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Q&A About School Age Stuttering - May 2009

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Q&A About School Age Stuttering

By: Chamonix Olsen, MS, CCC-SLP, BRS-FD

What are the important components to include in stuttering assessments for school-age children?

In order to use the SSI (Stuttering Severity Instrument- a commonly used instrument) you need to take a conversational speech sample and a reading speech sample. These should be videotaped in case you choose to score the speech sample after the assessment. It is important to assess the frequency and amount of tension and physical behaviors in stuttering but it is equally as important to assess a child’s reactions, feelings, and attitude towards their stuttering. We need to know how much stuttering is affecting this child and how they are functioning and feeling. Therefore using an attitude scale such as the OASES-S can be quite helpful as can the Behavior Checklist for Children.

In addition opening the conversation up to discuss stuttering in an informal way can help the child to share what they know about stuttering, how they feel about talking, and if they’ve been teased before. Coloring together and opening this discussion can take any pressure off and many children open up in a casual trusting environment. We need to assess the cognitive (how the child thinks about their talking and stuttering), affective (how a child feels), and behavioral (the frequency, duration, and physical behaviors) aspects of stuttering in order to obtain a complete picture. In addition overall language should be assessed as well to see if this could be playing a part in the child’s stuttering. Other speech problems (articulation/voice/phonology etc.) should also be assessed, as these can be confounding factors.

Is it okay to use the word “stuttering?”

Yes! I usually ask a child what they call it when their words get stuck or when they feel like it’s hard to talk. I then use their word (bumpy talking, stuck talking, hard talking, or whatever they come up with) but also let them know that stuttering is just another word for that. It is when stuttering (and even the word stuttering) is “off-limits” for discussion that can sometimes cause a child to feel that they are doing something that is so wrong that no one can talk about it with them. The more comfortable you can feel discussing stuttering the better. Stay casual and at ease, it’s okay to talk about the difficulty they are sometimes having getting their words out.

Am I responsible to make this child fluent?

No. You are responsible to educate yourself the best you can about treating stuttering but it is not your job to make the child fluent and this pressure will stress you out and the child you are working with. Many school-age children that have been stuttering for a number of years already will continue to stutter. Therefore our job is to help them to learn about stuttering, learn ways to stutter easier and to know how to produce smooth easy talking, gain or maintain self-confidence, take risks, face fears, and to participate in class. Remember, this treatment is not just about fluency, it’s about how to best support this child to become the most comfortable and effective communicator that they can be. Spend time getting to know this child and building trust between the two of you. Learn to be a good listener. Make sure you are not always telling the child what they should be doing but listen to what they have to share.

Who should be involved in stuttering treatment?

Ideally the child who stutters, the parents/caregivers of the child, and also siblings and friends of the child can be involved in the treatment process.

Parents need to know how to best support their child and if you are in a setting where a parent can be in the session then absolutely bring them in to a portion of each session. If you are unable to have parents involved in the setting where you work then communicate with them via phone, e-mail, or by writing notes home. Let these parents know what you are working on with their child and how they can best support this at home. Bring siblings and friends into sessions as a way to educate those around this child about stuttering and to increase their comfort using techniques with these children.

Once fluency is established in the therapy room, what is the next step? How do we begin to establish fluency in other environments?

Transfer should begin as soon as possible. If a child learns how to use a pull-out in the therapy room then assignments can be made to try this pull-out with other people. Creating a hierarchy of easy situations to use my “tools/techniques” in up to most challenging places can help the child to pick whom to try strategies out with. Assignments can be made where the child plans whom they will try this strategy with, for how long or how many times, and what day/place. Within the therapy room transfer can be started by making phone calls (if possible in the setting and if age appropriate), using the strategy with a teacher in the hallway, using the strategy while walking in the hall with the speech teacher versus just sitting in the therapy room (change of environment), anything to change the environment or person they will be speaking to. Be creative and see what the child can brainstorm as well.

How do I address bullying/teasing with a child who stutters?

Many children who stutter do get teased/bullied about their stuttering and some do not as well. I find children open up more and share more as they build trust in the relationship with the clinician. The more comfortable you can be talking about stuttering and teasing the more open the child will feel. Some children open up after I share some of the experiences that other children I’ve worked with have had with being teased. Children tend to be careful with whom they share their teasing stories. Our job is to help empower this child to know what their options are if they do get teased.

Teachers and parents will not always be there to protect the child. Some teasing is not vindictive and is actually done out of curiosity and the child can learn how to respond to this as well. For example, “why do you stutter?” The child could respond, “because words/sounds get stuck in my throat.” For real teasing, or what some then call bullying, one idea is to make a chart with three columns. The first column has the teasing situation (oftentimes they are imitated and laughed at which counts as teasing). The second column has all of their options. Here they can brainstorm all the ways they could respond (ignoring, hitting, yelling back, asking to stop or be left alone, etc.). The third column has all of the consequences listed. What could happen to them if they hit the child? They may feel better, they may be suspended from school, they could get grounded at home etc. This way the child can see what choices they have ahead of time and view what their consequences could be as well. This is just one idea. The book “Bullying and Teasing Helping Children Who Stutter” published by the National Stuttering Association has very helpful information in it and great ideas to try out.

Is it okay to discharge a child from therapy even if they are still stuttering?

Yes. Each case is individual but just because a child still stutters does not mean they have to stay in therapy. A child may be burnt out on therapy and need a break. A child may also feel great about talking, be participating in activities and situations that they want to be a part of, and know how to manage their stuttering when they choose to, yet they still stutter sometimes. This child may indeed be ready for discharge. Remember, every child who stutters is different, there is no one program for children who stutter, see what is appropriate for the particular child you are working with.

What may not be helpful for a child who stutters?

If a clinician has discomfort about addressing or talking about stuttering openly a child will sense this. Constant feedback to use a technique or tool can cause a child to shut down, again remember our goal is for the child to be a confident speaker and an effective communicator. We want to help them to develop healthy positive feelings about themselves and about their talking. Balance your amount of praise with your asking for correction. Always use more praise and too much feedback overall can cause a child to tune out. Finally, don’t teach a child to tap their foot, move their arms or their body to help get their words out. These physical behaviors and tricks are truly secondary behaviors and can exacerbate the stuttering behavior. Work on ways a child can feel more in control and positive about their talking.

What is a Board Recognized Fluency Specialist and how do I contact one?

Board Recognized Specialists in Fluency Disorders (BRS-FD) are professionals who have gone beyond the basic clinical certification (SLP-CCC) awarded by the American Speech-Language and Hearing Association (ASHA). BRS-FD's are individuals who have demonstrated a high level of clinical expertise in treating fluency disorders, advanced knowledge, and a commitment to serving people with fluency disorders. They have been mentored by another fluency specialist and submitted their credentials and a portfolio for review and approval by a Board of peers.

The Specialty Board on Fluency Disorders (SBFD) site is for consumers and professionals to locate speech-language pathologists who are Board Recognized Specialists in Fluency Disorders. This site is also designed for the professional who is seeking to become a BRS-FD or for those interested in becoming Fluency Specialist Mentors. Visit Specialty Board on Fluency Disorders

This Month's Featured Author and Organization: Chamonix Olsen, M.S., CCC-SLP, BRS-FD and the American Institute for Stuttering Treatment and Professional Training

Chamonix was initially a general practitioner but has focused exclusively on treating fluency disorders for the past seven years at the American Instutute for Stuttering and Professional Training in New York City. Chamonix is one of very few Board Recognized Specialists in Fluency Disorders (BRS-FD) in the United States and is currently SRP Coordinator of the Specialty Board on Fluency Disorders. She conducts clinical supervision, presents at area colleges and schools, and consults with speech-language pathologists across the country.

American Instutute for Stuttering and Professional Training (AIS) is the only non-profit organization in the United States that offers state-of-the-art treatment to people who stutter, and support to their families. AIS also provides clinical training to speech-language pathologists (SLP) interested in acquiring special expertise in stuttering treatment. Their mission extends to advancing public and scholarly understanding of this often misunderstood disorder. For more information, visit their website at: http://stutteringtreatment.org/


Tags: Q&A Stuttering SLP May 2009 Newsletter Article Bullying