ACQ Vol 12 No 2 2010

worth investigating with the parent the personal interests of each child so as to ensure compliance during treatment. Problem 2 Rewards do not motivate the child to participate in treatment. Possible solution More often than not, reward systems are abandoned prematurely for being ineffective. However, with a tailored system that is relevant to the individual child, rewards can be a powerful treatment tool. Generally, children tend to express lack of interest toward a particular system when the reward is either repetitive, or delivered in an inconsistent manner. It thus may be necessary for the parent to vary the form of reward used along with the way in which it is delivered, until an effective system is achieved. It is important for SPs to support the parent in developing reward systems that are both motivating for the child and practical for the parent to deliver. If a particular system is not feasible, or not suited to the child, its components are less likely to be followed through. Such inconsistency will only lead the child’s lack of interest and non-compliance. Problem 3 The child is overly talkative during the treatment session. Possible solution In the Lidcombe Program it may be necessary for the parent to limit the child’s speech output in order to establish fluency. Contingencies will not be effective if the child does not hear them, which can happen when a child talks incessantly. In order to control the amount of speech elicited from a child during treatment, the SP may consider training parents to use conversational techniques such as mirroring and closed-ended questions. Mirroring involves the listener repeating part of the conversation back to the speaker in order to convey their attention and understanding, for example: Child: “Dolly is going to the shops today to buy a new dress.” Parent: “To buy a new dress?” When used for the purposes of controlling speech output, mirroring provides a natural conversation break, allowing parents to re-direct speech output. Similarly, closed-ended questions can be effective in establishing speech constraints, whereby the child is only required to respond using specific pieces of information. In practice, closed-ended questions can be combined with mirroring, for example: Child: “Dolly is going to the shops today to buy a new dress.” Parent: “To buy a new dress, what colour will it be?” Together, these conversational techniques give parents a natural, yet purposeful method of conversing with their talkative child for the purposes of conducting treatment. Problems involving parents Problem 4 The parent has difficulty using the severity rating scale. Possible solution A 10-point severity rating scale is used by parents in both the Lidcombe Program and the Westmead Program. The aim is to provide information about a child’s response to treatment beyond the clinic. Usually, parents

each day and encourages the child to use the pattern. Again, the parent uses the Lidcombe severity rating scale to measure the child’s stuttering each day. Problem-solving Generally, participation in treatment for early stuttering is a positive experience for families (Packman & Langevin, 2009). With the Lidcombe Program, parents report being willing and enthusiastic about treatment, while children demonstrate overall enjoyment participating in therapeutic activities (Packman, Hansen, & Herland, 2006). When stuttering does not decrease over time as expected, conducting treatment can become burdensome and frustrating for all involved (Hayhow, 2009). For the SP, the situation may become overwhelming given the constant drive toward healthcare efficiency that is common in the Australian public sector. While the implementation of the Westmead Program is simpler than the Lidcombe Program, many of the logistic difficulties faced by parents acting as therapists are the same. However, evaluation of the Westmead Program is still in its early stages and the experiences of parents have yet to be fully investigated. Below, the experiences of two clinicians who specialise in stuttering are presented in order to provide SPs with direction when addressing some common problems that may arise when working with parents in the treatment of early stuttering. It is hoped that this paper will assist SPs to customise treatment for each child. For ease of reference a problem-solving format is used, which is divided into problems involving children and problems involving parents. Problems involving children Problem 1 communication disorders, children tend to demonstrate boredom when an activity is either too difficult or too simple. Even though it is important to set the child up for success during treatment, it is equally as important to provide the child with opportunities to challenge the child’s system. As a general rule of thumb, it may be useful for the parent to commence each treatment session at a level that will ensure the child is successful and gradually work toward more challenging goals as the session progresses. It is often the case that, in order to set the child up for success, structured activities such as imitation, modelling, or picture description tasks may be necessary. Such tasks, however, can have the effect of limiting language output and as a result may become frustrating for the child. To combat the situation, a reward system may be introduced. For younger children, rewards should be tangible and immediate, e.g., a tick on a page, a peg on a string, or a gem in a box. Where possible, the parent should avoid using rewards that will distract the child from the treatment task. If immediate rewards do not provide sufficient motivation, the child may exchange them for a more interesting reward once treatment has been completed, e.g., a trip to the park, time on the computer, or the opportunity to play a game. For older children, immediate rewards become less relevant and the topic of conversation tends to present as the motivating factor. Discovering relevant subjects can take time; it is well The child gets bored during treatment. Possible solution As with treatment for other

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ACQ Volume 12, Number 2 2010

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