Speech Therapy for School-Age Kids Who Stutter 101
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As a speech therapist, a common question that parents ask me when they call about speech therapy for their child who stutters is what would be covered in therapy. While each child’s treatment plan is different based on an individual evaluation, three areas that I generally work on include education, attitudes and emotions, and strategies. I discuss more about what to expect from speech therapy in my blog post, “Speech Therapy for Stuttering: What Should I Expect?” If you haven’t read it yet, go check it out and come back!
Often times I spend most of the session on education in the beginning stage of therapy. In the middle stages of therapy, the session often consists of an activity to work on attitudes and emotions and practice with strategies. In the later stages of therapy, we may spend more time talking about what happened over the past week, problem-solving, and making plans for the week ahead.
Education is an important component of therapy. It is important for the child and parents to understand stuttering. The child should learn about the speech mechanism and what is happening to their body when they stutter. Learning about stuttering is a foundational step for self-advocacy. It also takes the mystery out of it and helps to reduce fear, shame, and guilt due to stuttering myths. Increased confidence and knowledge allows the child to advocate for themselves and learn how to be respectfully assertive.
It is also important for children to reframe negative and limiting beliefs about their speech, become desensitized to stuttering, to learn how to handle time pressure, and to address teasing and bullying. I also share support resources with children so that they learn that they are not alone. For example, sharing support group events, reading books about stuttering together, watching videos of kids who stutter from support organizations, and reading articles from stuttering magazines can be a great way to reduce the sense of isolation that can come with stuttering. This can also lead to reframing beliefs about stuttering and desensitization.
I like a recent article by Scott Yaruss of Stuttering Therapy Resources about having “stuttering” versus having a “stuttering problem” (Yaruss, 2018). In general, the stuttering itself is not the problem; the effects of stuttering on the person’s life are the problem. If the person is afraid of stuttering and avoids speaking, that causes problems in their life. But if they reframe how they think about stuttering and possibly use speech techniques to make speaking easier when they choose to, they can enter speaking situations and participate in the desired activity. Thus, even with stuttering, they are able to do what they want to do.
And of course, parents would like to know what speech strategies could help their child speak more fluently. That is perfectly understandable and why it is important to talk to parents about stuttering and what to expect from speech therapy in order to view strategies from a healthy perspective.
When it comes to strategies, I think it is important to keep in mind their purpose. Is it to help the child learn more about their stuttering and become desensitized to it? Is it to help them stay in the moment of stuttering and learn a more effective way of dealing with the loss of control over speech? Is it to allow them to enter into a speaking situation that simply would be too hard to do without it at that time? If so, those are good purposes. However, if the purpose is to appear fluent and not show stuttering, there can be detrimental effects.
Maya Chupkov talked about this on an episode about covert stuttering on her podcast, Proud Stutter. She described the expectation of being fluent and how it resulted in a host of tricks to hide stuttering, eventually resulting in a covert stuttering profile. According to Douglass and colleagues (2018), covert stuttering is “a type of stuttering experience that occurs when a person who stutters conceals his or her stutter from others, attempting to be perceived as a nonstuttering individual. A person who covertly stutters experiences the cognitive and emotional elements of stuttering with minimum overt [visible] behavioral symptoms.”
One takeaway that I have gotten from people who stutter like Maya is that stuttering is a neurophysiological condition and that stuttering is the normal way for them to speak. That is why it important to consider the purpose of the strategy. If it is with the spirit of acceptance of stuttering and an option to make speaking a little easier, that is good. However, if it is with the expectation that it should always be used and that stuttering should not be seen, that can be harmful. It is eye-opening to listen to adults’ stories about how this mindset affected them. The episode of Proud Stutter I mentioned during which Maya told her story is “Episode 7: The Unpredictability of Covert Stuttering and Passing as Fluent.” Some other resources include the NSA Connects episodes for parents, during which parents interview young adults about their experiences with stuttering and speech therapy growing up. You can also listen to stories on the StutterTalk and Stuttering Foundation podcasts.
Overall, it is important to take a holistic approach to stuttering therapy by addressing the whole person. This may include educating the child with regards to speech, possibly reframing thoughts and beliefs about speech and communication attitudes, learning strategies that may make it a little easier to speak, and learning how to self-advocate. Together, we can help your child learn to speak freely and confidently!
References:
Douglass, J. E., Schwab, M., & Alvarado, J. (2018). Covert stuttering: Investigation of the paradigm shift from covertly stuttering to overtly stuttering. American Journal of Speech-Language Pathology, 27(3S), 1235–1243. https://doi.org/10.1044/2018_ajslp-odc11-17-0190
Yaruss, J. S. (2018, May 19). What if my child doesn't recover? Stuttering Therapy Resources. Retrieved April 27, 2022, from https://stutteringtherapyresources.com/blogs/blog/what-if-my-child-doesnt-recover
Resources:
Proud Stutter: https://www.proudstutter.com/
NSA Connects: https://www.youtube.com/playlist?list=PLIOFOVylZ38GzLywyb4KflTHVqk-UalP7
StutterTalk: https://stuttertalk.com/