Treatment for Preschool Children
I am a current graduate student at Western Carolina University. I am particularly interested in the treatment of preschool children who stutter. In your opinion are preschool children generally aware of their stutter? If not, should a clinician bring it to their attention? How might their lack of awareness impact therapy? Should parents play the role of a clinician by correcting or pointing out a child’s disfluent speech? I appreciate your thoughts. Thank you.
Yes indeed, preschool children are aware of their stuttering. There are treatments, derived from variants of multifactorial theory, that do not require attention being directed to a child’s stuttering. However, there is no clinical trial evidence that they are efficacious and hence they cannot be recommended. If you had the view that the clinical trial evidence for the Lidcombe Program is compelling, indeed you would be having parents direct attention to a preschooler’s stuttering.
I agree that pre-schoolers are often quite aware of their stuttering- little ones who don’t have the language to express what they feel happening will often express frustration non-verbally or show awareness by switching words, putting their hand to their mouth, or giving up on a speaking attempt. It is important for us and their parents be able to openly acknowledge the problem.. For example saying, ” I see that word was hard for you to say. That’s ok, I’m really interested in what you have to say” can be very comforting.
But, it could be dangerous to say without caveat that it is helpful for us to call attention to the child’s stutters and to direct parents to bring attention to the pre-schooler’s stuttering. Directing a parent to simply call attention to the child’s stutters could be very detrimental. Parents are apt to become “speech police”, listening more to how the child is speaking when they should be listening to what the child is saying. When praised for fluency and given suggestions to do something different when not, the child often gets the message that stuttering is bad, and fluency is good- and then begins the accumulation of avoidances, fears, secondaries, etc.
So, if I am following Heather’s argument, then a direct treatment for early stuttering would be associated with an effect of increased anxiety symptoms (“accumulation of avoidances, fears”) and worsening stuttering behaviours (“accumulation of … secondaries”). Do i understand the argument correctly?
Just as I said that we can not declare without caveat that it is always helpful to call attention to the child’s stuttering, I would never say that (all) direct treatments for early stuttering result in increased avoidance, tension, and fear. When parents are using Lidcombe, they are doing a lot more that just calling attention to dysfluencies, and that is important to remember. Taken out of context and without proper training, simply directing a parent to call attention to a child’s on-line stuttering CAN result in the child shutting down and getting the message that stuttering is BAD. An interesting book on this topic is “Voice Unearthed” by Doreen Holte. She is the parent of a PWS and describes first hand watching her son’s tension and struggle increase as the result of his early direct therapy.
Thank you so much for your reply and book suggestion! I will be looking it up. I can not imagine what it must be like for a parents to watch their child struggle. I want to ensure that I have all the information available to give to parents.
Very often I have had children 3-5 referred to me with disfluent speech who were not aware of having a problem, while others show definite signs of frustration. I have observed some differences in the type of disfluency in 2 groups. (This is observation, not hard evidence, but still worth some consideration and possible a subject for further research.) The unconcerned children have more initial repetitions of sounds and words with some “uh’s, em’s” and the like. The more bothered children have more difficulty activating their voice. They have more voiced and silent blocks and a less flowing kind of repetition. I am less concerned about the 1st group, because I have seen a lot of spontaneous recovery among them. With the 1st group, I would not bring any attention to the disfluency and would simply follow-up every few months to see how it progresses without direct intervention on the part of the clinician or parents. The second group may need more direct intervention, but, like Heather, I would relate to the speech in terms of hard and easy, rather than fluent/disfluent. In therapy, be it direct or through clinician guided parental intervention, the goal would be making it easier to speak. To do this I would work on enhancing all the basic skills required for speech and language production including auditory processing and memory.
So, if i am following Barbara’s statement, it is that (1) children who are not concerned about their stuttering are given no treatment and (2) if children are frustrated with their stuttering they receive a treatment for the purpose of “making it easier to speak.” Is my understanding correct?
Thank you for your input!I can imagine being the parent of a PWS would be very difficult. I think working with the family as a whole is extremely important and want to ensure I am giving the best advice to parents.