Demands and Capacities Model Presentation

Demands and Capacity Model

Working with Children: DIRECT APPROACH

FLUENCY SUPPORTIVE ENVIRONMENT

∗ Slow, relaxed interactions

∗Play quietly

∗Minimize demands

∗Model normal disfluencies

ENCOURAGE SLOW, RELAXED TALK

∗ Use slightly exaggerated models

∗ Label in concrete terms, use imagery

∗ Structured to less structured

practice

USE NORMAL DISFLUENCIES

Teach whole word repetitions:

∗As a normal part of talking

∗ To replace stuttering

TALK ABOUT STUTTERING

∗ Label all the ways we talk, use imagery

∗ Normalize disfluency

∗ Acknowledge feelings

∗ Identify smooth, bouncy, and bumpy

∗ Replace bumpy with smooth or

bouncy speech

Cognitive Change with Families

Goal: Help Families Acquire the Info They Need to Help Their Children

1. LEARN ABOUT FLUENCY/STUTTERING

∗ NORMAL FLUENCY

∗ CAUSES OF STUTTERING

∗ SPONTANEOUS RECOVERY

∗ RISK FACTORS

∗ THE THERAPY PROCESS

∗ REGRESSION, DISCIPLINE

Hannah Green & Christina Pak

STRENGTHS!

1. Involves and supports the family

2. Utilizes family’s strengths, experience

3. Encourages family to choose changes with

which they are comfortable

4. Parent and clinician work together

to ensure change

5. Individualized and comprehensive

6. Supports child’s developing skills

7. Addresses child’s and family’s feelings

8. Strong, positive clinical outcomes

SHS 167

"[the] model provid[es] a framework for much current work on stuttering"

-Ingham & Cordes (1997)

DCM

DCM: Affective Change Within Families

What is it?

What does it do?

To create affective change within families of stutterers, there are two main components: one, helping families understand their feelings, and two, engaging in the counseling process.

Treatment!

• Tool to understanding and harnessing dynamics of child and family development

• help clinicians understand fluent speech --> consider development of stuttering
• helps clinicians plan therapy

In addition to helping families understand their own feelings about having a child who stutters and about therapy, families must undergo the counseling process. The counseling process has three tenets:

• NOT a theory of stuttering

1. Provide support: Active listening

2. Provide information: Help parents make choices based on evidence

3. Model problem solving: Identify and verbalize the issue, brainstorm solutions

**DISCLAIMER: the DCM is not well developed or submitted to rigorous scientific test, but framework still used in clinitians work! (Adams, 1990)

"when the child lacks the capacity to meet demands for fluency, stuttering... will occur"

-Starkweather (1987)

Demands and Capacities Approach to Treatment

The intervention affects BOTH the child and the family; the therapist must work to create affective, behavioral, and cognitive change in the family, and work directly with the child.

Clinical Application

The DCM was originally used as the primary stuttering treatment until the Lidcombe Program became popularized. In 2007, a study called RESTART was commissioned to compare the success rates of these two types of treatment.

WEAKNESSES

1. Some level of family involvement is necessary –

may be too demanding for some families

2. Time consuming

3. Families may feel like failures if

child’s fluency does not improve

quickly

Thank You!

References

• Siegel, G. M. (2000). Demands and capacities or Mdemands and performance?. Journal of Fluency Disorders, 25(4), 321-327.
• Adams, Martin R. (1990). The demands and capacities model I: theoretical elaborations. Journal of Fluency Disorders, 15, 135-141.
• Ingham, Roger J. and Anne K. Cordes. (1997). Self-measurement and evaluating stuttering treatment efficacy. Nature and Treatment of stuttering: New directions (2nd ed) (pp 413-437. Boston: Allyn & Bacon.
• Yaruss, J. S. (2000). The role of performance in the demands and capacities model. Journal of Fluency Disorders, 25(4), 347-358.
• Packman, Ann, Mark Onslow, and Joseph Attanisio. (2004) Evidence-Based Treatment of Stuttering: Emperical Bases and clinical applications. Demands and Capacities model (4), 65-76.
• Gottwald, S.R. (2010). Working with preschoolers whostutter and their families: A multi-dimensional approach. In
• B. Guitar and R. McCauley (Eds.),Treatment of stuttering: Established and emerging interventions. Baltimore, MD:
• Lippincott, Williams, & Wilkins.
• Gottwald, S.R. & Starkweather, C.W. (1999). Stuttering
• prevention and early intervention: A multi-process
• approach. In M. Onslow & A. Packman (Eds.), Early
• stuttering: A handbook of intervention strategies (pp. 53-
• 82). San Diego, CA: Singular.

Behavior Change in Working With Families

Goal: To assist families in developing the skills they need to help their preschoolers through four elements

3. Altering Environmental Stressors

• Turn-Taking Rules
• Special Interaction Times
• Structure/Routine
• Minimize Fluency Stressors, e.g. fatigue

1. Altering Time Pressure

• Speech Rate
• Conversation Pace
• Interruptions
• Time for Talking

Challenging the DCM: Why is "Capacities" Misleading?

• According to Jerry Siegel (2000), capacities don't apply directly to the treatments associated with the DCM, nor should they be due to the complexity of their nature. "The model directs the clinician to the child’s behaviors (performance) and the environmental context in which those behaviors occur (demands)" (Siegel, 2000), hence his belief that the emphasis should be placed on the child's performance rather than their capacity, considering it is not easily measurable.

Main Evidence in Support of DCM

2. Altering Language Demands

• Comments for Complex Questions
• Confirm Intent
• Scaffold
• Rest Time

4. Develop Supportive Reactions

• Learn How We React
• Avoid Negative Comments
• Focus on Child's Message
• Show Acceptance, React Neutrally
• Acknowledge Child's Feelings

CAPACITY

inherited tendencies, strengths, weaknesses, and perceptions which may influence childs ability to speak fluently

4 Dimensions

1. Speech-Motor

2. Linguistic

3. Cognitive

4. Social-Emotional

1. Speech Motor Control

3. Cognitive Skills

• child exposed to demand for speech motor performance if parents spoke more rapidly than the child
• so CNS for processing language may detract from motor performance
• ability to move articulators smoothly and quickly in order to speak rapidly
• longer words and sentences require more complex motor plan

• metalinguistic (branch that studies relation between language and other cultural factors in society)
• all speaking places cognitive demands
• even asking what they did that day

2. Language Formulation

• the ability to formulate sentences
• longer words & sentences are more complex and becomes linguistically demanding
• both linguistically superior and inferior children at risk for stuttering
• share demanding environment for language performance

4. Social-Emotional Maturity

• the ability to produce and maintain smooth movements when excited
• anxiety does not cause stuttering but may exacerbate the problem
• 2 things (Starkweather & Gottwald, 1990):
• maturity
• childs reaction to dysfluencies

DEMANDS

environmental factors that challenge child's basic capacity

ex: time & environmental pressures

-ordering food at In n Out

-daily conversations (with fast speakers)

• when a child's capacity can't keep up with the demands in the environment, it can lead to stuttering
• therefore, clinicians encouraged to look at child's environment to develop an explanation to the stuttering and not just look at aspects strictly related to speech
• ex: family interactions