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Q5: More beneficial to treat simultaneously

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Q6. If anxiety regarding family dynamics is a trigger for her, this will impact her disfluencies greatly. Difficult to control environmental impact such as relationships between parents and brothers

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Q6. If anxiety regarding family dynamics is a trigger for her, this will impact her disfluencies greatly. Difficult to control environmental impact such as relationships between parents and brothers

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Parental consent. Conflict between parents could elongate time between onset of stutter and intervention.

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Tension between mother and father could increase Jessica's emotional insecurity-potential impact on stutter (attachment issues?)

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Q5. Direct treatment to focus on phonological and stutter simultaneously would be beneficial for age range and severity. Delaying treatment of either could have detrimental effects 

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Q5. Direct treatment to focus on phonological and stutter simultaneously would be beneficial for age range and severity. Delaying treatment of either could have detrimental effects 

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-Likely to be quite a significant impact at Jessica's age.
-Especially as she feels it is her fault that her dad does not live at home anymore. Resulting conflict and tension between parents which may distress her.
-May make her more nervous and tense - affect fluency, withdrawn at school.
-Left out by her brothers - used to playing alone? Less interaction with peers?
-Mother shouting at her may cause more tension, does not cope well with negative criticism at school and becomes upset.

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Simultaneously. Direct intervention seems to be necessary because of environmental instability e.g parents

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Q4: Weekly visits with clinic with mother with mother doing short fluency-related activities almost daily

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Simultaneously:
-Phonological treatment requires a far more direct approach e.g. aiming to produce target sounds
-Stuttering treatment likely to be more indirect and supplemented by parental support at home.

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Q3. Explain to mother that fluency devices aren't ideal for Jessica to use at her age. Suggest information sources such as BSA website so that she could see the information for herself.

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Consider anxious mother- clinical intervention may be more appropriate as it takes pressure away from mother and is a more appropriate environment for phonological intervention

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Q4. Difficulies of commitment to lidcome in home environment may mean a more direct approach would be beneficial. This would reassure  mother that treatment is being provided. Work alongside teaching staff to implement  similar strategies.

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Q4. Difficulies of commitment to lidcome in home environment may mean a more direct approach would be beneficial. This would reassure  mother that treatment is being provided. Work alongside teaching staff to implement  similar strategies.

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Q3: Advise mother to not use fluency devices unless taught at clinic or is deemed necessary by clinician

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Q3: Advise mother to not use fluency devices unless taught at clinic or is deemed necessary by clinician

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Q2: Depending on when the separation occured, it may have a large impact and can be interpreted as a traumatic event and cna affect/trigger stuttering

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-Agreement between both parents is desirable
-Mum could implement direct approach at home
-Mum might be busy with other children etc
-Combination may be most effective - want them to reinforce each other.

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Possibly too soon to consider at her age, may be something to look at in the future if alternative therapy doesn't work.

Also consider expense - is this feasible?

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-Refer her to the BSA website
-Don't want Jessica to rely on the fluency devices
-Possibility of it being intrusive, especially at such a young age
-Very personal and subjective - different for everyone and even day-to-day the effectiveness fluctuates
-Expense

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Jessica is still developing physically, emotionally and psychologically and therefore a device could potentially have a negative impact e.g. Self conscious

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-Anxiety
-School avoidance
-Highest with children <12 years old
-In therapy, child may become distressed if it appears their parent is leaving
-Can be helped if parent is integrated into therapy session e.g. play involving child, therapist and parent - builds rapport

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Q4. Treatment that involves both parents would Ben most ideal so that both parties feel included. Particularly for the father it isn't important he sees if the therapy is working/changing anything. This could change how he feels about it. (If parents were together then Lidcombe may be suitable however due to being departed different methods would need to be explored).

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Q4. Treatment that involves both parents would Ben most ideal so that both parties feel included. Particularly for the father it isn't important he sees if the therapy is working/changing anything. This could change how he feels about it. (If parents were together then Lidcombe may be suitable however due to being departed different methods would need to be explored).

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2. Considering jessica's age - Separation anxiety - low self esteem. Anxiety can present itself as feeling physically unwell.

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Q1. Low esteem can have a big effect of development as it can affect a person's confidence 

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Q1. Low esteem can have a big effect of development as it can affect a person's confidence 

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2. Separation anxiety is at its peak in children under 12.

Specific link to dysfluency- bidirectional with anxiety

Can affect the child's engagement in activities and intervention

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Q2. The change in Jessica's home dynamics could have influenced anxiety, which could have further added to her low self-esteem. This could make her stutter harder to manage.

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1. May be more aware of stutter at 6, could affect her confidence in educational situations. Could result in depression in later life if unaddressed 

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1. May be more aware of stutter at 6, could affect her confidence in educational situations. Could result in depression in later life if unaddressed 

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1. Evidence to suggest that a stutter increases the likelihood of low self-esteem. 

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1. Evidence to suggest that a stutter increases the likelihood of low self-esteem. 

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Detrimental ongoing effects once low self esteem is established

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-Difficult to know which comes first - stutter or low self-esteem.
-In terms of development, relationships may be hard to build. Insecurities may lead to damaging behaviours e.g. clinginess
-Social isolation may lead to development issues
-People with low self-esteem tend to perceive their illnesses as more serious than they are.
-In adult life, this may lead to anxiety and depression.

-Speech - stutter affects her fluency and speech and confidence.
-For Jessica, this issue particularly arises at school and she isolates herself and draws away from contributing in the classroom setting.

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6. How much influence might the family dynamic in Jessica’s life contribute to her fluency problem?

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6. How much influence might the family dynamic in Jessica’s life contribute to her fluency problem?

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5. Should Jessica’s phonological problems and stutter be treated simultaneously or individually?

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5. Should Jessica’s phonological problems and stutter be treated simultaneously or individually?

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4. Considering Jessica’s wider environment, what would be the most appropriate treatment method? 

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4. Considering Jessica’s wider environment, what would be the most appropriate treatment method? 

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3. How would you respond to Jessica’s mother's query about fluency devices? 

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3. How would you respond to Jessica’s mother's query about fluency devices? 

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2. How might parent separation impact a child such as Jessica?

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2. How might parent separation impact a child such as Jessica?

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1. What is the impact of Jessica’s low self-esteem on her speech and development? 

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1. What is the impact of Jessica’s low self-esteem on her speech and development? 