holteAbout the author: Doreen (Dori) Lenz Holte is a professional writer and author of Voice Unearthed:  Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter.  She is also the proud mom to Abe, Adam, and Eli.

When our son Eli was around 12, I asked him if he remembered being told that it was okay to stutter.  It had been three years since we stopped traditional speech therapy and I was curious as to how he would respond.  He thought for a moment and replied “Once I stopped stuttering they would give me stickers or let me play with the toys in the room.  They’d tell me it was okay, then they’d tell me not to do it… I stopped talking as much because they said it was wrong.”

When Eli was between five and nine years of age he saw a number of speech therapists for treatment for his stuttering.  These therapists had varying degrees of experience with children who stuttered – ranging from none to having an ASHA Board Recognized Fluency Specialist certification.  Each therapist enlisted fluency shaping and stuttering modification speech tools, the approach considered to be “evidence-based best practice” by ASHA and leading universities.  Each therapist enthusiastically rewarded Eli with an array of colorful stickers when he used his speech tools.  At the same time I witnessed each of them kindly and continually assuring Eli that it really was okay to stutter.   They never told him it was wrong…I am certain of that.

At home during special time (time set aside each day to practice using speech tools)  I would clap for and praise Eli when he successfully used his Tigger talk and turtle talk to deliver non-stuttered speech.  I would also assure him that it really was okay to stutter.  I also never told him it was wrong to stutter, but that was unfortunately the message he came away with.

We were confused and confounded when, even with all the positive reinforcement, Eli did not transfer the use of speech tools outside the clinic setting or our special time at home.  After four years of therapy we resigned ourselves to believing that at least we had given him a tool box full of speech tools…he would hopefully use them when he was ready.  (This is a common lament I’ve heard from both parents and speech therapists throughout the years.  “If he would just use his tools.  He can use them in therapy, so why not in other places?  He just needs more practice…”)

When Eli was nine, we stopped traditional speech therapy.  He had gone from mild to moderate to severe and was now twisting his chin to his shoulder and growling in order to talk…if we were lucky.  Most of the time he just didn’t talk.  We noticed the silence when he was sitting around the table at Easter with aunts, uncles and cousins.  We noticed the silence at 4H meetings and during home school co-op days with friends.  Even at home with us he became increasingly withdrawn.  We felt like we were literally watching our Eli fade away.   We would vacillate between gently reminding him to use his speech tools and ignoring the behavior. We felt increasingly fearful and lost when it came to Eli’s struggles with speaking.  It seemed that the silence and disconnection was proving to be a far greater handicap than the stuttering itself.

In retrospect, there is no doubt that the silence was a result of the shame Eli felt when he stuttered.  He also felt that shame when he didn’t meet up to the expectations implied in the ongoing praises and reward of stickers for non-stuttered speech.  Dr. Brené Brown has researched the subject of shame extensively and states that “nothing silences us more effectively than shame.”  Brown, Ph.D.,  licensed social worker, and renowned author and speaker goes on to say:

shame unravels our connection to others…In fact, I often refer to shame as the fear of disconnection – the fear of being perceived as flawed and unworthy of acceptance or belonging. Shame keeps us from telling our own stories and prevents us from listening to others tell their stories.  We silence our voices and keep our secrets   out of the fear of disconnection. ¹

The role that shame plays in stuttering behavior is no surprise to parents or speech therapists.  It is the absolute last feeling we want them to experience around talking but are our efforts backfiring? Was it really developmentally appropriate to expect a child of this age to manage the complex and conflicting messages of “It’s okay to stutter but here’s a reward if you don’t.”?  Research into the cognitive traits shared by children, ages 6-10, helps to shed some light on our discomfort.  In general, child development experts ² agree that this age group:

  • Has a strong desire to perform well and do things right.
  • Finds criticism or failure difficult to handle.
  • Views things as black and white, right or wrong, wonderful or terrible, with very little middle ground.
  • Naturally seeks praise and wants to conform.

Using speech tools requires a level of energy and concentration that is hard to fathom even for adults.  When you consider the development traits of children you begin to understand how shame can result from the unrealistic expectations and conflicting messages.  In addition, many experts (and parents) report that children who stutter are often more sensitive than others their age.   Mary Elizabeth Oyler,  a speech-language pathologist who also stutters has done extensive research around the issue of children who stuttering and sensitivity.  She found that:

children who stutter were significantly more sensitive and vulnerable than non-stuttering    children.  In addition, 84% of the children who stutter fell in the highly sensitive range as          compared to 36% of the children who do not stutter. 4

When we step away from a focus on eliminating the moment of stuttering behavior and look at the whole child, we truly begin to understand why a child might choose silence over risking continued failure in front of those they most want to impress and please.

In 2011, I  published Voice Unearthed: Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter.   During my six years of research and reflection for this book I discovered a plethora of  disagreement, confusion, and uncertainty around treatment for children who stutter.   Extensive research around shame and stuttering has been done by Dr. Bill Murphy, speech-language pathologist and a clinical faculty member at Purdue.  Murphy warns:

The emotions of shame are self-perpetuating, regenerated repeatedly by the child, even if the external stimulus (a parent inappropriately reminding a child to “use your techniques,” or a classmate laughing) is no longer present… the self acquires the identity of failure, at least in relationship to speaking skills. ³

Professional organizations and academia have an ethical obligation to abide by treatment approaches that are deemed to be best practice stemming from evidence-based research.  The problem in this particular area is that the vast majority of research has been done on adults.  The research done with children is extremely limited and often labeled as “emerging” or “promising.”   The goals of the research are to make fewer speech errors.  The goal for a child is to avoid feeling shame and the most realistic way to accomplish this is to stop talking.

I am encouraged when I increasingly hear about a greater focus on desensitization and creating positive feelings around communicating.  But the use of stuttering modification and fluency shaping speech tools remain as a significant component of therapy for children as conveyed in ASHA’s  Specialty Board on Fluency Disorders Manual.5  The Stuttering Foundation of America even acknowledges that “many children and teens who stutter do not have the maturity or skill to monitor their speech in all situations. Therefore, it may be unrealistic to expect your child to use her tools in other environments at all times.”  What happens when you throw in a few stickers as a reward for using those tools?  What message does a child really walk away with?   Eli says “I stopped talking as much because they said it was wrong.”

From the time Eli was nine to this day, Dr. Jerry Halvorson, retired Communicative Disorders professor at the University of Wisconsin, River Falls has helped us provide support focused on keeping Eli talking and engaged in the world around him.  Within three months of changing our focus from reducing speech errors to keeping Eli talking we saw significantly less twisting, gurgling, and far more talking.  It was a long process that is far from over.  But today Eli is 17 years old, a full-time college student, a part-time employee, and a supportive and positive role model to his group of friends.   He still stutters, sometimes severely.  But he puts himself out there each and every day.  He can be wickedly funny… I figured it was a good sign when his co-workers affectionately nick-named him “Snarky.”  Now there is a good reason to break out the stickers.

References

  1. Brown, Brene (2007) I Thought It Was Just Me (but it isn’t): Telling the Truth About Perfectionism, Inadequacy, and Power Penguin/Gotham
  2. The National Network for Childcare, Great Schools.org, Human Development and Family Studies at Iowa State University
  3. Murphy, B. (1999). The School-Age Child Who Stutters: Dealing Effectively with Guilt and Shame, VHS Publication NO. 86, Memphis, TN, Stuttering Foundation of America
  4. Oyler, M. E. (1996b). Vulnerability in stuttering children. (No. 9602431). Ann Arbor, MI: UMI Dissertation Services.
  5. http://www.stutteringspecialists.org/index.php?option=com_content&view=article&id=90:the-sbfd-manual&catid=79&Itemid=502

 

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Comments

The Right Time to Break Out the Stickers — 130 Comments

  1. Dori – Excellent ISAD presentation paper! I can completely identify with the truths in your article!

    As a person who stutters, I want to thank you for being the first parent of a CWS taking the time to research, write – and share the emotional journey – of writing a book from the first hand perspective of a parent of a CWS for parents of children who stutter.

    I believe your book for parents of children who stutter “VOICE UNEARTHED – Hope, Help and a Wake-up Call for the Parents of Children Who Stutter” is the single most important book a parent of a CWS should read prior to engaging in any therapy for their CWS. It is just the best in helping parents make truly informed decisions regarding the type of therapy they choose for their child to participate in.

    Years ago I heard a prominent speech and language pathologist leader in the field of fluency disorders share with parents and other professionals in attendance at a self-help convention that speech therapy for CWS NEVER hurts children or makes stuttering more severe….I have since learned that this is not necessarily true.

    Personally, I wish “Voice Unearthed” would have been available to my parents 57 years ago when they bagan their journey in therapy for me.

    Again — Thank you for this ISAD paper and all you do for Parents of CWS!

    Retz

    • Like I always say, if we have the power to do good, we have the power to do harm. I think it’s important that both parents and therapists fully understand this before choosing resources for child/clients. Thanks Retz for your insights and supportive words.

  2. Dori – this was a great paper, so full of insight and emotional honesty. I remember when we met at the FRIENDS convention and we talked about Eli’s journey and the conflicting messages. You were so passionate about sharing that “keeping him talking” is the best way.
    I can relate to the premise of messaging and internalizing shame. As a young child, my father and teacher never told me stuttering was wrong, but the negative feedback I received from both led me to believe that it must be wrong and I began doing everything I could to not stutter. The only way I could truly do that was to not talk. Thus began my journey of trying to hide my stuttering for 30+ years. It wasn’t until 7 years ago that I finally had enough and let my true voice come out and be heard. These days I stutter openly and confidently and push shame away when it tries to creep in.
    I have read Brown’s book on shame (The Gifts of Imperfection, I think it’s called – it’s her second one.) Her work on shame really resonated with me, as I’ve dealt with shame issues throughout my life that are not just related to stuttering. As you share about Eli, it’s about staying connected to the world, talking, engaging – anything but withdrawal and silence.
    Thank you for sharing this for the ISAD conference. It had me shaking my head and saying “yes, yes” as I read.
    Pam

    • Pam – so great to hear from you! I do remember our evening on the tour bus. I so appreciated your openness and honesty in sharing your journey. You too do so much to “keep them talking” with your amazing pod casts around women and covert stuttering. We are definitely on the same journey! Parents and speech therapists need to fully understand the risk of silence and withdrawal — and focus efforts on minimizing that behavior rather than minimizing speech errors. I can’t imagine what it would be like to go 30 years feeling like you had to hide your stutter. I’m glad that you’ve stopped doing that and are letting your true voice be heard!! Your efforts are so so important! Thanks Pam…

  3. Terrific paper Dori!

    My younger brother, Bryan, would sometimes stutter when he talked, ever since I can remember. He still does. However, from the very beginning, he was accepted and encouraged in the same light as the rest of us. It just wasn’t an issue. At the age of 5 or 6, he would be allowed to hang out with the adults during the card club gatherings (the rest of us who were older were not given that privilege), where he would visit each of the tables and carry on many a conversation. He took up square dance calling when he was a teenager, and remains popular in the square dance circuit today (He is nearly 50 years old now.) He just kept on talking.

    We met the Holte family when Eli was 6 or so. Our son Ryan and Eli are good friends. I remember the period of time where Eli struggled so hard to speak, with the head twisting and the growling. It was heartwrenching to see. And then, after he began to spend time with Jerry I remember the change in him. I salute the courage it has taken (and still takes, I’m sure) to keep on talking — to let out all the witty comments and astute observations. To remain vulnerable, but not silent.

    What do we really hope for those we love? That they can live in a way that honors their being, that they stand tall in themselves, that they can speak their truth. Thanks Dori for sharing your family’s journey so openly, and for inviting others to look at the big picture.

    Evonne

    • Wow my dear friend. Bryan was accepted and supported and encouraged to find his passion and look at him today! You do have a lovely family (all bazillion of them!) “To remain vulnerable, but not silent” — so incredibly profound. I’m honored to call you and your family my friends!! luv ya.

  4. Hello,
    Thank you so much for sharing your family’s story. I am studying to be a speech-language pathologist, and the title of your paper really caught my attention. I have not worked with a someone who stutters yet, but I have used sticker charts for other clients. The view I have always taken from sticker charts is they help reward the child for paying attention and trying during therapy. I really appreciate that you clarified that none of the people that worked with your son directly said stuttering was wrong. Your paper has helped me realize that my actions, intentional or unintentional, as a hopeful future speech-language pathologist are going to affect the kids that I work with. Even if I interpret a sticker chart as a hopeful motivator for a child, the child may be picking up a very different message that affects his or her self-esteem. Even being aware of this concept, I believe will help me better serve future clients.

    With that in mind, how would you have hoped that speech-language pathologists addressed (or not addressed) your son’s stutter? Did Dr. Halvorson use any type of reward system for Eli putting himself out there or were opportunities created and encouraged (with the reward being the participation)? Do you hope ASHA will change its disposition on the treatment of stuttering? What is the biggest take away you would like future speech language pathologists to know?

    Thank you for taking the time and effort to share your story and help others, like myself, grow and learn.
    Have a great day,
    Kim

    • Hi Kim, thanks so much for taking the time to respond. I think you’ll make an amazing speech therapist! It’s so hard to know how a kid is interpreting our actions – as parents, teachers, therapists, etc… We do what we think is best at the moment – but we must have the courage to reflect, accept, and switch gears as we gain awareness…

      I wish that until Eli was aware of and concerned about his speech, the speech therapist would have worked with my husband and me to keep him talking and keep him engaged. There are so many (fun) ways to do that! I also wish I had been more respectful and receptive to Eli’s protests about using stuttering modification and fluency shaping tools. I was just so convinced that all he had to do was practice more.

      If it had gotten to a point where Eli was concerned about his speech, I would listen and listen and listen. As I say in my book, we are not there to remove all the challenges, we are there to help them build a foundation for coping and flourishing. A speech therapist can be very helpful in supporting that process and many do — without speech tools.

      I have a chapter in my book called “Would I Have Listened to Me?” I know how desperate we were to make this all go away and I don’t know if I would have had the patience to not enlist speech tools intended to minimize speech errors — especially when they can use those tools so well in the clinic setting. I hope that my six years of research and reflection that I put into “Voice Unearthed” will help others to understand the very real risks.

      Jerry’s rewards consisted of having Eli muck horse stalls and pick up rocks from the fields. (Eli had no clue he was in speech therapy… ) While it was a unique situation that can’t be easily replicated, the essence can be captured and repeated in other environments. We just need to think long-term, be patient, and get a little creative! Thanks again Kim for your thoughtful questions… people like you will make our world a better place!

      • Thank you so much Dori for your kind words! I have learned so much from your paper and your response!
        Thank you for all that you do!
        Have a great day,
        Kim

  5. Dori,
    I had to start with your paper this year. I’m glad you took the time to provide a paper for others to read. Like some others, I share you book with all of my parents… in part to make sure that they hear from all sides of the issue. So many speech pathologists focus on changing the stuttering. Interesting…. the kids I see are kids that stutter sometimes… the rest of the time they just talk. And even the very severe kids, spend the majority of time talking… not stuttering. Makes more sense to me to help them figure out what they are doing when they are “just talking” and do more of that, instead of trying to teach them something new. Maybe I’ll start giving stickers for “just talking”…. NAH…. the kids I work with would rather get ice cream!

  6. Dori,

    Thank you for sharing your story. It is truly a motivating story that really made me stop and think about how I use stickers as reinforcers. I have found myself giving stickers to my clients when they do something correct rather than when they give it their best shot. It never dawned on me that this could be effecting their confidence. From your story, I have gathered a whole new insight on appropriate rewards via stickers, so thank you!

    I was just curious as to what you thought the SLPs your son had could have done differently as far as reinforcing fluent vs. nonfluent speech? Or even, what other methods do you think we as therapists should use for reinforcement? What type of reinforcement did Dr. Jerry Halvorson use, if any, with your son? What did Dr. Jerry Halvorson do that seemed to help your son open up?

    Thank you,
    Hannah Summerlin
    Graduate Student in Communication Sciences and Disorders
    Western Carolina University
    Cullowhee, NC, USA

    • Hi Hannah — thanks for listening! Rather than repeat myself, I’ll refer you to my response to Kim’s questions, similar to yours. As far as reinforcements go, I prefer a more intrinsic approach. Children will do something because THEY see it as useful, fun, pleasant, challenging, etc… if they don’t, well, stickers most likely won’t affect genuine and changed behavior. They probably enjoy getting the sticker and pleasing the adult and they may continue to respond in a way that leads to another sticker, but that doesn’t mean they are embracing the behavior. It means they are getting a sticker and pleasing the adult. Funny, I guess I never realized how much I really dislike stickers:-))

      Best of luck to you, and again, thanks for listening!
      Dori

      Reply ↓

      • Dori,

        Thanks so much for the reply and your helpful insight. Thanks again! I will definitely think twice before I grab for my stickers. 🙂

        Hannah

  7. Stickers for “just talking”… brilliant!! But I totally agree — the ice cream would be a far more effective motivator!

    Focusing on what they do well (talking, shooting hoops, drawing, gaming, math) doesn’t bring the short-term results that we adults crave but, I’m convinced, this approach will serve these kids far better in the long run. I often hear and read responses to childhood speech therapy — they always focus on the fun they had, that the speech therapist listened to them, and they felt safe. I’m not suggesting it doesn’t happen — but I have yet to hear of a kid (or adult reflecting on childhood therapy) say that they were saved by learning how to use speech tools and techniques. In fact they consistently lament that it was the worse part of therapy… we need to listen.

    Thanks Dr. Eldridge – for your comments and for your good work on the front line!

  8. Hi Dori,

    I was engrossed by your thought-provoking paper. You have acquired an impressive insight your son’s communication issues and express your views with such passion. Eli is so fortunate to be blessed with such a loving and caring mother. My late parents were also incredibly supportive and gave me a free rein to become involved in whatever activities were available. Despite my stutter, they encouraged me to speak at every opportunity.

    Have you considered addressing SLP students? Over the years, I have had the pleasure of sharing my experiences with students at several US universities. In order to provide them with an understanding of what it is like to live with stuttering, I touch upon such things as self-acceptance, expanding comfort zones, approach avoidance, negative self-talk, assertiveness, self-esteem, self-image, limiting beliefs, emotional baggage and the stuttering mindset.

    I also draw the students’ attention to the importance of recognising the uniqueness of their future clients. I emphasise the need to make good use of listening skills; earn the respect of each individual, and appreciate the difficulties associated with transferring speech gains and techniques from a safe therapy environment into the outside world.

    I never fail to be impressed by the enthusiasm and interest displayed by the students. They have an insatiable thirst for knowledge and I am always inundated with questions.

    If you have not already done so, you may wish to consider providing an input on future training programs. I’m sure that it would be mutually beneficial.

    Dori, it’s good to reconnect with you again.

    Kindest regards

    Alan

    • Yes Alan, I have had the privilege of talking to SLP students – mostly at UW River Falls. Eli often joins me…and does most of the talking… 🙂
      Yes, students are wonderful – and so fortunate to have people like yourself to expand their experiences.

      I would love to do more of this – to be part of training programs for SLPs. Just need to figure out how to get my foot in the door… Thanks for your encouragement! Keep up your great work….
      Best,
      Dori

  9. Hi Dori,

    Thank you so much for sharing your families story. I am currently in my master’s program to becoming an SLP and I find a special connection with other families of people who have communication difficulties. My brother has Down Syndrome, and like your son has been going to various therapies and speech classes for his whole life. I have often wondered at what point to children find our “reward’ systems boring, unhelpful, and unmotivating (my brother is mostly non-verbal, so we tend to read more of his non verbal signals if he is actually getting something out of it or not). I think there is so much more to therapy than the correct production of speech sounds, there is much more emotion and confidence levels driving attitudes toward focusing on our speech (especially if it is a focus of struggle).
    Do you have any suggestions for future SLP’s on how to “evalute” the effectiveness of a reward system? From a parent’s perspective, do think that it is hard for parents to consult with their SLP’s regarding effectiveness of the rewards?

    Thank you for your time and I really enjoyed reading your story.

    Allie T.

  10. Thank you Allie for taking the time to respond. I agree that there is more to therapy than the correct production of speech sounds. I also recognize that it’s not easy to get a distressed parent to understand that…the conundrum…

    I feel that if a reward system is working it will have extended impact beyond the presentation of the award. If the child enthusiastically embraces the desired behavior and carries it beyond the moment of the reward, then you might say it is effective. I’m still not sure the reward is necessary – I do prefer helping children to experience intrinsic rewards over external reward…you don’t get the instant gratification of their smiles over the sticker, but it just seems more conducive to long-term change. (side note: I have done considerable work in the field of youth development and home schooled three boys who are now 21 – twins – and 17, so I’ve given this some thought 🙂

    Regarding your last question on parents consulting with the SLP — I think it depends so much on the SLP. Like in any field, some are more welcoming and receptive to parental insights, some not so much. And some parental insights are constructive, some not so much… no easy answer there!

    It sounds like you will be one who will be open to constructive parental insights — best of luck to you and greetings to your dear brother!! Thanks again for your insightful questions.
    Best,
    Dori

  11. Hi Dori,

    I’m a graduate student studying to be a speech language pathologist and I found this paper extremely interesting.I never thought to think how a child would perceive rewards. Now I realize how some of our techniques can be misinterpreted and unfortunately affect a child emotionally. So now I think and question: do you agree that when working with a child who stutters it is best to first target the acceptance of stuttering then, techniques he can use to reduce the instances of stuttering?

    Thank you so much for sharing your story!
    Lupe B.

    • Thank you Lupe for your comments. I’m not a speech therapist, but as a parent (who has done years of research and reflection around this topic)I believe that the target for school-aged children should be to keep them talking and engaged in the world around them. I believe that any focus on having a child change the way they talk in order to reduce the instances of stuttering comes with the very real risk of adding layers of anxiety and stress to the speaking effort. This can either increase the stuttering behavior or result in silence and withdrawal. First do no harm. I wish, as a parent, I had better understood this risk. Thank you for listening and I wish you the best of luck!
      Best,
      Dori Lenz Holte

  12. Hi Dori,

    As a speech language pathology graduate student it is heartbreaking to see how a communication disorder could affect a child. The speech therapists Eli encountered probably meant well, but didn’t realize the mixed message they were sending. When I was reading the beginning of your paper, I even immediately thought stuttering must be wrong because Eli only got rewarded when he tried not to stutter. Educators and speech language pathologists have to be careful about how they reward their students and clients. Since Eli was frustrated with his stuttering, it is easy to see why he would just stop talking. It was easier for him to just stop talking then to put up with the struggles he encountered while speaking. I like how the focus was changed to keep Eli talking and to put less emphasis on the stuttering. It is wonderful that progress was seen shortly after because of that change. He’s lucky to have such caring parents! From now on I will think twice before rewarding my clients and I will forever ask myself, what message am I really relaying by giving this reward?

    Thank you for sharing your story!

    Casey C.

    • Hi Casey, thanks for taking the time to respond. Yes, I do believe that the speech therapists meant well, certainly didn’t mean to have a negative impact! It’s hard because what happens in the clinic setting as far as a child using speech tools to minimize stuttering behavior is rarely carried beyond that setting and this is well documented. I hope my efforts through my book have helped broaden the reality that these kids and their families face on a daily basis. We need to understand the impact beyond the clinic setting. We need to keep them talking and do no harm!

      Thanks for listening and best of luck to you!
      Best,
      Dori Lenz Holte

  13. Dori,

    Thank you so much for sharing your story and giving us a parents’ point of view. I am amazed by your dedication to research and study how to best help Eli, rather than taking a more passive stance and just leaving it up to the therapist. As a graduate student I have learned in my fluency class how important a family system is in helping a child who stutters achieve fluency. Also, the importance of identifying positive speech behaviors before pointing out the negative has been highlighted. My question to you is did the speech-language pathologists who treated your son ever take an approach to therapy that included the entire family system? Do you feel this would have been beneficial? Also, do you think if the SLPs had given your son stickers for other positive speech behaviors, even as he stuttered, it would have made a difference? For example, if they had given him stickers for using a gentle onset to speech even if he still stuttered later in the sentence. Thank you again for being so involved and motivated to find answers as a mother independently.

    Laura Newman, Graduate Student
    Western Carolina University, North Carolina, USA

  14. Thank you Laura for taking the time to read and respond. To answer your question, one speech therapist included Eli’s brothers, dad, and myself in some of the sessions. She also had Eli bring a friend once. Was it beneficial — not really. Is it a good idea? Depends on the focus of the therapy. Is it necessary? Absolutely. How’s that for confusing?

    As a parent, I think therapy should focus on keeping the child talking, addressing the emotional aspects, and minimizing anxiety around communication. If this is the focus, then parental/family involvement is pretty crucial. If the focus is on eliminating disfluencies, then family (and teachers and grandma) can turn into the speech cops. Surrounding a child with speech cops runs the risk of increased anxiety, silence, and withdrawal.

    Stickers for positive speech behavior…I feel this is risky. Children could easily interpret this as “no sticker if you stutter thus stuttering is bad.” You might find my question and responses in the “Ask The Expert” section useful too.

    My research, reflection, and writing has led me to the conclusion that we simply do not have good answers around treating children who stutter. We all must work harder to come up with solutions that don’t run the very real risk of silence and withdrawal…solutions that keep them talking and engaged…solutions that we are confident will not detract from the child’s overall well-being.

    Thanks again Laura — I wish you the best of luck in your studies.

    Best,
    Dori Lenz Holte

  15. Hi Dori,

    My name is Meaghan and I am currently studying for my Master’s in Speech-Language Pathology. I really enjoyed this article. The title especially caught my eye! I am sorry to hear that traditional speech therapy had such a negative impact on your son. I was wondering what sort of suggestions or advice you would offer those clinicians now, given that your son is older and more verbally active. I was also wondering if your son, Eli, ever considers joining support groups for people who stutter. Thank You! – Meaghan

    • Hi Meaghan – thank you for your response. I don’t speak for older teens and adults — and I’m not a speech therapist, but from a parent’s perspective, I would advise clinicians working with school-aged children to focus on finding ways to keep them talking and to be great listeners. Work directly with the parents (more so than with the kids) to nurture this approach at home and in school. If the child has negative emotions around their speech, again, be a good listener. Changes need to happen at many levels – at the moment speech therapists must treat the child directly in order to receive insurance reimbursement. Reporting measures (insurance, IEPS) focus primarily on disfluency counts which then drives the treatment. I’m not suggesting that we don’t want fewer disfluencies, obviously we do. But we don’t want the trade-off to be silence. Providing support that focuses on keeping them talking and building their self-confidence (in general, not just in speaking) doesn’t have that immediate satisfaction of using speech tools (at least in the clinic setting). It will have a far more positive impact on their well-being in the long run and doesn’t carry the risks of increased silence and withdrawal. I believe it will also minimize adding layers of speech anxiety, contributing to less tension and fewer disfluencies in the long run.

      Quite honestly I wish Eli would feel more compelled to connect with others who stutter. I think it would be helpful to him and maybe someday he will go that route. For now he says he wants to hang with people because of shared interests and their love of HALO, not because they stutter. What’s that all about??

      Thanks again for responding to my paper. Best of luck to you Meaghan….
      Dori Lenz Holte

  16. Hi Dori,

    Like many of the individuals who posted above, I too am an aspiring speech-language pathologist. I am currently a second-year graduate student and have finally gotten the opportunity to take a Fluency Disorders course this semester.

    Unfortunately, I have not yet worked with any clients who stutter; however, I am currently interning at a school for young children (K-2) and have noticed that several students have goals to address their disfluent speech. That being said, I look forward to learning about how such goals are typically targeted at my particular site.

    After reading your insightful and inspiring article, I will be sure to include your thoughts into my own, therapeutic plans in the near future. Your writing allowed me to realize just how misleading good-intentioned token reward systems can be for children.

    During lecture the other night, my class was taught about just how crucial counseling in our field can be. Counseling is one aspect of our Scope of Practice that tends to get overlooked, but that is invaluable. We were taught that counseling is, in large part, something that needs to be a part of therapy for people who stutter. SLPs must remember to include casual conversation time into therapy sessions. From what I have learned thus far, stuttering is not simply about attaining “fluent” speech, but also about understanding a person who stutter’s outlook on and overall feelings about their own, individualized stuttering. SLPs need to put down the stickers at times and just take the time to listen to their clients.

    As a graduate student, I am all too familiar with token/reward systems for clients. You’re right – SLPs like to hand out stickers like there’s no tomorrow, but we need to be more mindful of the potential messages we are sending to the children we see. At my current placement, stickers are provided at the end of each session, as long as students have demonstrated that they are doing their best job. This does not necessarily mean talking effortlessly and fluidly for children who stutter, but rather that they are putting forth their best effort to learn and try.

    No SLP should deem stuttering “wrong”, and the child’s opinion and own feelings about stuttering should always be considered. If a child is comfortable with their stuttering and chooses not to “fix” the “problem”, then SLPs need to find a way to encourage students and help them, without making those children think that their speech is flawed. Unfortunately, we still have not found this perfectly balanced solution! As research progresses, we hope to eventually learn more about mysterious stuttering, but for now, I guess all that we can really do is learn from others and consider others’ experiences (both good and bad) to try and individualize treatment as best we can and to send appropriate messages throughout the therapy process.

    Thank you for sharing your perspectives and personal experiences. I hope that Eli continues to feel comfortable talking and expressing himself in whatever way he does. He sounds like a strong young man, and I am grateful to have heard his and your story.

    Best,
    Cara

    • Thank you Cara for your thoughtful comments. The whole topic of whether or not it’s effective to give extrinsic rewards to children is beyond the scope of this forum – but I will say that I’m not a fan — at all.

      If you’re interested in reading more on the pros and cons of extrinsic rewards, go to “The Risks of Rewards” By Alfie Kohn http://www.alfiekohn.org/teaching/ror.htm

      She states that “If the question is ‘Do rewards motivate students?,’ the answer is, ‘Absolutely: they motivate students to get rewards.’ Unfortunately, that sort of motivation often comes at the expense of interest in, and excellence at, whatever they are doing.”

      So I’m not a fan of these types of rewards in general. I’m also strongly opposed to asking a child to change the way they speak in order to exhibit fewer disfluencies, rewards or no rewards.

      You are so right in saying we still have not found a perfectly balanced solution… In my “Ask the Experts” response in this conference I refer to a report that was forwarded to my by Judy Kuster. This “Review of Stuttering Intervention Approaches for Preschool and Elementary School-Age Children” opens with “stuttering treatment is a contentious issue for speech-language pathologists (SLPs) and has posed a pressing challenge in the field of speech-language pathology for decades. There are many treatments for stuttering: however, this is little agreement as to which should be used and when treatment should begin.”

      I think every parent and every speech therapist/student of speech therapy must fully understand this. They also need to understand the risks inherent in any therapy that includes the use of stuttering modification and fluency shaping speech tools.

      Thank you again for your comments — I will pass them on to Eli too..
      Best,
      Dori Lenz Holte

      • I’m compelled to, at this point, refer to my credentials as they relate to the topic of kids and rewards. I have (professionally) researched and written about youth development for the past 13 years. I have done extensive volunteer work with a crisis nursery, having children in our home, 4H Leader, teaching classes in a home-school cooperative, co-coaching a Lego League team, and raising (including homeschooling) three boys, age 17, and twins, age 21. All without stickers…at least not from me… :-))

        Dori

  17. Hello,
    The title of your paper caught my eye right away and I knew I had to read it. It is so nice to be able to read the opinions and expertise from the parental perspective on stuttering. As a graduate student, we often find ourselves as a class inferring about many of the ideas and emotions behind having a child who stutters, but we don’t actually know. What is the biggest take away when working with children who stutter for aspiring speech-language pathologists? Stuttering is such a grey area it seems in our coursework with no definite answers. It is hard to really understand what is best for each individual. Again, thank you for your paper and I really enjoyed reading it!
    -Kortney

    • Thank you Kortney for appreciating a parent’s perspective. It means a lot!!

      The biggest take-away…keep them talking and first do no harm!!

      I hope you’ll take the time to read my responses to others comments and my questions in “Ask the Experts.” I believe that more needs to be done to understand cognitive and emotional developmental stages as they relate to the current speech therapy components for the elementary school age group.
      Thanks again,
      Best,
      Dori Lenz Holte

  18. Hello Dori,

    I appreciated reading your article and think it is great that Eli has not let stuttering take over his life and kept him from going to school and working. Being a parent of someone who stutters, is there any advice you would give to other parents of children who stutter? Maybe something that helped you when you were worried about Eli’s stuttering?

    Thanks,

    Luke Heckly
    Graduate Student
    Idaho State University
    Pocatello, ID

    • Hi Luke — thank you for your questions…they are important ones!

      At the risk of self promotion, I would first have them read “Voice Unearthed: Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter.” I know of speech therapists who are doing this and getting great responses.

      If I had better understood the importance of keeping him talking and engaged, and the fun ways we could do that, I think I would have had far fewer worries. I worried because he wasn’t using what seemed to be the only option, speech tools, to fix his speech. He could clearly use these with the therapist. The contributed to increased worries, frustration, stress, guilt, shame, increased disfluencies, silence, and withdrawal. But it’s not easy for a parent to understand not focusing on the overt behavior, but it’s critical that they become informed because the are the decision-makers for these kids and the risks are real.

      Thank you again Luke, and best of luck to you! This field need more men!!

      Best,
      Dori Lenz Holte

  19. Hi Dori,
    My name is Karissa and I’m currently a speech-language pathology graduate student. I really enjoyed reading your article and your personal insight into your positive and negative stuttering therapy experiences. You are right on when you discussed how therapists reward fluency, but at the same time say it’s OK to stutter. Like you said, I think the therapy focus is becoming more focused on the emotional aspects and accepting stuttering. It’s great to hear this type of therapy was helpful for your son and has allowed him to be an active communicator again!

    Karissa
    Idaho State University Graduate Student

    • Thank you Karissa for your kind words. Eli and I just spoke to speech students at UW River Falls yesterday — he loves communicating!! I feel so sad when I think of all the times he chose not to speak up… but so grateful for where he’s at today…

      Thanks again…and best of luck!
      Best,
      Dori Lenz Holte

  20. Thanks so much for such a thought provoking article. I am going to share your book with all my parents of children who stutter. I also would love to have you speak with my undergraduate SLP students if it is feasible for you. I think, as has been discussed, your message is so important to current and up and coming SLPs. If you wanted to discuss further, please email me at: kscott@misericordia.edu. Thanks again for all you are doing.
    Kathy Scaler Scott
    Misericordia University

    • Thank you Kathy for your kind words and support! I’ll be in touch…
      Best,
      Dori Lenz Holte

  21. Hi Dori,
    My name is Gabrielly and I’m currently a speech-language pathology graduate student. I enjoyed reading your article and share your insight about extrinsic rewards. I believe extrinsic rewards should be kept at a minimum and that the client’s personal motivation should come from within them. I’m also glad your son was able to have a positive stuttering therapy experience later on. However, it seems to be common place that most people’s initial experience with stuttering therapy tends to be negative. In your son’s case it was the rewards for being “fluent”; but do you think it could have been what the rewards represented? That he was being told that there was something wrong with him, and that could have caused the communicative shut down?

    Thanks again for you wonderful article.

    Gabrielly
    Long Island University Graduate Student

    • Hi Gabrielly – thank you for your response. Yes, it does seem commonplace that initial experiences with stuttering therapy are perceived as negative — especially for children. So many report reactions similar to Eli’s – they chose silence over speech techniques. While increased silence might not be an unusual reaction to speech difficulties, I feel that suggesting that a child use speech tools in order to not stutter runs the very real risk of exacerbating the behavior. And yes, I think you’re right on. Those stickers screamed “it’s not really okay to stutter because I will reward you when you don’t.” We must focus our efforts on strategies that will keep them talking – not on strategies that risk increasing anxiety around speaking… Thank you again for your comments and best of luck to you in this field…
      Best,
      Dori Lenz Holte

  22. Hi Dori,
    As a speech language pathology graduate student, I am grateful for the insight on the importance of facilitating positive feelings about communication in general rather than focusing solely on fluent speech. You mentioned that the silence and disconnection was becoming a greater handicap than the stuttering itself. When Eli was beginning to withdraw himself, how did you address this as a parent? Did you notice a shift within your family, such as siblings offering to speak for Eli more to compensate for the silence or as parents trying to include him more/allowing him to participate less in conversations?
    Thank you for sharing this paper and your personal experiences!
    – Kerry

    • Kerry,

      When I was reading this paper I had some of the same questions you did. I think the questions you asked were great and I can’t wait to read her reply. I agree that there should not be so much energy put into fluent speech as there still is in current therapy sessions. Good questions!

      -Carrie

    • Hi Kerry, thank you for your reply. As parents we were heartbroken, confused, and frustrated. Initially we kept on track with the therapy focused on minimizing speech errors with sm and fs speech techniques — as this did seem to make sense. If we could get him to use the techniques then he wouldn’t stutter as much and he would speak more. So we pushed and practiced and continued down the path we were on. One day we just stopped. No more speech therapy. Then we were more lost than ever. We felt very alone and he continued to shut down. Ultimately we found a therapist who helped us to focus our energy on keeping him talking, and over time, we got him back. He still stutters, and honestly, I still have hopes that it will fade away, but he’s living a full life and engaging in the world around him with courage and enthusiasm. That’s far (far) more important.

      I can’t really recall how his brothers reacted…they are twins, 4 1/2 years older. I don’t ever remember them speaking for Eli — they had become pretty accustomed to his tension and his silence. I know I vacillated between wanting to push him to speak up (ordering in restaurants, giving presentations at our home-school group, asking him questions around the dinner table) and just letting him be. It’s very confusing for a parent. And for the child. No easy answers.

      Thanks again for your response and best of luck to you!
      Best,
      Dori Lenz Holte

  23. Hi Dori,

    Your research and experiences are very eye-opening. As a future speech and language clinician who is currently taking a fluency course, it was very helpful to hear your experiences as a parent of a child who stutters.

    It was particularly eye-opening to realize that Eli felt that his stuttering was “wrong” even though no one had specifically told him that. It will definitely will make me think long and hard about providing physical reinforcement for using speech tools in stuttering therapy for children, especially if they have not yet accepted their stuttering. After all, how can we truly expect them to have accepted it at such a young age?

    I agree that there is a greater focus on desensitization and creating positive feelings around communicating for adults and children who stutter. I hope you will find it encouraging that I believe that a huge part of providing speech therapy to adults and children who stutter involves counseling and talking about an individual’s attitudes about stuttering.

    Best,
    Jessie

    • Thank you Jessie for your reply. As a parent, I wish speech tools had never been introduced, rewards or no rewards. It’s just not worth the risk. I’m not sure that our focus should be helping them to accept their stutter either. I believe that the best we can do is to provide support that keeps them talking and does not risk contributing, in any way, to increased anxiety around talking. The well-known and widely-used saying “stuttering is what one does when they are trying not to stutter” is a popular one, and I think there’s truth in it. Why do we continue to ask children to focus on therapy components directed at getting them to change how they talk so they will stutter less? We need to do better.
      Thanks again Jessie, and best of luck to you!
      Best,

      Dori Lenz Holte

  24. Hi Doreen,

    This article was very interesting and just the title alone drew me in. As a future SLP, it really made me think about how, when, and what we are praising our clients for. As portrayed in your story, this has a huge impact on the client and we need to make sure that the right message is coming across. It was nice to hear your opinion as a parent because in class we often try to hypothesize how a parent would feel about certain issues, but we never have a concrete answer- if that even exists in the field of fluency?
    I was reading a comment you made back to someone else’s question and your response really made me think. You said, “therapy should focus on keeping the child talking, addressing the emotional aspects, and minimizing the anxiety around communication.” Then you went onto say that if the therapy is focused on decreasing disfluencies the parents and family members can turn into the “speech cops” which can have a negative impact on the child. I had never thought about this in that way before, but it really made sense to me. In my fluency class we tried using speech techniques to get a glimpse of what it would be like to be a person who stutters and have to think about everything you say before you say it. This experience proved to be very challenging and exhausting and I couldn’t imagine asking a young child to implement these techniques. Even during the activity in class, I had something to say but didn’t even want to try to say it because I knew how much work it would be. I can see how asking children to take on these techniques would push them to not talk as much.
    When there is too much anxiety put on communicating especially through the family members playing “speech cops”, I can see how the easier option for the child would be to shut down. Through reading this paper, I learned that the most important thing is to just keep the child talking and work with the parents to make this happen instead of creating parents who are “speech cops.” This seems to be the most beneficial approach for the child in the long run. Thank you again for sharing your story and your expertise!

    Amanda Weber

    • Hi Amanda — thank you for your response. I’m so glad that your professor had you use the speech techniques! Can you imagine spending each day of your entire childhood thinking you should be doing this?? You’re so right – there are no concrete answers, but at minimum these kids deserve support that will first do no harm. I think you’re on the right track and will make a great speech therapist! Best of luck to you!

      Dori Lenz Holte

  25. Dori,

    I am currently a graduate student studying to be an SLP. I really enjoyed reading your paper about your son Eli and his/your personal experiences. As a beginning clinician it is nice to read other people’s experiences to better understand what they go through/went through with their fluency disorder. I am currently doing a practicum placement in a correctional institute and have a 20 year old male with a fluency disorder. I feel like I can relate to your paper because my client avoids many situations and is quiet in certain situations just like Eli. During therapy sessions we try to praise him for both his moments of fluency and moments of disfluency. I know he is too old for stickers but I was wondering if you knew of any other types of reinforcement for a male this age? I think that other types of reinforcement would be beneficial for this client because he really wants to be successful in therapy as well as outside of therapy so that he can lead a normal life when he is released. I think he has to potential to be successful like Eli and his personality but he needs different types of reinforcement.

    Thank you for sharing your experience, I really enjoyed reading your paper.

    Thank you!

    -Carrie

    • Hi Carrie – thank you for your response. I always say that if a teens or adults feel that an approach is useful, well then, it’s useful at least for the moment. In my opinion a 20-year old man does not need external reinforcement. If he is not coming to the table motivated to tackle this challenge, then no amount of external reinforcement is going to affect real change. I’m not a speech therapist, but I do believe that teens and adults who want change must educate themselves on the array of possibilities and try those that feel most comfortable. I would encourage him to read all the first-hand accounts he can get his hands on including my book, “Voice Unearthed.” (I would be happy to gift him a copy. – email me at voiceunearthed@gmail.com) There are many out there — Ruth Mead, John Harrison, Marty Jeezer, Kenneth O. St. Louis (a compilation of first-hand accounts), to name a few — The Stuttering Home Page has tons of stuff. He needs to find what resonates with him and be very motivated to change. You, as his therapist, can be a wonderful guide, provider of resources, listener, and supporter. Best of luck to you!!
      Best,
      Dori Lenz Holte

  26. Dori –

    As a PWS and as a Board Recognized Specialist in Fluency Disorders, I am hoping you don’t mind my intrusion into these threads.

    To me, there are significant and major differences when deciding upon therapy to administer to Child VS Teen and Adult who stutters. I urge ALL students hoping to become SLP’s working with children who stutter to considerdoing the following before engaging in fluency training/shaping or stuttering modification techniques with a child who stutters:

    Requirements for the speech & language clinician to complete prior to suggesting, assigning or demanding the CWS to use Fluency Training or Stuttering Modification Techniques while talking or interacting with others…

    1. The person directing the child to use the
    “techniques” must use the “techniques” in all
    their own talking and interactions with others for
    a full week.

    2. If it is SLP directed, complete # 1… then, administer
    the “techniques” to your own child, grandchild or a
    much loved youngster, and assign them to use those
    “techniques” in their talking and interactions with
    others for a full week. Finally- if you still insist – administer
    as # 1 indicates to the parents of the CWS in order to direct
    you to STOP THE MADNESS!

    I’d appreciate any thoughts you would share regarding this idea.

    Thanks in advance!

    Retz

    • Hi Retz – you will be interested in reading the comments from Amanda Weber above. It great to hear that communication disorder programs are asking their students to try it on themselves first! Your comments remind me of a story I was told by one of Eli’s former therapists after she read my book. She did not have children when she treated Eli. She had three when she read my book, one who exhibited some stuttering behaviors. She admits she was at a loss and realized she was not at all comfortable doing this type of therapy with her own child. I really admired her courage to admit that to me. Thanks for “intruding” with your insights…as both a PWS and a therapist, your insights are so important…
      Best,
      Dori

  27. Thank you for posting this wonderful piece. I am currently a graduate student in speech-language pathology and am grateful for being able to be exposed to the experiences of someone who has dealt with a fluency disorder. Throughout the paper, you discuss how her son stopped talking due to being ashamed of his stuttering. This is a common occurrence in young speakers who have been dealing with stuttering for many years and is consistent with current research that suggests that children are likely to react to stuttering with shame and embarrassment (Guitar, 2006). Based on your experiences, it appears, though, that there is a slight gap between her son’s treatment and recommendations from the literature. You comment that your son’s speech therapists incorporated a stuttering modification approach into his intervention; however, before actually attempting to use modification techniques, it is essential that the child has been desensitized to stuttering. Do you believe that more speech language pathologists should be spending more time with this desensitization stage before addressing actual behavioral modifical techniques? It appears that you recommend a greater focus on desensitization. In fact, many researchers support this and claim that desensitization is a prerequisite before implementing and using stuttering modification behavioral techniques. Murphy, Yaruss, and Quesal (2007a) stress how important it is for the child to learn about stuttering, become tolerant of stuttering events (e.g., freezing or staying in the moment of stuttering) and be more open about their stuttering with their communicative partners. It is important, as you mentions, for individuals who stutter to “put [themselves] out there each and every day.” This idea has been emphasized by acceptance commitment therapy and avoidance reduction therapy; in order to find success with treatment for fluency disorders, it is necessary to accept, acknowledge and confront the situation, which will help with desensitization and allow those individuals to participate fully in daily activities (Wingate, 1964). Thanks again for sharing your story. It is insightful and inspirational!

    • Hi Ryan – thanks for your comments. I’m not a speech therapist, but I’m not sure that I agree with Barry when he says that the shame and embarrassment is in response to stuttering. Shame and embarrassment most often results from other’s reactions to the stuttering — facial expressions, bullying, teasing, inappropriate reminders to use speech tools, and about a million other ways. It is difficult, if not impossible, for a parent to hide their fear and concern, especially when they are hauling them to speech therapy once or twice a week and spending an hour a day on the use of speech tools (or when they agree to an IEP for weekly school-based therapy). Strangers continually express confusion or surprise through facial expressions — this is unavoidable. We cannot possibly eliminate all sources of shame in any child’s life, regardless of whether or not they stutter. But we can do so much to minimize these devastating emotions, help them to build coping skills (in general, not just as they relate to stuttering) and to keep them talking and engaged.

      I believe the continued failure so many children experience when they try to use speech tools outside of the clinic setting contributes to shame and embarrassment. This is unnecessary and we can do better. As a parent, I wish that the idea of speech tools (behavioral modification or fluency shaping tools) was never introduced in the first place. It’s not worth the risk. Parents and speech therapists have the right to fully understand these risks before introducing the therapy. I hope this is helpful and best of luck to you…we need more males in this field!!! Thanks again,
      Best,
      Dori Lenz Holte

      I’m not a speech therapist, but I know that Eli wasn’t ashamed or embarrassed by his stuttering until after he started speech therapy.

  28. Dori,

    Thank you for sharing your experiences with traditional speech therapy. I was sorry to read that reinforcing the use of “speech tools” had a negative impact on Eli’s communication. However, now that he is older and is fully engaged in the process of “put[ting] himself out there each and every day” – are there any specific speech tools he learned in the past that he now finds helpful? Is there a place for them now that he has developed a positive attitude toward communication or does he find that he does not need them? Thank you!

    Zisel

    • Hi Zisel – thank you for your response. So far Eli has not used any of the techniques he has learned. I’m not a speech therapist, but in my response to Amanda Weber, I talk of the value of motivation and exploration in this journey, especially for teens and adults. I know there are some adults who used speech tools as part of their journey to natural speech, there are adults who enlist speech tools on a short-term, situational basis, and there are a few adults who use speech tools continually, often with unnatural sounding speech. I believe that whatever an adult perceives as helpful is helpful. There are many adults who have foregone speech tools and adopted the IDGAS (Halvorson) approach. Stands for I Don’t Give a S#@#@. They have found that the less they focus on their speech, the more natural it becomes. I think there are many ways we can incorporate that into therapy for school-aged children. Thanks again for responding and best of luck…
      Best,
      Dori Lenz Holte

  29. Dori,
    I’m an SLP grad student and I found your paper very interesting. I’ve been using sticker charts as motivation for all of my students and had never thought about the fact that rewarding for one behavior (fluent speech) tells the child that it’s not ok to stutter, even if you do tell them that. Actions speak louder than words! Would you say that fluent speech should ever be praised? It’s a tough situation, as in therapy you want to provide motivation for the desired result, yet you don’t want to scare the client into silence.
    Thank you!
    Emma

    • Hi Emma – great question. I think that praising fluent speech comes with risks of shame and embarrassment around non-fluent speech. Real motivation needs to come from within in order to affect real change. Most children just aren’t there. They are motivated to play video games, be with friends, eat candy and to please adults.

      I’m not a speech therapist, but I think a therapist should be one of the child’s best listeners. That’s the only way they will start to understand what really motivates the child. In general. Not as it relates to speech. Allowing a child space to talk freely about what motivates them will keep them talking (I’ve listened to hours of profound life-changing insights about Pokemon:-)

      I think all parents and therapists need to truly understand what desired result they are aiming for. Do they desire fewer speech errors or self-confidence and engagement in the world around them. I choose the latter. You don’t get the short-term satisfaction you get with the use of speech tools (most often only in the clinic setting) but greater long-term likelihood of the child living up to their potential and becoming a productive, contributing, happy adult. That’s my goal for all of my kids…we need to keep our eyes on that goal!
      Thanks again Emma – best of luck to you!
      Best,
      Dori Lenz Holte

  30. Dear Dori:
    Thank you for sharing your son’s story. As a future SLP this story has made me rethink how tangible rewards could be construed in different activities regardless of the disorder. I know we are looking for the best outcomes for our clients and sometimes those we are treating can misconstrue the underlying message. I am glad that your son is an active member of society and has not withdrawn especially after all society has to offer and vise versa. I do have a couple questions for you:
    As a parent of a person who stutters is their any advice you would give to other parents who are beginning therapy with their children?
    Is there any one specific thing you would do differently looking back on your experience that would benefit future SLP’s if they knew it?
    Thank you again for sharing your story.
    Stacey Bastin
    Graduate Student
    Western Carolina University

    • He Stacey – thank you for your response. Most advice I would give to parents is in my book, “Voice Unearthed: Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter.” I know there are numerous speech therapists who are recommending the book to parents of children they connect with. Please know I’m not saying that to sell books. I will happily gift anyone who is interested a copy as I feel readership is more important than money.

      There are many things I would do differently. Again, the book talks about this at great length. But the first thing that comes to mind when I’m asked that question is that when Eli said “this is stupid, Mom” I would have listened and believed him instead of thinking he was just being obstinate and lazy. I guess I would tell speech therapists that if they just can’t let go of using speech tools on a child (and since ASHA still recommends this, it probably won’t happen soon), please know that if the child is reticent or clearly not finding them useful outside of the clinic setting, then continuing down this path is most likely to do far more harm than good. Focus instead on keeping them talking and engaged in the world around them… Thanks again for your response and best of luck to you.
      Best,
      Dori Lenz Holte

  31. Hi Dori,

    What an insightful story! As a future SLP, I greatly appreciate you sharing your story, as it has given me a new perspective on reinforcement in therapy, especially working with children who stutter. In my fluency class, we had the privilege of speaking with a panel of 4 PWS who shared their stories and experiences in speech therapy. As future clinicians we were all eager to find out what techniques/tools they were taught to use in therapy that they have found helpful. In general, all 4 members of the panel said that they have a large tool box full of strategies to use, but the truth is that some days they work and other days they don’t. They all agreed that the best SLP’s were the ones that helped them accept their stutter and encourage them to educate others about their stutter, which made them less fearful to speak. Your story reiterates the importance of building the confidence of children with stutter and accepting it, to prevent them from feelings of shame. Thanks again for your thoughtful insight.

    Kristen

    • Thanks Kristen for your response. I think it’s wonderful that your professor is bring in PWS to share their stories! I assume they were adults? I always say that if an adult finds something useful, then it’s useful. Children are a different story — communication challenges certainly make a person more vulnerable to choosing silence over speaking, but we must make sure we are not doing something that runs the very real risk of exacerbating that silence, especially in children. Thanks again and best of luck to you.
      Best,
      Dori Lenz Holte

  32. Dori- Thank you so much for sharing this story! I am currently graduate student in the field of Communication Sciences and Disorders and find myself constantly using reinforcement with most of my preschool and school-age clients at least once in every therapy session. Although I try to not give the client a reward until after the session is finished, I am aware of the impact my facial expressions or/and vocalizations have on my client’s during therapy. This is something that I feel dramatically effects the success of my clients and I am working to develop new methods for treatment reinforcement.

    I do have some questions about the methods you used as a parent to cope with your son’s disfluency and the ways you encouraged your son to continue communicating at home. What methods would you, or have you shared with other parents who have children who stutter? Is there anything you would have done differently when communicating with the SLP?

    Thank you for sharing your story,

    Erin Greger
    Communication Sciences and Disorders
    Graduate Student
    Western Carolina University

    • Hi Erin – thanks for your response. It’s common knowledge that most kids can “successfully” use speech tools within the clinic setting, but rarely find them useful in the real world. I believe that awarding success in the clinic setting for using speech tools runs the tremendous risk of these kids choosing silence over making speech errors in the real world. Children simply do not have the capacity to use these tools without adding layers and layers of anxiety around speaking. This is also reported by many adults! So we have to be careful at how we define success…a hot-button issue throughout the field of stuttering therapy.

      At the risk of sounding like I’m here to sell books (email your address to voiceunearthed@gmail.com and I will gift you a copy…), my book, “Voice Unearthed,” shared some of what we did to get Eli back. I think that will look different for each child – that’s why I believe that the role of a speech therapist should be to help educate parents and work with them to identify the circumstances that exist when the child talks most. For us it was in the car, before bed, talking about what he’s passionate about, even if it means hours and hours of Pokemon-related conversation, etc… take the pressure off.

      What would I have done differently? Based on what I knew at the time, I’m not sure that I could have done anything different. I didn’t have the knowledge or context for the therapy — I assumed they knew best. Even though I grew increasingly uncomfortable and frustrated with how things were playing out, I simply didn’t have the language to express anything other than “this isn’t working.” Most often the response was “keep practicing.”

      We can and must do better…
      Best of luck to you Erin!
      Best,
      Dori Lenz Holte

      • Dori-

        Thank you so much for your response. I am very appreciate for all you feedback. I plan on emailing you and look forward to reading through you book and using what I learn throughout my clinical career.

        Best Wishes,
        Erin Greger

  33. Hi Dori,

    Thank you so much for sharing your family’s story. I truly enjoyed reading about the experiences you and your son had. As a graduate student studying Communication Disorders, I find it extremely valuable to hear parent’s perspectives and opinions. The concept of generalization is always being explored in our field. Clinicians work with their clients and try to provide them with the tools and resources to help them feel self-assured when outside the therapy room. We know generalization is much more complex than simply transferring those learned skills. SLPs tend to use stickers to either keep their client motivated (on task) and/or in response to applying that learned technique. However, when working with a CWS, I understand how stickers are not appropriate. You brought up a great point that many people probably have never considered: How does your client feel when you do not provide that sticker? When your son was in speech therapy, do you think simple positive praise and acknowledging his efforts would have resulted in less negative feelings towards speech therapy when compared to be given stickers? Also, do you think speech therapy would have been more beneficial if a greater focus was first paid attention to counseling such as, desensitization and creating positive feelings before speech tools were even introduced in therapy?

    Thanks to parents like you and individuals who stutter sharing their stories, our field is learning the importance of incorporating counseling in therapy when working with CWS and PWS. A person who stutters should never feel ashamed. When working with children who stutter, it’s important to help him or her build to feel confident and to accept their stutter. Those are the feelings that we want them to generalize. Thank you again for sharing your thoughtful paper.

    Danielle R

    • Hi Danielle — thank you for your response. I’m not sure we should ever praise a child for fluent speech or non-fluent speech even though they are trying their best. It runs the risk of increasing anxiety around that effort and making the struggle worse. Or having the child choose silence…or both! If a child isn’t on-task, it usually means they are not finding whatever it is they are suppose to be doing relevant to their world. Rewards might lead to submission, but not necessarily to long-term well-being. Don’t get me wrong, I will occasionally reward my kids for say, doing the dishes as they, for some reason, do not find the need for clean dishes relevant to their world. Most often their reward is that they’ll get fed :-))

      I think speech therapy for school-aged children should focus on educating and supporting the parents on how to keep them talking. It should also be on listening to what’s going on with the child. They may not care about their speech tension, they may be greatly bothered by it. We do not have risk-free options for achieving fluency with kids, so first do no harm. Listen, help them build life-skills that will prepare them to cope — with life’s challenges in general. Celebrate their strengths, nourish their passions (which, by the way, can change at the drop of a hat), and listen listen and listen some more. Shame is a far greater handicap than disfluency — keep them talking!
      Thanks again and best of luck to you Danielle –
      Dori Lenz Holte

  34. Hi Dori,

    Thank you so much for sharing your son’s story. I’m a graduate student in speech-language pathology right now, and I think that reading this was a good reminder that even with all the positive reinforcement in the world, there’s still a good chance that an (albeit unintentional) message of shame might come across. I will remember your story as I continue with my practice.

    Thanks!

    Rachel
    Idaho State University Graduate Student

  35. Hi Dori,
    Thank you again for sharing your story. I am currently in a master’s program studying to be a speech language pathologist. I use stickers a lot as reinforcement for correct productions. I never thought that I might also be affecting their confidence. I agree that introducing concepts of speech tools and positive reinforcement for not stuttering may give a child the wrong idea when presented at a young age. Do you think therapy should focus only on desensitization to a certain age?

    Thank you,
    Geoff

    • Hi Geoff — thanks for your questions. I am not a speech therapist, but as a parent I believe the therapy should focus on minimizing anxiety around communication and keeping them talking. Focusing on desensitization may or may not be helpful, depending on how the child feels about his speech, and depending on how it’s done. I think therapists should facilitate this by working with the parents and being wonderful listeners for both the parents and the child… there are no easy answers, but first do no harm! Thanks Geoff — so happy to see men pop up on this forum!! We need you!
      Best of luck
      Dori Lenz Holte

  36. Dori,
    Thank you so much for sharing your story and the unique perspective on stuttering. I am currently a graduate student in a Communication Science and Disorders graduate program and I have never thought how contradicting the stickers could be for a child. As a future clinician I feel that it is very important for me to be aware of my behaviors and what I am trying to achieve from therapy.Thanks again! I will definitely think twice before I grab for my stickers.

    Jenna
    UWSP Graduate Student

  37. Dori,

    Thank you for sharing your story. The ending was extremely heart-warming, and although your son is not perfectly fluent (who is?), I think it is a happy ending. I am a first year graduate student in the area of speech-language pathology, and I truly believe that stuttering therapy should be aimed at making the client feel comfortable in their own skin. Goals of fluency are sometimes unrealistic. As I read your story, I grinned when you talked about the contradictory statement, “it’s okay to stutter, but if you don’t, I have a sticker.” We discuss these issues for all types of therapy. It is extremely difficult to explain to a child that they do not have a problem, as we try to correct their speech and language. I think honesty is a great first place to start. Perhaps, as children reach the ages of 7, 8, and 9, we should be explaining that we are working to make them more easily understood. We can tell them that their difference is not a problem, but we want to teach them strategies that make their social life easier and more relaxed. Do you think this type of approach would have made a difference in your son’s final years of traditional therapy? What were some of the approaches Dr. Halvorson used?

    Thank you again for sharing,
    Alisa
    Graduate Student
    University of Wisconsin-Stevens Point

    • Hi Alisa – thanks for your response. I’m not sure it’s best to try and convince a child who is concerned about their speech that they don’t have a problem. If they are concerned (no matter how that concern came about), then they do have a problem. If they are not concerned, then they should not be in therapy. I know, kids can pretend they’re not concerned, but really are being impacted in some way. I think we need to be good listeners, acknowledge we don’t have all the answers, and help them to build coping skills for life in general. The approach you are talking about sounds similar to the approach that was used with Eli. Kids are smart — they see through “it’s not a problem, but we are going to make you do therapy to fix it” no matter how you wrap the package.

      As a parent, I would prefer the field of speech therapy to find ways to minimize anxiety around speaking and keep them talking!! First do no harm!
      Thanks again and best of luck to you Alisa!
      Dori Lenz Holte

  38. Hi Dori,

    The story you have shared has allowed me to link an example to a concept I have recently learned in my fluency course at Kean University in NJ. This concept was that when demands exceed capacities the PWS will become less fluent, which is why it is so important to work with both the PWS and their family. I am glad that through all of your research for your novel you were able to find Dr. Haalvorson who has helped Eli and your family focus on having less demands and just living life to the fullest. From what I have learned, it is important for the speech-language pathologist and the family to understand that speech therapy for a PWS is suppose to be the ability to communicate effectively (not perfectly), and to improve their quality of life.

    I was wondering if Eli had considered posting this same story in his own perspective. It would be interesting to read his reasons for resorting to silence, and how the change in therapy focus years later helped him to become the young man he is today.

    Thank you for your time!
    Amanda Doran
    Graduate Student
    Kean University in Union, NJ

    • Hi Amanda – thanks for your reply. I am somewhat familiar with the demands and capacities model and I believe it has a great deal of validity.

      “Stuttering results when demands for fluency from the child’s social environment exceed the child’s cognitive, linguistic, motor, or emotional capacities for fluent speech.”

      C. Woodruff Starkweather

      I’m not just trying to sell books, but my book, “Voice Unearthed,” includes Eli’s voice and his perspective. You can email me at voiceunearthed@gmail.com and I will gladly gift you a copy. Otherwise it is available as an e-book and on Amazon.

      Thanks again for your questions, and best of luck to you.
      Dori Lenz Holte

  39. Hi Dori,

    The thoughts posted by my fellow classmates of Speech-Language Pathology such as Cara and Jessie are similar to my own. We recently had a panel of adults who stutter and while each had their own ideas on what works or doesn’t, it was clear to me that a lot of the therapies we, as SLPs, provide may be effective in the therapy room but do not extend to other situations. I sometimes wonder if there is really much we, as SLPs, can really do except provide counseling and possible strategies, that may or may not be effective.

    I also wonder how much of the effect of therapy in the therapy room has to do with the comfort level one may build with the person receiving therapy and how much of it also may be due to the reward/token systems either through stickers or other rewards. I agree with you completely that doing this with children who stutter sends the wrong message. If they stutter, they don’t get the prize, if they don’t stutter, they do get a sticker. It casts a negative light on episodes of disfluency which is not what one should be doing.

    The panel I mentioned before commented that what most helped them was the idea of self-acceptance, which I believe is the way to go in helping easing the concerns and fears, even the insecurities that a child who stutters may have. It’s important to teach them, as you wonderfully articulated, that it’s okay to stutter. I really enjoyed your post and thank you for sharing your son’s story. It’s enlightening to me as a future Speech therapist.

    Sincerely,
    Daisy Mejia

    • Hi Daisy, thanks for responding. I think there is tons SLPs can do to support a child and their family – but I believe it must focus on keeping them talking and engaged, not on minimizing speech errors. The biggest challenge there is to educate the parents, as they are most likely just wanting the behavior to go away ASAP. I know I did! I think you’re so wise to understand current limitations when it comes to therapy for kids. We really must weight that against the time and resources needed to get therapy and the risks involved (silence and disengagement).

      I do believe that therapy can be a comforting place for kids who are struggling. So many adults speak of how much it meant for them to have a time and place to be heard without being judged. That is what leads to genuine self-acceptance, self-confidence, and a sense of well-being. You are on the right track Daisy, best of luck to you!
      Dori Lenz Holte

  40. Hi, Dori. Thank you for sharing your story from a parent’s perspective! I am a current graduate student in communication sciences and disorders (graduating in December!), but I also have a master’s degree in early intervention (EI). In the EI field, there is emphasis on working within the systems that the child is part of (family, school, community, etc.), but also on helping parents understand that they are the experts on their children and empowering them to become advocates for their children. All too often I have found that parents of young children don’t advocate because they don’t feel they should question the “professionals.” It sounds to me that you’ve become a wonderful advocate, not only for Eli, but also for other children who stutter and their parents. I was wondering if you were outspoken about Eli’s therapy from the beginning or if it took several years for you to become comfortable enough to question treatments and research? When speaking to future SLPs, do you have any advice on what we can do as professionals to empower parents to advocate for their children?

    Martha

    • Hi Martha – thanks for your response. I too was one of those parents who didn’t feel equipped to question the professionals, at least not for many years. I agree that parents should be advocates, at the same time, the helpfulness of this advocacy depends greatly on what exactly is being advocated! If a therapist suggests that your child can use speech tools to help “manage” their speech, and you encourage this at home and at school, you are being an advocate. But is this such a good idea?

      I’m not sure that anyone is an expert on anyone else, even themselves. Maybe we need to step away from that idea. Human beings are just too complicated and the brain still way too much of a mystery. We parents do the best we can (most of the time) with what we have. Even that doesn’t always happen! We are better off getting to “I’m not an expert, I don’t have all the answers, I will make mistakes, but first I’ll do my best to do no harm!”

      There are SLPs out there who are having parents read my book, “Voice Unearthed” prior to therapy. The book helps to educated and empower parents as they are the crucial decision-makers on this journey. It gives them a voice…kind of ironic! You can email me at voiceunearted@gamil.com and I will happily gift you a copy.

      Thanks again Martha – best of luck to you!
      Dori Lenz Holte

  41. Hi, Dori. Thank you for sharing your son’s story with us. He seems like a great kid and to be improving with each and every day. I initially chose to read your paper because I thought it was about speech therapy for stuttering, but within the first few paragraphs I realized it was about much more. You incorporated a wide range of things involved with stuttering, from emotions to behaviors and everything in between. I am currently a graduate student studying speech language pathology and have become particularly interested in fluency disorders specifically. I am presently enrolled in a fluency disorders class now and each class I learn something new about stuttering. Before taking the class, I had no idea to what extent stuttering played in underlying emotions, like shame, guilt and others you mentioned in your paper. I really liked the fact of how you mentioned that although you, or the speech therapists that worked with eli had never actually told him that stuttering was wrong, somehow that is the message that stuck with him!! As you mentioned in your papers, young children love praise and acceptance from others, therefore the retrieval of stickers for talking fluently sent him mixed messages. He believed that taking fluently was good, and stuttering was bad.
    Another point you addressed was the fact that he would only use his speech tools in therapy and not functionally in everyday activities. I have heard that time and time again and was curious about your thought on that? It is truly admirable that you cared more about your child talking rather than focusing on his stuttering. Looking at the child as a whole and not solely on his stuttering is so important for development. As you mentioned in your paper, so much of stuttering is connected to shame. You are more interested in Eli being engaged and talking, than him being silent and not participating in activities because of his stutter.This says a lot about your character as a parent. The amount of research you have done is amazing. You seem to be a great advocate for your son and I hope that you continue to share more stories about his stuttering.

    Questions
    Although speech therapy did not necessarily work in your son’s favor, do you still believe that therapy may be a good option for others?

    What would you say are the most important aspects of stuttering that professionals should focus on in therapy?

    Does Eli find it difficult to get through daily situations because of his stutter, or has he accepted it?

    Has he/you ever been to a support group for stutterers?

    Jocelyn

    • Hi Jocelyn — thank you for your thoughtful response. Here are answers and responses to your questions and comments:

      1) “Another point you addressed was the fact that he would only use his speech tools in therapy and not functionally in everyday activities.I have heard that time and time again and was curious about your thought on that?”

      A) I too have heard this time and time again, from both parents and speech therapists. Quite honestly Jocelyn, I don’t understand why there isn’t more effort around eliminating this practice from therapy for children who stutter. This is my mission. I was struck by the “Catchphrase: A Stuttering Intervention Activity with Unexpected Benefits” another ISAD paper in this year’s conference. (Bragg, Fowler, Shapiro). The clinicians describe how they felt when attempting to use these tools themselves during the Catchphrase exercise…

      ”We were so focused on how to speak that we forgot our place in the narrative. The demand created by speaking in a prescribed manner seemed to overwhelm our capacity to keep up with what was needed to be said. By the end of the session, we yawned incessantly due to interrupted breathing and our eyes watered from fatigue. When we tried to speak in our usually fluent voices, we continued to stutter on occasional words and experienced generalized speech disruption.”

      These were adults. Although well-intended, I think that what they experienced sheds light on why a child would choose silence over that level of focus and exertion.

      2) “It is truly admirable that you cared more about your child talking rather than focusing on his stuttering.”

      Thank you, but for the first five years of his receiving therapy, that wasn’t the case, not at all. We wanted the blocking and struggle to just go away. We were desperate and so scared for him. It wasn’t until the silence and withdrawal screamed louder than the stuttering behavior that we started to reflect, research, write, and finally change our focus. I wrote “Voice Unearthed” so that other parents and speech therapists can get there much more quickly than we did.

      3) “Although speech therapy did not necessarily work in your son’s favor, do you still believe that therapy may be a good option for others?”

      A) It depends on the therapy. While I’m not a speech therapist and I don’t speak for adults or teens, I think support should focus on helping the parents to keep kids talking and engaged. This support should hinge on listening and focusing on what the child does well in all aspects of his life. I also believe that this approach will keep the door open wider to the opportunity of seeing a more natural speech emerge and secondary behaviors melt away.

      4) “What would you say are the most important aspects of stuttering that professionals should focus on in therapy?”

      A) The 90% beneath the tip — referred to in the Iceberg theory (see the ISAD submission “Icebergs and ice cubes – the value of discussing stuttering with children and teenagers” Linklater). Again, I’m not a speech therapist, but the only way that can be determined is by listening, listening, and listening some more. For school-aged children, this listening must include listening to both parents and kids, to what they are observing and feeling. Basically I think professionals (and everyone else) should focus on keeping them comfortable with communicating, not on the stuttering.

      5) “Does Eli find it difficult to get through daily situations because of his stutter, or has he accepted it?”

      A) Both. He most often doesn’t let it stop him from engaging (phone, strangers, classroom setting, friends, relatives), but I could never say that he is never frustrated by it, that he never chooses silence. As he matures, he becomes more confident and assertive. He practices Halvorson’s IDGAS approach (I don’t give a sh*##) on a daily basis.

      6) “Has he/you ever been to a support group for stutterers?”

      A) We have been to several FRIENDS and NSA conferences and he’s met kids and adults who stutter outside of those venues, but just isn’t interested. He says he wants to engage with kids who share his interests more so than kids who stutter. I sometimes wish he would show more interest, but he’s happy, has friends, and is fully engaged in his world, so I guess that’s my problem!

      Hope this is helpful, feel free to ask more great questions…Thanks again Jocelyn for your response and best of luck to you!
      Dori Lenz Holte

  42. Dori,

    Great article! I am a graduate student in Speech-Language Pathology. Your article grabbed my attention for a couple reasons. The first is that I use stickers all the time in therapy with children (not with fluency or stuttering). In my experience, they tend to make great reinforces. Second, when I started reading your article, the first thing I thought was that it made so much sense what you were saying. Like you mentioned, there is a time and a place for stickers. We need to make sure we reward the things that really matter (for example, confidence). I can only imagine how confusing that would be for a child if one person is telling you its okay if you stutter but reinforcing you with a “good job” of sorts when you don’t. It really got me thinking that our actions, even if unintentional, could be creating some implication of how someone should feel about something such as stuttering. How, in your opinion, would have been a better way for your son to receive the support he needed from his speech therapists? What would you recommend for child clients that would like to use speech controls to reduce their stuttering and also be confident in their voice?

    Thank you for sharing your story!
    Kelsy

    • Hi Kelsy — thank you for taking the time to respond. I thought of a great place for stickers yesterday while taking care of a two-year old — potty training! Now that really matters 🙂

      You ask “How, in your opinion, would have been a better way for your son to receive the support he needed from his speech therapists?” See my response to Jocelyn — I don’t have all the answers by any stretch of the imagination, but first do no harm!

      You also ask “What would you recommend for child clients that would like to use speech controls to reduce their stuttering and also be confident in their voice?”

      I’m not a speech therapist, but I would be truly surprised/stunned/shocked if a child child came to a speech therapist requesting speech controls. I don’t that suggesting they can “control” or “manage” their speech comes with considerable risk of silence and disengagement…and it’s just not worth it! If this concept has been introduced and is not contributing to speaking freely outside of the clinic setting, (or if they say “this is stupid” as Eli did) then I think we need to understand the harm that can be done and to listen. Ideally the idea of “controlling” or “managing” their speech is never broached. Again, I refer to school-aged children, not teens or adults.

      Thanks again for your response and feel free to ask more questions…best of luck to you!
      Dori Lenz Holte

  43. Like others, I am a graduate student and I think some of the previous students would agree with me when I say we sit in class, learn the possible etiologies, treatment methods, and even the importance of addressing the clients feelings and emotions, but sometimes they still get overlooked. I have never worked with a child who stutters so for me it was nice to get a parents perspective and to try to better understand the emotional struggle that accompanies the child as well as the parent. Reading your article and seeing the parent’s perspective was very beneficial for me. This was a great story and I am happy you shared with us. It is definitely a perspective we should always keep in mind.

    Also, I never would have thought twice about using a sticker chart as a reinforcer. But, like Dori pointed out to us, it is so contradicting when you think about it! We are absolutely reinforcing an action we tell the child that is perfectly okay. I am glad I read this article because it will give me a better understanding of both the client’s feelings as well as the parents, not to mention the insight I have gained from the multiple posts and questions! And with any future client, I will re-think what action I am reinforcing by using a sticker chart!

    A couple questions I thought of while reading this was…

    Did you ever encounter any situations throughout therapy where you felt the need to interject in the therapy process with the SLP and Eli? and if so how did you handle that situation? I feel it is very important the SLP listens to the families wishes and concerns. Did you ever have a situation where the SLP went against yours?

    Thanks!
    McKayla

    • Hi McKayla — thanks for responding and for appreciating a parent’s perspective. It is so very easy to fall into hinging therapy on lessening moments of stutter — it’s the measure that’s easiest to come by and demanded by IEP, insurance, and even parents. And too often a child responds well to this focus within the clinic setting, fooling all into thinking this is the way to go.

      In answer to your questions “Did you ever encounter any situations throughout therapy where you felt the need to interject in the therapy process with the SLP and Eli? and if so how did you handle that situation?… Did you ever have a situation where the SLP went against yours?”

      It’s a long story. If you email your mailing address to voiceunearthed@gmail.com, I would be happy to gift you my book, “Voice Unearthed.” In short, some therapists allowed me to observe therapy (where, of course, it looked like Eli could successfully use his speech tools), most suggested exercises and games to do during our “special time” at home where he was to practice his speech tools. I didn’t question this because I knew nothing, absolutely zippo, about speech therapy for children who stuttered. I tried hard to support and nurture the therapist’s recommendations. Eli’s struggle went from mild, to moderate, to severe. All we were told was to keep practicing. I had nothing to offer for the SLP to go against until I did six years of research, reflection, writing, and working with Dr. Halvorson. That’s why I wrote the book, so other parents and speech therapists could be educated, self-empowered, and aware of the risks.

      Thanks again McKayla — feel free to ask more questions and best of luck to you…
      Dori Lenz Holte

  44. Hi Dori!
    I am a graduate student currently studying to be a speech-language pathologist. I really enjoyed reading your paper about both your experiences and Eli’s experiences with therapy and his stuttering. Your comments have made me rethink the usage of stickers or other rewards in therapy sessions. I know children often need praise for doing a task well, but what does this mean we are telling them when they do not produce something in the way in which we want them to? I think this is something that we should always be mindful of as therapists. I am currently taking a Fluency disorders class this semester and we are learning about different therapy approaches to be used with children. This past week, we discussed having children identify their own feelings about their stuttering, both good and bad. I was wondering if any SLPs that you guys worked with tried this approach with Eli? I feel as though only working on speech behaviors within therapy sessions is definitely not the right way to go, especially in children. If we don’t address their feelings about their disorder, what are we really telling them in therapy when we are praising them for their “correct” productions? I really enjoyed your paper and your insights as a parent. I always think it is very interesting to get a parent’s perspective because you are the one that spends the most time with your child and you know them best. Thank you so much for sharing!

    Brittni

    • Hi Brittni – thank you for your response. You ask “if any SLPs that you guys worked with tried this approach with Eli?

      “Having children identify (and articulate) their own feelings” is not nearly as easy as it sounds. Kids don’t always have the language, intellectual, and emotional maturity to to accurately and appropriately express what they are feeling (ditto for adults!!). Too often a child’s reluctance or lack of cooperation is reacted to as a behavioral issue on the child’s part. In my opinion, that’s most likely the expression of their true feelings and we need to listen. Kids are incredibly good at figuring out what it is we want to hear and will go to great lengths to please us – especially if it will get us off their backs so they can go do what is important to them.

      Telling a child “you are safe here, now tell me your feelings” just doesn’t cut it. It takes considerable time, patience, and trust — lots of trust. Unfortunately there is so much pressure on therapists to eliminate the speech errors that most find it difficult to even begin that delicate and complex process. And yet I’ve heard so many adults who stutter say that the bast thing they got out of therapy as a child was a friend and great listener – someone they felt safe with.

      In my opinion, we need better options, safer options, options that do not run the risk of silence and withdrawal for school-aged children. Thanks again Brittni – I wish you the best of luck.

      Dori Lenz Holte

  45. Hi Doreen,

    I truly enjoyed reading the insight you brought about your experience with your child who stuttered. As you stated, it was clear that you and those speech therapists that Eli worked with never told Eli it was wrong to stutter. One part of your presentation that truly will stick with me for a long time is the research you included on the cognitive traits of children, ages 6-10. Throughout both my undergraduate and graduate coursework on stuttering, it never occurred to me to look at the innate reasons why children still find criticisms and seek praise. It makes complete sense to why an individual who stutters, can shut down because of unrealistic expectations, even though those around them are filled with positive energy. As a graduate clinician, who will most likely work with an individual who stutters in my career, because of your article I will definitely think twice about including any positive reinforcement system for using stuttering techniques, and focus my attention more on reinforcing just talking!

    Autumn

    • Hi Autumn – thanks for your response.

      You’re right, no one ever told Eli that it wasn’t okay to stutter, in fact, he was consistently told just the opposite. That clearly isn’t the message he walked away with.

      Thank you for tuning into the cognitive traits — it doesn’t appear as if much research has been done around this (see my question about research in “Ask the Experts)and I think it’s KEY in bringing about better and safer options for children. Great topic for a dissertation (hint hint 🙂
      Thanks again and best of luck to you.
      Dori Lenz Holte

  46. Hello Dori,

    My name is Breanna and I am a first year graduate student in speech language pathology. First of all I would like to thank you for taking the time to share your family’s story. This semester I am taking my first Fluency class and I am learning so much about all the different aspects of stuttering, especially the emotional aspects. When I read the title of your presentation it immediately caught my attention. As a big lover of stickers I was interested to find out about the “right” time to hand them out. After reading your paper it really made me think about being more conscientious about what behaviors we are reinforcing in our clients. While we as clinicians can mean one thing by handing out rewards, the child can be receiving an entirely different message. To me this reinforced the benefits of talking with children about their stuttering and how they feel about it. I can definitely say that after reading your paper I will think twice about why I am handing out rewards before I do so.

    Breanna Minor
    UW-Stevens Point

    • Hi Breanna – thank you for taking the time to respond. As I told Kelsey, I thought of a great place for stickers yesterday while taking care of a two-year old — potty training! Now that really matters 🙂 You might also be interested in my response to Brittni regarding talking to children about their feelings — not as easy as it sounds!
      Best of luck to you…
      Dori Lenz Holte

  47. Hi Dori,

    Thank you for taking the time to share your family’s story. I am a first-year graduate student in speech-language pathology and I am currently taking a fluency class. We have learned a great deal about the emotional aspects of stuttering. However, your paper has made me reevaluation how stickers are used in therapy. I did not realize that using stickers as rewards could affect a child’s confidence negatively. After reading your story, I realize that some therapy techniques can be misinterpreted. When providing therapy in the future to an individual who stutters, I will be careful about how I use positive reinforcements. I definitely can see how drastically things changed when the goal of therapy was changed from reducing errors to just talking for your son! Thank you again for sharing your story!

    Justine

    • Hi Justine — thanks for listening to a parent’s perspective! I means more than you’ll ever know…best of luck to you.
      Dori Lenz Holte

  48. Hello Doreen,
    Thank you for writing this wonderfully insightful and informative paper about your experiences with having a child who stutters. I think that it is wonderful that you wrote a book and you are putting your experiences out there for others to learn from and for graduate students like me to ponder. I have not used any type of stickers or tangible reinforcement with any of my clients thus far, just verbal feedback. What do you think, in replace of stickers,(if anything) would have been a good way for Speech Therapists to reward “good talking” to your son? When you said he told you he stopped talking because they told him it was wrong, it broke my heart! I cant imagine this young child not talking because he doesn’t want to stutter and NOT get a sticker! Also earlier you commented on a post that “I wish that until Eli was aware of and concerned about his speech, the speech therapist would have worked with my husband and me to keep him talking and keep him engaged.” In a class that I am taking right now we are learning about how important it is to employ a “family based treatment” where not only does the SLP work with the child who stutters, but also educates the family and is interested in the family’s opinions and concerns about their child. My question for you is, if any of the many speech therapists that worked with Eli also worked with you and your husband to teach you what you could do at home to help Eli, or just talked to you about your questions or feelings about how Eli was progressing.

    Thank you again for posting your story and I look forward to hearing back from you!

    Stacey

    • Hi Stacey, thank you for your response. Your first question is a tricky one… “What do you think, in replace of stickers,(if anything) would have been a good way for Speech Therapists to reward “good talking” to your son?”

      I fear that an external reward for “good talking” can easily be interpreted as “no reward = you should not stutter.” I tell a story in my book about one day when Eli and I were laying about and he started going on and on about something — and his speech as pretty natural. I told his speech therapist about how great this felt, and she asked me if I praised him for his good speech. I remember being thrown by this — it would never have felt appropriate to make that moment about his speech.
      Which brings me to another comment he made several years later…”Wah wah wah wah does everything have to be about my speech?” I so wished I had paid more attention to his complaints!

      I’m not a speech therapist, but in my opinion, “employing a family-based treatment” is only helpful depending on exactly what you are asking the family to do. We felt that we were “involved” when the therapist helped us to understand the speech tools and ways we could practice at home. I begged for this involvement as I couldn’t imagine he would ever be able to use these naturally without lots and lots of practice. Same with “educating” the family…depends on what your educating them on…how to make fewer speech errors, or keeping them talking and engaged in the world around them. Too often the family involvement is hinged on practicing speech tools and working to transfer these into their real world. There is so much a family can do to encourage talking, to keep talking fun, to enhance communication, to build on what the child does well and with a passion. And this can be done without risk of silence and withdrawal.

      Thanks again Stacey — best of luck to you.
      Dori Lenz Holte

  49. Dori,

    Thanks for sharing your personal story; it was a joy to read about your experience with your son! Like many others, I am currently in graduate school and still learning all the tricks and trades of therapy. I have not had the opportunity to work with a child who has benefited from positive reinforcement yet; however, so often we are taught how beneficial stickers can be. I noticed you’ve commented about appropriate uses for stickers, like potty training, and that is so true. Verbal reinforcement has so many positive benefits and encouraging individuals to preserve in using their language should be of upmost importance to SLPs, parents, and others who work with this population. You’ve presented great information on how children process the information they are presented with, and I’ll be sure to keep this in mind as I continue pursuing my degree. Thanks again for sharing!

    -Lauren

    • Thank you Lauren for listening — I hope my “parent’s perspective” is helpful to all in this field! Best of luck to you…
      Dori Lenz Holte

  50. Dori,

    Thank you so much for sharing your story. You perfectly articulated thoughts I believe many parents of children who stutter have. When I think back on when I was younger, I remember having feelings of wanting to conform, wanting to do things right, and wanting the approval of my family and friends. While we believe we are doing a good thing by giving children stickers or rewards when they are doing something right, I think it is easy to overlook how the child might interpret receiving those so-called rewards. I appreciate that you pointed out that many children and teens do not have the skills or the maturity to monitor their speech in all situations. As clinicians, parents, and caregivers, we need to understand that it may be unrealistic to expect a child to use his speech tools in every environment all the time. It sounds like Eli has had both positive and negative experiences with speech therapy. Has he ever been a mentor for other children or students who stutter? Has he ever joined any support groups? I’m sure many children and adults who stutter would love to hear his story. Thank you again for sharing,

    Lyndsey

    • Thanks Lyndsey for your response. It’s great to hear that you connected with having those feelings of wanting approval — it’s powerful in children and drives so much behavior.

      Eli was always treated kindly in therapy by well-intentioned therapists. They are doing what they have been told is “evidence-based best practice.” See my question in “Ask the Experts” and Dr. Kevin Eldrige’s response — Speech therapists and parents need to understand that the “evidence” is incredibly sparse, almost non-existent, when it comes to sm and fs treatment with children (or any treatment for that matter). I believe that even the suggestion of using speech tools carries the risk of increased silence and withdrawal — a child does not have the ability to “monitor” their speech and engage fully in the world.

      Eli and I both speak to speech therapy students (via Skype or in person) so yes, he is a mentor for students. He was even taught how to dance in one session. 🙂 We’ve attended several NSA and FRIENDS conferences, so he has connected with others who stutter, although he hasn’t maintained those relationships. I guess he just doesn’t feel the need, but he knows how to find them if that time comes. Feel free to connect with me via voiceunearthed@gmail.com if your class/professors would be interested in having us do a presentation. We’d be honored.
      Best of luck to you,
      Dori Lenz Holte