Final

Question 1

Describe the basic dual-route model of reading.

Answer 1

Both routes start with the same three steps: print is registered as visual feature units then as letter units.
Route #1 (direct) takes those letter units and applied the grapheme to phoneme rule system then uses the phoneme system to produce speech, resulting in a word being read allowed without meaning being looked at, allowing us to speak words we don’t know the meaning of.
Route #2 (indirect) takes these letter units and map the graphemes onto orthography. The semantic system then applies meaning and results in phonological output and then speech. The semantic system step is optional.

Question 2

Identify the main brain regions involved in single word reading.

Answer 2

The basic reading circuit consists of 3 areas primarily in the left hemisphere of the brain. There are two posterior areas: the dorsal (temporoparietal) system which consists of the inferior parietal lobe and wernicke’s area (posterior aspect of superior temporal gyrus) and the ventral (occipitotemporal or OT) system, which consists of the visual association cortex and the inferior occipito-temporal area. The third area is the anterior system which is centered in and around Broca’s area and the inferior frontal gyrus.

Question 3

Summarize the main changes in the brain circuits over time.

Answer 3

The dorsal system, which is involved in learning and rule-based analysis such as learning the mapping of letters, develops early and continues to be active for new, irregularly spelled or nonwords. The ventral system, involved in memory-based word identification. This developes relatively late and is highly influenced by in individual’s educational experience. As you grow, the ventral system becomes more prominent than the dorsal as words become memories, but can also swtich during tasks. By age 11, these automatic processesare expected to be within place. The anterior circuit, responsible for translating reading into what you are going to say as well as silent reading, becomes less active with age as word reading becomes more automatic.

Question 4

Identify the four principles that guide intervention for literate language development.

Answer 4

Principle 1: use curriculum-based instruction
Principle 2: integrate oral and written language
Principle 3: Go meta
Principle 4: collaborate to prevent school failure by participating in RTIs, incorporating 1-3.

Question 5

Describe principle 1 of literate language development.

Answer 5

Target goals that are based on material drawn from the academic curriculum and support the achievement state standards for language and literacy
Allows functional improvement in their literacy and performance in the curriculum

Question 6

Describe principle 2 of literate language development.

Answer 6

Provide both oral and written opportunities for students to practice the forms and functions targeted in the intervention
Ex. Working on comprehension and use of abstract vocabulary not just in oral exercises but also in activities involving printed forms (elementary level)
Continue to work on this goal with intermediate kids, encouraging them to pull it together

Question 7

Describe principle 3 of literate language development.

Answer 7

‘Metas’ are activities that direct conscious attention to the language and cognitive skills a student uses in the curriculum
Ex. talking about talking and thinking about thinking
Involves clinician and client talking about the language forms and functions being used and state rules and principles explicitly, focusing attention on structure of language

Question 8

Describe principle 4 of literate language development.

Answer 8

SLPs have an important role in providing tier II and III services for students in the classrooms using RTI to prevent reading failure, at both the decoding and comprehension level

Question 9

Provide 1 reason we would target oral language with school age children.

Answer 9

One reason to target oral language is that including oral language training in reading comprehension programs has been found to result in greater gains than programs focused on written language and tradition reading comprehension activities alone.

Question 10

Provide 1 reason we would target narrative development with school age children.

Answer 10

One reason to focus on narrative development is that narrative development is the bridge between oral language and literate language.

Question 11

What are some intervention strategies that can be applied before reading to target narrative comprehension?

Answer 11

Activate the child’s background knowledge and use the title for prediction.

Question 12

What are some intervention strategies that can be applied during reading to target narrative comprehension?

Answer 12

Use questions and discussion during reading to: discuss, link, & infer (ex. What do you think will happen next), and using thinking allowed, voicing obsercations, feeling, and visualization.

Question 13

What are some intervention strategies that can be applied after reading to target narrative comprehension?

Answer 13

Graphic organizers (do you have any memories with this object? Draw it) and link feelings and actions.

Question 14

What are the four different question types?

Answer 14

Right there (found easily in the story ex. why did the littlest billy goat decide to cross the bridge = wanted grass)
Thin and search (found in the story but requires information from multiple places ex. why were the goats afraid of crossing the bridge)
Author and you (not in the story, have to think about topic knowledge and combine with the story information to infer ex. why did the troll let the littlest billy goat go by without eating him? = greedy and through he could get more waiting for brother)
On my own (search their own knowledge).

Question 15

Develop two examples of activities that target cohesion.

Answer 15

Pronouns: chose a sentence from a story that has a referent and a pronouns in it, talk about who the pronouns refer to and have them identify them in the text
- Can also generate sentences with pronouns about the characters
Conjunction use: provide students with 2 sentences and they use conjunction words to connect them using temporal (then, after), causal (because), conditional, ‘wh’ words

Question 16

Define normal fluency.

Answer 16

Speech that is smooth, at an appropriate rate, minimal physical and cognitive effort. But some small disfluencies are typical.

Question 17

Define normal disfluency:

Answer 17

These disfluencies are not often noticed by the listener or speaker because they are common, infrequent, and do not distract the listener from the spoken message, no secondary behaviours

Question 18

Define developmental disfluency.

Answer 18

Disfluency that accompanies typical development in children

Question 19

Define the different stuttering behaviours.

Answer 19

Repetition: can be part word or syllable/sound repetition ex. Look at the b-b-baby
Blocks: a type of prolongation that results in inaudible or silent fixations or the inability to begin a soun
Prolongations: Elongation of a sound ex. ssssssssometimes we stay home

Question 20

What are some key considerations and the purpose of case histories for disfluency?

Answer 20

Interview with parents, child, teacher,

Consider the child’s awareness of their stuttering

Question 21

What are some key considerations and the purpose of observations in disfluency?

Answer 21

Speech sample
Complete in a clinical setting and natural one
Yields information about frequency of disfluent speech, duration of the stuttered moments, types of dysfluencies and description of 2 behaviours
May include conversation, oral reading, monologue, object naming, picture description, or sentence production

Question 22

What are some key considerations and the purpose of standardized tests in disfluency?

Answer 22

Provide measures of stuttering severity and percentile rank

May measure across different tasks

Question 23

What are some key considerations and the purpose of self assessment for disfluency?

Answer 23

Gathers info about speakers behaviours, thoughts, and feeling about communication and stuttering
Shows how they think and feel about something which can influence behaviour

Question 24

What are the different domains of CALMS?

Answer 24

Cognitive: child’s thoughts about, understanding, and perceptions of stuttering; their level of awareness of stuttering
Affective: the child’s feelings, emotions, and attitudes associated with their stuttering
Linguistic: child’s language skills and the impact of language formulation and discourse complexity on their stuttering
Motor: sensorimotor control of speech movements; overt aspects of the child’s stuttering
- Rating the types of stuttering along with frequency and duration of disfluencies, and the extent to which the child displays tension and struggle behaviours
Social: effects of listener type and speaking situation on the child’s stuttering
- Includes rating the frequency with which the child avoids words or a variety of situations, frequency at which the child stutters across a variety of situations, how often stuttering affects the level of social engagement and the impact of stuttering or fears of engaging in typical school activities

Question 25

How can CALMS be used in assessment for school-aged children?

Answer 25

In each domain, a series of items are rated on a 1 to 5 scale Scores are calculated based on the average of the item scores Provides a profile of the child’s strengths and weaknesses

Question 26

Describe the prevelence, risk factors, gender differences, and age differences of children's voice disorders.

Answer 26

Prevalence has been estimated to be anywhere between 11-36% Nodules are most common for school age children Chronic hoareness can stem from functional, structural or neurological bases Complicating factors: reflux, asthma, allergies, medication side effects NICU trauma Can be congenital (eg. Paralysis or glottic web) or acquired (use related, trauma, or secondary to intubation) More males present with use-related voice disorders (opposite of adults)

Question 27

How are the anatomy and physiology of children and adults different?

Answer 27

Infant larynx sits high in the neck with a slightly different shape, the thyroid taking a more semicircular shape and the epiglottis being more omega-shaped A greater portion of the glottis is cartilanginous in children There is no differentiation of the vocal ligament until nearly 4 years of age and the low calcification or the cartilages makes it more flexible The hyoid overlaps with the tyroid cartilage, redugint the thyrohyoid space Size of the larynx in relation to the tracheobronchial tree is comparatively large in infants and adults Position and shape of the mechanism in infants supports rapid alteration between breathing and swallowing More involvement of the ribcage during breathing Higher lung pressure and subglottic pressure

Question 28

What are the norms for acoustic measures for children? How might this impact assessment?

Answer 28

Accoustic measures will be impacted by children’s high fundamental and formant frequencies due to the smaller, shorter vocal tracts This can make spectrograms difficult to interpret as the high fundamental frequency creates less defined formants Jitter among children with vocal fold nodules is increased Increased instability in vowel production among children o Perturbation measures must be interpreted with caution in the pediatric population o Repeated measures and female setting for vowel production tasks will minimize the impact of this instability and compensate for the fact that acoustic analysis programs are more likely to make mistakes with higher fundamental frequency

Question 29

What are the norms for aerodynamic measures for children? How might this impact assessment?

Answer 29

Aerodynamic measurements will be impacted by respiratory differences between children and adults Childrens lungs generate pressure 50-100% greater with rib café excustion that can be twice that of adults Children use a higher subglottic pressure and have shorter maximum phonation time High a high percentage of rib cage contribution to breathing versus abdominal contribution

Question 30

What are some key areas of assessment for children with voice disorders?

Answer 30

``` Behaviour Speech sample: vocal quality, rate of speech, vocal characteristics, learning style, temperament, motivation and social interaction with family. Tension and breath Pitch and volume range Maximum phonation time ```

Question 31

How could you conduct assessments for the different key areas in children with voice disorders?

Answer 31

Behaviour: observation, parental reports Voice quality: GRBAS (grade, roughness, breathiness, asthenia, strain) or CAPE-V Tension and breath: watch for clavicular breathing, shallow breaths, pushin at end of phrase, or end of day Pitch and volume: watch for vocal quality instability at the extreme ranges (visipitch), may use metaphors to elicit (ex. hill for pitch and animals for volume) Maximum phonation time: slinky activity

Question 32

Differentiate vocal hygiene and direct voice therapy, using examples.

Answer 32

Vocal hygiene is education to inform children about voice production mechanisms and injury and guide them towards the identification and reduction of “vocal abuse/misuse”. This includes little changes to daily routines such as drinking more water, limiting yelling, reducing background noise, etc. Direct voice therapy involves teaching techniques to help support a healthy voice and a way to be loud while minimizing potential damage to the tissue and physical effort. This focuses more on the biometrics (anatomical structure and function). Therapy involves things such as resonant voice training, vocal function exercises, LSVT, and breathing and relaxation exercises.

Question 33

What are the three main functions of the brainstem?

Answer 33

Conduit for pathways: corridor for all major sensory, motor, cerebellar, and cranial nerve pathways Location of cranial nerve nuclei Location of other nuclei with unique functions: critical for control of consciousness, cerebellar circuits, muscle tone, and cardiac, respiratory, and other essential functions

Question 34

How is the brainstem functions related to consciousness?

Answer 34

The Rostral reticular formation is involved in consciousness but alert does not mean aware. Alertness depends on the normal function of the RF, thalamus, and cortex where as attention requires the above and some additional cortex, and awareness requires an unknown substrate.

Question 35

What is the name and function of cranial nerve I?

Answer 35

Olfactory: Olfaction (sensory)

Question 36

What is the name and function of cranial nerve II?

Answer 36

Optic: vision (sensory)

Question 37

What is the name and function of cranial nerve III?

Answer 37

Oculomoto: eye movement, pupil size and accommodation (motor)

Question 38

What is the name and function of cranial nerve IV?

Answer 38

Trochear: eye movement (motor)

Question 39

What is the name and function of cranial nerve V?

Answer 39

Trigeminal: control of jaw muscles to open and close, myloyoid, tensor veli palatine, tensor tympani (motor), sensation of entire face, teeth, palate, gums, anterior two-thirds of tongue (sensory)

Question 40

What is the name and function of cranial nerve VI?

Answer 40

Abducens: eye movement (motor)

Question 41

What is the name and function of cranial nerve VII?

Answer 41

Facial: control of muscles in facial expression and stapedius muscles (motor), control of salivary glands, taste from anterior two thirds of tongue (sensory)

Question 42

What is the name and function of cranial nerve VIII?

Answer 42

Auditory-vestibular: hearing and balance (sensory)

Question 43

What is the name and function of cranial nerve IX?

Answer 43

Glossopharyngeal: stylopharyngeus, senstation of outer ear, upperpharynx, and posterior one third of tongue (motor), control of salivary glands, taste to posterior 1/3 of tongue (sensory)

Question 44

What is the name and function of cranial nerve X?

Answer 44

Vagus: velopharyngeal, pharyngeal, and laryngeal muscles, smooth muscle and glands of pharynx, larynx, heart, and digestive system (motor), sensation from heart, digestive system, esophagus, and trachea (sensory)

Question 45

What is the name and function of cranial nerve XI?

Answer 45

Accessory: sternoceleidomastoid and trapezius (motor)

Question 46

What is the name and function of cranial nerve XII?

Answer 46

Hypoglossal: control of three of the four muscles of the tongue and all intrinsic muscles (motor)

Question 47

Define meninges.

Answer 47

The meninges are the layers of protection around the brain. There are three: dura, arachnoid, and pia mater. The main function of these is to provide insulation and protection for the brain, to prevent it from banging against the skull and causing damage. It also helps protect the brain from the outside environment, such as bacteria.

Question 48

What are the three main subtypes of executive function?

Answer 48

The three main subtypes of executive function are working memory, inhibitory control, and cognitive flexibility. Working memory: the workspace for executive functions Inhibitory control: can you stop doing what you’re doing? Ex. stopping thoughts and memories, inhibition at the level of attention and behaviour Cognitive flexibility: Your ability to stop thinking about something and switch to something else, flexible thinking

Question 49

What regions of the brain are typically associated with EF?

Answer 49

The brain regions typically associated with EFs are the prefrontal cortex, the premotor cortex, the primary motor cortex, the supplementary motor area, Broca’s area, the limbic orbitofrontal cortex Dorsolateral prefrontal cortex (PFC) = working memory Orbitofrontal or ventromedial PFC = control and switching

Question 50

Name one caveat to a strict localizationist view of EF.

Answer 50

One of the main caveats to a strict localization view is that many people who suffer from problems with executive function post-concussion did not receive damage to the frontal lobe or lesions typically associated with EF and lesions in other parts of the brain can cause EF issues. This may be due to damage to the connections, showing the EF is not strictly a frontal lobe function. Children can also develop executive function difficulties.

Question 51

What are some SDH?

Answer 51

Stress, bodies and illness, income and income distribution, education, unemployment and job security, early childhood development, food insecurity, housing, social exclusion, social safety net, health services, aboriginal status, gender, race, disability

Question 52

What are some therapy approach considerations to be made in assessments when looking at poverty?

Answer 52

Is affordable, high quality childcare available? -> consider subsidies or early on centers Are other professionals involved with the family? -> can you collaborate, is family and children service involved with the family? Will you have regular therapy appointments with the family -> will the family be able attend? Can you support attendance? Consider public health approaches to therapy such as COFFEE and HEALTH The goals and therapy approaches are the same and can include direct therapy with children, group therapy, parent training, and coaching.

Question 53

Define social determinants of health.

Answer 53

Social determinants of health are social and economic conditions that people experience in their everyday lives that impact health outcomes, whether positively or negatively. Often used as a conceptual framework, they help better understand the presence or absence of disease or disability in a population. Some examples are SES, work environment, education, etc.

Question 54

Provide an example of how you might work SDH considerations into practice.

Answer 54

For example if a child is struggling to attent their scheduled appointments, we may look at the social and economic factors that may be impacting his ability to attend the appointments if we were to take a SDH framework. By applying this to family-centered care, it would help us learn about and understand their specific context. Some considerations are which therapeutic technique would be most beneficial and applicable to the family, what are their goals, how might their economic status impact their ability to access services, etc.

Question 55

What are the observable features of ASD?

Answer 55

Restricted, repetitive patterns of behaviour, interests, and activities and persistant deficits in social communication and social interaction across multiple contexts

Question 56

Describe individual therapy for ASD, including a goal and target.

Answer 56

Goal: get the child to begin using words or gestures to request what he wants Target activity: the use of behavioural reinforcement to pair the concept fo vocalization or gestures to getting a snack using communicative temptations. Some other targets include teaching intentional communication (ex. using PECS), building vocabulary and phrase length (ex. using PODD), or improving receptive language and participation or behaviour Includes therapies such as Intensive behavioural intervention, applied behavioural analysis, DIR, and relationship development intervention Goal can be achieved through working with the child and others

Question 57

Describe group therapy for ASD, including a goal and target.

Answer 57

Stay & Play is an integrated social skills program developed by St. Joseph’s Health Ventre and KidsAbility o Includes children with social communication delays, typically developing peers, parents, and childcare teachers o Includes group for children and peers that does name songs, games, crafts, free play, snack, and goodbye song o Includes education and coaching for parents and teachers eg. What is self-regulation Targets might include increased initiation of peer interaction, etc

Question 58

Describe parent training for ASD, including an example.

Answer 58

Allows children to practice in the context where skills will be used Could recomment improving in providing immediate positive reinforcement when the child produces an imitation of teaching the parent to imitated the child to allow them to enter the child’s world

Question 59

Describe daycare training for ASD, including an example.

Answer 59

Could have picture cues at the entrance to the room and/or rotate hacing a greeter of the day.

Question 60

Define language formulation disfluency.

Answer 60

Children are typically unaware, does not include prolongations and muscle tensions, and is likely related to syntax and semantic demands

Question 61

Define cluttering.

Answer 61

Rapid speech with high rates of disfluency, irregular prosody and decreased intelligibility, often coexisting with ADHD, LD, CAPD, and more often seen in school age

Question 62

What is an acquired fluency disorder?

Answer 62

Initial onset is from an event, often in adulthood

Question 63

What is neurogenic stuttering?

Answer 63

From damage to the CNS, most often from a stroke or a TBI but can also result from a neurodegenerative disorder.

Question 64

What is psychogenic stuttering?

Answer 64

Onset in adulthood, sudden, involuntary and often related to an identifieable event.

Question 65

What is word final repetition?

Answer 65

Often produced with other within-word disfluencies. Most commonly observed in people who have brain injury, ASD, ADHD, etc.

Question 66

How can the cognitive aspect of CALMS be used in assessment?

Answer 66

Determining the child’s readiness for change and is important in deciding which goals to target and beneficial activity types

Question 67

How can the affective aspect of CALMS be used in assessment?

Answer 67

Sensitivity to stuttering, thoughts and feelings of fear, anxiety, and/or tension related to stuttering Coping abilities to negative events, self-esteem and self-confidence, and willingness to discuss stuttering with others

Question 68

How can the linguistic aspect of CALMS be used in assessment?

Answer 68

Linguistic complexity, MLU, presence/absence of word avoidance

Question 69

How can the motor aspect of CALMS be used in assessment?

Answer 69

Types of stuttering, frequency and duration of disfluencies | Determining if child displays tensions and struggle behaviours (secondary behaviours)

Question 70

How can the social aspect of CALMS be used in assessment?

Answer 70

Social/pragmatic skills, verbal interactions in familiar and unfamiliar situations Number of opportunities for the client to use new skills in realistic speaking activities Strategies for dealing with bullying and self-advocacy strategies

Question 71

How can the knowledge of a childs voice norms be used to guide assessment?

Answer 71

Informal: knowing general voice norms allows us to be able to make quick, informal decisions about whether or not a child’s voice may be disordered or whether further instrumental testing is required Formal: allows us to determine the degree of severity

Question 72

How can knowledge of a child's voice norms be used to guide intervention?

Answer 72

May help guide to goal setting (eg. Increasing MPT, increase/decrease F0, etc.

Question 73

Construct an argument for individual therapy for voice in children including issues.

Answer 73

Effective in reducing symptoms – more intensive, one-on-one attention with the SLP Issues: perceived lack of support, possible difficulties with generalization outside of the clinic, and may not address contextual factors that may be impacting voice (ex. busy/environments)

Question 74

Construct an argument for family or school-based therapy for voice in children including issues.

Answer 74

Greater generalization of newly learned skills and greater sense of support from others Increased awareness of behaviours that impact vocal quality (not just for the client but their family and peers as well) – increased benefit Issues: does not address structural or physiological voice problems, the client must be motivated to benefit from indirect therapy and be willing to put in the work and make those lifestyle/behavioural modifications.

Question 75

What are some things to take into account when considering therapy pre and post ENT laryngeal exam?

Answer 75

Depends on the child’s behaviours and the factors that may be affecting the voice quality Consider the wait time to see the ENT (consider starting therapy before ENT if long wait) Important to see the ENT as quickly as possible to determine if there is a structural problem affecting the voice – possible that no amount of voice therapy would help the client

Question 76

Why should we relabel vocal abuse/misuse?

Answer 76

Places blame on the child/client Behaviours are not always done purposefully Can leadto negative feelings or emotions

Question 77

Name the origins or terminations of the cranial nerves.

Answer 77

``` Cerebrum (termination): I and II Midbrain (origin): III and IV Pons (Origin): VI Pons (termination): VIII Pons (Both): V and VII Medulla oblongata (Origin): XI and XII Medulla oblongata (both): IX and X ```

Question 78

Explain the development of EF.

Answer 78

EF becomes steadily better through the teen years and adulthood, ending around 25. - Huge variability with some children scoring higher than older adolescents - This makes it very hard to determine if a child has been affected by brain injury because we need to know where their baseline was Major implications for the youth criminal justice system which ends at 18 EF declines with age with out peak performance depending on the measure - Perceptual motor component peaks in early 20s - Verbal classification measures peak in 40s - Verbal retrieval measures peak in 50s/60s

Question 79

What is it meant that EF is replensiable?

Answer 79

EFs are fatiguable but also replenishable: Self-regulation fatigue (ie. self-control fatigue) is a common problem with everyone, including people with EF impairments o Anecdotal comments: running out of thinking energy party-way though the day, having more behavioural problems when tired, stressed, or multi-tasking o Thinking about brain injury = mental effort you have to put in all the time, thinking about how it feels to control your behaviour all the time o Children will show or tell you what you need with behaviour You can restore your EF by using mental breaks or things to eat that replenish

Question 80

Give an example of how EF controls other cognitive functions.

Answer 80

Ex. studying for an exam In order to communicate our knowledge effectively on the exam: Requires self-control and concentration to focus on studying and understanding concepts Working memory to retrieve information we have studied from our long term memory Ability to organize thoughts and ideas and plan how to answer effectively based on knowledge retrieval Inhibitory control to stay on task during the exam so we can complete it within the time limit with minimal to no distractions Cognitive flexibility to switch from topic to topic of each question

Question 81

What are the effects of the different SDH on psychology and physiology?

Answer 81

Malnutrition -> difficulty learning, hard to concentrate Illness -> missing school, potential hearing loss Hearing or vision problems Housing or neighbourhood problems -> frequent moving, no safe place to play outside Family stress -> increased cortisol can lead to negative impact on working memory, behaviour, and attention Lack of cognitive and linguistic stimulation

Question 82

What are some assessment considerations to take into account with poverty?

Answer 82

Important ot consider the unique circumstances of each client and their families/loved one and how their may influence their performance Do you ask about parent mental health, addictions, literacy levels, housing, and food security/safety? What are the potential consequences if we don’t ask about these? How do you have these conversations?

Question 83

What are some things to address during therapy in relation to poverty?

Answer 83

Parent attachment and emotional responsiveness Increased exposure to language to build expressive and receptive vocabulary Increased exposure to abstract language, verbal elaboration, and problem solving Pre-literacy and phonological awareness (ex. mother’s education lvel is the highest predictor of SES) Exposure to academic talk and the hidden curriculum

Question 84

What are some considerations and questions we should look at in relation to SDH, family-centred care and the therapy considerations?

Answer 84

Ask families/clients about their top priorities at the moment Can therapy be provided at home? Joint appointments with other healthcare professionals to limit the amount of time the client/family must travel (especially important for those who rely on public transportation) Making sure families are comfortable enough to say that services are not a priority at the moment How can we make our sessions more available & accessible? Is telepractice an option? Ask the family what they hope to get out of therapy, to further explore their goals Ask about an appointment schedule that works best for the family (e.g. evening or weekend appointments)

Question 85

Name and describe the different types of intervention for children who stutter.

Answer 85

Feedback and technology: Devices which alter the way that a person who stutters (PWS) hears their own speech (altered auditory feedback -AAF), by changing the frequency (Frequency altered feedback – FAF), and/or by introducing a delay before the speech is heard (delayed auditory feedback – DAF) Cognitive: Aim to lead to psychological changes and may be used alone or to support, optimize, or prepare for other interventions. Behavioural Modification Aim to chance the child or parental behaviour or the behaviour of an adult who stutters Speech Motor: Aim to impact the mechanisms of speech production, such as the respiratory, laryngral, or articulatory system Speech Motor and Cognitive: Combination of speech motor and cognitive

Question 86

What perspectives might children have that may enhance or limit successful fluency interventions?

Answer 86

School year challenging Teasing and bullying Lack of understanding of teachers and peers Lack of role models Lack of access to interventions in schools Reading out loud can be distressful Parents not always helpful

Question 87

What perspectives might parents have that may enhance or limit successful fluency interventions?

Answer 87

Not knowing if stutter was serious and hoping child would grow out of it Thinking therapy would fix stutter Mixed emotions over leaning the significant role of parents in stuttering intervention (ie. Lidcombe) Challenge of making time for intervention Enhanced bond between parent and child

Question 88

What perspectives might teenagers have that may enhance or limit successful fluency interventions?

Answer 88

``` Avoiding feared situations Feeling isolated Need to be internally motivated to seek out and engage in intervention Needing help with real world situations Seeking other people like them ```

Question 89

What perspectives might adolescents have that may enhance or limit successful fluency interventions?

Answer 89

Gradually acknowledging that stuttering is part of who they are Many continue to avoid certain situations – impact many aspects of daily life Coming to terms with stuttering and seeking therapy Valuing therapist who is client-centered and compassionate Involving significant others Seeking strategies for real-world Accepting stuttering and lessening anxiety (older adults)