Teacher’s ability to refer students who stutter
Hello all- I was interested in an expert opinion on a teacher’s ability to refer a child who stutters for therapy. Do you feel teachers over-refer or under-refer children who stutter compared to other communication disorders? Do you feel school-based SLPs are doing their job to educate teachers on appropriate signs or behaviors that children who stutter exemplify and how spontaneous recovery can happen? Do you think Response to Intervention (RTI) has caused more preschool children to be diagnosed earlier? Thanks so much for your response!
In my experience, the teachers seldom refer children who stutters for therapy at all, compared with other communication disorders. Most often the parents refer. But, I do experience, that after the parents, the teachers are the most important “collaborative partners” which can make a big difference in treatment and life for a person who stutters, especially when they are invited or involved in a specific or wanted way. The Teachers are really an important group who can make stuttering more easy to handle also during the years in School/education. (I do not know RTI, therefore I cannot give an answer on this question. Best, Hilda Sønsterud
My first response is that teachers under-refer school age children because they tend to “disappear” into the classroom. A common clinical picture of a school age stuttering child is one who is thought to be quiet and withdrawn, but in reality is reluctant to participate in classroom activities, and is constantly anxious about being called on to speak in class. The teacher is a critical person in the life of a school age child who stutters: someone who can make the difference between the classroom being a perceived dangerous place or a safe place. Regarding teacher education, the Michael Palin Centre has an outstanding, freely downloadable video on the topic. That video is a useful resource for clinicians who have contact with teachers of stuttering children. Clinicians may also direct parents to it so they can show it to the teacher of their stuttering school age child.
Hi – you’ve asked a good and challenging question… We often have the sense, here in the US, that students who stutter are under-referred to SLPs. And, as you have pinpointed, much of this has to do with teachers’ general lack of understanding about stuttering – and, more importantly, a lack of understanding about the nature and goals of stuttering therapy for this age group. Educational efforts are very important. I agree with Dr. Onslow that the materials from the Michael Palin Centre are outstanding. There are also numerous teacher education materials available in the US from organizations such as the Stuttering Foundation, the National Stuttering Association, and Friends. The challenge, often, is getting teachers to read those materials. Teachers have too many demands on their time, and while they may be very eager to provide individualized instruction to all of the children in their classroom, it can be difficult for them to manage all of the different strategies and suggestions they receive, as their classrooms are increasingly filled with children with unique needs. The situation is not hopeless, though. Many have described methods for helping children become their own advocates for educating others in their environment (including teachers). I think in particular of the work of Bill Murphy, who has described classroom presentations that can be given by school-age children to educate teachers and peers (again, there are others who have written about this, as well — see disclosure below). For the younger children, of course, they are not yet ready to achieve such self-advocacy… there, our task is to educate and encourage parents to advocate for the children.
Do I think SLPs are doing enough to do this? Well, some yes and some no. I know many clinicians who have accessed the materials available from the organizations mentioned above(and others), who do an excellent job of advocating for their children who stutter. I know many other clinicians (also excellent clinicians) who simply are overwhelmed with the breadth and depth of their workload and therefore are not able to give each disorder area the attention they would like. The result is that many children find themselves in classrooms where the teachers have not been adequately prepared by the SLP.
As for your question on RTI… well, this is another tough one. My personal sense is that there are cases in which RTI has caused teachers to identify children more readily than they might have previously… but, at the same time, I think the reason for this is not ideal. RTI has become in some instances a sort of back-up plan (or almost a cop-out) wherein a child can be referred but not really for treatment. Children who stutter need actual treatment to help them overcome their speaking and communication difficulties. RTI does not always provide that, and in some cases, can actually result in a child’s therapy being delayed rather than implemented more aggressively because of inconsistencies in the application of RTI and pressures on caseload/workload for the SLPs. So, I think it’s a mixed bag. Others here who are more directly connected with the school system can probably comment better than I can.
Anyway, you’ve asked excellent questions – thanks for the discussion.
Disclosures: I have worked with Bill Murphy (mentioned above) in several capacities, most notably, he and I published several articles and a book together (along with coauthors Bob Quesal and Nina Reeves) on minimizing bullying in children who stutter. The book contains detailed instructions for planning and providing the types of classroom presentations mentioned in this post. We receive royalties from the sale of that book, and Nina Reeves and I are co-owners of the company that publishes that book, Stuttering Therapy Resources.
Thanks for reading this far…
Scott
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J Scott Yaruss, PhD, CCC-SLP
University of Pittsburgh