The Right Time to Break Out the Stickers

holteAbout the author: Doreen (Dori) Lenz Holte is a professional writer and author of Voice Unearthed:  Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter.  She is also the proud mom to Abe, Adam, and Eli.

When our son Eli was around 12, I asked him if he remembered being told that it was okay to stutter.  It had been three years since we stopped traditional speech therapy and I was curious as to how he would respond.  He thought for a moment and replied “Once I stopped stuttering they would give me stickers or let me play with the toys in the room.  They’d tell me it was okay, then they’d tell me not to do it… I stopped talking as much because they said it was wrong.”

When Eli was between five and nine years of age he saw a number of speech therapists for treatment for his stuttering.  These therapists had varying degrees of experience with children who stuttered – ranging from none to having an ASHA Board Recognized Fluency Specialist certification.  Each therapist enlisted fluency shaping and stuttering modification speech tools, the approach considered to be “evidence-based best practice” by ASHA and leading universities.  Each therapist enthusiastically rewarded Eli with an array of colorful stickers when he used his speech tools.  At the same time I witnessed each of them kindly and continually assuring Eli that it really was okay to stutter.   They never told him it was wrong…I am certain of that.

At home during special time (time set aside each day to practice using speech tools)  I would clap for and praise Eli when he successfully used his Tigger talk and turtle talk to deliver non-stuttered speech.  I would also assure him that it really was okay to stutter.  I also never told him it was wrong to stutter, but that was unfortunately the message he came away with.

We were confused and confounded when, even with all the positive reinforcement, Eli did not transfer the use of speech tools outside the clinic setting or our special time at home.  After four years of therapy we resigned ourselves to believing that at least we had given him a tool box full of speech tools…he would hopefully use them when he was ready.  (This is a common lament I’ve heard from both parents and speech therapists throughout the years.  “If he would just use his tools.  He can use them in therapy, so why not in other places?  He just needs more practice…”)

When Eli was nine, we stopped traditional speech therapy.  He had gone from mild to moderate to severe and was now twisting his chin to his shoulder and growling in order to talk…if we were lucky.  Most of the time he just didn’t talk.  We noticed the silence when he was sitting around the table at Easter with aunts, uncles and cousins.  We noticed the silence at 4H meetings and during home school co-op days with friends.  Even at home with us he became increasingly withdrawn.  We felt like we were literally watching our Eli fade away.   We would vacillate between gently reminding him to use his speech tools and ignoring the behavior. We felt increasingly fearful and lost when it came to Eli’s struggles with speaking.  It seemed that the silence and disconnection was proving to be a far greater handicap than the stuttering itself.

In retrospect, there is no doubt that the silence was a result of the shame Eli felt when he stuttered.  He also felt that shame when he didn’t meet up to the expectations implied in the ongoing praises and reward of stickers for non-stuttered speech.  Dr. Brené Brown has researched the subject of shame extensively and states that “nothing silences us more effectively than shame.”  Brown, Ph.D.,  licensed social worker, and renowned author and speaker goes on to say:

shame unravels our connection to others…In fact, I often refer to shame as the fear of disconnection – the fear of being perceived as flawed and unworthy of acceptance or belonging. Shame keeps us from telling our own stories and prevents us from listening to others tell their stories.  We silence our voices and keep our secrets   out of the fear of disconnection. ¹

The role that shame plays in stuttering behavior is no surprise to parents or speech therapists.  It is the absolute last feeling we want them to experience around talking but are our efforts backfiring? Was it really developmentally appropriate to expect a child of this age to manage the complex and conflicting messages of “It’s okay to stutter but here’s a reward if you don’t.”?  Research into the cognitive traits shared by children, ages 6-10, helps to shed some light on our discomfort.  In general, child development experts ² agree that this age group:

  • Has a strong desire to perform well and do things right.
  • Finds criticism or failure difficult to handle.
  • Views things as black and white, right or wrong, wonderful or terrible, with very little middle ground.
  • Naturally seeks praise and wants to conform.

Using speech tools requires a level of energy and concentration that is hard to fathom even for adults.  When you consider the development traits of children you begin to understand how shame can result from the unrealistic expectations and conflicting messages.  In addition, many experts (and parents) report that children who stutter are often more sensitive than others their age.   Mary Elizabeth Oyler,  a speech-language pathologist who also stutters has done extensive research around the issue of children who stuttering and sensitivity.  She found that:

children who stutter were significantly more sensitive and vulnerable than non-stuttering    children.  In addition, 84% of the children who stutter fell in the highly sensitive range as          compared to 36% of the children who do not stutter. 4

When we step away from a focus on eliminating the moment of stuttering behavior and look at the whole child, we truly begin to understand why a child might choose silence over risking continued failure in front of those they most want to impress and please.

In 2011, I  published Voice Unearthed: Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter.   During my six years of research and reflection for this book I discovered a plethora of  disagreement, confusion, and uncertainty around treatment for children who stutter.   Extensive research around shame and stuttering has been done by Dr. Bill Murphy, speech-language pathologist and a clinical faculty member at Purdue.  Murphy warns:

The emotions of shame are self-perpetuating, regenerated repeatedly by the child, even if the external stimulus (a parent inappropriately reminding a child to “use your techniques,” or a classmate laughing) is no longer present… the self acquires the identity of failure, at least in relationship to speaking skills. ³

Professional organizations and academia have an ethical obligation to abide by treatment approaches that are deemed to be best practice stemming from evidence-based research.  The problem in this particular area is that the vast majority of research has been done on adults.  The research done with children is extremely limited and often labeled as “emerging” or “promising.”   The goals of the research are to make fewer speech errors.  The goal for a child is to avoid feeling shame and the most realistic way to accomplish this is to stop talking.

I am encouraged when I increasingly hear about a greater focus on desensitization and creating positive feelings around communicating.  But the use of stuttering modification and fluency shaping speech tools remain as a significant component of therapy for children as conveyed in ASHA’s  Specialty Board on Fluency Disorders Manual.5  The Stuttering Foundation of America even acknowledges that “many children and teens who stutter do not have the maturity or skill to monitor their speech in all situations. Therefore, it may be unrealistic to expect your child to use her tools in other environments at all times.”  What happens when you throw in a few stickers as a reward for using those tools?  What message does a child really walk away with?   Eli says “I stopped talking as much because they said it was wrong.”

From the time Eli was nine to this day, Dr. Jerry Halvorson, retired Communicative Disorders professor at the University of Wisconsin, River Falls has helped us provide support focused on keeping Eli talking and engaged in the world around him.  Within three months of changing our focus from reducing speech errors to keeping Eli talking we saw significantly less twisting, gurgling, and far more talking.  It was a long process that is far from over.  But today Eli is 17 years old, a full-time college student, a part-time employee, and a supportive and positive role model to his group of friends.   He still stutters, sometimes severely.  But he puts himself out there each and every day.  He can be wickedly funny… I figured it was a good sign when his co-workers affectionately nick-named him “Snarky.”  Now there is a good reason to break out the stickers.

References

  1. Brown, Brene (2007) I Thought It Was Just Me (but it isn’t): Telling the Truth About Perfectionism, Inadequacy, and Power Penguin/Gotham
  2. The National Network for Childcare, Great Schools.org, Human Development and Family Studies at Iowa State University
  3. Murphy, B. (1999). The School-Age Child Who Stutters: Dealing Effectively with Guilt and Shame, VHS Publication NO. 86, Memphis, TN, Stuttering Foundation of America
  4. Oyler, M. E. (1996b). Vulnerability in stuttering children. (No. 9602431). Ann Arbor, MI: UMI Dissertation Services.
  5. http://www.stutteringspecialists.org/index.php?option=com_content&view=article&id=90:the-sbfd-manual&catid=79&Itemid=502

 

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Comments

The Right Time to Break Out the Stickers — 130 Comments

  1. Dori,
    Incredible. I loved reading your story and your perspective! I am a graduate student studying speech pathology at Appalachian State University. I have always have an interest in stuttering, but it has not been until this semester while I am taking a fluency course, that this interest has really taken off. I hope and plan to work in the school system when I graduate. As students in the field, and like you pointed out, we hear that SLPs feel unprepared, or often unqualified to work with kids who stutter due to the wide range in levels of education on the topic we receive. I am aware that the overall prevalence of stuttering is low compared to other things we may see in the schools, but I do not want to feel unprepared or unable to help the (potentially very few) students I see over the course of my career who stutter. I am still learning about all of the different therapy approaches, but I too believe in less focus on “fixing” the stutter, and more focus on the counseling aspect and working on an “easier” stutter. No matter what I may adopt as my preference, I am not a person who stutters. I think that the biggest stakeholder in deciding specific therapy approaches will be the person who stutters themselves. As a therapist, I will aim to provide each individual client with a therapy approach that is best suited for their personal goals.

    My question for you is in regards to Eli’s history of speech therapy. What are some specific things that you really disliked, or rubbed you the wrong way perhaps, that his therapists did? What things did you really like and would recommend for an upcoming therapist, such as myself?

    Thank you so much!
    Ansley McSwain
    Appalachian State University

    • Thank you for your response Ansley — I’m so happy to hear that you’re interest in fluency has taken off. It’s a baffling challenge that requires patience and caution, sounds like you’ll do well!

      I have heard from so many school-based speech therapists who resonate with my message in my book “Voice Unearthed.” It is totally understandable, based on, as you say, the low prevalence of stuttering, that most speech therapists have spent little, if any, time on the subject. I think it’s so important for them to understand that there are risks and harm can be done. I’ve spoken to many adults and older teens who say the best school therapist (or therapist in general) they had was one who was their friend and just listened to EVERYTHING they had to say (not just about their speech). The relationship where they felt safe and appreciated was the only thing that mattered to them. In that respect there is so much a school-based therapist can do to support these kids that doesn’t lead to increased anxiety around speaking, withdrawal, and silence. So so much!

      It took us years of research, writing, reflecting, to understand what it was that “rubbed us the wrong way.” We knew nothing, zippo, about stuttering and treatment for stuttering. We trusted that his therapy would help him, and at best, do no harm.

      Instead, the focus on getting him to use stuttering modification and fluency-shaping speech tools in order to lessen speech errors backfired. He decided it was a lot safer and easier to just be quiet. I believe that both parents and speech therapists have a right to fully understand this risk. I’m not a speech therapist, but as a parent, I wish there had been far more parent-involved therapy focusing on keeping him talking and keeping talking fun and stress-free as possible.

      There are no easy answers – we are just not there yet. So let’s make sure that whatever we do with these kids doesn’t serve to increase anxiety and tension around speaking. Let’s keep them talking!

      Thanks again Ansley, best of luck to you!
      Dori Lenz Holte

  2. Hello Dori,

    Thank you so much for contributing this paper. Your story really helped put this issue into perspective. It is easy to forget that our actions may be interpreted differently than we intend. This is a great reminder to objectively think about what we are encouraging and therefore discouraging… and that the child’s goal is to have his/her message heard, something so easy to forget when our focus is on treating the stuttering. I also appreciate the reminder that intrinsic rewards are the longest lasting and most meaningful to a child. Moving forward, my goal will be to work to build in more intrinsic rewards that allow each child to feel accomplished and proud, ultimately creating a desire to communicate. Thank you again for sharing your family’s story.

    Emily

    • Thanks for your response, Emily. The intrinsic rewards may not be as satisfying for the rewarder, but I think they’re far more apt to contribute to real and lasting change. I love your goal! We must keep the fire alive in these kids — to keep them communicating as they have soooooo much to say. Best of luck to you —
      Dori Lenz Holte

  3. Hello Dori,

    Thank you so much for sharing. Your insight has been very thought provoking for me. I am currently a graduate student in California, studying Speech-Language Pathology. The professor for my Disorders of Fluency class stresses that we address the message of what a child who stutters says first, rather than immediately targeting any issues regarding their fluency. I understood this to be important, because it is connecting with someone on a human level and communicating, but I guess I never thought about the various ways in which a child might interpret the messages of rewards. It is important to be aware of the messages that might be relayed, however unintentional they may be. Your paper makes it even more clear to me the importance “keeping them talking.” Thank you again for sharing.

    ~Mara

    • Thank you Mara for your response. My mission is to help parents and speech therapists understand the risks that come with targeting issues with fluency for school-aged children. They are real and significant. Thanks for listening…
      Best,
      Dori Lenz Holte

  4. Hi Dori, thank you for sharing your story! I think it is so important to hear from the parents of people who stutter. You see things from a whole other perspective and I think the ISAD Conference really gives you the opportunity to share your insights. I think generally we tend to misjudge the intelligence of young children. We say things and do things without realizing how the child is interpreting our messages. I think your story is a great reminder to parents, or anyone, to be aware of this. Sometimes we think we are doing all the right things, when in reality, we are only further impeding our child’s capabilities. Thanks again=)

    Lindsey

    • Hi Lindsey, thanks for listening! Yes, my goal with my book, “Voice Unearthed” and my continued efforts is to broaden the perspective, to help everyone involved see the big picture and the whole child. I love it when you say that we “generally tend to misjudge the intelligence of young children.” Do we ever!! If we could only know what really goes on in those little big minds. I have probably experienced what most parents experience…we find out much later, after the fact. This is why I think it’s important for more research to be done around what is developmentally appropriate for school-aged children. Parents and therapists mean well and are truly doing the best with what they are given. We simply need to reflect on the unintended harm that can result and then do better. There are no easy answers… thanks again for listening. Best of luck to you!
      Dori Lenz Holte

  5. Dear Dori,

    I found your story to be very informative. I am a second year Speech-Language Pathology student. I think positive reinforcement can be helpful, but as you’ve clearly outlined, it can also inadvertently instill a sense of shame. I am happy that your son is more relaxed and that the change in approach was effective. I am curious, during your family’s journey, did you ever participate in any parental support groups? Were they available? Or did you meet with other parents of children who stutter?

    Thank you!

    Eileen
    Idaho State University Graduate Student

    • Hi Eileen – thanks for your response. I think positive reinforcement is helpful to get what the reinforcer wants, not necessarily to promote real change in the recipient. I’ve used reinforcements twice in the past week — one to keep a two-year old from wetting her pants while sitting on my carpet and napping in my bed – and one to get my 17-year old to clean the guest bathroom. I know, I know, he should do these things because he’s part of the household — and I’m under no illusion that giving him money to go to the store and buy candy is going to result in this kid wanting to clean the guest bathroom in the future. But a clean bathroom makes ME happy.

      Okay, enough already. It’s the last day of the conference and I think I’m getting a little loopy. I have connected with parents both through NSA and FRIENDS conferences and through the group that gathers monthly at UW-River Falls. It’s funny — the parents I’ve stayed in touch with are those I’ve really gotten to know and enjoy being around — most often having nothing to do with our children’s shared challenges. Eli seems to have the same outlook — hmmm, wonder where he gets that from!

      Thanks again for responding — best of luck to you.
      Dori Lenz Holte

  6. Interesting insight. I am a graduate student in the field of communication disorders and currently taking a fluency course. With all the presented information from class I feel like I keep asking myself, ‘What is the best route for therapy’. It makes sense that young children don’t have the skills to apply the taught techniques to spontaneous speech, and it seems like it is therapeutic to encourage children to keep talking. This seems like an appropriate approach to ‘therapy’.

    • Hi – and thanks for listening. You bring up the million dollar question – “What is the best route for therapy?” That has not yet been determined and it’s important that both parents and speech therapists understand this. What is referred to as “evidence-based research” is lacking — mostly non-existent, for school-aged children. So they’ve simply taken whatever evidence they have for adults and applied it to children. The risks are real and significant. Thank you for listening…
      Best,
      Dori Lenz Holte

  7. Hello Dori,
    I loved reading your story, thank you for sharing! I have never before considered the negative effects that could result from using positive reinforcements such as stickers during speech therapy for a child who stutters. Do you feel that speech therapy helped your son at all or do you feel that the therapy techniques made his stutter worse? Besides encouraging speaking, what would you recommend clinicians use instead of positive reinforcements for therapy with a child who stutters?

    Thank you again!
    Bianca
    Idaho State University Graduate Student

    • Hi Bianca — thanks for your enthusiastic response. Honestly I feel the therapy made it worse. Focusing on eliminating or lessening the stutter only served to increase the anxiety and fear around speaking, greatly exacerbating the situation. Over a five-year period, his stuttering behavior went from mild to moderate to severe, and he withdrew and chose silence over having his voice heard. Let me be clear — not one of his clinicians intended for this to be the outcome. They used what they had been told was a treatment based on evidence-based research and is promoted by ASHA, the organization that trains and certifies these professionals. (see my response to the previous post) This must change.

      While I am not a speech therapist, I have heard from so many adults, young and old who say that the best thing they got out of therapy as a child was a friend and a good listener. Make therapy fun — meaning what’s fun to them! You find that out by listening. Playing hoops, doing art, being goofy, sharing their Pokemon card collection — I think the best and safest reinforcement a clinician can use is to provide a safe place for the child to talk as much as they want about whatever they want, and listen and listen some more. First do no harm.

      Thanks Bianca for listening – and best of luck to you…
      Dori Lenz Holte

  8. Hi Dori,

    It is interesting that we are taught to tell our clients who stutter that stuttering is “okay”, but then proceed to reward fluent speech. But, if we don’t reinforce the fluent speech and the client isn’t producing fluent speech, our therapy is perceived as ineffective. Thank you for sharing your perspective on this. Although I am not currently working with anyone who stutters, I feel that this perspective can be shifted to clients with other communication issues. T

    Thanks,
    Gina
    SLP Graduate Student
    Idaho State University

    • Hi Gina – thanks for responding. You have put your finger on the conundrum of therapy for children who stutter — that if the client isn’t producing fluent speech then therapy is perceived as ineffective. Parents, insurance companies, IEPs, etc… all demand the fluency count go down. That’s why I wrote the book, Voice Unearthed. It took me years of observing therapy with our son and years of research and reflection to understand the dangers of letting fluency counts drive therapy for children who stutter. One thing I was surprised by in my research was how many experts agree! I feel that parents and speech therapists have a right to understand this and be educated about the risks. There are no easy answers, but first we must do no harm.

      Best of luck to you Gina,
      Dori Lenz Holte

  9. Dori,
    Thank you for sharing your and your son’s story. I am a second year SLP graduate student and am currently enrolled in my program’s fluency course. It is one thing to read about studies and best practices from a textbook, but I find it to really drive the point home when hearing a personal story and making that personal connection. We have been educated on the greater focus of addressing feelings, emotions, and anxieties with children who stutter. I hope to remember and execute this knowledge by remembering your story.

    Your statement, “Was it really developmentally appropriate to expect a child of this age to manage the complex and conflicting messages of “It’s okay to stutter but here’s a reward if you don’t?”” really got me thinking. We are taught about the feelings and emotions of stuttering but I had not thought about how rewarding fluent speech or use of techniques could actually be counterproductive to increasing confidence and speech use. Thank you for this realization.

    Christy Baltazor
    Idaho State University, Graduate Student

    • Hi Christy — thanks for listening to a mother’s perspective and taking the time to respond. I’m so glad you resonated with the statement around the developmental inappropriateness. You might be interested in my question on this matter in “Ask the Experts.” I hope that this will result in further research being done on this subject. It would make a great dissertation paper (hint hint 🙂

      Thanks again and best of luck to you!
      Dori Lenz Holte

  10. Dori,
    I absolutely agree with you that looking at the whole child is key. I appreciate the data in your paper, in particularly the information on what a child of 6-10 is typically capable of. I think too often speech pathologists play to the parents and the parents’ wishes without considering where the child is at and what they need now. Yes, looking forward is important, but they won’t be able to successfully progress unless you’ve strengthened the child where they are already at. The experience that you shared with your son and how a typical therapy practice affected him should help speech pathologist and parents to look at how they are working with children and perhaps rethink their own methods. I’m glad that you found a professional that you felt was supportive of the deeper needs of your child’s communication. Thanks for sharing!
    -AH

      • Glad you liked it! If you email your mailing address to voiceunearthed@gmail.com, I will gladly send you “Voice Unearthed” where you can experience more of my genius :-)! As I told a previous poster – it’s the last day of the conference and I’m getting a little loopy…
        Dori

    • Hi AH — you are absolutely right in that parents often drive the technique-laden approach as it does work to lessen speech errors, at least in the clinic setting. I was one of those parents. That’s why I wrote the book, “Voice Unearthed.” Parents and therapists have the right to understand the risks of this approach and I feel the “powers that be” and support organizations have an obligation to educate. First do no harm.
      Thanks again AH
      Best,
      Dori Lenz Holte

  11. Dori,
    I am a graduate student and although I don’t have much experience with working with people who stutter yet, I have always believed that a mix between counseling and fluency enhancing strategies are necessary for successful therapy. I hadn’t realized the mixed messages that we may be sending our clients with our reinforcement. I appreciated your evidenced based description of how children view the world. I don’t have a client who stutters at the moment, but I think that this relates message relates to many communication disorders. I will be very cautious about the message I am sending with my sparkly stickers in the future. Did your son ever receive any group therapy? If so, how did that environment contrast individual therapy? Did he find more encouraging? Were the reinforcements less fluency driven?
    Thank you ,
    Breanna
    Graduate Student, Idaho State University

    • Hi Breanna — thanks for your response. Thanks for tuning into the description of developmental stages for children this age. I posed a question related to this in “Ask the Experts” and got some interesting responses.

      Eli has been participating in a group therapy environment since he was maybe 14 or so. It is in a university setting so most often includes students. The focus is on keeping them all talking. Oh, and in one session they taught him how to dance. Yes, this has truly helped him and there is absolutely no focus on fluency — it’s mostly on having fun and getting comfortable in his own skin. He really enjoys it…

      Thanks again for your response and best of luck to you…
      Dori Lenz Holte

  12. Dori,

    Thank you for sharing your son’s story. It is very interesting that we, as clinicians, can be contradicting in what we are communicating. I will have to think about this subject for a while, but as of right now I am torn about how to fix this problem. You’re right, we are taught to address the emotional side of a stutter (saying it’s ok to stutter), but we are also taught to use fluency enhancing techniques. I believe that a person needs to feel known and feel that they can be themselves in therapy, but I also believe that a child going through therapy so young will not understand not matter how we go about it. The concept that it is ok to stutter, but for their benefit we would like to help them improve their speech is difficult for a young mind to understand.

    Just an idea, maybe clinicians can reward a young client for a certain amount of focus time, or a reward for participation, rather than a reward for fluency. Let me know if you have any thoughts on that.

    Again, thank you for sharing.

    Haley Lounsbury
    Idaho State University Graduate Student

    • Hi Haley — thanks for your response. You have every reason to feel torn – When I was researching my book, I was stunned by the level of disagreement and uncertainty that is conveyed by researchers and speech therapists.

      In my opinion, if the child finds the experience relevant and enjoyable, they will feel rewarded no matter what. If they don’t find the experience relevant and enjoyable, an extrinsic reward will maybe bring a smile, which of course, the reward-giver enjoys, but won’t bring lasting and meaningful involvement. It may even send the wrong message — I don’t think it’s worth the risk.

      This conference has helped me to understand just how much I dislike giving extrinsic rewards to get children to perform. I believe it’s manipulative and meaningless…and kids can see right through it…

      Thanks again Haley – best of luck to you.
      Dori Lenz Holte

  13. Dear Dori,

    Thank you for your paper. It was ten years since I graduated with an undergraduate degree in Speech Pathology until I started grad school about a year ago. I can honestly remember that the take home message was always. “Reward the kids with stickers” I had no idea how damaging this could actually be in certain therapy situations (like stuttering). What you said in your paper actually makes a lot of sense especially if you try to use psychological theories on what certain re-inforcers can do to a child. Also, thanks to your paper I will be now more careful about whatever messages I convey to my clients and will try not to send mix messages. Lastly, I’d like to ask you what your advice would be for a future SLP professional. Thanks in advance.

    Paul Gutierrez

    • Hi Paul – thank you for your response and I’m so glad you got back into school — we need more men in this field! My advice to you would be to please read as much as you can outside of the textbooks, especially autobiographies and first-hand accounts. Also read my book, “Voice Unearthed: Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter.” Getting the perspective of those who have lived it, including parents, can be the most important thing an SLP can do. Read through my replies in this conference – I’m not a speech therapist, but I am a mom who lived it, and spent six years researching, writing, and reflecting on this topic — I so appreciate you and all of the students who have participated in this conference. Kudos! and best of luck…
      Dori Lenz Holte

  14. Hi Dori,
    Oh my goodness! Such an inspiring paper! Reading these thoughts from a mother’s perspective is so impactful!

    I feel that you are completely valid in each of your opinions. I, however, approach the subject from the other side of the coin as well. The effects of stuttering are felt so heavily from speaker’s perspective, yet are so socially influenced by the listener’s point of view; it makes it a difficult issue to address. From a clinician’s perspective, it is also difficult to find that fine line between reinforcing an “intended behavior” while discouraging an “incorrect behavior.” After being in therapy so long, it is understandable that one would confuse or associate all of the seemingly “positive reinforcement” with a negative connotation.
    I also appreciate your perspective as a mother, noticing that it is difficult for us as SLP’s to address stuttering as a social issue. You mentioned that SLP’s are obligated to address and treat stuttering with ethical practice and evidence based treatment methods; which is completely accurate (from an educational standpoint). However, it is my belief, that whatever technique you are able to employ to decrease your stuttering is valid and applicable…. even if it is not evidence based. Each client is different. Each client’s instance, and severity of stuttering is different. And that is ok. As you mentioned before, it’s ok to stutter. For a PWS, speaking fluently is HARD! It requires a lot of attention and effort that typically fluent speakers don’t have to put forth when they are speaking; and a lot of clinicians don’t understand that. For example, if someone who spoke fluently were to pseudostutter (or fake stutter) for a day, they would often find by the end of the day that it was effortful and tiring to engage in this act that was so unnatural for them. Speaking fluently for a PWS is similar. Stuttering is definitely a difficult thing to deal with socially, but if you have an amazing family support system (which it sounds like your son does), and a great group of friends to back you up and stick with you, you’re going to be just fine! It is tough, don’t get me wrong, I’m not discrediting the difficulties your son undoubtedly experiences on a daily basis, but it sounds like he is doing great! Keep encouraging him every day, and keep praising him for his accomplishments. Stutter or not, college is TOUGH! And it is absolutely phenomenal that he is taking that step to better himself, and not letting anything stand in his way! ☺
    Keep up the good work!
    ~Kendre Howland
    ISU Graduate Student

    • Hi Kendre — I’m hoping it’s not too late to reply to your response. Thank you for taking the time…

      I have found, in my research, a tremendous disagreement on definitions of “intended behavior” and “incorrect behavior.” Yes, the intended behavior goal of his original therapy was to decrease stuttering. “Incorrect behavior” was making speech errors/stuttering. He succeeded in accomplishing the intended behavior by participating less and growing silent in his world… the unintended, but oh so real, behavior that served to be a greater handicap than the stutter itself. I only speak for children — they are not adults and should not be treated with adult therapy. The vast majority of the research in existence has been done on adults, not children, which means that what the field is referring to as “evidence-based” is not evidence-based. As a parent and decision-maker for my child, I have the right to know this and to be educated on the risks.

      You state how hard it is for a PWS to speak fluently. Not necessarily, considering that in most of their talking, their speech is natural and fluent. What is going on here? We simply do not know, but whatever we do with these children, we must do nothing that can serve to exacerbate the problem.

      When it comes to children, suggesting that they should change how they talk in order to avoid stuttering also “requires a lot of attention and effort…and it is effortful and tiring to engage in this act that was so unnatural for them.” Talking in a prescribed manner, whether it’s pseudostuttering or using speech tools, is hard, even for adults. But adults can manage these messages and make choices. Children not as much. Most adults (not all) abandon the effort at some point because it is too difficult and awkward. Why are we doing this with children? It’s just not worth it.

      You sound like a very passionate and engaged speech therapy student — keep up the good work and best of luck to you!
      Dori Lenz Holte