When a child who stutters is demonstrating the ability to make changes to their speech in the therapy room, it seems obvious that they’d want to use the same strategies to improve their speech outside of the therapy room as well. Children, especially teenagers, rarely want to stand out in a way that can stigmatize them, provoke questions or increase the chances of teasing. The question then arises, “Why aren’t they using their tools?!”
Speech and stuttering modification techniques are often learned quickly and easily within the therapy setting. However, speech/language pathologists and parents often feel discouraged when knowledge of these techniques seem to disappear as fast as it takes for the child to get to their car in the clinic’s parking lot. Is it laziness on the part of the child? Is it the fault of the family for not following through with home assignments? Is the speech/language pathologist not teaching the correct strategies? Instead of pointing fingers at each other, let’s uncover why speech/stuttering strategies can be difficult and determine how we can best navigate these challenges.
Reason # 1: These Techniques Are Too Hard!
Making changes to one’s speech becomes exponentially harder when you introduce factors that often are not present in the therapy room, such as interruptions, time pressure, and feelings of embarrassment or shame associated with stuttering. Learned escape and avoidance behaviors develop as a response to these environmental stressors and linguistic demands and make it even more difficult to use strategies. Suddenly, what felt like an easy decision to use a technique, becomes complicated by the person’s desire to be heard in a large group of chatty peers or by the language demands involved in formulating an excuse about why they don’t have their homework.
How Can I Help?
Children will be more likely to use speech/stuttering strategies if they are first introduced to them in safe and supportive environments (ex. home, therapy room). To expand on this, you might choose to create a hierarchy of speaking situations and use it to guide where the child practices using strategies. If a child who stutters is not yet using strategies in a certain situation (ex. in the classroom), it most likely is not because they are not trying hard enough, rather it might have to do with where that situation is on their hierarchy. The hierarchy can also be used to brainstorm with the child about which situations they will most likely be successful in using strategies and which situations they should cut themselves some slack.
Reason #2: These Techniques Make Me Sound Weird!
There are several techniques that may be introduced to a child who stutters. Some strategies involve prolonging the initial sound to ease into or out of a word with less physical tension or struggle. Other strategies involve inserting more pauses in your speech. The listener may believe that speaking while using these strategies is preferred to stuttered speech; however there is no getting around the fact that these strategies require a child to alter their speech in a way that is still different from how their friends sound. Children may report that they have similar negative thoughts and feelings about their speech while using strategies as they do about their stuttering. This is yet another reason why a child may be choosing not to use speech strategies outside of the therapy room.
How Can I Help?
Just as you might spend time trying to help reduce negative reactions to stuttering (ex. voluntary stuttering assignments), you might also spend time desensitizing a child to hearing themselves use strategies. Children can also benefit from improving their ability to handle listener reactions. This can be addressed by participating in role-playing activities that help create “scripts” for responding to curiosity/teasing. (ex. “Why do you sound like that?” “Sometimes I stretch my sounds like that to help me get out of a stutter”). The more comfortable the child feels with their strategies and their ability to respond to questions about their speech, the more prepared they will be to use these techniques outside of the therapy room.
Reason #3: These Techniques Aren’t Worth it!
A cost-benefit analysis can be useful when trying to understand why a child may choose not to use speech/stuttering strategies. At the surface, it may appear that there are many benefits of using strategies which include increased fluency and improved overall communication. However, SLPs and parents must be careful to consider the costs, as well. Costs may include increased effort, difficulty concentrating on the content of message, the risk of showing more stuttering and the potential that the strategy doesn’t work.
How Can I Help?
You might have a discussion with the child about what they perceive as potential costs and benefits of using strategies in a variety of different speaking situations. You’ll notice that as the child becomes more accepting of stuttering and is better able to tolerate both their feelings about stuttering and listener reactions, there will be a reduction in the physical tension and struggle associated with speaking. As tension and struggle reduces, strategies are easier to use and the costs may not feel so high.
The bottom line
There are several speech/stuttering strategies available that may be helpful in reducing the frequency and severity of stuttering. However, you often cannot treat the observable behaviors of stuttering with strategies without first considering how the child’s feelings and thoughts about their speech is impacting them and their ability to make changes.