Speech Therapy for Stuttering: What Should I Expect?

Whenever I start working with a new client who stutters (or their parent), I ask them what they would like to achieve by the time they are ready to “graduate” from therapy (any other Steven Covey fans out there? I like to begin with the end in mind!). The answer is usually something along the lines of “stop stuttering” or “not stutter anymore.” That is a perfectly natural response. However, because there is no cure for stuttering, part of my job as a speech-language pathologist is to educate clients about the nature of stuttering and what they can expect from the therapy process.

First, I would like to acknowledge that many people who stutter have painful emotions and experiences associated with it. Parents may be frightened about what a lifetime of stuttering could mean for their child. In these cases, it is natural to hope for a cure or to wish that the problem could be eliminated. Anything else could be scary to contemplate. Maybe the adult is thinking, “This is too hard to deal with every day.  I want to speak fluently.” Or maybe the parent is thinking, “If my child would just use their strategies, they wouldn’t have to deal with stuttering. They’ll be able to talk to their friends more easily, and in a few years they won’t struggle during job interviews.”

When it comes to “not stuttering anymore,” however, that is not necessarily a realistic goal. Some people, especially children, will recover from stuttering. Five percent of children go through a period of stuttering before age five and 80% will outgrow it (National Stuttering Association, 2022). However, 20% will not outgrow it, meaning that 1% of the world’s adult population stutters. We can’t predict the future and we don’t know what stuttering will look like for the child when they are a teen, a young adult, or an adult. But we do know that there are genetic and neurophysiological differences in people who stutter, meaning that there are differences in the way their brain is structured and functions (National Stuttering Association, 2021), and that speech therapy does not change these underlying differences that contribute to stuttered speech.

“So,” you may ask, “if speech therapy for stuttering isn’t there to cure it, what’s in it for me?” The good news is, there is a lot that speech-language pathologists can do to help people who stutter, whether they outgrow it one day or not!

Let’s start with a few basics. The American Speech-Language-Hearing Association (ASHA) recommends the International Classification of Functioning, Disability, and Health (ICF) Model for “interprofessional collaborative practice” and “person-centered care.” The ICF framework consists of two components, Functioning and Disability and Contextual Factors. Each of these are broken down into two sub-components.

Functioning and Disabilities consists of Body Functions and Structures and Activity and Participation. Body Functions and Structures refers to each body part and how they work in the context of their respective bodily systems. Activity and Participation refers to the individual’s ability to complete specific tasks and take part in various life activities.

Environmental and Contextual Factors include Environmental Factors and Personal Factors. Environmental Factors refers to the physical, social, and attitudinal environments surrounding the individual, while personal factors refers to characteristics of a person that are not directly related to their health, such as their age and gender.

What does this have to do with speech therapy? Well, it helps explain that while the purpose of therapy isn’t to eliminate stuttering (the bodily function and structure), we can improve activity and participation and environmental factors! Furthermore, there are speech strategies that a person may choose to use to increase fluency (the bodily function) – while these are not curative, they are compensatory, and can be useful.

Your next question might be, “OK, what would this look like for me or my child?”

I’m so glad you asked! During the speech evaluation, the speech-language pathologist should assess stuttering, your reactions to stuttering, its impact on your daily communication, and its impact on overall quality of life. With regards to Body Functions and Structures, the SLP will assess what you would typically expect – how often you stutter, what types of stutters you exhibit, how long the stutters last, and if there are any struggle behaviors (also known as physical concomitants or secondaries) that accompany them.

But wait! We don’t stop there! We also examine how the stuttering impacts your activity and participation in life and daily activities. “But how could I increase my activity and participation if I don’t stop stuttering?” you ask – well, you don’t have to stop stuttering to do the things you want in life. This may feel shocking to you right now. It might feel very hard to hear. But it is possible change your thoughts and beliefs about stuttering. In addition, you may choose to use compensatory strategies to make speaking a little easier in certain situations. You can also unlearn habits of responding to stuttering moments that are more effortful, and this can also reduce the severity of stuttering.

Plus, you can also become empowered to make environmental changes. If family members, your boss, or your co-workers are not supporting you in the way you need, change starts with YOU. You can learn how to self-advocate and get the support you need and deserve. Children can also learn how to self-advocate with their peers, teachers, and members of the community.

To sum it up, you may come into therapy with a goal to stop stuttering, and that is perfectly understandable. But through coming to therapy, you will become educated about what to expect and how you can life a full life, whether you stutter or not. You will learn about your body and how it works. You will become empowered to self-advocate to make changes to your immediate and wider environments. Therapy is an investment in yourself and a catalyst for powerful, lasting healing and change!

References:

American Speech-Language-Hearing Association. (n.d.). International Classification of functioning, disability, and Health (ICF). American Speech-Language-Hearing Association. Retrieved March 4, 2022, from https://www.asha.org/slp/icf/

National Stuttering Association. (2021, August 20). Causes of stuttering. Retrieved April 5, 2022, from https://westutter.org/causes-of-stuttering/

National Stuttering Association. (2022, February 7). Facts about stuttering. Retrieved April 5, 2022, from https://westutter.org/facts-about-stuttering/

World Health Organization. (2002). ICF beginners guide - who | world health organization. Retrieved March 4, 2022, from https://www.who.int/classifications/icf/icfbeginnersguide.pdf