Seeking advice to best support 9 year old boy who stutters

I  work with a 9 who has challenges speaking in the classroom and to his peers. He is new to this school. He talks during our therapy sessions with no problem stuttering. He even introduced himself the first time he came in my room saying, I am ” ” and I stutter.  Since then he shared “if I didn’t stutter I would talk a lot more and be much more friendly”.   Today he said, “I am afraid if I stutter I  will be lonely because others will not want to be my friend.” He followed up saying, “I am not lonely b/c I get to play tag and there is not a lot of talking in tag.”

I met with his teacher last week and told her what he shared with me. She does not have any experience with stuttering so I gave her some information to review. My student’s IEP is coming up in less than two weeks. To my disappointment, he only came in with one goal from his previous district- to speak more fluently (it is more specific down to percent of syllables but I can’t remember off hand/no surprise, he has not met it) I am going to create new/more goals (scrapping that one) and take the focus away from “fluency”. I want to focus on identification of core and secondary behaviors, education/desensitization, and some structured fluency shaping techniques but I am open to more ideas.

I plan to give a presentation to the class on stuttering.  I offered my student two options- he can present with me or I can do it on my own. He said he wants me to do it on my own but as of today he did not object to having a role in the presentation. This will likely take place in November. I would value any feedback you may have regarding goals and the type of role he can have in the class presentation.

Lastly, to complicate matters more, his parents are divorced. Dad is remarried and parents are not on good terms. Mom has given him the idea that screen time makes him stutter more so he thinks he stutters more at his Dad’s house since his Dad is more lenient on screen time (at least this is what he implied).  His older brother teases him and tells him he can’t play a video game because it will make him stutter. He tells his brother to “shut up” but he is the one who gets in trouble for saying “shut up”.  This boy is a great kid but the family has so much to learn about stuttering.

I appreciate your feedback.  As of last week,  he reported having one friend at school, a girl who sits next to him .  The teacher reported she encourages other boys to include him and they have said “he doesn’t like what we like” I don’t know if that is true or if that is their way of “nicely” not including him. He has not been teased. I was happy to hear he began participating in a regular game of tag with other boys although, he isn’t having to speak very much per his report.

Thanks for any insight, expertise you can share!

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Comments

Seeking advice to best support 9 year old boy who stutters — 8 Comments

  1. That child is fortunate to have a caring and compassionate SLP such as yourself. I’m not sure where you and the client are located, but I’d suggest getting him involved in some local, national or even international self-help organization. In the U.S., for example, the National Stuttering Association (NSA) is a great organization offering support for clients, families, SLPs, etc. They have many local chapters that have periodic meetings, which the client (and his family) might benefit from attending.

    Also, I know that the NSA used to have a program called “Stutter Buddies,” wherein a child who stuttered would get essential a “pen pal” to correspond with. The kids used to write each other letters, but nowadays, I’d imagine they would utilize technology such as e-mail, Skype, etc. I’d contact the staff at the NSA to find out more information about what they currently offer to help child who stutter realize that they are not alone. For example, they have a convention every summer that the kids (and adults) have a great time at!

  2. Paul makes a good point about the importance finding support for your client in the form of other children and families affected by stuttering. I’d like to add a few other comments. Your idea of giving a class presentation is a good one. I would caution that you be sure that the child is truly on board, as opposed to agreeing because he wants to please you. I wonder if the latter is the case, from what you write. A presentation will work if he is truly on board and actively participates in developing the content that you will share with his classmates, whether or not he participates in giving the presentation. If not, he may end up feeling embarrassed and possibly further set apart from his peers. I typically will not begin work on a presentation until the child is absolutely on board, and I do it on his or her terms. For example, years ago we worked with a child of the same age as your client. He was interested in informing others about stuttering, but did not want to do this in his class. Rather, he chose to put together a slide show presentation that he created, and he chose to invite his parents and a few of his friends to attend. He was a very creative child, and spent quite some time researching stuttering for the facts he included in his presentation, and he also drew special invitations to send to his invited audience members. Even though his classmates did not participate in the presentation, he learned quite a lot about stuttering by researching for his presentation. In giving the presentation, his first to an audience, he gained confidence in speaking in front of others, and that eventually led to his engaging in talking more with peers in his class at school.

    Your client told you that he wants to work on being more fluent, which is common as a goal that is important to children who stutter. When a child tells you that this is what they want to work on, it is important to include ways to communicate with a more relaxed speech mechanism in treatment. In your conversations with him, you have already identified several additional goals when he told you that he is afraid of stuttering because listeners may not want to be friends with someone who stutters when they talk. From this, at least two goals seem apparent: a) a goal of exploring how people actually react when they hear him stutter (reality testing), and b) increasing his confidence as a communicator, which can be addressed when engaging him in very practical activities related to the first goal of testing out others’ reactions. Developing a hierarchy related to comfortable listening partners, and starting with those within his comfort zone, he cab set up experiments to engage those individuals in a conversation and then working out how he will identify what they think about him and his communication. He may, for example, want to directly ask them about what they think about his communication, at least with speakers he is already fairly comfortable speaking with, or, asking him to think about what the other person’s behavior can tell him. For example, he may notice that they answer his questions, or add to the conversation that he has started, both of which can inform him that the other person paid attention to what he said, and/or was interested in continuing the conversation. If he anticipates that someone will react in a way that is negative about his stuttering (particularly when he decides he wants to start up a chat with a classmate, or anyone who is slightly out of his comfort zone on his hierarchy), this is an opportunity to help him figure out how he wants to react when/if this happens (a third goal: self-advocacy). In other words, rehearsing with him responses that are appropriate and that boost his own sense of self (e.g., “It doesn’t help when you tease me about my stuttering”, or, “Sometimes I do stutter when I talk”, or, if they interrupt him, “Please let me finish”).

    I hope this gives you some ideas about how you might approach his fears about talking. You clearly are making some very helpful observations about this child and are interested in focusing on the larger problems surrounding his stuttering.

    Best wishes!

    Lynne Shields

  3. Hi-
    Thanks for posting such a great question! Like both Paul and Lynne said, your client is very lucky to have you supporting and advocating for him.

    I was wondering if you talked with him about certain speaking situations that he participates in on a daily basis (e.g., asking questions in class, talking to friends, giving a presentation in class) and had him rank them in order from easiest to most difficult. This may help to give you an idea of what type of speaking situations he feels comfortable in and others that he may not feel so comfortable participating in. Once he’s created his list/rankings, you could prompt him to pick one or two of the speaking situations on that list that really matter to him. These speaking situations then can become your actual therapy goals. You can pick the speaking situation that he wants to work on first and you can have a conversation about the steps involved in meeting his goal within this speaking situation. For example, maybe he wants to focus on introducing himself to others. The first step for him might be to make a list of people he wants to introduce himself to. Then, he may want to practice with you, his parents or a close friend. The focus initially (or all together) may be on introducing himself regardless of whether he stutters or not. With time, as he gets more comfortable, he may decide that he wants to introduce himself while using a voluntary stutter or while approaching talking in an easier way. Within each of these speaking situations, you can talk about communication as a whole – not just fluency. What does it mean to be a successful communicator in these situations? Perhaps it is making eye contact, speaking using a powerful voice, etc. By focusing therapy on the speaking situations that are important to your client, he will be much more invested!

    You also wrote that he mentioned that he “would talk a lot more and be much more friendly” if he didn’t stutter. Perhaps you can explore that more with him. What does “talk a lot more” and “be much more friendly” actually look like. By getting him to describe this to you – it may shine light on other possible goals. You could also talk to him about his values – what is important to him? Have him make a list of his values or use magazines and pictures to make a collage of “who he is.” You could then talk to him about the words other people would use to describe him. If there seems to be a discrepancy between how he acts and what’s important to him – then you may want to talk through that as well. For example, I once had a client who valued openness and connecting with others; however, he stated that everyone would describe him as quiet or shy because he never talked. We then talked about ways he could move towards his goal of being open and connecting with others and centered our therapy goals around that.

    Hope this helps! Good luck!
    ~Jaime Michise

  4. You’ve received some excellent input from our colleagues up above. There’s little that I can add! But, I would like to offer 2 thoughts: First, I like what you’ve written about what you’d like to help him learn in therapy…one way to help him in this is to think through with him the ways that stuttering is affecting him. (I do this by going through the OASES questions with my students in therapy, one-by-one. This leads to some interesting discussions beyond what I learn from the scores themselves.) (Disclaimer: I’m coauthor/publisher of the OASES.) This type of discussion can also help you identify other goals that may be worth considering – and it can help to increase the student’s understanding of why he is doing all of the things he is doing in therapy. He’s not just learning about the speech machine because it’s interesting (it is!); he’s learning about the speech machine because having a greater understanding of how he talks will help him do XYZ (e.g., increase his sense of control when he is stuttering), and that can help him do ABC (e.g., reduce the negative impact of stuttering…) (You’ll fill in the specific blanks with him in therapy.) Understanding the reasons that we do things helps us persevere when the going gets tough.

    Second, you mentioned a classroom presentation – there are a number of good resources out there for planning a good classroom presentation. I’ve done these in many different ways. The most important question I’d ask to start is what he wants his friends to learn. (I ask kids, “If you could tell your friends anything you wanted about stuttering, what would you tell them?”) This question often leads to an outline of the content for the classroom presentation. (We also do this through an activity like creating a brochure about stuttering, or making a quiz show, etc…) Because the child is the one coming up with the content, then he is more likely to want to be involved in the presentation itself (with your help and the support of parents and teachers, of course.) Happy to say more about this; feel free to send along follow-up questions.

    Thanks for reading.
    Scott

  5. Other ways to utilize support organizations are 1) visit their web sites (FRIENDS comes to mind here) and look at some of the responses to desensitization questions and activities (as well as the activities themselves) and 2) contact a chapter and ask specific questions (e.g., How would you react to your SLP doing a class presentation? How do you think you would have reacted when you first started therapy?). I’ve done that sort of thing before and was helped by the insights I received. Good luck.

  6. Hi,

    You’ve received so many great suggestions above, I only have one teency thing to add and that is that it’s not unusual for kids switching schools to have challenges finding their place within pre-established friendship circles. It’s easy to see that the child’s concern about stuttering may be exacerbating these challenges, but it may not necessarily be causing them. One option may be to consider liaising with the parents and/or school to explore the possibility of some extra-curricular activities in very small groups, so that this child has the opportunity for more extended one-to-one interactions with peers. Engaging in some fun activities with peers outside of school may help the child feel more confident within classroom settings.

  7. Thank you all for the helpful guidance on this case. I will see my student tomorrow and include some of your suggestions in our therapy session immediately. Thank you your helpful site and on-line conference. I discovered an old post that included an “About Me Powerpoint” I introduced to my student last week and he was so enthusiastic about working on it. In it, he can input “What I want my teacher to know… “” friends to know… ” ” parents to know…If he completes it tomorrow, I will share it at the IEP meeting with his permission. I will also finalize his goals with him based on your feedback and his own values. Your advice was invaluable. I appreciate it. Thank you, again.

  8. I wanted to post an Update. First I wanted to correct myself as my students is working on a
    “My Story” powerpoint thanks to Diane Games post in 2009! It is such a great tool and my student included this statement under “I Still Need to Work On:
    “I still need to work on being ok with it, dealing with it, and just being able to get my words out in one piece and not shattered.”
    It was profound. This exercise really helped me understand him and what he recognizes he needs to to. When asked if he is ok with the presentation he typed “yes, kind of” It was interesting how he liked to type his feelings on the computer vs. say them. Thank you all again. I appreciate your feedback.

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