Stuttering: the most effective “treatment?” – International Stuttering Awareness Day

Hello! My name is Karrighan Quick and I am a first-year graduate student working towards a degree in speech-language pathology. A class I am currently enrolled in dives into the features of stuttering including its causes, treatments, and feelings associated with stuttering. One topic I continually question is how I will effectively treat stuttering in my future if I encounter a client with a fluency disorder. For those SLP’s out there – what have you found to be most effective when treating individuals with fluency disorders? Do you frequently come across counseling those clients and their families? For those people who stutter – what has worked for you during treatment? Did you find yourself utilizing counseling from the professional you received treatment from? If so, was it beneficial?

Thank you for reading, I look forward to reading your feedback!

Karrighan Quick

Hi Karrighan,

Thanks for your question. Whenever I’m asked about a “most effective” treatment, my first reaction is, Helpful for whom? Preschool children, school-age age children, older children, adolescents, adults? It depends. Therapy goals are often very different for preschool children, who stand a greater chance of recovering from stuttering and may have fewer negative attitudes and emotions, than for school-age and older children and adults, for whom stuttering is more likely to be persistent and who may exhibit more negative attitudes and emotions, extraneous behaviors, and avoidance behaviors.

Also, Helpful for what? Enhancing fluency? Modifying stuttering? Desensitizing? Reducing avoidances? Nurturing acceptance? Coping with unwanted attitudes and emotions? Developing overall communication skills? Reducing stigma? Building a general community of support? Educating parents and teachers? Responding to bullying? And so on. …

If you are truly interested in stuttering therapy, I would recommend learning all you can about stuttering, and options for stuttering therapy, at the different age levels. Learn how to do a comprehensive, differential evaluation that considers not only fluency and fluency breakdowns, but also attitudes and emotions and reactions to stuttering and anticipated stuttering. Involve relevant parties, such as parents and teachers, in the process. Learn to treat the whole process as ongoing problem solving. Since my expertise is primarily in school-age stuttering, I am going to link you to my 2017 ISAD paper that describes our efforts in my school district to take a comprehensive approach to stuttering evaluation and treatment and implement Basic Principle Problem Solving:

https://isad.live/isad-2017/papers-presented-by/research-therapy-and-support/fluency-consulting-in-a-metropolitan-school-district-helping-school-slps-understand-stuttering/

Regarding counseling, most of my students need counseling of some kind as a component of stuttering therapy. Since stuttering tends to become persistent after the preschool years, many of our clients need us to help them (and their families) learn how to manage a chronic problem. A very helpful place to start is “The School-Age Child Who Stutter: Working Effectively with Attitudes and Emotions,” by Kristin Chmela and Nina Reardon, available from the Stuttering Foundation (full disclosure: no financial interests).

As a person who stutters, I have benefitted over the years from education about stuttering, fluency shaping; stuttering modification; reducing avoidances; minimizing extraneous behaviors; desensitizing; learning to manage the moment of stuttering and its attendant thoughts, emotions, and behaviors; Acceptance and Commitment Therapy (ACT); Cognitive Behavior Therapy (CBT); mindfulness; self-advocacy; learning to access communities of support, such as the National Stuttering Association (NSA); developing overall communication skills; and so on. I use the counseling skills I have learned on a daily basis – particularly accepting and tolerating unwanted thoughts and emotions in the service of valued outcomes and pursuing a Life Worth Living. Speech therapy was definitely not the only, and probably not the primary, kind of therapy I have needed and benefitted from over the years.

There is so much more to say. For now, I hope this is helpful. Wishing you all the best in your studies and career,

Rob Dellinger

Comments

Stuttering: the most effective “treatment?” — 2 Comments

Gunars Neiders on October 22, 2018 at 8:25 am said:

Hello Karrighan,
I suggest that you become acquainted with Sheehan’s iceberg and include in your therapy the below water line aspects. Rational Emotive Behavior Therapy and other Cognitive Behavior Therapies that focus on changing beliefs, attitudes, and self-talk appear to be the most effective. However, I have not heard of any horse race studies comparing one approach against another.
A good therapeutic relationship really helps as does the therapists commitment toward the approach he or she is using.
Read some of my comments and my paper to get a more complete description of REBTS.
Gunars
Rob Dellinger on October 23, 2018 at 2:09 am said:

Hi Karrighan,

Thanks for your question. Whenever I’m asked about a “most effective” treatment, my first reaction is, Helpful for whom? Preschool children, school-age age children, older children, adolescents, adults? It depends. Therapy goals are often very different for preschool children, who stand a greater chance of recovering from stuttering and may have fewer negative attitudes and emotions, than for school-age and older children and adults, for whom stuttering is more likely to be persistent and who may exhibit more negative attitudes and emotions, extraneous behaviors, and avoidance behaviors.

Also, Helpful for what? Enhancing fluency? Modifying stuttering? Desensitizing? Reducing avoidances? Nurturing acceptance? Coping with unwanted attitudes and emotions? Developing overall communication skills? Reducing stigma? Building a general community of support? Educating parents and teachers? Responding to bullying? And so on. …

If you are truly interested in stuttering therapy, I would recommend learning all you can about stuttering, and options for stuttering therapy, at the different age levels. Learn how to do a comprehensive, differential evaluation that considers not only fluency and fluency breakdowns, but also attitudes and emotions and reactions to stuttering and anticipated stuttering. Involve relevant parties, such as parents and teachers, in the process. Learn to treat the whole process as ongoing problem solving. Since my expertise is primarily in school-age stuttering, I am going to link you to my 2017 ISAD paper that describes our efforts in my school district to take a comprehensive approach to stuttering evaluation and treatment and implement Basic Principle Problem Solving:

https://isad.live/isad-2017/papers-presented-by/research-therapy-and-support/fluency-consulting-in-a-metropolitan-school-district-helping-school-slps-understand-stuttering/

Regarding counseling, most of my students need counseling of some kind as a component of stuttering therapy. Since stuttering tends to become persistent after the preschool years, many of our clients need us to help them (and their families) learn how to manage a chronic problem. A very helpful place to start is “The School-Age Child Who Stutter: Working Effectively with Attitudes and Emotions,” by Kristin Chmela and Nina Reardon, available from the Stuttering Foundation (full disclosure: no financial interests).

As a person who stutters, I have benefitted over the years from education about stuttering, fluency shaping; stuttering modification; reducing avoidances; minimizing extraneous behaviors; desensitizing; learning to manage the moment of stuttering and its attendant thoughts, emotions, and behaviors; Acceptance and Commitment Therapy (ACT); Cognitive Behavior Therapy (CBT); mindfulness; self-advocacy; learning to access communities of support, such as the National Stuttering Association (NSA); developing overall communication skills; and so on. I use the counseling skills I have learned on a daily basis – particularly accepting and tolerating unwanted thoughts and emotions in the service of valued outcomes and pursuing a Life Worth Living. Speech therapy was definitely not the only, and probably not the primary, kind of therapy I have needed and benefitted from over the years.

There is so much more to say. For now, I hope this is helpful. Wishing you all the best in your studies and career,

Rob Dellinger