Stuttering Therapy: The Focus of Increased Communication

Today there are many stuttering therapy options, and research is being completed on numerous ways to approach stuttering therapy. It is important to rely on expert and evidence based practices when deciding on the course of treatment for a client who stutters. As a speech-language pathologist (SLP) who has a stutter, I have found that it is pertinent to remember that the most important goal of therapy is to increase communication rather than increase speech fluency. If eliminating stuttering is not an option, then ultimately we want our clients to be able to communicate in a variety of environments with a variety of communication partners. Stuttering therapy often includes stuttering modification, fluency shaping, positive communication attitudes, and education about stuttering. The balance of these strategies depends on the individual needs of a child and the child’s age.

I often begin stuttering therapy with education about stuttering. The first steps may include teaching how speech is produced and about different types of stutters. It is essential for children to have a clear understanding of the speech mechanism and stuttering to be able to learn how to change and shape their stuttering. Here are a few ways to teach the different types of stutters.

• Train tracks: repetition of stutter sounds, syllables, words, and phrases. You can also describe it as a ball bouncing.
• Bridge: prolongation stutter; you can also describe it as stretching.
• Brick wall: A block stutter; you can also describe it as opening your mouth and nothing comes out.

Stuttering modification involves teaching children how to change stuttering to be easier and less tense. Exploring stuttering is a critical part of stuttering modification, because it teaches children what is happening while they are stuttering. Children learn what the articulators are doing during a stutter. Once children learn how their articulators move and tense during a stutter, they can then learn to physically change a stutter. In addition, exploring stuttering helps children become desensitized to stuttering. Here are some of my favorite exercises for exploring stuttering:

• Have a child volunteer and pretend to stutter.
• Have a child teach you how to stutter.
• Have a child identify your stuttering.
• Practice identifying tension during a stutter.
• Practice relaxing tension during a stutter to make it an easier stutter.

Physical tension and secondary behaviors often become part of stuttering and increase with time. SLPs can help secondary stuttering behaviors by practicing stuttering with less tension to help move speech forward. A starting point can be to practice voluntary stuttering with tension and then without tension. Once a child feels comfortable increasing and decreasing tension during speech and pretend stuttering, he may be ready to practice during a real stutter. Voluntary and pretend stuttering can also help children achieve “easy stuttering” by reducing muscle tension. Here are some common “easy stuttering” techniques.

• Cancellation: Cancel out of a real stutter by repeating the stuttered word with a voluntary stutter and with less tension.
• Pull-out: Pull out of a real stutter by turning the stutter into a voluntary stutter with less tension.
• Prep set: Prepare for stuttering by feeling a stuttering moment and change the stutter to a voluntary stutter with less tension.
• Sprinkling: Sprinkle speech with voluntary stuttering when talking to help keep muscles from tensing too much.
  

A second therapy option, fluency shaping, decreases stuttering by changing time and tension. Time changes can include:

• Speaking rate: slowing rate of speech to increase speech fluency.
• Pausing: increase pause time between phrases to increase fluency.
• Decrease interruptions: Decreasing interruptions increases fluency.

The most effective place to change tension is at the beginning of phrases, since many children stutter more often at the beginning of phrases rather than at the middle or end of phrases. In combination with tension changes, it is helpful to teach children to reduce their rate of speech at the beginning of phrases too. It is key for time and tension changes to sound natural.
Many children who stutter have low communication attitudes. Stuttering is often frightening, frustrating, and shameful to children. As professionals, we need to teach positive communication attitudes, so that children do not avoid communicating to avoid stuttering. It also important to remember, that many children who continue to stutter after the age of 7 will have disfluent speech throughout their lifetime. We don’t want to exacerbate the shame of stuttering by giving a message that only fluent speech is good.

SLPs can help increase communication attitudes by talking and teaching about stuttering. Talking about stuttering and using the word “stutter” help reduce anxiety and fear and increase understanding about stuttering. Stuttering modification strategies let children choose to stutter with less tension and more easily in addition to facilitating forward moving speech. Voluntary and pretend stuttering also help children reduce tension during speech and help desensitize children to stuttering. Another technique to aid positive communication attitudes is to create hierarchies that increase from most comfortable to least comfortable communication environments, situations, people, and times. Children and SLPs can systematically work up a hierarchy to conquer fears about stuttering. For example, a child’s hierarchy may start with pretend stuttering to his mother at home 1x a day and increase to pretend stuttering to a peer at school 3x a day.

Stuttering therapy should also be age specific. Therapy for pre-school children should focus on fluency shaping techniques and eliminating stuttering. Parents and teachers are critical to providing effective therapy for children 7 years and younger. SLPs can assist parents and teachers to create fluency facilitating environments by teaching fluency shaping skills, environmental modifications, and modeling. Important skills include increased pause time, decreased interruptions, slow to natural rate of speech, and child set communication agendas. It is also significant to begin increasing healthy communication attitudes and to talk about stuttering in a supportive and accepting manner. For children over the age of 7, therapy should include stuttering education, stuttering modification strategies, fluency shaping strategies, and communication attitudes. SLPs should encourage children to become experts of stuttering, become their own therapist, and to take ownership of their speech.

Stuttering can be intimidating for children, parents, teachers, and SLPs, since the disorder often does not go away with or without therapy. Therefore, it is important to remember that communication is the goal of therapy, and that it is fundamental to equip children who stutter with the tools they need to be successful communicators. SLPs can help children have forward moving speech by using stuttering modification and fluency shaping strategies combined with education about stuttering and positive communication attitudes,. As a SLP and person who stutters, I rely on my tools to communicate to colleagues, clients, family, and friends. I hope the strategies discussed in this article help more SLPs find success treating children who stutter.

This article is based on techniques that have worked for me and information I have learned in the study of fluency. Sources for information include Dr. Conture, Dr. Ratner, Dr. Yaruss, Dr. Pellowski, Ms. Sisskin M.S., CCC-SLP, Ms. Gregory M.S., CCC-SLP, and The National Stuttering Association.

For information on evidenced based speech-language treatment, please visit the Imagine Speech website at www.imaginespeech.com.

Thank you for reading,

Anne Coady