Initial Stuttering Evaluation
Hi! My name is Gisele, and I am currently a second-year grad student at the UofSC. While I have not gotten the chance to work with a PWS in a treatment session, I have given a full evaluation to a young child who presented with stuttering and secondary behaviors as well. While I knew to maintain eye contact and tried to be reassuring in my nonverbal behavior, it was obvious that he really struggled with his confidence and self-image as we were going through the different instrumentals. I understand PWS explore strategies to improve comfortability with stuttering as they attend therapy, however, do you have any advice or words on how to comfort or make the initial evaluation session more positive for the PWS? I look forward to hearing your response. Thank you.
Hi Gisele!
You are raising an important question! I think in the initial stuttering evaluation, it is important to normalize all kinds of information and (stuttering) behaviour, regardless if it is related to stuttering or not. There are so many aspects which may break the progress or continuity of a communicative setting. It is also important to be aware of the fact that evaluation is based on both informal and formal evaluation. Much information can be collected by talking with the person. I also think it may be helpful if the young child could get to know you before you start the formal evaluation. According to Wampold (2015), the clinician and client have to establish an initial bond before the therapy process (or should I say evaluation) can continue. So, maybe to spend some more time with the child may help?
This is just my quick thought. I wish you a meaningful time further with the child!
Hi Gisele!
Good to know that you’re inclined to put in efforts over and above the facts you know as a clinician!
In my experience, just the attitude of wanting to be of help gets communicated nonverbally somehow, and that itself goes a long way in making a child who stutters comfortable around you as a person. So despite the physical struggle and hesitation that occurs as a result of living with a stutter, you’ll soon realize (through feedback from parents and your own observations) that this child is relatively more open and comfortable with you than with other people they’ve met for the first time.
As I read in your question, you’re already on the right track, with trying to read between the lines, observe the child informally, and try to be reassuring non verbally. Another important thing is to get to know the child as a PERSON, rather than someone who stutters. Being non judgmental, patient, compassionate and ready to listen is all it takes!
Pallavi
Hi Gisele,
Thanks for a great question. That first meeting with a child and their parent is crucial. In spite of wanting a “baseline” of stuttering behavior, I try to avoid recording the child or taking a syllable count in front of them. This can cause children to shut down and induce increased feelings of shame. I think that it is important to “explore” their experience by eliciting information without asking questions. “I wonder if you have any tight feelings in your body when you stutter. I wonder if there are some times that it gets harder to talk. I wonder who your best friend is at school.” This last question helps you start to know more about this child’s allies. I also think that it is important to use the word “stuttering” with the child. This begins to decrease stigma right from the beginning. If a child refers to his “bumpy speech” or some other language, I usually say: “oh, right! Some people call that stuttering. Have you heard that word before?”
It is important to include the child in any discussion with the parent and not talk “over them.” I often have parents ask me: “How severe is he/she compared to other kids you see?” or, “How long will therapy take?” I have worked with teens and adults who stutter, who tell me that during their first experience with an SLP, they remember being assigned a “severity level” and it often didn’t align with their belief. I have also had adults tell me that this created “shame” to be told this. Avoiding any “analysis” or interpretation in that first meeting is important. You are obtaining such limited insight with that small glimpse into that child’s life, I find that the best thing for me to do is explore what happens outside that room.
Finally, I make that first session fun! I always play a game and relate it to what we want to accomplish in therapy; games of advocacy, games that open the discussion about resilience, games that introduce emotional flexibility. I had a child leave his evaluation last week and turn to his mother and say: “when do we get to come back?” That is an indication that you made the right connection.
Welcome to a wonderful profession!
Rita