Treatment suggestions for atypical stuttering
This is my first time participating in this online conference. I’m not exactly sure how I found it, but I’m excited to read and learn from other posts.
I’m a school-based SLP and I have a question regarding treatment suggestions for a CWS. I have a student who is 11 years old and has been in treatment for 3 years now. His stutters are primarily mid word inhalations, irregular breathing, and audible nasal emission. Occasionally silent blocks have been observed. He’s been noted to not make eye contact when responding initially. No other secondary behaviors noted. He is aware of his speech difference, and reports not having any anxiety about it. He also states he hasn’t noted any changes in tension in any of his speech articulators during moments of stuttering eg. no increased tension in his chest, neck, mouth etc.
Our plan for the year is to continue therapy to address: using his tools to increase fluency during moments of stuttering and to share his knowledge of stuttering with the SLP, another adult, and then a peer/sibling.
The student is home-schooled and has several siblings. His mother reports that the siblings are not to “bother” him about going to speech therapy. Mom reports her son talks to her about therapy though she is not sure if he’s ever spoken to dad about it. Mom really wants to be finished with therapy. She does understand therapy is not about “fixing” or eliminating the stuttering.
I am most concerned that the CWS doesn’t talk to anyone else about his speech. How will he be able to handle bullying or advocating for himself if he can’t talk about his disability openly?
What else can I do or am needing to consider? I can’t say for sure how his disability is impacting him other than his parents are concerned. He does not participate in any extra-curricular activities like sports or clubs. I’m pretty sure he doesn’t do so not because of his speech but because he is not interested. Sometimes he will be around other adults like uncles and aunts. To me, there doesn’t seem to be much impact on his communication, other than when responding to complete school work. Our fluency tool box includes maintaining eye contact, taking full breaths, taking breaths between groups of words instead of within words, language planning/think of your response first, and discreetly using a finger to tap out stuttered words. I can’t say there’s been much improvement to increase fluency over the three years. He’s had a different therapist each year and we all feel stumped as to how to effectively help him. We feel his stutters are atypical and our usual strategies e.g. pullouts/cancellations are not useful.
I’ve only just started with him this year. If you have any suggestions, treatment ideas, or areas to consider, your help is greatly appreciated.
Hi Sumi,
Thanks for your email. I am wondering if this student might be helped by natural pausing. I try to focus on pausing rather than breathing as I find whenever I focus on breathing, kids get very confused and apply the strategy inappropriately. In stuttering blocks, it sounds to the listener like the child is running out of air, thus the inclination is to tell someone to take a breath. However, stuttering can be counter intuitive, and in reality a breath in is counterproductive. But when we pause naturally in speaking, our breathing takes care of itself. So I wonder about increased focus on pausing, which would also help for language planning as well. If he tends to block after a pause, he can use a preparatory set to get started with his next phrase.
His disfluencies sound like they may fit in the “atypical” category, and often (though not always) we find that children with atypical disfluency are less aware and/or impacted by the disfluency. I would always want to leave the door open for the child to talk about stuttering, but if he doesn’t have negative attitudes or feelings right now, I would just monitor it. You can consider connecting him with support networks like those offered by the National Stuttering Association (www.westutter.org), if he is open to it. But if he doesn’t see much impact, that’s good. The support resource may not be as meaningful for him now, but something to have in the background in case that changes.
Finally, the nasal emissions to me needs investigation. I did work with a student who was pushing so hard against her stuttering that nasal emissions resulted. This was a student who was very negatively impacted by her stuttering and needed support. She was working so hard to fight her stuttering that she needed more work on densensitization….not sure if this is the case here given the other things you say. But if the nasal emission occurs in speech at other times than stuttering, then this may be a separate issue that needs investigation by a craniofacial team.
Hope that helps a little with some areas to further investigate/try.
Have you tried identification? I had 3 different adolescent PWS that had mid-word disfluencies and inhalations. They were somewhat aware of what they were doing but generally were not bothered. Stuttering had minimal impact on their life or attitudes about communication. All 3 also had pragmatic deficits, two of which had a diagnosis of Aspergers Syndrome.
2 of the 3 made dramatic and lasting improvements with identification of stuttering moments. They knew they had disfluencies but really did not know when, how often, or what they sounded like. We did videos of others, videos of self, and identification in the moment. We also used some continuous phonation to help move through their utterances smoothly.
I am not sure if this seems suitable for your client. Best of luck to you!
Tricia 🙂
To scalerscott and Tricia Hedinger,
Your comments and suggestions are wonderfully helpful and has got the cogs turning! Though the family/student is eager to discontinue services, with your suggestions in mind, there are few more things I think I can do.
I am thankful for this community and support 🙂