The “S” Word: Talking to Children, Teens and Adults about STUTTERING (Rita Thurman)

About the Author: Rita Thurman, M.S., CCC–BRS-FD received her Master of Science degree in Communication Disorders from Utah State University in 1977.  She has worked in the schools and in clinical settings in Utah, Idaho, Illinois, Montana and North Carolina.   She has been in private practice in Raleigh, North Carolina since 1985. Her practice focuses on the evaluation and treatment of children, teens and adults who stutter.  She is a Board Certified Specialist in Fluency Disorders and serves on the Executive Board of the American Board of Fluency and Fluency Disorders.  Ms. Thurman was awarded the North Carolina Clinical Achievement Award in 2012 and the NSA Speech Language Pathologist of the year in 2015 for her work to improve services for children and adults who stutter.

Ms. Thurman is a National Stuttering Association Adult and TWST (Teens Who STutter) Chapters leader, coordinates a Parent-Child Stuttering Information Group and sponsors an annual Friend’s Workshop in North Carolina.

A few months ago, a 13-year-old boy and his father came to my office for an evaluation.  The son had been going to therapy for stuttering since he was four years old.  But when I asked the father the reason for the visit, the father said: “We want to find ways to help J. with his bumpy speech.”

Why is it so hard for parents, therapists and even people who stutter to say the “S” word?  Why do we insist on terms like “bumpy speech” or “dysfluency”?  The misuse of terms is not only confusing, but perpetuates the stigma of stuttering. If you can’t even say the word, it must be horrific.

Stuttering and the Preschool Years

But let me back up.  I use “bumpy”, “stopped speech”, “smooth” when a child’s developmental vocabulary requires description rather than labels.  At the age of three and four, those terms make more sense to a child.  But I also tell them: “Sometimes people call that stuttering and you may hear that word.”  I often hear a gasp from a parent when I say that or when I talk about a preschool child’s reaction to their stutter.

When I treat preschool children who stutter, I talk to them about what happens when they stutter, how it feels when it happens and how they react to it.  During a therapy session with a four-year old, after he experienced a significant block with struggle behavior, he stopped and heaved a giant sigh. When I said: “Wow, that was really hard, what did that feel like?”  He replied: “It felt like a big rock came up from my tummy and stuck in my throat so that the word couldn’t come out.”  Wow!  For someone that young to have that insight….it would be a shame to dismiss it or pretend we didn’t notice. It is important to give validity to those physical and emotional feelings as soon as they emerge.

During another session, a different four-year-old described his block by saying: “I don’t know what happens, the word just won’t come out.”  When I asked: “What do you do when that happens?” He said: “I use a different word.”  Avoidance behaviors can start young and need to be addressed.

During the NSA Research Symposium this past summer, Rick Arenas presented his work on anticipation in people who stutter.  His research indicated that a large percentage of people who stutter anticipate the moment.  If a child is reacting to his stuttering moment before it occurs, he has struggle behavior in the moment of stuttering, he senses shame/frustration/embarrassment following the stutter –you need to be there to validate those feelings, not dismiss it.

Sure…many preschoolers are oblivious to the repetitions and blocks, continuing to describe their latest Lego creation, playground adventure or tea party.  Is it OK to talk to those preschoolers about stuttering?  Absolutely! Let them hear the language from a concerned, caring adult–before they hear it from the gutter.

Recently, a Speech Language Pathologist who treats preschool children told me that her strategy for treatment was to make preschoolers think that they were coming in to play games, implying that she would never talk to a preschool child about the reason he was in therapy or the goals of the session. While games can certainly be an effective way to engage with children of that age, it can be very confusing for a child to know that even adults don’t understand why he stutters and worse, can’t talk about it.

Stuttering and the School Aged Child

As children grow, the way we talk about stuttering changes because the experience of stuttering changes.  As children develop and begin to experience stigma in communication situations, we need to recognize and give language to that experience.  In a study about stigma associated with mental illness, Biernat & Dovidio state: “When people reported concealing the true nature of their illness by using ambiguous terms, they were unable to face the challenges of their illness.”

Recently a parent of a third-grade child contacted me to say she was seeking therapy for a “fluency disorder.” When I asked the mother, what type of stuttering she saw at home, she said, “Oh, he doesn’t stutter, he has a fluency disorder.”  Although this family had met with multiple educational professionals when her child had been tested through school, none of them had used the term “stutter.”  I suspect they considered “fluency” a euphemism, when in reality it only served to confuse the true diagnosis and perpetuate the stigma of stuttering.

At this age, stigma can frequently lead to bullying. Janet Beilby’s research revealed “that young people who stutter experience greater adverse impact on their lives and more bullying than their fluent peers.”  Children often don’t want to discuss bullying because they want to handle it themselves, are embarrassed by the event, or are worried that their parents will overact.

But like stuttering, talking openly about bullying can have a positive impact. I have a monthly “communication group” for children ages 7-11 years of age who stutter.  Our meetings give them a chance to develop communication skills but also to talk about stuttering openly with their peers. In the course of our discussions, we often role play bully situations.  When we present the skits and role playing to parents at the end of the session, parents are usually more uncomfortable discussing these topics than the children. But like stuttering, bullying needs to be acknowledged and addressed.

Stuttering and the Teen/Adult

The two greatest social sins a teen can commit is to do something that is “awkward” or something that makes them appear vulnerable.  Stuttering can often result in either or both. In order to elliminate this awkwardness, I like to tell the teens that I work with a quote from one of my favorite comedians: “Tragedy + Time = Comedy.”  Although it can be tough, it is possible for teens to find humor in stuttering-with guidance. This is best accomplished but putting teens who stutter together in a supportive environment while discussing those awkward situations and how to deal with each.

One night in my NSA TWST (National Stuttering Association– Teens Who STutter) chapter, we were discussing jokes, bullying, and teasing.  One teen reported that his first-grade teacher asked him a question in front of the class and when he blocked on his answer, she said sarcastically: “Do we need to call an ambulance?” Although the parents in the room became teary eyed, the teens recognized the enormity of the situation and then created humorous ways that the teacher should have been tortured. They were able to reflect on an upsetting incident with humor….together.

In both my TWST and adult chapters, we try to use the word “stutter” to describe and desensitize to the word.  Some of my teens and adults will tell other people they have a “speech impediment” or say: “I have trouble saying….” This ambiguity leaves the listener questioning whether the person who stutters had a stroke, has word retrieval issues or learning difficulties.  Just saying: “I stutter, so sometimes you will hear that” can be freeing and kind to the listener who is trying to figure out what is going on or how to respond.

Disclosure or “advertising” a stutter can help reduce anxiety and stress in a situation.  The authors Blood, Blood, Tellis and Gabel discuss the importance of talking about stuttering and telling people about your stuttering to reduce stress and isolation. Conversely, in his studies involving people with social anxieties and depression, Goffman, found that patients’ attempt to avoid disclosure resulted in stress, isolation and a sense of shame.

Desensitizing to the word may be a first step for many people.  I give homework assignments to teens that require them to say the word at least once a day.  I believe that saying the word out loud empowers the person who stutters and takes power away from the word that often connotes shame and sadness. After all, the famous villain in Harry Potter was referred to as “he who must not be named.”  What power Voldemort held because everyone was too afraid to even say his name!

When I pair mentor groups in therapy (an adult working with a teen, or a teen working with a child) I always ask the mentor to tell their mentee about their stuttering before we start.  I love the look on a child’s face when a teen says: “When I stutter….” Or “I stutter…” –They have connected in a unique way and were not afraid to say the word out loud.  Often in this situation, the child says: “Wow, me too!”

As we all strive to develop a World that Understands Stuttering, let’s start by using the real vocabulary:  STUTTERING, STUTTERING BLOCKS, STUTTERING PROLONGATIONS, STUTTERING REPETITIONS.

Words have power and energy.  Let’s direct that power and energy towards positive outcomes for people who stutter.  Go ahead…say it out loud.

 

References

Arenas, Richard M. Ph.D., University of Mexico  Contextual Variability of Stuttering:  Its impact on quality of life and how anticipation may be playing a role.  2017 National Stuttering Association Research Symposium

Biernat & Dovidio—Stigmas and Stereotypes The Social Psychology of Stigma 2002

Beilby, Janet. —Social Impact of Living with a Stuttering Disorder: Knowing Is Not Enough. Seminars in Speech and Language. 35 (2)–2014

Blood, Blood, Tellis, Gabel  —The social and communication impact of stuttering on adolescents and their families:  A preliminary study of self-esteem, stigma, and disclosure in adolescents who stutter  –Journal of Fluency Disorders–Volume 38, Issue 4, December 2013,

Goffman E. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs NJ: Prentice Hall; 1963.

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Comments

The “S” Word: Talking to Children, Teens and Adults about STUTTERING (Rita Thurman) — 76 Comments

  1. Wow! What a wonderful paper, Rita. I feel that what you write about “The misuse of terms is not only confusing, but perpetuates the stigma of stuttering” is such a simple yet important concept for us to learn. I wonder what can be done to get your paper to be required reading for school SLPs; saying the feared word takes away its power, as you described.

    Thank you so much for continuing to help create a world that understands stuttering. People like you make all the difference for the better.

    • Thanks Hanan!
      I really appreciate your kind words and support with my “rant!” After working with people who stutter for 40 years, I have been able to watch our field go through massive changes–for the better. However, we need to continue to develop better understanding of stuttering, remove the stigma and help the rest of the world understand stuttering. What a great theme this year!!

  2. Rita, what a terrific and important paper. I am going to recommend it to every speech-language pathologist in my school district. I wholeheartedly agree that “The misuse of terms is not only confusing, but perpetuates the stigma of stuttering.” I think our field adopted the term “fluency disorder” in order to be inclusive – stuttering is not the only disorder of fluency that we treat. However, avoiding the term “stuttering” when we mean “stuttering” may lead to negative outcomes, including the kind of confusion you describe, in which a child who stutters is referred, evaluated, and made eligible for speech services in the schools for a problem the parents do not even know exists. We must do better. Notably, in my school district, I am the “fluency consultant” even though nearly 100% of cases on which I consult involve stuttering. Colleagues often refer to their “fluency cases” and interventions and treatments for “fluency.” My ISAD 2017 paper describes our “fluency consulting” efforts in our district. In the interest of being the change we wish to see in the world, I am going to refer to myself as the “stuttering consultant” and encourage a continued shift toward using precise words – “stutter” and “stuttering” – in our conversations around stuttering. Thanks again for a wonderful and eye-opening paper.

  3. I love this piece! I will try to remind myself of this paper as I work with my two five year old girls who stutter on my caseload this school year. They are very familiar with the terms “bumpy speech” and “smooth speech” from their preschool SLP, but I was shocked that “stuttering” was a word neither of them ever heard of! I have recently started introducing and using the word “stuttering” with them. I believe it is so crucial to de-stigmatize the word “stuttering.” And what better way to do it when the children are young enough that they don’t already have any negative association with the word?! Thanks for sharing your wisdom with the stuttering community!

    • Thanks Chani!
      I do think that it is good for children–even as young as five–to hear that term from loving, caring adults.
      Thanks for being one of those adults in those little girls lives!

  4. Great piece Rita! Talking about stuttering and using the word stuttering is so important for our self esteem and the desensitization we all need to not fear stuttering as much. Most people I talk to understand what stuttering is because I talk about it (now – didn’t always!) My talking about it opens the door for others to be comfortable talking about it too, which does increase understanding.

    This concept of putting the correct name to stuttering brings to mind one of the email list-serv I am part of – and have been for about 10 years now. The founder of this particular group called it “Covert S” because she couldn’t bring herself to say or acknowledge the word stuttering. I’ve always wondered if she has ever got comfortable enough with the word stuttering to change the name of the group to include the word stuttering.

    When I first started attending NSA conferences, I remember putting on my resume that I was a member of the NSA – National Speech Advocacy – I too couldn’t bring myself to put the word stuttering on my resume. Now I do so easily and proudly. Thanks for this important contribution.

    • Wow! That was a powerful response! Thank you so much for your insight and sharing your experience. It is hard for me to imagine that you ever had difficulty with the word stuttering. You are such an ambassador for open communication and community support for people who stutter now. Thanks for reading and for your great comments.

  5. Thank you so much for an amazing paper! I am a SLP graduate student learning about stuttering, and I greatly appreciate the push for desensitizing the term. In my classes we have been discussing how the negative emotions surrounding stuttering are the most important thing to address as an SLP when working with a PWS, and I was wondering how you think the SLP community as a whole can work to desensitize “stuttering” terminology in research.
    Thank you for your insight!

    • Great question! Many SLPs are uncomfortable with the word and uncomfortable saying it to families. I think that practice brings comfort. Fluency disorders is the general term used because SLPs want to include Cluttering and dysfluencies secondary to language delay–so, I think that there is still a place for “fluency disorders” as a general term. However, if someone stutters, the profession needs to use appropriate language and say “stuttering” in the literature, in the IEP, and during parent counseling.

      • I also am an SLP graduate student and I really enjoyed your paper! It is such a powerful, yet simple, idea to desensitize the term “stuttering”. I really appreciated the Harry Potter reference as it perfectly illustrated how avoiding the term can give it such a negative power. Thank you for bringing this topic to light!

  6. Rita, Thank you for your contribution! I enjoyed reading about your experience working with children and teens who stutter in your practice and in support groups. I agree desensitization is an essential first step toward positive outcomes for all people who stutter.

    • Thanks Lisa! Yes, desensitization is important and learning to defuse some of the negative thoughts that spring up when the word is mentioned.
      I appreciate your kind words–as always!

  7. Hi Rita! I love this point of view. I love that you treat preschoolers as little humans that have feelings and thoughts. They deserve to understand what is going on. I 100% agree that by using the appropriate terminology that the stigma will decrease-especially if those who do stutter use it! Shame and stuttering do not have to go together. Have you received any negative responses or kickback from parents or other educators from this perspective?

    • Actually, I have had some negative reactions from parents and pushback from other SLPs. During an evaluation of a second grade child, I started to talk about her stuttering and her father said: “Excuse me, may I talk to you in the hall?” He took me past the waiting room, to the hall and said: “We are not going to call “it” that because we don’t want her to feel bad about herself.” When I said: “Why would that make her feel bad about herself?” He just said: “Just don’t call it that!” I finished the evaluation, let the little girl leave with her parents and called the father at home. The little girl had reported– during the evaluation, in front of her parents, that children were teasing her at school, she had stopped raising her hand and she hated her speech–pretty powerful stuff coming from an 8 year old. When I talked to the dad about the importance of recognizing and validating his daughter’s struggles, he just said: “We are done here…” and I never saw them again. We have a battle ahead of all of us!

      • That is the reaction I imagine received more times than not. I think it also really depends on the background you come from. As somebody who grew up with a scientifically minded family, it seems fitting to call it by the correct term but I do understand many others are just so concerned about protecting their children’s self image.

  8. Hi Rita! Thank you for your insight on this topic. I agree wholeheartedly that using appropriate terminology will lead to a decrease in the stigma associated with stuttering. I am a graduate student studying to become a SLP and I am currently in a stuttering and fluency course. My professor is a PWS, and he has spoken a lot about the importance of addressing negative emotions and the stigma attached to stuttering throughout the course so far. You discussed some awesome strategies you use with your clients who stutter in the different communication groups to work to desensitize the word “stuttering.” I was wondering how you typically approach desensitizing the word with parents and if you could provide more insight on how the SLP community could work to desensitize stuttering terminology as a whole in research and in the clinical field. Thank you in advance for your feedback!

    • Hi Abigail,
      What a wonderful experience for you to have a professor with such insight teaching your class. In working with parents in a counseling situation, you need to remember that they are facing a kind of grieving process. They often have been given wrong information (the child will grow out of it even when they are 9 and 10 years of age, all that the child needs to do is “work harder” and he/she will be fluent.) When you present it as a chronic disorder, you have pulled away a type of hope. They immediately start to worry…will my child go to college, get married, ever hold a job–because their concept of stuttering is naive. You need to replace it with a new “hope.” One where they see their child stutter, communicate effectively, become a successful teenager, adult, mother/father, whatever… Meeting teens and adults who stutter can help this too.

  9. Rita,

    My name is Hannah Adams and I am in graduate school studying to receive a master’s degree in speech-language pathology. I am currently in a stuttering and fluency course with a professor who is both an SLP and PWS. I absolutely loved this paper. The line “I believe that saying the word out loud empowers the person who stutters and takes power away from the word that often connotes shame and sadness.” is so powerful. You discussed how parents of children who stutter have a more difficult time saying the word “stutter.” For these particular situations, what advice would you give a new SLP regarding helping a parent move towards using the word “stutter” to describe his/her child’s speech? What has worked for you in therapy sessions with these parents and potential conversations?

    Thank you,

    Hannah Adams

    • I love seeing such amazing questions from graduate students–who presumably are just starting your knowledge base! It is great to see interested young professionals! Along with my comment to Abigail, I think sometimes just letting parents talk and being a good listener. Given time and your model of nonchalantly saying “stutter” they will start to use the correct terms also.

  10. Rita,

    Thank you for sharing! I was so inspired by your message and I know that when I become a speech-language pathologist, this is something that I will continue to refer to. I love how you were able relate your experiences to various populations, such as preschool children, school-aged children, and adolescent/adults and that you created an open environment for teens to talk through the NSA TWST. I completely agree that desensitization is an essential first step toward positive outcomes for all individuals who stutter. Can you share how you approach talking to parents, and even individuals who stutter about using the word Stuttering? How do you counsel parents? I agree that our society needs to be aware of stuttering and it is our job as a society to educate each other. Thank you in advance for your feedback.

    Sincerely,
    Mary Smyers

    • YES! I have achieved my goal. –which is to inspire graduate students and young clinicians to work with children and adults who stutter with a working knowledge of different view points and a focus on treatment that encompasses more than “fluency.”
      I think that the most important aspect of counseling is being a good listener. You can learn a lot from a family and child if you spend time listening. Counseling should not be a “here’s what you do” situation–but, a way to guide parents to figure out “what are you going to do”…

  11. Hi Rita,

    I really enjoyed reading your post! I love the views and strategies you have chosen to use in therapy for people of all ages who stutter. As a SLP graduate student, who is currently taking a fluency class, it was very helpful to hear your ideas on therapy. I will definitely add to my clinical “tool box” the idea of having mentor groups in therapy. I think that would be a great way to not only empower the adult who stutters but also further desensitize the younger child to the “negative” connotations society has put upon stuttering.

    In your experience of working with families who had children who stuttered, have you ever came across a parent/caregiver who never warmed up to saying the “s-word” and completely refused to say it?

    Thanks,
    Nicolette

    • Thanks Nicolette,
      Yes I have had some challenges with parents who won’t “accept” the term and speak to this in my response to “hhgibson1 on October 3” above; although it was posted under Lisa (I feel sure this is my fault from being technically impaired.) The Pollyanna in me wants everyone to desensitize, de-stigmatize, and communicate opening–but, we will not always be able to make that happen.

  12. Rita,

    This post is phenomenal. Thank you for your insight. I found it interesting to read how you introduce stuttering terms to children in the preschool years. I like how you start off by saying “bumpy” to describe their speech, but then you use that as an open opportunity to introduce and teach the term stuttering.

    Do you think parents’ approach to the “s-word” influences the way children think of their stuttering? Do you think it adds more negative affective, behavioral and cognitive aspects to the child?

    As a graduate student getting my Master’s in speech-pathology, I noticed that many schools are beginning to get rid of some labels, but are keeping more “acceptable” labels (i.e. Learning disability, ADHD etc.). Would you agree that some labels are more accepted to parents and society than others? If so, why do you think that is?

    Thank you,
    Briana

    • Hi Briana,
      I do think that how parents approach the language they use with their children is crucial. I believe that saying “stuttering” does not add negative affective, behavioral and cognitive aspects (I think that is your question)to treatment. It helps defuse the negative feelings and thoughts. I also believe that “stuttering” is not a label but a diagnosis. Would we call asthma “bumpy breathing?” It is not really a matter of “what is acceptable” but, more a matter of using language to that moves toward reducing stigma and promoting open communication.
      Thanks for your comment and good luck with your graduate work!

  13. Thank you Rita,

    My name is Meredith Towey. I am currently a graduate student studying speech-language pathology in a fluency course. I really enjoyed how you compared the S word to ‘he who shall not be named’. I think it is a very strong example of how language can perpetuate fear. I attended one of your Super Saturday events and was really moved by how well elementary school children were able to articulate their emotions with stuttering. I was wondering, what are some ways you can encourage young children to be open about their diagnosis in a classroom setting. Do you think it would be beneficial to have the student talk to the class about their diagnosis during the first week of school? Let me know what your thoughts are.

    Best,
    Meredith Towey

    • Hi Meredith,
      First, thanks for your help with Super Saturday! This intensive communication practice for 7-11 year old children who stutter that I conduct once a month is made possible with graduate helpers, so I really appreciate your support. You raise a great point! Yes, class presentations, teaching children to disclose, encouraging children to talk to their teachers about their stuttering are all great ways to “humanize” stuttering. I encourage children to simply say: “I stutter and sometimes you may hear that.” There is no need to apologize (some children and adults are compelled to say: “I am sorry, I am stuttering a lot today”) because it is not their fault. One adult told me this week that she had been saying for years: “I have a stuttering problem” and by using the word “problem” she brought a negative connotation to the disclosure. She decided to drop the “problem” part of the description. Presenting to the class and educating peers about stuttering can be empowering for children of all ages. Thanks for your comment!

  14. Hi Rita!
    Thank you so much for this post. I am currently an SLP graduate student and enrolled in a stuttering and fluency course. After reading many personal stories about stuttering, while so insightful, it’s interesting to read from the perspective of treatment. Your desensitization strategy of having your clients say the word “stutter” at least once a day is great. I learned a lot from your post and your strategies are certainly ones I will use in the future. While I was reading, I kept thinking “that makes so much sense, but I wouldn’t have thought of that.” I love the “ah-ha” moments of learning something new and useful, so thank you for an educational, easy to understand read. You spoke on how parents sometimes react negatively to your desensitization strategy but I was hoping you would speak on how your clients felt about it. In the past, have you ever asked your older clients how it felt to say the word out loud or what it felt like to make others aware that they stutter? If so, what did they have to say about it? Also, have you ever had a client who refused to refer to themselves as a person who stutters?

    Thank you,
    Marcie

    • Hi Marcie,
      Excellent questions! Usually when I use the word “stuttering” I am usually met with a reaction of “relief.” Or, “so–we can really talk about this…”
      So many children and adults have only the negative experience of the word–during teasing and bullying. To say the word as a way to discuss and explain is often a reassurance. I have talked to adults about saying the word and how they disclose to others. We talk about this a lot in my NSA adult support group. Everyone is an individual and brings something different to the party. Some will embrace the idea of using the word and disclosing, others remain uncomfortable with both. Many of my clients and NSA chapter members refer to themselves as a person who stutters, others say “I am a stutterer.” It is all person preference and I don’t really where they place the word “stutter” in the sentence–as long as it is there.

  15. Ms. Thurman, thank you so much for sharing your clinical expertise in both general and specific terms. I really appreciate the big-picture ideas you present brought down to specific scenarios and how your recommend addressing them. It felt like a conversation to read this piece and I feel like I can immediately implement what I have learned.

    Words have such power and I appreciate your willingness to address the contradiction of avoiding the word stutter in favor for ambiguous or descriptive terms, which can cause even more feelings of isolation and shame. Thank you for thinking about this topic from every angle and answering the question of preschoolers who are unaffected or oblivious about their stuttering. It makes absolute sense that these children should first hear the actual language from a caring adult before they hear it from the gutter, as you say! I needed this connection to be made for me because I had this question myself, now I have internalized this answer in a meaningful way.

    The connection your draw between stuttering and mental illness from Biernat and Dovidio’s quote regarding ambiguous language, is so appropriate when you consider the magnitude of the emotional impact of stuttering as outlined in Sheehan’s iceberg analogy. As having a chronic illness with mostly covert signs and symptoms, I really identify with having a sense of control and empowerment using and understanding explicit language related to my illness. Additionally, I identify this as an aspect of my culture based on a contrast in other cultures. In some Native American cultures, for example, giving a name to an idea gives it power, which would impact my clinical approach with Native American families who ascribe to this cultural idea.

    • What a great comment! I look forward to seeing more writings by you in the conference. You bring up a good point with the iceberg analogy. Saying the word stuttering gives you a way to peer down through the water and navigate past the obstacles…instead of pretending it is not there. You also raise a great point about working with different cultures with stuttering. The area where I live is very culturally diverse and I find that a person’s culture and family dynamics have a huge impact on how people talk about stuttering.

  16. This was such an interesting topic to read about! I am a speech-language pathology graduate student; this semester I am taking a fluency course with stuttering being a main topic. Through the course I am currently taking, I learned that people who stutter typically have adverse reactions to stuttering. Vocabulary is not an aspect I considered to contribute to the desensitization of emotions felt when using or hearing the word ‘stutter’. After reading your perspective on the issue, I completely agree that utilizing the term ‘stutter’ is an extremely important part of desensitizing the word. I particularly enjoyed learning that clinicians should use the term ‘stutter’ with preschool children, even though the child may not fully understand what the word entails. Using the word ‘stutter’ early in therapy is beneficial in desensitizing a child’s reaction to the term, and the desensitization may then carry over into teenage years and adult years. This is a great technique to incorporate into speech therapy when working with a client who stutters. In the future, I will remember to use appropriate vocabulary to help my clients become more comfortable with using the word ‘stutter’ as well to assist the clients in becoming desensitized to the term. Thank you for the insightful information!

    • And…thank YOU for reading and showing interest in serving a population who is so often under-served or receives inappropriate treatment. It is refreshing to see all the graduate students on this format who are interesting in learning the nuances of stuttering treatment. Welcome to an amazing profession!

  17. Rita,

    This is an amazing paper and gives such a unique outlook on how confronting a stuttering problem as a teenager can be freeing to them instead of creating more anxiety. I love that you support and encourage teens to be happy with who they are, even if they have a fluency problem! As a grad student, I now see how impactful stuttering can be in a person’s life and also how they avoid talking about it because they are ashamed. I love that you challenge people with a stutter to become more prideful with who they are, because at the end of the day, stuttering does not define them!

    • Exactly! We often talk in our teen group about how stuttering is just one part of that teen. They are a basketball player, a trumpet player, a son/daughter, a brother/sister, a math super star and…a person who stutters.

  18. I loved reading this paper! As a graduate student, I have two patients of my own right now who stutter, and I am learning a lot about this area of study. While reading this article I realized that I have previously avoided using the term, stutter, because of the age of the child. I think this paper has helped me realize that we should all be calling it as it is. This is one great strategy to help decrease the stigma associated with the word.

    • Those two patients are lucky to have you! Good luck with them and the upcoming children and adults you will see who stutter. The cognitive and emotional piece is so crucial and often the aspect where we as SLPs receive little training. I love how you are going above and beyond the call of duty!

  19. Thank you Rita – very powerful! I love how the tone of your article matches its message. As a second-year graduate student, just beginning to learn about what fluency disorders are really all about, as well as someone who considers herself a student of life, I completely agree with the idea that a feeling of confidence and empowerment in confronting challenges makes all the difference. You mentioned that “many preschoolers are oblivious to the repetitions and blocks, continuing to describe their latest Lego creation…” while teens and adults are much more self-conscious of their stuttering. I was wondering what is the difference between someone who stutters confidently vs someone who experiences tension and anxiety related to their stuttering. Do some feelings come more naturally to some and less so for others? Are the behaviors/feelings learned or inborn? Would love hear from someone who’s seen a lot. Thanks!

    • Wow! that is really a thought provoking question. I think that so much plays into the fact that a person may stutter and communicate competently vs someone who struggles with tension and anxiety. I truly believe that some people who stutter have a more impaired motor system than others, which creates more struggle in that moment. Another parameter is the amount of panic a person feels in that moment. One thing that I always tell my children and adults…in that stuttering block, when the vocal folds have slammed shut and the air has been cut off…a message is sent to the brain that says: “you are not breathing, you must be dying!” The Amygdala (the part of the brain that controls flight, fight, flee)takes over and that panic response is very hard to manage. Some manage it better than others and there has been a load of research done on temperament that plays into that. Another thing to consider is the amount of shame that person feels in that moment. Shame creates a powerful reaction. The amount of support a person who stutters has in their life is valuable. Meeting other people who stutter alleviates anxiety and the feeling of being alone. So many variables…so little time =) thanks for being a life long learner–keep asking hard questions!

  20. Hi Rita,

    I’m a graduate student and you actually came to speak with my class a couple weeks back. I must say that I loved your Harry Potter reference in this paper. Fear of a name increases fear of the thing itself. One of the other contributors wrote about how her stuttering prepared her (somewhat) for a cancer diagnosis and treatment. Just like the “C” word, hearing the word “Stuttering” as a diagnosis for a child could be a very frightening thing for a parent and may initially lead to denial.

    Have you ever had parents or adults get angry with you for using the word “stuttering”, even after explanation?

    Also, you mentioned using humor as a way of coping with stuttering. With the teen group do you encourage just making jokes after the fact of a difficult situation or actually making jokes in a real-time context like with a witty comeback? How hard might it be for someone experiencing a stuttering block under stress to make light of the situation? Any strategies?

    Thanks for your insights!
    Melissa Smith

    • I have had parents react negatively to saying the word “stuttering” around their child, I mentioned one situation in my response to hhgibson1 above. I have also had adults say that they prefer I not use the word…I still do. I don’t feel that I can be authentic unless I use proper language.

      You need to be careful with jokes. The teens and adults in my support group can do this among themselves, but some will say…there is nothing funny about stuttering and you need to respect that reaction. Remember the formula “Time + Tragegy = Comedy…it may not be funny in the moment and they make light of it later. Someone under stress and blocking is never funny–to them or anyone. I would never make light of it. Rather, I would validate how hard that was for them and recognize the enormity of the situation. They may be the one to add lightness to it later. I never would because I don’t stutter. Even though I have worked with people who stutter for 40 years…I do not know what it feels like and would never pretend I do. I listen and guide, I don’t advise people to make jokes about their stuttering. I allow it to come up among the group.

  21. Thank you so much for sharing your perspectives! I’m a graduate student and my fluency professor is a PWS. The “s word” has been used since day 1 of grad school and I hadn’t really considered that there is a social fear of using it. I thought your story of the young child recognizing the physical effects stuttering – it felt like a big rock – was so interesting. Children really do have a lot of insight and they can be responsible for more than we give them at times. That’s why being open about stuttering is so important. Your example of “Voldemort” was a perfect way to describe how much power something can have when we are afraid of using the word. Stuttering doesn’t have to be a scary thing. There are ways to help and ways to feel confident and comfortable. To get there, stuttering definitely needs to be addressed.

    Thanks again for sharing!

  22. Thank you for sharing your insights and real life experiences! I am a first year speech language pathology graduate student and I am currently enrolled in a fluency class where we always refer to stuttering in class. We have learned about how parents can be concerned for their children, but I have never considered the fact that they may not want to say the word “stutter.” This educated me even more on understanding clients and their feelings and the importance of helping them not fear their stutter. I remember you saying that it is okay to introduce the word stuttering to preschool children because avoidance behavior can start young. I have been learning in class about differing views on starting speech language therapy early in preschool children or allowing time for them to develop their language more. What are your views on this subject?

    • Treating preschool children is tricky because of the high incidence of spontaneous recovery. However, if children have multiple risk factors, have been stuttering more than 9 months (my protocol) then, I include them in therapy. My therapy is direct, involves the parents and provides education, support and establishes a comfortable communication environment that allows the child to develop like his/her peers.

  23. Hello!
    My name is Katelyn Bauman and I am a 2nd year graduate student at the University of MN Duluth. I am currently taking an Advanced Fluency Disorders course and we have recently been having discussions around addressing terminology used to describe a stutter. I really enjoyed reading this article. I found great insight that I find extremely clinically applicable. I do have 2 questions for you:

    1. When working with parents of a child who stutters who is having an extremely difficult time talking about/addressing/accepting their child’s stutter as a stutter, at what point is it appropriate to include other professions such as Psych in the treatment?

    2. What are some strategies for working with a PWS (school-age/teen) who wants to work on their stutter while desensitizing others, but the parents are not on board?

    • Hi Katelyn,

      You’ve asked some good questions.
      1. First, I have found that often psychologists have no training in working with children or adults who stutter. So, the counseling piece of treatment becomes the responsibility of the SLP. I believe that training in ACT principals allow us to guide parents during this difficult time. However, I have found the most effective tool is to throw a bunch of parents together–who have children who stutter. They learn from each other, gain support much like the teen and adult stutter support groups and learn that stuttering is just one aspect of their child. As therapists we need to keep in mind that we are treating the who family when we take a child into therapy.

      2. As far as “strategies” for working with children and teens who stutter to desensitize when the parents are not on board….I would bring the parent into the session. I would have the child/teen direct the therapy. Ask the parent to direct the session/indicate what is most important. Do a value line–fluency at one end, communication at the other. Where does the child fall? the parent? Parents who are “not on board” don’t understand the complexities of the disorder, so help them through education. These parents may also be fluency driven–they want their child to just stop stuttering. And, what parent wouldn’t? Discuss the chronic nature of stuttering. Whew–only a gazillion “strategies” I can think of right now, but most involve including the parent in the process…let them have input. They know their child best. Work as a team.

  24. Hi Rita,

    Thank you for advocating for the desensitization of the word stutter. I believe in the importance of acceptance and working to build a child’s, or adult’s, view of their stutter to include positive emotions rather than the negative ones that others tend to associate with the “s-word”.

    I am currently a SLP graduate student. I’ve been learning about the Lindcombe Program for stuttering and the core of the program is teaching parents to acknowledge stuttering and to talk to their children about their speech. I was wondering if you often implement this intervention for your younger clients, and if so, how would you approach parents to actively participate in order to provide the most efficacious therapy for the child?

    Thank you!
    Maddie

  25. Hi Maddie,

    Personally, I don’t use the Lidcombe program. I find that it uses too many “judgemental terms” stuttering is contrasted with “good speech” and the nature of asking a child to “say it again” inhibits forward moving speech, which I think is better communication. Yes, they do talk about stuttering in Lidcombe..but,I like to talk stuttering without passing judgement. It is there, it prevents you from moving forward, what can we do to make communication easier. I always have my parents involved in the treatment process. You don’t need to do Lidcombe to have parental involvement.

  26. Hi Rita!
    My name is Kara Hendrickson and I am currently a 2nd year graduate student at the University of Minnesota, Duluth. I am currently in an Advanced Fluency Disorders class and we have had many discussions regarding the different terminology involved in stuttering. Your article was very eye opening and I enjoyed the realistic examples that you used. I currently am working with an elementary school student who stutters and he uses the word “stutter” on his own frequently, I now realize how admirable that truly is. I have a question for you:

    1. Have you ever had a student perform a “school program” to share their experiences with stuttering? (To get the word out about stuttering and the experiences that come with it)

    *I have heard of programming of this nature being performed about the “r word” and I know it has worked well!

    Thank you!
    Kara Hendrickson

  27. This was very intriguing to read! I am currently a graduate student in a fluency class. I also took an undergraduate fluency course, so I have heard about the “dreaded s-word”. I have heard about the fear many parents or individuals may have around the word “stutter” and have learned about trying to desensitize it. Stuttering is not a negative word, so it’s unfortunate that many people view it that way. When you come across clients or clients who have parents that don’t like using the word stutter as they refer to their speech, do you have conversations with them about how it’s not a negative thing and try to help desensitize the word? What do you do if you have that conversation and they still aren’t willing to accept the word “stutter”? Do you respect their wishes and refer to their speech in the way they prefer or how do you go about addressing stuttering when the client or their parent doesn’t want to call it stuttering?

    Thank you!
    Marissa

  28. Rita:

    Thank you for your advocacy in using the word “stutter” – I was a huge fan of your Lord Voldemort analogy; what a perfect example of how when we avoid our fears (stuttering), it can only make us fear it more. It’s a great lesson to teach pediatric clients who stutter so that hopefully it will carry over with them for the rest of their lives, and also that they will be more accepting of their stutter. My question to you is as follows: have you ever kept up with any of your clients who stutter over the years? If so, how has some of their overall attitudes towards their stuttering changed over time as a result of teaching them to use the word “stutter”?

  29. Hi Rita,

    Thanks for sharing your perspectives on how powerful word choice can really be. I really love the Voldemort reference in how fear of naming can increase the fear itself. It’s important for people who stutter to be able to accept stuttering for what it is and not live in denial or confusion, which is something that starts with using the term stuttering rather than avoiding it. You said it well went you said calling it stuttering can be so freeing to a person who stutters, relieving some of the anxiety they may already be feeling. I really do appreciate you sharing your reasons for desensitizing the word to diminish stigma as well as sharing your personal experiences. As a 1st year graduate student, your thoughts will have a guiding impact on my future career.

    Thank you,
    Arianna

  30. Hi Rita,
    Thank you for sharing your insight and experiences with the “S” word. I am currently a graduate student and I anticipate having to deal with this situation often in my future. As I am learning more about stuttering I was initially kind of surprised by parent’s reactions to the word “stuttering”. I understand the emotions behind it but it is interesting how the word stuttering has received such a negative connotation. You talked about how important it is to be honest with children who stutter, no matter how young, with what stuttering is and allow them to express how they feel. Have you ever had a young child who has not accepted it? I know acceptance can be hard for parents and older children, but I’ve always wondered what to do when a preschool child refuses to accept that they stutter.
    Thanks!
    Michelle

  31. Hi Rita,

    Love this, love this, love this! There are so many points here that resonate with me (even the bit about Voldemort! What a great example to use in therapy!) The awkwardness that so often accompanies “outsider” reactions to stuttering include a desire to delicately skirt around “taboo” vocabulary and to not offend the person who stutters – inadvertently doing just that! How powerful that would be for the person who stuttered to break that barrier themselves!

    In my current fluency class, my professor mentioned a preschooler who created a neologism that replaced the word “stuttering”. I was curious about your thoughts on that matter. Since he was a preschooler, would that still be acceptable, considering this made-up word still represented stuttering and all the associated dysfluencies and social/daily life difficulties – or would even that, though it was not an active avoidance of the word, attribute to the stigma about the word “stutter”?

    Many thanks,
    Haley

  32. Hi Rita,
    Such a fascinating and important article! I was wondering what your take is on the father’s choice of words. Do you think he could of possibly said it to protect his son? Or perhaps to protect himself? Or was he just clueless? It might have been shame but maybe it was just for protection or of a lack of knowledge? I would love to hear your insight! Thank you

  33. Hello! I am a graduate student at the University of Minnesota Duluth taking an advanced fluency course. I love this article. I think that it is very important to address the stigma of stuttering. Information from this article is something I will take with me as I begin my career as an SLP.

    Your article discussed helping children who stutter and their families use the word “stutter” in their vocabularies. Do you have any suggestions on how to increase and promote the positive use of the word “stutter” in the vocabulary of the general population?

    Thank you for your help!

  34. Hi Rita,

    I am a graduate student at the University of Minnesota Duluth taking an advanced fluency course. This was a very informative article. We just learned the benefit of using labels to help explain to our clients and their families what is happening. How do you balance calling stuttering what it is and using alternative labels? Also, if children are unaware would you still recommend this?

  35. Hello Rita,

    I am currently a first year graduate student at University of Wisconsin- Stevens Point and taking a Fluency Disorders course. I found your post very insightful and loved your perspective on saying the “s” word. The word, stutter, and many other “taboo” words, are often avoided in discussions with clients and family members because of the negative connotation that is associated with it. However, avoiding the terminology only adds to the stigma! I am a strong believer in labeling things for what they are, which in this instance can help people who stutter avoid denial and accept their stuttering. As J.K. Rowling wrote, “fear of the name increases fear of the thing itself”. This quote is extremely applicable to the clinical setting and hopefully will continue to be referenced during stuttering intervention. I also agree that using the word “stuttering” in your vocabulary with young clients and validating what they are experiencing can be extremely beneficial to them as they grow up. I will definitely remember this post as I work with PWS in my future career and take your advice in hopes of normalizing the “s” word and minimizing the anxiety and stress that can come with it.

    When you encounter a client/parent that is against using “stutter” in their vocabulary because of a negative connotation, what advice do you have for trying to remove the stigma of the word for them?

    Thank you,

    Ali Peterson

  36. Hi Rita,
    I am a graduate student at the University of Minnesota Duluth taking an advanced fluency course. After reading your paper and some of the comments from others I have a question regarding the “S” word and parents. You stated that you have had some upset parents in the past not appreciate you using the word stuttering with their child. Do you have any tips or recommendations to help a parent understand the word stuttering is not a bad term? Getting a parent on board can either make our break the future success with their child so I’m curious if you have any insight on things to say or do to help them better understand.

    Thank you!

  37. Hi Rita,

    Thank you for sharing your experiences with kids, teens, and adults who stutter. I agree that self-disclosure is so, so powerful. There is not enough research to back it up, but SLP’s have story after story of successful experiences with their clients using it.

    Do you think that parents and/or clients hesitation with using the word stuttering comes from the stigma attached to it? When I was a kid, we didn’t know that I was stuttering. I couldn’t get my words out and my mom just told me, “your thoughts are racing faster than your mouth.” Eventually I googled “not being able to get words out” and came across blocking. This was in 2011. I know a lot more is known about stuttering than in 2011, but my parents still call my stuttering a “speech block.” It’s not so much denial, as it is their (mis)understanding of what stuttering is (repetitions and prolongations).

  38. Hello! I am a graduate student at University of Minnesota Duluth. I’m currently enrolled in an advanced fluency course, so I have been learning a lot about stuttering throughout the lifespan. Your article was incredibly eye-opening for me; you provided some shocking examples that showed how difficult stuttering/fluency terminology can be for the SLP, parents, clients who stutter, and the general population. Of course defining stuttering is a priority for you. I’m wondering if there are any other terms in the stuttering/fluency realm that are of importance to you so that stuttering can be clearly labeled but other terms are also included within therapy. Thank you!

  39. Hi Rita,
    Thanks so much for you insight on stuttering. I would definitely agree to the things you said in your paper. I was just at a conference and the speaker talked about how many people think speech-language pathologist just play games with children. Speech-language pathologist do so much more than just play games with children during therapy. So I would agree with you that it is important as a clinician to tell the child why they are receiving therapy along with their families. By doing this you are keep those lines of communication open so there is no confusion. I also hope that we as a society can talk about stuttering more so it is not thought of as this “awkward” thing that often leads to the person who stutters getting made fun of.

  40. Wow, thank you so much for this post! I’m an SLP graduate student, and I wish I had read this before writing recommendations after a fluency evaluation of a four-year old. She is already aware enough of her stuttering to the point that she avoids talking and gets frustrated. I’ll be sure to pass this along to the SLP who will have her on their caseload.

  41. Hi Rita! I am a first year SLP graduate student and I really enjoyed your paper! Your examples provided great insight into how people seem to associate a stigma with the word “stuttering,” whether or not they are aware they are doing it. I think it’s a great plan to attempt to desensitize the person who stutters and their family/friends to the word. Someone previously asked what you do if the parent’s are not on board with the open use of the word “stuttering” and you said that you still use it. Have you ever had an instance where the parents ultimately ended up leaving because of the continued use of the word and their disagreement about it?
    Thanks,
    Courtney

  42. I found the part where a parent (talking about her son) said, “He doesn’t stutter, he has a fluency disorder” particularly interesting. I wonder if the previous SLP calls it a “fluency disorder” and not “stuttering” because of his/her own thoughts toward stuttering, or if he/she just called it a fluency disorder without explaining it to the parent in much detail.

  43. I am an SLP graduate student and am so happy to have read this paper. I never thought about how avoiding using the word “stuttering” could have such implications or that I might come in contact with people who avoid using the word. I also really enjoyed the breakdown of how to discuss stuttering with various age groups. I found the preschool section very interesting because we have to recognize the child’s feelings. Thanks for the great read!

  44. Hi Rita,

    My name is Alexis and I am a graduate student studying to be an SLP. I really enjoyed your paper and how applicable it is to treatment and working with clients who stutter. I liked your point about children who stutter being subject to bullying- I have learned that in general it is often best not to bring attention to a young child’s stuttering to prevent self consciousness and anxiety being factors in causing the stuttering to worsen. Your point about bullying made me realize that older children are often aware of their stuttering because of the bullying, so it becomes appropriate to address it. My question is, for younger children, at what age do you think is it appropriate to talk about the child’s stuttering with them?

  45. Rita,
    Thank you for your article. I wasn’t aware that parents had such difficulty with the term “stutter”. I thought it was less stigmatizing than “disfluency” or “fluency disorder”. When you counsel the parents, do you find that they change their attitudes and communication about stuttering with their children easily or is it still a challenge?

  46. Hello Rita,

    This was a very interesting read with a lot of valuable perspectives from the kids and teens who stutter! I definitely agree when you say that one of the biggest social sins is doing something that is “awkward”. This is a critical age where they are figuring out their identities and socializing is a great tool to do so. However, when they are self-conscious about their stuttering, they may miss a lot of missed out opportunities due to that nervousness and anxiety. Having group therapy is a great idea because the students are able to openly practice without the shame of judgment from others who may not understand their stuttering. You mentioned Goffman’s study where avoidance of disclosure can result in stress, isolation, and feelings of shame and I think that this is a great point. Even though talking about it may be scary and forces one to confront their fears, it also helps others who may have the same issues realize that they are not alone. I would like to leave you a question regarding desensitization; do you believe that more (positive) exposure about stuttering in the media, such as movies and TV shows, can benefit those who stutter by taking away the stigma? Thank you!

  47. Hello Rita,
    My name is Gillian and I am a second year graduate SLP student, and a current SLPA working at a private clinic. I admit I have been guilty of “avoiding” the s-word myself, multiple times, with my young elementary and preschool age clients. I have questioned myself as to why I have struggled to enable that empowerment on younger children, to have control over the word, as I have encouraged older children whom I felt were ready to speak openly about being a person who stutters. I agree that it is best for children to be introduced to the term “stuttering” from a concerned and caring adult, and who better than the SLP. I would be curious to know what research is available regarding the specific vocabulary used to define stuttering and if it has any impact on disfluencies in children who stutter. I appreciate this post and will continue to help break down the stigma barrier as I grow in this field. Thank you for your insight!

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