Treatment for school-age children who stutter is quite different from treatment for preschoolers who stutter. With preschoolers, the primary goal of therapy was to help the child develop “normally” fluent speech. For school-age children, fluency is still an important goal, of course; however, the older a child becomes, the more important it is for treatment address other issues beyond just speech fluency.
In addition to learning to speak more fluently, school-age children who stutter must learn to address the feelings they experience when they stutter, the physical tension and struggle that often accompany their speaking disfluencies, and, the reactions of other people in their environment. Often, these factors cannot adequately be addressed if therapy focuses only on fluency, so a broad-based approach to therapy is often helpful.
Unfortunately, many speech-language pathologists are not comfortable working with children who stutter. Although most clinicians are experts at helping children with speech sound (articulation) or language problems, many simply have not have sufficient experience with stuttering to be able to successfully address the full complexity of the disorder. Therefore, it is important for parents to advocate for their children to ensure that they are working with a speech-language pathologist who is comfortable with stuttering and skilled at applying a variety of treatment strategies to help children achieve an optimal outcome from therapy.
It is difficult to provide a concise overview of everything that will occur in treatment for school-age children. Every child who stutters has his own individual needs and concerns. Therefore, speech therapy for children must be individualized. We are always wary of any clinical approach that suggests that all children who stutter need the same uniform program of treatment. Instead, we prefer to see clinicians identify the specific needs that a child has then develop a customized treatment plan that will address those needs.
Ultimately, the aim of therapy for school-age children who stutter is to ensure that they can communicate effectively and freely, and that stuttering does not hinder their ability to say what they want to say, when they want to say it. Note that this goal does not require that the child be 100% fluent. Recall that even though many school-age children who stutter may continue to stutter to some extent throughout their lives, stuttering does not necessarily have to be a burden for them. The goal of therapy is to help children deal effectively with stuttering so it does not negatively affect their ability to communicate. Children can stutter and still communicate effectively—and they can still achieve any goal they want in their lives.
Helping children achieve this goal of optimal communication may include may different components. For example, children will need to learn strategies for speaking more fluently. When children stutter, they typically experience disruptions in timing (sounds take too long or are not produced at all) and physical tension (muscles are too tense to be able to move smoothly from one sound to the next). Thus, treatment strategies often involve changes to the timing or physical tension involved in producing speech. There are several techniques available to help children modify their timing and tension so they can speak more fluently. Examples include “easy onsets,” “smooth movements,” “easy speech,” “easy starts,” “slow speech,” etc. Because each child is different, your speech-language pathologist should work with your child to identify which techniques are most effective for him.
In addition, your child may also learn strategies for reducing physical tension during moments of stuttering. At first, it may seem to you that teaching the child to stutter differently is counter-productive. Parents sometimes ask, “isn’t he supposed to be learning to speak fluently?” While this is true, it is also important to remember that no technique for increasing fluency is 100% effective all the time. Even with the best use of such techniques, children will still exhibit some stuttering. Thus, it is important for children to learn to stutter more easily, with less effort, so that the stuttering moments are not as disruptive to communication.
When children are feeling “stuck” in their speech, they will try anything they can think of to get out of the stutter. Typically, this means that they tense up their muscles and try to force their way out. Ironically, the best strategy for getting out of a block is actually to reduce the tension in their muscles. Therapy activities designed to teach children how to “ease out” of their blocks can go a long way toward helping children communicate more effectively, for their stuttering moments become less severe.
It is important for parents and others to realize that the primary reason children tense their muscles during moments of stuttering is the simple fact that they do not want to be stuttering. Stuttering is embarrassing, and nobody would want to stutter if they didn’t have to. Because of the child’s discomfort with stuttering, he struggles to get out of the block as quickly as possible, and this leads to more severe stuttering. If the child could become a little more comfortable with the moment of stuttering, then he would be less likely to engage in this tension and struggle, and his stuttering would be less severe.
Thus, another component of successful stuttering therapy for school-age children who stutter involves helping the child become less concerned about stuttering. The more a child accepts the fact that he stutters, the less likely he will be to tense his muscles and struggle with his speech, and the less likely he will be to exhibit severe moments of stuttering. Put simply, acceptance of stuttering leads to less stuttering and more effective communication.
Acceptance of stuttering also helps the child minimize the overall impact of stuttering on his daily life. School-age children who stutter sometimes react to their communication difficulties by avoiding opportunities for talking. Perhaps they try not to say words they think they are going to stutter on, or they make arrangements with their teacher so they do not have to read aloud in class, etc. When they make these accommodations, they may not experience the embarrassment they feel about their stuttering. Unfortunately, however, they are actually missing out on key opportunities for development. The more the child can participate in his life, the better. Therefore, learning to accept stuttering also helps the child reduce avoidance so he can more fully participate in his life.
Finally, therapy for stuttering in school-age children may also address the reactions of the people in the child’s environment. Sometimes, children who stutter experience teasing from their peers or misunderstanding on the part of family members or teachers. Your speech-language pathologist can help you educate the people in your child’s life so they develop a better understand of stuttering. In addition, the clinician can help you and your child learn to minimize the impact of teasing and other negative reactions your child might face through education, advocacy, acceptance, and support.
In sum, treating children who stutter is a complicated process that may involve several different components depending upon the child’s individual’s needs. As parents, you should be sure to work closely with your speech-language pathologist to learn how you can best reinforce the lessons your child is learning in therapy with your support at home.
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Reprinted with the permission of the National Stuttering Association. © 2008 National Stuttering Association.
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