ACQ Vol 12 no 1 2010

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.

Client C1

Client C2

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 Figure 2. C1’s severity rating chart (Key: o = % within-clinic SS, • = beyond-clinic SR)

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.

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ACQ Volume 12, Number 1 2010

ACQ uiring knowledge in speech, language and hearing