Effectiveness of School-based Therapy for Stuttering

Hi All,

As a second year, graduate student of speech/language pathology I have observed treatment of stuttering in clinic settings as well as in schools.  From my experiences, I have felt that treatment does not appear as effective for stuttering as it may for children with other speech disorders (i.e. articulation, phonological disorders). I have also felt that in some cases stuttering was essentially overlooked. Could this possibly be due to lack of time, experience and/or knowledge of stuttering of speech/language pathologists? I was also wondering if there is any current research out there regarding this issue?

Thanks,

Deana Jeziorkowski

Mercy College Graduate Student

Speech/Language Pathology

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Comments

Effectiveness of School-based Therapy for Stuttering — 5 Comments

  1. Hello Deana
    Stuttering is a complex speech disorder. The results of the treatment are not as successful. In addition, not many clinicians have the needed expertise to treat that particular fluency disorder. The effectiveness of a stuttering treatment depends on the following factors:
    1) The type of treatment protocol applied :a)Fluency shaping techniques which focus on the remediation of the primary behaviors (i.e. repetitions, prolongations and speech blocks); b) Stuttering Modification techniques which treats stuttering from a cognitive emotional perspective and focuses on stuttering more easily; and c) a combination of both.
    Effective treatment targets fluent speech directly as the aim is to calibrate the neurophysiological processes and instill an instinctive “Correct and Control” mode.
    2) The delivery and application of the treatment also factor into the success. Intensive concentrated treatments applications are the most effective instilling instinctive “Correct and Control” mode and provide a high long- term retention level. The treatment must not only address the physiological symptoms but also the defense mechanism that the individual who stutter has developed. Traditional spaced therapy becomes diluted with time and the retention levels are low and short term.
    3) Post-treatment computerized maintenance and support program is essential in maintaining the newly acquired speech patterns that sustain a long-term, fluent speech,
    4) The application of the treatment by an experienced and specialized Clinician is cardinal to the success of the treatment. Not all speech language pathologists are specialized in that particular field. There are many scientific research papers that address stuttering.

  2. Hi Deana – Thanks for your post. You are right that treating stuttering in the school setting an be a challenge. In my opinion, however, the school is one of the best places to treat stuttering. The reason? You have the child’s real world there all around you to support desensitization and generalization exercises. I have worked with children who stutter in the schools, in a private clinic, in a hospital setting, and in a University clinic. All settings have their strengths and weaknesses, and, if those are accounted for adequately, then any of those settings can provide an excellent opportunity for helping children who stutter. The question is, how do you do it? Clinicians who are skilled in working with stuttering find the ways of emphasizing those strengths. Unfortunately, as you have identified, many speech-language pathologists simply aren’t comfortable in working with people who stutter. The result is that many clinicians maybe aren’t as skilled in taking advantage of the strengths of their setting. These difficulties can be overcome, as the clinicians develop expertise about stuttering, but that takes time and effort, and many SLPs don’t have the opportunity to emphasize the development of their stuttering skills. So, it is due to all of the concerns you mentioned – and there is quite a bit of research on the topic (specifically, highlighting the fact that many clinicians aren’t well-trained in stuttering, and highlighting that they are not as comfortable with stuttering). One of my personal goals in my career has been to reach out to clinicians who aren’t comfortable with stuttering and try to help them become more comfortable. My belief is that as they develop comfort, they’ll also have the opportunity to provide higher quality clinical service. I’ll be happy to chat with you further about these issues – either in this forum, or offline – just drop me an email at jsyaruss@pitt.edu. Thanks!
    J Scott Yaruss, PhD
    University of Pittsburgh

  3. I would prefer to address this a different way.
    Articulation disorders RESOLVE with treatment. I hate to say this, but if you think Child Language disorders are CURED with treatment, you are wrong – they are helped, managed, etc. It helps to view stuttering more like language than like articulation. The goal is not necessarily to “get the kid off the case load” (defined by some as success), but work effectively to improve fluency, reduce speech frustration, improve verbal effectiveness, enable the child to meet the educational and social requirements of the school environment, etc.
    I will not pretend that all school-based SLPs are as good as they could be in treating stuttering, but this is also true of many other things that school-based SLPs try or are expected to do (I am counseling a recent graduate who feels extremely challenged by a medically fragile child who uses AAC, for example).
    I am not fully following all of Dr. Sarfati’s response, but it is true that a few minutes a week also doesn’t do much to help a child unless you can involve him or her in WANTING to practice FS or SM techniques that you BOTH agree seem useful, helping to work with families, teachers and even good buddies of the child, when you can, etc.
    So, if your question is whether or not SLPs can assist children in the schools, the answer is YES! Just remember, as one of my friends who is a PWS said: you can’t view it as your success or failure if the child is not completely “fixed” in a semester or a year. You are an important brick in the wall of this person’s eventual path to success in managing the stuttering so that it doesn’t impact his/her life negatively. Nan

  4. Dear Deana,
    If you don’t mind I would like to answer your question with suggestions on how we can work together to achieve the best outcomes for students who stutter in school settings. I believe your gut level is correct-there are challenges to successful therapy in the schools. Each setting provides different challenges. Each therapist has different skill sets. I am sorry to say that SLPs in most settings lack sufficient experience working with individuals who stutter. Unless you specialize in stuttering its difficult to acquire confidence in your evaluation procedures or treatment recommendations. I am lucky and have that experience and freely share suggestions with others. I am in private practice and have limitations too. Parents have limited time and money for privately funded sessions. I have to work my plan around these limitations. I need to be creative and use their limited resources to achieve the best results. Some of the following suggestions may help families and SLPs to find ways around the obstacles in the school setting. Let’s talk about how to collaborate with the school therapists, classroom teachers and the parents to overcome obstacles.
    Consider the following situation: The father of a fourth grade student wants his son seen for stuttering therapy in the school district because his son stutters a lot at home. His father admits he sometimes stutters. You see his son for a 10 minute screening and he demonstrates initial sound and word repetitions a few times while answering questions. His teacher reports he rarely stutters in class, is quiet, has great writing skills and is a top student.
    You recommend that he be screened the following year if the problem still persists since there appears to be no adverse negative educational impacts. Is this a good decision? Not really.
    First, assess the true educational impact-ask the student if they are a quiet person in general or are they especially quiet in class due to their stuttering. Complete checklists for attitudes and feelings about communication to create goals which are important to the client. Observe the student in unstructured settings. Request his parents to tape the student at home to determine fluency counts and sentence length. Compare the students fluency at home and at school. Request the student meet with the teacher and you to discuss communication strategies in class. During your data gathering you will find this student likely has a significant increase in stuttering when triggers are present.
    The father may still stutter as an adult and if so, his son is at increased risk for long term stuttering. Your screening results may have caught the student on a good fluency day. Stuttering fluctuates. Observations on various days with a number of individuals will provide a more accurate picture of his true fluency needs. Ask the student what he values and be sure to integrate his goals into the sessions. A 16 year old boy recently came to me because he wanted to ask a girl out on a date at his school. Together, we created a therapy plan which outlined a step by step approach using fluency strategies and delayed auditory feedback support. Because his priorities were included he was very motivated and successful.
    No one method works for any student or client. Consider the following suggestions which I have used dependent upon client needs. They may work for your student at school to create a successful plan.
    Empower students to create their own goals with an internal locus of control rather trying to control external factors. Research has indicated that an internal locus of control has been associated with less chance of relapse.
    Discuss alternate ways to for students to present information in class until they are ready to take the next step. Allow the student to use a video presentation created at home rather than a live speech in class. The student can edit out stuttering and record a presentation which demonstrates his knowledge rather than being judged on fluency. The admiration of his classmates may encourage the student to risk speaking during the next class presentation.
    Develop your skill set as an SLP by accessing continuing education classes and brainstorming with your local SLP stuttering expert. A multitude of online classes and tapes are available. Know your limitations and reach out to other SLP stuttering experts.
    Stuttering is Multi-faceted. Include goals to address motor skills using tactile and visual feedback. Computer apps are wonderful to use in classrooms as a discrete reminder to work on fluency goals. Use voice apps which display voicing, pitch fluctuations to teach the client how to maintain vocalizations and vowel prolongations. Use memory apps which remind the client through a vibration cue to focus on targeted goals for delayed auditory feedback, breathing, voicing, vowel prolongations, phrasing, relaxed lip closure or increased vocal volume.
    Learn how to use cognitive behavioral therapy (CBT) to improve how the client thinks about his communication. Create healthy attitude about speaking. Always encourage students to express their message without modification despite instances of stuttering.
    Positive affirmations and preparation improve readiness for speaking. Role-play situations that students encounter in the classroom when no other students are present. Strategize with the teacher how to provide nonverbal cues to the student to encourage use of techniques in class. One teacher touched her ear to cue a student that they were using good vocal volume and vowel prolongations naturally in class and this student made incredible progress. Teachers may provide students with sample questions/answers to class discussions several days in advance so the student can practice answers at home using fluency techniques.
    Provide carryover of therapy techniques to natural settings; have students deliver verbal messages practiced in therapy to the school staff. Educate teachers and staff by providing videos and contest for them to answer questions about stuttering. Desensitize staff, parents and teachers to stuttering. Invite PWS to your school as guest speakers. People who stutter are the experts on the experience of stuttering and are happy to share advice to the community. Have a person who stutters mentor a student. Attend local NSA chapter meetings to hear about stuttering research, support and networking.. Provide positive role models at schools by inviting famous people who stutter to speak.
    Individuals who stutter and their families deserve outstanding care from SLP’s. They deserve to have access to current research, a variety of therapy tools and community support groups. Trust your client to make the choices that are right for them. We provide the banquet and they choose the items that work for them. Trust that good tools and accurate research PWS will make the best choice for their individual needs during each stage of life. It takes the coordinated effort of public, private and nonprofit agencies to support the PWS with the best care. Thank you for caring enough to learn more about stuttering.
    Nancy Barcal

  5. Deanna,
    You have already received a number of thoughtful replies to your question. I was especially impressed with the time and thought that the last responder put into her response.
    I would like to add one more short comment.
    From my clinical experience, the biggest factor that needs to be addressed if one is to see a child in the school is…. how is the parent involved. Too many of the parents I work with in my private practice have very little idea what there child is doing in therapy. I understand this is a huge challenge for the school SLP. But, that doesn’t change the fact that family involvement is crucial to successful treatment of stuttering, and therefore school SLPs must find a way to involve parents in the therapeutic process.
    Kevin Eldridge