How has therapy changed for children?
I’m really interested in thoughts about how speech therapy for kids and teens has changed from, say, 20 years ago. It used to be pretty standard (in my opinion) to approach therapy for kids (guided by parent requests) towards the medical model of “fixing.” I know there has been huge shifts in the approaches to therapy. But there are still parents who want their kids fixed.
How does therapy today help young people who stutter feel seen and heard?
Hi Pamela,
Thanks for this very interesting question that definitely warrants discussion!
Unfortunately, I still see parents anxious to ‘get rid of’ the stutter; and sometimes negative thoughts and feelings about stuttering in parents exceed those in the child. I see this more among school-going children and adolescents. Some things that help me make them understand and accept their child’s tendency to stutter are:
1. Giving analogies of other tendencies that can be controlled but not removed / stopped completely. Spectacles, or a tendency to put on weight, for instance.
2. Talking about the child/ adolescent being an individual in themselves, while acknowledging that the parent’s love and attachment to the child might make it hard for them to separate the child’s individuality / existence from their own. (This happens a lot even for older adolescents or young adults in collectivistic cultures such as Indian)
3. Especially in case of high school children and adolescents, giving agency to the child to make their own choices- putting across the concept of choice-price- and explaining that each choice they make might come at some price which they have to understand, accept, think about, and then make a decision. E.g., the choice of wanting or not wanting to continue therapy. This not only helps parents understand and implement what I mentioned in #2, but also helps bring the child on board as an active contributor to therapy.
After the conversation I mentioned in #3, I am completely prepared for the child/ adolescent to say that they are not very bothered about their speech at present, or that they want to take a week or two to think about all the information I gave them. In my experience, about 3-5 percent of children might give me this response, and in these cases I talk to the parent alone after, and discuss the difference between the impact of stuttering on the child, and impact as the parents perceive it.
A tool that helps me quantify impact as perceived by adolescents and parents, is the ISACS, or the Impact Scale for Assessment of Cluttering and Stuttering. The scale gives me a profile of impact scores that the adolescent gives themselves, and those that the parent gives their child. If the impact as perceived by the parents is way more than that perceived by the adolescent, the profiles clearly convey to the parent what I want to tell them. Sometimes I succeed, sometimes, sadly, I may not.
But being seen and heard by their own parents and their therapist is, in my opinion, the first step towards people who stutter being seen and heard by the world.
Regards
Pallavi
Hi Pamela,
In my experience, approaches to therapy has changed a lot over the last couple of decades. Within my practice there has been a shift away from the medical model, where the aim is to ‘fix’ stuttering and help a child achieve fluent speech, towards acceptance and recognition of stuttering as a different (but equally valid) way of speaking. This approach is one I know many colleagues I speak to regularly who work with children and families who stutter also follow these days. I agree with Pallavi, there are often parents whose hope for therapy is a ‘fix’ but I find that educating parents alongside the child to understand that stuttering comes from neurodiversity, isn’t ‘wrong’ or ‘broken’ (just different) and doesn’t equate to ‘poor communication’ goes a long way to changing parental expectations of therapy and to beginning to view their child’s communication differently. I look at the impact stuttering is having for the child or young person – is it getting in the way of them contributing in class or making friends? Are their thoughts and feelings about talking and potentially stuttering lowering their confidence to speak? The impact stuttering is having for the individual guides my recommendations for a therapy approach, which may involve direct work with the child or young person and/or their parents, or education of key adults in their environment (such as teachers).
I sincerely hope that this approach means the child feels seen and heard and able to contribute to joint goal setting when deciding on a therapy plan. I hope this is empowering for them, and, as Pallavi says, the first step to children and young people recognising their right to be seen and heard within the world.
Jenny