We often think that stuttering in children is easy to identify. Common stuttering behaviors include 1) word and sound repetition (go-go-go away; ba-ba-basketball), 2) prolongations, in which the sound is held for too long (Sssssssam is here), and 3) blocks, in which the child tries to speak but no sound comes out (I am…..so hungry).
Often, however, a child’s dysfluencies go undetected. Children may avoid words or only say words that they can say fluently. They may shy away from stressful speaking situations, such as answering questions in class or initiating conversation with a new friend.
What does stuttering therapy look like?
In our work with children and adults who stutter, we focus on extinguishing stuttering behaviors that are easily observed, such as sound repetitions. There are many techniques we can use to improve fluency. We can help slow the rate of speech by increasing the number of pauses between phrases. We can teach the child to initiate words in a relaxed and easy manner and “lighten” the articulatory contacts of the lips, tongue and jaw.
However, if we fail to provide counseling and emotional support to the child and parent, our treatment will often be minimally effective. In counseling, our primary message should be that it’s OK to stutter. This can be a difficult concept to impart. If it’s OK to stutter, why invest time and money in speech therapy? And how can it be OK to stutter if it affects the child’s ability to communicate?
Emotional Responses to Stuttering
Children who are conditioned to believe that stuttering is unacceptable are at risk for anxiety in relation to their speech and communication. Children may come to believe that dysfluent speech is unacceptable. Over time, being told to “slow down” or “try it again” by teachers and parents solidifies the idea that only fluent speech is permissible. In response, they may use avoidance strategies to ensure that their speech is always fluent. The stress and exhaustion from constantly monitoring their speech significantly decreases their quality of life.
Secondary Behaviors
Children may also begin to engage in “secondary behaviors.” These are behaviors that typically arise from negative reactions to stuttering. Secondary behaviors may manifest as head jerks or extraneous arm movements. Physical tension and secondary behaviors must be addressed; otherwise, one behavior will continually replace another. [Coleman, C. & Yarus, J. Scott (2014): A Comprehensive View of Stuttering: Implications for Assessment and Treatment, Perspectives on School-Based Issues, 15 (2)] Rather than solely focusing on extinguishing external stuttering behaviors, we must manage the negative reactions to stuttering.
Desensitization and Counseling in Stuttering
Once we have educated the child and parent and reinforced the idea that stuttering is OK, we can develop a plan to treat the child’s overall communication abilities. It’s important to share information about stuttering and talk about famous people who stutter, recognizing their achievements. It’s helpful to “practice” stuttering in various speaking environments by “pseudostuttering,” or stuttering on purpose. Over time, children should gradually expose themselves to stressful speaking situations to become more comfortable stuttering in front of others.
We often see children using fluency strategies successfully during sessions, but then they revert back to their old speech pattern once they exit the therapy room. The constant use of fluency strategies is a heavy cognitive loud and can be extremely taxing. It’s analogous to a fluent speaker attempting to stutter on every sentence. Children should be encouraged to speak freely, without worrying that others will judge them for stuttering. We must transfer the locus of control to the child. They will decide when to use their strategies – for example, when giving a class presentation or engaging in debates.
Our goal in the treatment of stuttering is to increase the child’s well-being and their ability to connect with others. Without counseling and the determination to address negative reactions to dysfluent speech, we run the risk of producing a child who is more fluent but less happy and self-assured.