Hi Keith – Thanks for your post. This is actually a situation that we run into frequently. If kids are communicating effectively and saying what they want to say, then they are often not bothered by their disfluencies even if they stutter (and in some cases, even if they stutter frequently). In my opinion, it would be very hard to convince a child to work hard at changing his speech in that situation, because he doesn’t see a problem. True, he could learn strategies for being more fluent…and, if learning those strategies were easy, then it might be worthwhile for him to do so. But, given that the strategies are hard to learn (well, hard to learn well — they require a lot of practice to master), then it would be understandable for the child not to want to put in the effort. The result would be a child who goes to therapy but doesn’t actually do any of the work associated with therapy. This can often lead to frustrated parents, frustrated clinicians, and, ultimately, frustrated clients. I use a general rule of them as a starting place – if the child is not experiencing adverse impact (which I examine through interview and the use of a tool such as the OASES – see disclosure below), then I do not feel quite as pressed to ensure that the child is receiving therapy *at that time*. The time may come when the child is experiencing adverse impact, and that would be the time that I would want to treat him. Now, as I mentioned, that’s just a rule of thumb. If the parents are very concerned, or if the child is experiencing difficulties in communication that he is not aware of or just not attending to, then he may need to be enrolled in therapy even though he doesn’t feel that it’s the time. In that case, we can spent our efforts in the early part of therapy building his readiness for therapy. (In general, I think our profession spends too little time in therapy focusing on readiness skills, so this is a good way to start in any case.) From the child’s perspective, though, I always try to be aware of this equation: if the pain of change is greater than the pain of staying the same, then there’s really no reason to change — even if the person is uncomfortable where s/he is at that point. If the amount of work required to change speech is greater than the amount of work required to maintain the status quo in stuttering, then the change will likely not happen. If, on the other hand, the child is experiencing adverse impact (pain of staying the same is great), and we can help him bring down the pain of change (by making therapy accessible and increasing readiness in the early stages of treatment), then change can be achieved and great accomplishments can be made in improving the child’s communication.

The whole equation is complicated, though, by the parents’ wants and wishes. Of course, the parents do not have to do the actual work that goes on in therapy… so to them, the (apparent) pain of change is quite a bit easier than the (apparent) pain of staying the same. That is one of the reasons that they don’t always understand their children’s reluctance to engage in therapy. But, from the child’s perspective, the mere presence of stuttering is not necessarily sufficient to warrant the hard work that goes with stuttering therapy. If he is communicating freely, he may feel that he is “just fine” and doesn’t need the treatment.

Now, all of that may be negated if the child is indeed struggling in general but just had an “easy” day during that evaluation. Then, treatment is probably indicated even though that one evaluation showed minimal stuttering. As for the child being able to work on the advanced cognitive concepts, well, that relates again to the foundation-building stages of therapy. In my opinion, these have been largely overlooked in our profession in general. I would recommend taking time to set the stage (e.g., as described in Chapter 5 of School-Age Stuttering Therapy: A Practical Guide – again, see disclosure below). To give you a sense of the importance of this in my opinion, the chapter on setting the stage in my book is longer than the chapter on teaching fluency strategies (but shorter than the chapter on learning to cope with and manage moments of stuttering effectively).

Well, that was a long response. Here are disclosures: I am co-author of the OASES (with Bob Quesal and, for the school-age version, Craig Coleman) and receive royalties from Pearson Assessments. I am co-author of School-Age Stuttering (with Nina Reeves) and receive royalties from Stuttering Therapy Resources. I am also coowner of Stuttering Therapy Resources (with Nina Reeves).

Thanks for reading this far 😉

Scott

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J Scott Yaruss, PhD, CCC-SLP
University of Pittsburgh, PA