Speech therapy is not a cure for stuttering. Instead, it is a process that leads to change in a child’s speech and communication over time. Appropriate speech therapy can help a child who stutters manage speech and make positive changes for the long term.
For preschoolers, the goals is to help the child speak as fluently as possible so he will be less likely to develop a chronic stuttering problem. For the school-age child who has an established pattern of stuttering behaviors, it is important to recognize that improved fluency is a part of stuttering therapy, but it is not the only part of therapy. The ultimate goal of therapy is not simply fluent speech; it is effective communication overall.
The objectives are to assist the child in improving his fluency while preventing the development of negative emotions that can affect his ability to get the most out of his life. This means that even when the child cannot speak fluently, he can speak freely. Therefore, there are several components to effective stuttering therapy, addressing the child’s speech, the child’s beliefs and feelings, and the impact of stuttering on the child’s ability to participate effectively in his daily life.
Speech. Complete remediation of stuttering is most likely to occur only in very young children who stutter (preschoolers). An indirect therapy approach may be used that is oriented toward encouraging the child to use "smooth" (rather than "bumpy") speech. The child is praised for their intentional use of smooth speech. While no negative judgment is placed on bumpy speech, it is merely suggested that the smooth speech they also produce is easier and preferable. The child manipulates his or her speaking attempts to produce smooth speech; no instructions are offered, just praise for smooth speaking.
For older children who are more conscious of their stuttering, the aspect of therapy focus on speech may be directed toward using "targets" to better manage existing disfluent moments and speak in a manner that is more conducive to speaking fluently. These targets may include speaking in a deliberate manner, at a controlled pace, stretching the initial syllable of words, easing the tension in the throat, mouth, or lips gradually to pull out of stuttering blocks, or beginning with a soft, breathy voice. As the child gains more skill and confidence in the targets, he or she then attempts to use them in progressively more challenging situations. Note again that these strategies are not the only important components of therapy; they simply represent the portion of therapy that is focused on helping the child improve his fluency.
Beliefs, Feelings, and Emotions. Most children who are aware of their stuttering feel embarrassed by it, partly because they find it difficult or impossible to control. These feelings, which may be acerbated by teasing, can create significant anxiety and increased muscular tension that lead to more severe stuttering. Speaking and the fear of stuttering are generalized to other situations. Sometimes negative speaking experiences in specific situations create fears or "mental blocks." Many children respond by withdrawing from social situations, while others express their feelings by acting out or becoming the "class clown." The child's fears and beliefs about their stuttering serve to increase the likelihood that they will stutter more. Therefore, complete therapy for stuttering must include components to address these concerns so the child will learn to cope effectively with his stuttering, and so that his reactions to stuttering will not result in greater interruptions in this ability to communicate.
Impact of Stuttering. Due to the effect that stuttering has on communication, the child who stutters may experience difficulties in various parts of their lives. These problems may include difficulties participating actively and effectively in social and educational activities. Children who stutter often experience teasing and other social penalties, and this may further contribute to the child’s difficulty interacting with others. If these aspects of the child’s stuttering disorder are left untreated, then the child may experience a variety of social problems in adolescence. Academic settings may be particularly difficult for children who stutter due to the emphasis placed on verbal performance. Children who stutter may choose to avoid social and educational activities, thus limiting their achievement. Therapeutic intervention for these aspects of stuttering play a critical role in helping children and their families overcome these limitations so the child can communicate effectively and participate effectively in life.
Note: Original material provided by Gary Rentschler, PhD, CCC-SLP (Duquesne University, Pittsburgh, PA), and Rod Gabel, PhD, CCC-SLP (Bowling Green State University, Bowling Green, OH). |
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