Advice for SLPs Providing Services to PWS
I am currently a graduate student studying to be a speech-language pathologist. I will be starting my student teaching externship next semester, and I was wondering if I could get advice from someone who stuttered as a child on how to approach therapy with my future clients. Do you think it’s important to provide services to children who stutter only if they want to fix their stutter?
Hi, Elizabeth, and thank you for these interesting questions.
I stuttered severely as a child from a very early age. My stuttering began at age 3 (or possibly age 2), and by age 4 I was in speech therapies (yes, plural; often as a child I was in different speech therapies at the same time – I guess my parents wanted me to get as much help as I possibly could!).
But sadly, I received no real help at all from any speech clinician until the age of 17. All my childhood speech therapy was worthless, largely because no one knew what to do with me, and the severity of my childhood stuttering was unusual. (This was back in the late 1950’s and early 1960’s; knowledge about stuttering, including childhood stuttering, was much less than it is now.)
The types of worthless therapy I remember from my childhood included:
– just talking about life and school in general, without regard to my stuttering (that had no effect on me – I don’t believe I had any psychological problem);
– listening to my stuttered speech on a tape recorder (that made me feel worse);
– practicing articulation of sounds with a mirror, along with kids with articulation difficulties (articulation wasn’t my problem; that was a waste of time);
– having stories read to me, with nothing about stuttering (I had no idea why this was done, and I felt bad as I could have easily read the stories myself – I could read since age 3);
– in one therapy, blowing through a straw (perhaps related to breathing, but it was worthless).
So the question becomes: What type of speech therapy would be best for children who stutter?
I think that building self-acceptance and self-confidence should be the prime goal. The child needs to build an understanding that there are differences among people, and that includes disorders and differences of speech. In other words, that it is perfectly okay to speak differently. And that speaking differently should not inhibit the spheres of life in any way. An emphasis should be placed on not avoiding situations, and living life to the fullest as a person who happens to stutter.
Fluency shaping wasn’t around when I was a child, but I had numerous fluency shaping programs and fluency refreshers as an adult. I did experience much success with fluency shaping, but only for temporary periods. (Eventually I gave that up, and simply and calmly accepted myself as a person who happens to stutter.)
I know that many speech-language pathologists today discourage the use of fluency shaping techniques with children (that is, they discourage viewing stuttering as something that must be “fixed”). Personally, I’m not convinced that such techniques should not be used. With some children, especially older children, they may be quite helpful in the proper context.
For example. practicing relaxed diaphragmatic breathing may help to reduce stuttering-related anxieties and tensions. It can also help to build confidence if a child can be shown that he or she can speak fluently in certain special circumstances (such as reading in unison, or under altered auditory feedback). It might also help to relax a child if he or she can experience some fluent speaking in such circumstances.
Older children might find benefit in practicing relaxing diaphragmatic breathing, and/or gentle onsets, and/or gently stretched sounds in the therapy room. They might also benefit from such practice at home, if their parents are given some guidance in this.
Still, teaching such techniques – when this is done – should only be regarded as the secondary focus of therapy. The main focus should always be on building self-acceptance, self-confidence, and living one’s life to the fullest with a speech difference.
Hi Elizabeth
To start with your last question: when it comes to children who are fine the way they are, the help they need is to help with their parents, family members, teachers, to also accept that this child is a happy talker with no need to “fix” it. As in my opinion the goal of speech therapy should be to be able to say what you want to say, when, where and in the way you are OK to say it. So this can be with speech techniques, but also to have to choice to simply keep calm and stutter on. As it’s not always the child’s wish to have therapy, but those surrounding the child. So here you really need to listen and read between the lines who wants what, and why.
There are some things I wish SLPs would do.
1. Listen and ask questions. Don’t just listen to the stuttered syllables, but listen to the story. The background. The goals. The culture, religion, anything that makes the person the way s/he is. As stuttering is so much more than what comes out of the mouth. Also listen to the parents and maybe even a friend, a partner. If a PWS doesn’t feel heard or safe, s/he will not give you the information you need.
2. Think out of the book, or box. One size does NOT fit all. One client (or the parent) might want to be fluent. Tell them fluency might not be for all. That climbing the Mount Everest is too hard for most people. So to set up reachable goals. Maybe tools to get out of a block. Maybe working on acceptance and self-worth. Maybe by giving them the knowledge to learn more about stuttering and explain to others. Maybe by suggesting something else but speech therapy. F ex presentation techniques, yoga, a choir. Or all of the above!
By listening, asking questions and providing a smörgåsbord of things to try, TOGETHER you might find something that fits that very client to reach acchievable goals.
3. Show the way to meet others who stutter, like camps, meetings, chat groups (check out Penny’s paper on playing video games with other kids who stutter). But also group therapy to proof they are not alone and can support each other. Let him/meet other adults who stutter. Bring a friend into the therapy room and let them do homework together. But… add fun!! When it’s fun, it’s more likely to continue, and to open up. And when giving assignments, do them yourself too. Don’t give assignments you’re not willing to do. Also offer help to speak to the classroom, you or your client, or maybe someone from a local support group. To talk to the class and/or the teachers (but decide that together).
I recently was at a weekend where a group of PWS who stutter practice public speaking together. With the funniest assignments, that made us ROFL! I had a social studies teacher in school who literally jumped on the table to make a point. Don’t just be the therapist. Be the friend. 🙂
Keep them talking