 hours in the evening

and weekend days) playing video games

Language: PPVT-4: 115; EVT-2 110;

CELF-5 Core Language 110; no discrepancies across subtests

noted

Cognitive: Cognitive ability average; strength in math noted;

academics impacted by lack of follow through regarding

assignments; some teachers feel he is “holding back” in

classes from participating orally; they note he often talks in

class when he is not suppose to and at times can be a bit

“disrespectful” to authority figures; weak participation in his

foreign language class is impacting his grade negatively;; his

English teacher noted she does not call on him to read

because it is “painful to listen to him try to get the words out”53


Teacher Rating Form

• L. was reported to speak “less than peers” in the classroom;

English and Foreign Language teachers noted seldom

volunteering to speak in front of whole class

• L. noted as “exceeding peers” across the following:

Interrupt others, Appear lost or respond with “I don’t know” when called upon, blocking, revising, and speaking in a way that impacts hisintelligibility (clarity) of speech




In what circumstances (frequency-manner or both) is this problem impacting the child the most right now in school?




What areas of Focus related to Communicative Competency can assist this child in making a positive change across those identified circumstances?




What type of data collection can I use to show progress? Who can I involve?

Attentive: Am I aware of what is going on around me? Am I aware of my thoughts? My emotions? What my physical body is telling me? Am I aware of listeners’ expressions and body language? Am I tolerant of waiting? Do I know what I do when talking is harder? Do I notice when it is easier? Do I hear it, feel it?



Attentive

Regulation-Communication (Zones of Regulation; L. Kuypers)

Breath Awareness

Executive Functioning Strategies (Ward, S.)

Assertive: Do I talk if I want to? Do I talk enough? Do I talk for myself? Do I self-advocate around communication if need be? Am I the first to introduce myself to someone new? Is the language I am using, voice tone and loudness appropriate for the situation?



Assertive

Talking regardless of fluency/stuttering with whomever you wish

Creating-holding space for oneself

Educating others about fluency and stuttering

Confident: Do I have a strong body core? Do I sit with dignity? Stand like a majestic mountain? Do I connect with my eyes while communicating? Do I have a firm handshake and make a connection with my eyes when introducing myself? Is my voice from the start to the end of a phrase powerful? Do I feel a sense of ease in the pause?


(The next finger)


Confident

Core seated & standing postures

Handshake

Volume-power of voice

Natural Eye Contact

Effective: Do I communicate moving towards instead of away from the movement of talking? Can I create greater ease? Are my sentences complete? Is my message organized and clear? Does the manner of my speaking allow the listener to focus upon my message?



Effective

Turning the Question around (TTQA)Changing communicative intentUsing an Easier Relaxed Approach and Phrasing Using voluntary, easier stuttering modificationsUsing “self-adjustments” prior to, during, or after

speaking

Proactive: Do I know how to set myself up for success as a communicator ? Who is on my team? Do they knowhow to help me? Do I knowwhat my goals are? Do I knowhow to ask for feedback?Am I working on self-feedback? Do I do Core Practices?



Proactive

Core Daily Practices

Creating Hierarchies of Guided Practice

Developing & Utilizing Feedback Rating Charts


Guided Practice Action Form

Student:

What is the speaking situation you want to focus upon?

While in this situation, I am going to: (What are the actions you are going to do during this speaking challenge?)

Feedback: Give yourself feedback, and choose 1-2 others to give you feedback.

Rating Scale 1------------------2-----------------3-------------------4------------------5

Rate these Actions Who-Rating-Comments

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http://www.mnsu.edu/comdis/isad9/papers/chmela9.html


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• Murphy, W., Yaruss, J.S., & Quesal, R. (2007). Enhancing treatment for school-age children who stutter through role-play and self-disclosure, Journal of Fluency Disorders, Vol. 32, Number 2, 2007.

• Onslow,M., Packman, A. & Harrison, E. (2003). The Lidcombe Program of early stuttering intervention: A clinician’s guide. Austin, TX: Pro-Ed.

• Ramig,P.R. & Dodge, D.M. (2005). The child and adolescent stuttering treatment and activity resource guide, 2nd Ed., Clifton Park, NY: Thomson Delmar Learning.

• Reardon, N.A. & Yaruss, J.S. (2004). The source for stuttering: ages 7-18. Moline, Illinois: Linguisystems, Inc.


• Riley, G: SSI 4: Stuttering Severity Instrument, 4th Edition; www.pearsonassessments.com

• Riley G., & Riley, J. (2000). A revised component model for diagnosing and treating children who stutter, Contemporary Issues in Communication Science and Disorders, 27, 188-199.

• Ryan, B. P. (1974). Programmed therapy for children and adults. Springfield, IL: Charles C. Thomas.

• Scott, L.A. (2009). Decoding IDEA eligibility for children who stutter, an instructional DVD produced by Stuttering Foundation of America. Memphis, TN.

• Sisskin,V. (2002). Therapy planning for school-age children who stutter, Seminars in Speech and Language, 23, 173-179.

• Smith, A. (1999). Stuttering: A unified approach to a multifactorial, dynamic disorder. In N.B. Ratner & E. C. Healey (Eds.),Stuttering research and practice: Bridging the gap (pp. 27-44). Mahwah, NJ: Lawrence Erlbam.

• St. Louis, K., Myers, F., Bakker, K., & Raphael, L. (2007). Understanding and treating cluttering, In E. G. Conture & R. F. Curlee(Eds.), Stuttering and related disorders of fluency (3rd ed., p. 297-325). New York: Thieme.

• Tilly III, W.D. (2008). The evolution of school psychology to science-based practice: Problem solving and the three-tiered model. In A. Thomas & J. Grimes (Eds.), Best practices in school psychology IV (pp. 17-36). Bethesda, MD: National Association of School Psychologists.

• Van Riper,C. (1982). The nature of stuttering (2nd ed.), Englewood Cliffs, NJ: Prentice- Hall.

• Vanryckeghem, M. & Brutten, G. (1997). The speech associated attitude of stuttering and non-stuttering children and the differential effect of age. American Journal of Speech-Language Pathology, 6, pp. 67-73.

• Vanryckeghem, M. & Brutten, G. (2007). The KiddyCAT: Communication attitude test for preschool and kindergarten children who stutter. San Diego, CA: Plural Publishing, Inc. ISBN 10: 1-59756-117-7 ISBN13: 978-1-59756-117-4

• Whitmire, K. & Scott, L.A. (2007, July). IDEA 2004 and speech-language services: Key issues for children who stutter. ASHA Division 4 Leadership Conference, Minneapolis, MN.

• Whitmire, K. & Reardon-Reeves, N. (2006, November). Meeting the Challenges of Stuttering: Writing IEP goals for school age children. ASHA National Convention, Miami Beach, FL.

• Yaruss, J.S., Coleman,C.E., & Quesal, R.W. (2010). OASES for school-age children and teens. Minneapolis, MN: Pearson.

• Yaruss, J. S., & Pelczarski, K. Evidence-Based Practice for School-Age Stuttering: Balancing Existing Research with Clinical Practice, EBP Briefs, 2(4), pp. 1-8.

• Yaruss, J.S., & Quesal, R.W. (2004). Stuttering and the International Classification of Functioning, Disability, and Health (ICF): An update. Journal of Communication Disorders, 37, 35–52.

Board Certified Specialists in Fluency Disorders: www.stutteringspecialists.org

Stuttering Foundation: www.stutteringhelp.org 1-800-992-9392; resources, education, research

friendswhostutter.org Friends: (support group for school-age children-teens and families) conventions & workshops; support; volunteer opportunity for speech and language pathologists

westutter.org – National Stuttering Association conventions & workshops, support; volunteer opportunity for speech-language pathologists

Stutteringhomepage.com – resources and International On-Line conference-section available for school clinicians

The MindUP Curriculum: Brain-focused Strategies for Living & Learning by The Hawn Foundation


http://www.stutteringhelp.org

stuttering therapy: building communicative competence

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