The document outlines the general therapeutic plan and various treatment approaches used by speech language pathologists for managing stuttering. The plan typically involves assessment, goal setting, selection of therapy approaches, transfer of skills to natural environments, follow up and maintenance. Key approaches discussed include shaping stutter-free speech, modification therapy, integrating the two, use of mechanical devices, counseling and various techniques for children including environmental manipulation, direct work, desensitization and parent-child interaction therapy. Transfer, maintenance and follow up play important roles in ensuring new skills are maintained over time.

1. MANAGEMENT OF
STUTTERING
The SLP during assesment has a general
therapeutic plan ,although the goals &
strategies are different in case of young &
older stutterers,

2. GENERAL THERAPEUTIC
PLAN
1.Identification of problem
2.Setting Goals
3.Selection of an Approach / combination
of Approaches.
4.Transfer & Maintenance.
5.Followup

3. Treatment Approaches
1. Shaping Sttuter-free Speech
2. Modification Therapy
3. Integrating Stutter-free Shaping & Modi-fication Therapy.
 4. Mechanical Intervention Devices
 5.Counseling (adult stutterer).
 6. Approaches for children.
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4. 1.SHAPING STUTTERFREE SPEECH
 1.Innitial therapy targetting stutter-free speech
at one or two word level ,when stutterer is
successful the SLP increases the complexity of
utterance.
 2. Altering speaking pattern.
a.Silent / whispered speech/Articula-tory Pantomimming.
b.Singing.
c. Slowed & Prolonged Speech.

5. 
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d. Coral Speaking & Shadowing
e. Easy Onset Method
f. Light contact Method
g. Voluntary sttutering
h. Imitate Stuttering
i. Adronian Speech.

6. MODIFICATION
THERAPY
 SLP modify the moments of stuttering by
introducing RELAXATION TECHNIQUES
 And decreasing stress,effort & struggle.

7. INTEGRATING STUTTERFREE & MODIFICATION
THERAPY
 The SLP benefit from both types of
therapies.

8. MECHANICAL
INTERVENTION
DEVICES
 Some of these devices resemble a
normal hearing aid.Best candidate for
such a therapy is one who has
 a.stuttered for a significant period of
time
 b.continue to struggle with stuttering
 c. has found speech shaping & other
tra-ditional therapias ineffective.

9.  Edinburg Masker
 DAF (DELAYED AUDITORY
FEEDBACK)
 Enhanced Vocal Feedback
 Frequency Altered Feedback
 Use of a Metronome(Rhythmic Speech)

10. COUNSELING
 Counseling does not mean ‘lecturing’ the
stutterer rather it refers to providing an
opportunity to explore, verbalize &
express feelings about himself,his
problems,about his therapy about the
process of changing ,about his
expectations & fears about the future.

11. APPROACHES FOR
CHILDREN
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1.
2.
3.
4.
5.
6.
Environmental Manipulation.
Direct work with the child.
Desensitization Therapy
Parent-Child interaction therapy.
Fluency-Shaping Behavioral Therapy.
Parent & Family Counseling.

12. 1.Environmental
Manipulation
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1.general excitement level in the home.
2.Fast paced activity
3.Communication stress.
4.Competition for talking time.
5.Social & emotional deprivation.
6.Sibling rivalry.
7.Excessive speech interruptions.
8.Talking attempts aborted by family members.

13.  9.Standards & expectations unrealistically
high or low.
 10.Inconsistent discipline.
 11.Lack of availability of parents
 12. Excessive pressure to talk & to perfo-orm.
 13. Arguing & hostility among family mem-bers.

14. 14. Negative verbal interaction between
child & family.
15. Use of the child as a scapegoat,or dis-placement of family problems onto the
child.
16. Use of a faster than normal speaking
rate by one or both parents.

15. 2.DIRECT WORK WITH
THE CHILD
 Directly working on the speech
symptoms in a caring and supportive
manner.

16. 3.Desensitization
Therapy
 This therapy attempts to increase
gradually the child’s tolerance to
stress.The SLP starts with play activity
that reduces disfluency to its lowest
level,The SLP keeps as many stress
factors as possible out of the activity.A
typical desensitization session involves,

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1.Eliminating talking altogether
2 Not asking direct questions
3. Silent parallel play
4 Maintaining a slow pace of interaction
5 Maintaining a low excitement level .
6 While not playing avoidind stressful
themes.

18. 4.Parent –Child Verbal
Interaction Therapy
 The assumption is that childhood disfluencies
develop in respones to parent-child verbal
interaction.The SLP will observe such behavior
in a non-formal setting then can mirror image
the process doing just the opposite of what the
parent did following instances of disfluency.
When child’s disfluency reduced to 1% or
less,parents are introduced into the therapy to
learn more positive forms of

19.  Of verbal interaction with their child and
to use them at home.

20. 5.Parent & Family
Counseling
 Identifying and changing some family
behavior patterns,by making them
understand how their behavior & feelings
interact with the child.
 Sometimes the SLP feel child’s speech
within boundries of normal disfluency,but
anxiety &concern of parents persists.

21. TRANSFER &
MAINTENANCE
 This is a very critical phase of therapy .In
this regard after reducing stuttering to a
minimal level the person practices these
new skills in a non-clinical
environment.This is called transfer and
maintaining these new skills is called
maintenance.

22. FOLLOW - UP
 Follow up is very important to help
maintaining the new learned skill.
Innitialy on alternate days,then twice
aweek ,then once a week, then once
after every week,then once a month for
few months.

23.  THANK YOU