Treatment for school children up to 17/18 years old
There is already a question re preschool children, so I have not included them. I want to ask about Pre-University / Pre-Job children.
Background. I spent the majority of my life to 2006, thinking about and planning words. I assume people who do not stutter usually think in ideas and let the words flow (please correct me if you usually think in words and plan your words ahead). I am now thinking about communication and thinking in ideas and letting the words just come.
Three Questions.
- Would treatments based on the spoken words (only 7% of communication), re-enforce to the child that it is best to think and plan words and the articulation of a word?
- What treatments are available to encourage more communication of ideas and less emphasis on speaking words?
- At what age range do none stuttering children shift from speaking words to communicating ideas?
Thank you all for your time, Keith (ISA Chair)
Keith,
Good questions. Let me take a shot at providing a partial answer to all three.
1. A number of authorities (e.g., Ed Conture and a number of his associates many years ago) looked at the coexistence of stuttering and articulation disorders. They concluded that is might be best with a young stutterer who also misarticulates to target the misarticulation in terms of what are called phonological processes. These are not sounds per se but components of sounds, e.g., whether the sound is produced in the front of the mouth or not. In this way, articulation therapy could be carried out without drawing undue attention to specific words. I believe this is relevant to any child who stutters. IF stuttering therapy seems to have the early effect of drawing attention to words and thereby, for the child, implant the idea that speech is difficult (one of Oliver Bloodstein’s common themes), then an approach that focuses on communication in a broader sense might be warranted. Of course, for many children who stutter, this is not an issue.
2. Scott Yaruss, Craig Coleman, and Mary Weidner (among others) have developed a strong communication-based approach to treating youngsters who stuttering. Scott, in his disclosures in earlier posts has identified some materials that may be quite helpful.
3. This is an interesting question. I confess that I have not kept up in this area in the past 20 years or so, but I would like to mention an hypothesis that Van Riper posited in the 1970s regarding the auditory system’s function in speaking. He wrote that all children under the age of 3 years use their auditory systems for “acoustic matching” in order to match their own speech productions to those of the majority language community. This, of course, occurs gradually as their speech mechanisms mature in order to achieve correct articulation. At the age of about 3 years, most speakers begin to shift their auditory systems (unconsciously and likely due to other maturational processes) to “semantic monitoring” (or listening to whether or not they are saying what they mean to say). Van Riper further postulated that children who stutter do not (for physiological reasons) make that shift as completely as nonstutterers do and continue to listen to the sound of their words excessively. He noted that stutterers rely too much on auditory feedback. This problem is compounded by other physiological defects, i.e., instability of the motoric system in producing sounds and syllables, inability to integrate speech sounds consistently around the dominant beats inherent in a language’s rhythm (or stress beats), and intermittent difficulty programming upcoming speech sounds simultaneously in order to achieve correct coarticulation. (If you want a definition of some of these terms, a Google search might work.) Anyway, this is speculative, but very interesting to me. If correct, it means that for some stutterers, the focus on words and not communication is part of their innate problem–not entirely a by-product of therapy.
I’ve probably rambled enough. Ken St. Louis
Hello Keith,
I am very pleased that you brought up this aspect of stuttering. As you know I believe that planning words and articulation is a big part of what makes the speech stuttered. Dr. Courtney Byrd has done some research on how speech develops and has come up with some interesting findings.
http://www.utexas.edu/features/2011/07/25/stuttering/ This a small excerpt of what she has found: “Up until about age 2 and one-half, children’s speech consists of a constellation of unrelated, but familiar words: mommy, daddy, baby, milk, book and so on. Once they hit age 3, children undergo a vocabulary growth spurt when they start to organize language into global syllable shapes, or neighborhoods, of words that differ by only one individual sound segment, such as back, bath, bag, bad and bat.
“This global syllable shape selection strategy enables 3-year-olds to efficiently organize and access their limited vocabulary. However, by age 5 an expanded vocabulary compounded by faster utterances, and longer, more complex, phrases makes it inefficient for typically developing children to rely on this strategy. In fact, it inhibits their ability to produce speech fluently.
In contrast to typically developing children and adults, my research has shown both children and adults who stutter continue to rely on the global syllable shape organization system, which is inefficient and slows their ability to access the individual sound segments that represent the words they’re trying to say. The outcome is what we perceive as stuttered speech.”
Actually, it is often very obvious in the speech of people who stutter even when there is not perceived stuttering that the unit of speech production is the more global word rather than the sound segments that make up the language. With full disclosure that this the therapy I developed, Dynamic Stuttering Therapy does emphasize focusing on ideas, not words and getting used to accessing individual sound segments.