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ACQ
Volume 12, Number 1 2010
ACQ
uiring knowledge in speech, language and hearing
figure 1) and beyond-clinic (see figure 2). During his fifth
clinic visit, C1 stated that his severity overall had improved
and he had minimal stuttering but that he was using SITO
and “slow deliberate” speech for conversations when he
thought he would stutter, and this resulted in SRs of 1–2 all
of the time. He attended 6 clinic visits over 14 weeks. These
were scheduled weekly but several visits were missed. At
his final therapy visit, his stuttering was rated at 0.5%SS
and SR 2. His beyond clinic SRs were 1–2. C1 stated that
he was comfortable with his speech strategies and felt
able to sustain his low stuttering severity. Following his
treatment sessions, C1 completed performance-contingent
maintenance over a period of 12 months. At the final visit,
within clinic speech measures were 0.7%SS and SR 2. His
beyond clinic SRs continued to be 1–2.
Client 2 (C2)
C2 was a school student in year 10 when he presented for
therapy. He reported delayed developmental milestones and
late onset of stuttering at 11–12 years of age. His stuttering
was initially reportedly characterised by frequent, easy
repeated movements. However, at assessment C2 displayed
fixed postures without audible air emission with tension in his
chest and word-avoidance. He stated that he stuttered most
when excited or anxious and avoided some situations (e.g.,
ordering food). C2 had developed a strategy to control his
stutter. He “stopped and waited a while, then started again”.
This apparently helped control his stutter.
During this visit C1 was again instructed to control
his stutter the best he could. It reduced to 0.2%SS
but C1 stated that although stuttering severity reduced
with that strategy his speech felt unnatural. SITO was
introduced despite his low severity in the clinic and SR
1 was maintained during conversation. The treatment
was implemented in a non-programmed format during
conversational speech. The period of time that C1 stopped
talking when he stuttered became quite brief so his speech
was relatively natural. Although it was unclear whether C1
was using elements of self-control and SITO or just SITO
to control his stutter, C1 was advised to practise SITO daily
with his wife or sister for 15 minutes and to apply SITO to
everyday conversations with the goal of reducing the severity
of his stutter to a sustainable level. He reported that he did
not always practise SITO in set-up times, but consistently
practised using the technique of SITO in real conversations.
He collected daily SRs which were used to monitor progress.
C1’s severity had reduced by the next clinic visit and
gradually improved over several weeks within-clinic (see
Client C1
Figure 2. C1’s severity rating chart (Key:
o
= % within-clinic SS,
•
= beyond-clinic SR)
Client C2
Figure 3. C2’s severity rating chart (Key:
o
= % within-clinic SS,
•
= beyond-clinic SR)
At assessment, a significant stutter was evident (3.8%SS
and SR 4). Typical SR was reported to be 3 (see table 1).
At C2’s initial treatment appointment 6 months later, his
speech was measured at SR 5 and 3.8%SS within the clinic.
His stutters were characterised by repeated movements,
fixed postures with and without audible airflow. Clinician-
imposed time-out was trialled and C2 spontaneously used
SITO in conversation. With time-out set for five seconds,
C2 was able to produce lengthy stutter-free sentences. His
treatment was implemented in a non-programmed format.
He was advised to practise daily with his mother/father for
10 minutes or 2 x 5 minutes. Daily severity ratings were
recorded by C2 to monitor his progress beyond the clinic.