Stuttering Pride with children (and their parents) (Elaine Kelman, Ali Berquez, Jane Harley)

kelmanAbout the authors: Elaine Kelman is a consultant speech and language therapist and the head of the Michael Palin Centre for Stammering Children in London. She has contributed to the development of the various therapy programmes for children who stutter, particularly the management of early childhood stuttering and has published a number of papers, chapters and books, having co-authored the Palin Parent-Child Interaction Therapy manual. She participates in the Centre’s international training programme and the research programme and has been invited to present at many international conferences. Elaine is President of the International Fluency Association, on the board of the European Fluency Specialists and is an affiliate of the American Speech and Hearing Association.
ali-2016About the authors: Ali Berquez has a Clinical Lead role at the Michael Palin Centre for Stammering in London, UK. She qualified as a speech and language therapist from City University in 1993. She completed a foundation course in Personal Construct Psychology in 1994 and an MSc thesis comparing the View of Self in adults and adolescents who stammer from a Personal Construct Psychology perspective in 1996. She has worked at the Michael Palin Centre since 2000 and obtained a Post Graduate Diploma in Cognitive Therapy at the Oxford Cognitive Therapy Centre in 2005. Ali was Joint Project Lead for the Stammering Information Programme, to develop awareness and skills about stammering in the education workforce in the UK, which completed in 2010. Her current role involves clinical work with all ages including adults, teaching nationally and internationally, writing, clinical supervision and contributing to research projects. She is currently collaborating with Dr Patricia Zebrowski and her team in Iowa, USA, to explore the expectations of older children and their parents from therapy and whether their hopes are met. Ali presents regularly at conferences. She has managed and developed the Michael Palin Centre’s Teaching Programme since 2004. She manages new referrals for children and young people to the Centre and marketing what the Centre provides to local SLT teams and commissioners.
harleyAbout the authors: Jane Harley is a Clinical Lead Speech and Language Therapist at the Michael Palin Centre, London. Jane has a Post-graduate Diploma in Cognitive Therapy from the Oxford Cognitive Therapy Centre and an MSc in Psychological Counselling. She has an interest in Acceptance and Commitment Therapy (ACT) and Mindfulness Based Cognitive Therapy. Jane has authored, and co-authored peer and non-peer reviewed clinical and research publications. Her research interests include the effectiveness of therapy with adolescents and school aged children who stutter. Jane regularly contributes to the Michael Palin Centre teaching programme.

mpcAt the Michael Palin Centre we have a long history of working with children, young people and adults who stutter and our focus has always been on becoming a confident and effective communicator, rather than a fluent speaker. Way back in the 1970s and 80s Lena Rustin ran group therapy courses which incorporated social communication skills and confidence-building, alongside fluency strategies (Rustin, Purser, Rowley 1987).  ‘Minding less’ about stuttering was our earlier (and possibly watered-down) version of ‘it’s OK to stutter’. So this message is by no means new to us – but we need to be thoughtful about whether we are consistently conveying it in our work with the youngest children and their families, through to the young people and adults.

Anxious parents of a three year old may be aware of the ‘window of opportunity’ (which is open for longer than we first thought) and seek help to ‘fix’ the stutter before it becomes established. They may not wish to consider the possibility that it’s going to be OK for the child to stutter, especially if a parent is a person who stutters who has had negative experiences. At this stage we cannot be sure about what the outcome will be – the stuttering may resolve, with or without therapy, and clinical experience and common sense tell us that parental anxiety may have a role in this outcome. So we have the delicate task of providing hope without creating unrealistic expectations, by developing the parents’ understanding about stuttering and what causes it and how they can respond to and support their child.

Our work with school-aged children continues along the same lines: we do not know what the long term outcome of therapy will be for the child, so we offer a combination of fluency building skills, social communication skills and confidence building, working with families to find the balance that is right for their child and for them. When families come to us their focus may be on how to help the child to stop stuttering. From the first session, we use Solution Focused Brief Therapy (de Shazer, 1985) to help them all to explore what confident happy and effective communication looks like, rather than focusing on fluency alone. Some of these children become more fluent, some continue to stutter and we consider either to be a successful outcome if the child is also confident in himself, a good communicator, resilient to deal with setbacks and comfortable with the notion that being an individual, being yourself and saying what you want to say is more important than being fluent.

References

De Shazer, S. (1985) Keys to solution in Brief Therapy. New York: Norton

Rustin, L., Purser, H., & Rowley, D (1987) Progress in the treatment of fluency disorders London: Taylor and Francis.

1,958 total views, 2 views today

Comments

Stuttering Pride with children (and their parents) (Elaine Kelman, Ali Berquez, Jane Harley) — 25 Comments

  1. Hello Elaine, Ali, and Jane,

    I thoroughly enjoyed your paper. I love the flexibility of your approach and how either stuttered speech or fluent speech can represent a successful outcome, so long as the client is self-confident, communicates well, is resilient, and values saying what he or she wants to say over being fluent. I, too, value these outcomes and am interested in all the ways a person can become a great communicator. However, fluency is easy to measure, while the more important aspects of a successful outcome are not. In this age of accountability, I am curious about how you measure self-confidence, good communication, resilience, and valuing saying what you want to say over fluency. Perhaps I will have the chance to visit your clinic one day. Thanks again for a great paper. Best,

    Rob

  2. Hello Elaine, Ali, and Jane,

    I too enjoyed your paper! As a future SLP (I am currently a second year in the Master’s program), I have learned that one of the most important things to work on in therapy is to help clients “accept” that they stutter. I love how you addressed the fact that fluency is not the only positive outcome, that becoming a confident, resilient communicator is more important than being fluent. If we can instill confidence and acceptance in our clients who stutter, I feel like we will be able to help people who stutter more than just addressing fluency alone. I am wondering in your experience if it is harder for the parents or the children to accept the stutter?I feel as though because parents want their child to be “fluent” if that influences the child’s thinking and attitude. Thanks again for a wonderful paper!

    Jackie

  3. I really enjoyed your paper! I currently in a graduate level fluency class and plan to work with children in the future. I liked how you discussed the fears and worries that parents of children who stutter have and how you addressed them. What is the most important piece of advice that you would give to one of these fearful parents? It would be helpful for me in the future to have a key piece of advice to share with parents in these situations.

  4. Hi Elaine, Ali, and Jane!

    I very much enjoyed this article. I am also a future SLP (first year in a master’s program) and I am currently enrolled in a stuttering course and we have actually watched some videos of some of the staff from the Michael Palin Centre for Stammering in London, UK demonstrating various techniques with children who stutter! I really enjoyed how in this paper you addressed that it is more important to work on being a confident and effective communicator as opposed to just focusing on “fixing” the stutter. I agree that it is so important for individuals who stutter to be able to express their thoughts in any setting and I think that because there are so many different treatment techniques out there that they should be shaped to fit each individual case. In my course, we have also been learning about the role that parents can play in the lives of children who stutter and how it can sometimes make the stutter worse. What do you recommend be said to parents who appear to be too controlling or who have too much parental anxiety? Thanks for sharing the focus of MPC!

  5. Great topic, great paper!

    This paper definitely seemed to address some of the very important issues that SLPs would be facing on a daily basis. Since I am interested in serving toddlers to preschoolers, developing skills to deal/solve parental concerns is one of my main goals. I love the idea of focusing on becoming a confident communicator rather than a fluent speaker. Although many parents may want to “fix” their children’s stuttering problem the moment they discover, developing understanding about stuttering and learning to accept their children as who they are will help children to have a better quality of life. As SLPs, we should always acknowledge parental concerns and let them know their concerns are being heard. When planning intervention strategies, we should let parents know that we are in this journey together to make them realize the importance of support system for successful interventions. I believe it’s our job to help increase positive awareness of stuttering and spread the message “It’s ok to stutter” into our community.

    I am a first year graduate student. Prior to starting grad school, I learned that early intervention is always the key for communication deficits in general. However, I’ve also heard that many children “outgrow” stuttering and in fact, speech therapy would increase children’s awareness of their disfluencies in speech and possibly increase stuttering as a result. Since some children grow out on their own with no therapy, do you recommend parents to “wait and see” or start therapy as early as possible?

  6. Hello!

    As a future speech-language pathologist, I found your paper to be very informative and applicable to dealing with parents of children who stutter. It is so important to remember that the child is the focus throughout the therapeutic process. Due to my current lack of experience discussing communication disorders with parents, it is a skill I am not yet confident in, but your article really helped me to understand how to keep the child as the focus and educate the parents. There are so many concepts of communication that are more important that fluent speech, and I really love how all of you emphasized that throughout the article!

  7. Hello there,
    As another future speech-language pathologist, I found your paper to be very relative to topics we have talked about in our fluency class, as well as others. It is important, as you mentioned, to establish therapies to aid in the confidences of the PWS and their family. Eliminating the stutter completely is not always realistic and establishing that from the beginning may lead to better therapy success in the long run.
    Olivia

    • Olivia,

      Great thoughts on realism. Making sure to be clear with parents and caregivers is so important. Unrealistic expectations can lead to more stress being put on the child (“why can’t you just speak normally?” “that’s NOT how you’re supposed to talk” etc.), which may even cause the stuttering to get worse. I too am a future SLP, currently in graduate school, and find that this paper meshes well with what I’ve been learning so far.

      I think that, especially in today’s google-centric world, it is incredibly important to educate parents on what outcomes are most likely. I can imagine that many parents may come into therapy, thinking that their child will surely recover because of x, y, and z. It is our role, then, to bring those parents back to Earth and provide them with our realistic clinical view. A difficult role to fill, but incredibly necessary for the sake of the child and the success of intervention.

      Kyle.

  8. As future SLPs (currently enrolled in a masters program) our course work has stressed the importance of acceptance and working with the PWS on building awareness, self-confidence, learning techniques, and advocacy instead of only focusing on fluency. While reading your article, it further stressed the importance of these things and how they are widely accepted when working with these individuals. While we know the negative effects that stuttering can have on a PWS no matter the age, how would you suggest that we document this acceptance and have this not only in a therapy setting but in other environments? Also when working with adults who stutter, is there anything you can suggest that can help us is the process of bring them to acceptance when they themselves have negative experiences that could hinder this process?
    – Brooke M., Michelle M., & Sarah N.

  9. Good afternoon Elaine, Ali, and Jane,

    I am a first year graduate student currently enrolled in a fluency course. I liked how the ideas addressed in this paper directly correlated to the important concepts that I am learning in class. Through class discussion and readings, I have learned that it is important to help the client become more comfortable talking about talking. In addition, I have also learned that pointing out the disfluencies observed in fluent speakers can be useful as well. In particular, I really liked how you concluded the paper by stressing the importance of being able to say what you would like to say even if it is not what others might define as fluent. I was wondering how you specifically address confidence building? As a future SLP, I would like to be able to help build confidence in my clients and would love to hear some useful strategies. Thanks again for providing this paper with such useful information!

    Sincerely,
    Kelsey H.

  10. Hi there,

    I love the holistic approach your clinic takes with children who stutter and their families. I especially liked your closing statement about the importance of being yourself and saying what you want to say. This idea is especially important to introduce at a young age and begin cultivating that self-acceptance piece (hopefully) before encountering negative self-perceptions and those from society. When working with a young school-aged child, what would you address first to foster that awareness and acceptance? Thank you for your thoughts!

    Best,
    Kylie

  11. Hi Elaine, Ali, and Jane,

    I am a CSD graduate student currently learning about fluency therapy and enjoyed your insight about how attitudes of pride can have such a positive impact on quality of life. In your experience, have you found that is more difficult for parents who do not have experience with stuttering or parents who have an experience with stuttering to adjust in this way when their child has stuttering?

    Thank you!
    Katey

  12. Hello,
    I am so happy to have read this article! In all aspects of therpay, we need to focus on providing the means to a happy, fulfilled life. This may or may not mean correcting the “problem”. As a previous pre-school teacher, I can directly relate to the strong influence a parent has on the confidence of their child. As a future SLP, I can use the information from this post to always include success stories to families, as a reminder that children can have a happy, successful future even without perfectly fluent speech! Thank for the article and the “realness” of your thoughts!
    Kathryn

  13. Hello Ms. Kelman, Ms. Berquez, and Ms. Harley,
    I appreciate that in your therapy, you not only work on fluency, but also work on confidence and resilience. These character traits will aid clients whether or not they continue to stutter. What are some of the ways you foster these traits with your clients?

  14. Hello,
    I really enjoyed reading your paper about working with children who stutter. I especially love your statement that, “Some of these children become more fluent, some continue to stutter and we consider either to be a successful outcome if the child is also confident in himself, a good communicator, resilient to deal with setbacks and comfortable with the notion that being an individual, being yourself and saying what you want to say is more important than being fluent.”
    I think confidence plays a huge factor in the life of someone who stutters.

    I wonder though, to what extent should peer or classroom education also be incorporated beyond just educating the patient’s parents?

    I’m not sure how much of a problem bullying is in the classrooms in London, but in the USA it is a pretty big problem. In what ways can a child who stutter’s realize that their message is more important than being ‘fluent’, if when they try to be fluent they are ridiculed or taunted by bullies?

    I think a child would require a lot of resilience in order to overcome other’s perceptions of them and realize the importance of their own message.

  15. Hello,

    Reading your article, specifically the section on school-age children, I was wondering how often you collaborate with school SLPs in England. I’m a graduate student in the USA and know that private practice and school SLPs often try to collaborate together to achieve best therapy for the client.

    I was also wondering how often parents are receptive to this style of therapy, and how you approach therapy when you’re faced with a parent that may not understand a more holistic approach as opposed to “fixing” a stutter?

    Thank you for your article!

  16. Hello,

    I am currently a student pursuing a master’s degree in speech-languge pathology. This article was informative, and I found myself agreeing with the techniques mentioned for therapy. I too believe that when dealing with a communication disorder, a wide scope of issues must be addressed, including not only the obvious treatment goals but also the more subjective ones, such as building a higher confidence level and self-esteem. Although I am sure that in the future I will come across parents who strictly want to “fix” their child, I will be sure to keep in mind that several aspects of the communication disorder must be addressed to provide the best possible therapy for the client.

    Thanks for sharing!
    -Breanna G.

  17. Hi Elaine, Ali, and Jane,
    Your paper is truly intriguing and brought about some questions as I was reading. In your paper, you stated, “Anxious parents of a three year old may be aware of the ‘window of opportunity’ and seek help to ‘fix’ the stutter before it becomes established.” What would you do if some of these parents became more demanding on a more intensive fluency treatment than the one that you suggested, especially if the child was unaware of his or her stutter?
    Thank you!
    Corina

  18. I am currently an SLP extern in a public junior high school and have a student who stutters. I really love your ideas on using Solution Focused Brief Therapy in order to expose the child to confident communication rather than he/she focusing on stuttering and the negative attitudes that come along with stuttering. Does an SLP need to receive training or certification in this program?

    Thank you!

  19. Thank you all for this wonderful insight. As a first year graduate student, one of my initial clients is a child who stutters. He has some other language issues but primarily the stutter is what we are addressing. I appreciate you mentioning “Some of these children become more fluent, some continue to stutter and we consider either to be a successful outcome if the child is also confident in himself, a good communicator, resilient to deal with setbacks and comfortable with the notion that being an individual, being yourself and saying what you want to say is more important than being fluent.” When the parents first came to us, they were expecting us to be able to eliminate the stutter completely so I appreciate this insight as it will be something I will pass on.

    I do wonder though, how do you measure the confidence and resiliency of the child? And is it at that point that therapy is over? Or do these children become lifelong clients?

  20. Ms. Kelman, Ms. Berquez, and Ms. Harley,

    I really enjoyed reading your paper, and love your focus on effective and confident communication rather than fluency. You mentioned the anxiety some parents may feel related to the “window of opportunity.” I’m wondering if there are any counseling-type strategies you’ve found to be effective in easing some of the anxiety parents may feel about this?

    Thank you for sharing your knowledge and insight,
    Autumn

  21. Hello,
    I really enjoyed this paper. I am a speech – language pathology graduate student and I am planning on working with children in the future. This paper really instilled the importance of providing people who stutter confidence and encouragement, rather than focus on “fixing” stuttering. In addition, it is important to include the parents and family in therapy process. I was really inspired by the end of this paper and the idea of just being yourself and saying what you want instead of worrying about being fluent. My question is, in your experience, have you found it to be more difficult to work with parents who stutter compared to parents who do not stutter?
    Thank you,
    Michaela

  22. Hi Elaine, Ali, and Jane,

    As an aspiring SLP who would like to work with the school-age population, I found your article very interesting. I feel that it is so important to involve the whole family in the speech therapy process, and admire your comprehensive approach to therapy with school-aged children who stutter. It is especially important to focus on being an effective and confident communicator, because stuttering does not necessarily have to be a setback. It is unfortunate that people tend to focus on the negatives of stuttering, when people who stutter have so much more to offer. I had a friend in high school who had a prominent stutter. He struggled with bullying as a kid, and said that it was not until high school that he felt confident enough with who he was to speak comfortably in front of others. Because of his resilience and self assurance, he became one of the most popular and successful students in the school, but I am sure that it was difficult for him to get to this place. My question for you is how would you address the teasing and bullying of children who stutter in therapy?

    -Amy

  23. Hello,

    It was great to learn a little about your program at the Michael Palin Center. Thank you for touching on a subject/area we can sometimes overlook. It’s vital to teach acceptance and pride for PWS stutter but I hadn’t really thought about how you teach that to a child so young – like a 3 year old. And how you work with the parents who might be adamant that it be ‘fixed’ and not agree that it’s ok to stutter.
    Thank you for sharing your techniques and how you all go about working with a younger age group and their parents.

  24. Hello,
    Thank you all for taking the time to write this paper and tell us more about the Michael Palin Centre in London. I found this especially interesting, because it had a different approach – in comparison to what I’ve seen – when looking at stuttering. I liked that your work focuses on becoming an effective communicator but also acknowledges that it is okay to stutter. This reminds me of the work I’ve done with children who are on the autism spectrum.
    While the experiences of a child who stutters versus the experiences of a child with ASD are not the same, I do see similarities in the approaches to therapy. There are many parents who are worried that they need to “fix” their child in order to become “normal.” Furthermore, I’ve found that many intervention techniques for young children involve eliminating certain behaviors in order to “fix” something about them. Again, while understanding that these experiences are not synonymous, I sometimes found that there was nothing to fix in a child with ASD. I could help them become a more effective communicator, but the goal of therapy wasn’t to create a cure.
    This was difficult for some parents to accept, and it was the company’s job to provide them with hope, reassurance, and information for moving forward in the child’s life. It was really a great thing to see happen in families, and I hope to one day experience something similar with a fluency client.
    Thank you all for sharing this, and I hope you have a great day!
    Sincerely,
    Erika