Before the parent and child demonstrates some home practice, we discuss the how things went at home in great detail. Setting, tracking and monitoring the ‘treatment dose’ is key to making sense of the severity rating chart. Treatment can be adjusted and developed depending on what’s happening at home. The parent knows from the outset that the home practice will be scrutinised. Some parents keep a log of what they do, knowing they will be reporting on it!
Before each session, I draft a checklist of questions based on my recommendations from the previous session. I will ask the parent about:
1. Talking Practice sessions: Did these happen every day? How long were the sessions? What tasks were used? Dose – how many contingencies were given? What was the ratio of contingencies for stutters versus stutter free speech (SFS)? What was the severity rating (SR) during practice? What was the language level? e.g. single words, phrases, long sentences etc What was the vibe? Was it fun? Any issues? e.g. Was the SR too high? Was the child too chatty?
2. Everyday Talking situations: What was the typical dose of contingencies each day? (minimum/maximum) How ‘spread’ was the dose? What was the ratio of contingencies for stutters versus stutter free speech (SFS)? How did the child react?
3. Semi-structured conversations: These are used to increase the daily dose and spread of contingencies. When a child has severe stuttering, it can be difficult to add in a daily dose of contingencies in everyday talking. Helping the parent to create moments of SFS by structuring conversations for a short time, allows a transition to using contingencies in everyday life and helps boost the overall dose of contingencies. I will ask the parent: Did these conversations happen daily? How did they elicit smooth speech? Was there any ‘halo effect’ into the ensuing talking? What was the dose?
After this, the parent then shows me what home practice looked like – I’ll talk about this in the next post.