PBL Week 15 - Jessica by Bethany Potter

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

bethanypotter15 — 2017-01-27 13:54:29 UTC

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

bethanypotter15 — 2017-01-27 13:54:40 UTC

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

bethanypotter15 — 2017-01-27 13:54:55 UTC

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

bethanypotter15 — 2017-01-27 13:55:44 UTC

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

bethanypotter15 — 2017-01-27 13:55:59 UTC

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

bethanypotter15 — 2017-01-27 13:56:18 UTC

Q1

2017-01-30 09:13:30 UTC

-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.

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

2017-01-30 09:14:29 UTC

Detrimental ongoing effects once low self esteem is established

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

2017-01-30 09:15:19 UTC

2017-01-30 09:15:59 UTC

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.

2. Separation anxiety

2017-01-30 09:17:17 UTC

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

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

2017-01-30 09:17:43 UTC

2017-01-30 09:18:26 UTC

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

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).

2017-01-30 09:18:40 UTC

Q2

2017-01-30 09:18:49 UTC

-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

3. Fluency devices

2017-01-30 09:20:43 UTC

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

Q3

2017-01-30 09:20:45 UTC

-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

Q3

2017-01-30 09:22:06 UTC

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?

Q4

2017-01-30 09:22:43 UTC

-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.

2017-01-30 09:23:17 UTC

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

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

2017-01-30 09:24:15 UTC

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.

2017-01-30 09:25:01 UTC

4.

2017-01-30 09:25:18 UTC

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

2017-01-30 09:25:53 UTC

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.

Q5

2017-01-30 09:26:43 UTC

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.

2017-01-30 09:27:44 UTC

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

5.

2017-01-30 09:27:49 UTC

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

Q6

2017-01-30 09:29:20 UTC

-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.

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

2017-01-30 09:29:21 UTC

6.

2017-01-30 09:29:25 UTC

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

6.

2017-01-30 09:31:35 UTC

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

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

2017-01-30 09:31:49 UTC

2017-01-30 09:32:40 UTC

Q5: More beneficial to treat simultaneously