Working with children who stutter

Hello! I’m a 2nd year graduate student studying Speech Language Pathology and I am seeking some advice/tips on working with children who stutter who are cognitively aware of their stutter, but have no desire to go to speech therapy to work on it. I recently worked with a 9 year old who had mild-moderate disfluencies. He knew he stuttered, but always complained about coming to therapy before, during, and after the session. It seemed as though he knew he stuttered, but it didn’t bother him enough to want to come to speech for it. His Mom seemed more concerned about his stutter than he did. 

I understand that one of the major goals that we want to target when working with disfluencies is confidence. This particular client was incredibly active, always talked about sports and hanging with his friends, and was doing well in school. He also had a good understanding of techniques that helped decrease his stuttering and behaviors associated. I don’t think his stutter inhibited his confidence. If anything, going to speech therapy and hearing mom talk about it like it’s a bad thing inhibited his confidence more. I guess what I’m asking is – Is it ethical and/or necessary to continue recommending services for a kid like him? I hope my question makes sense! 

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Comments

Working with children who stutter — 3 Comments

  1. Dear Nicole,

    HI! Welcome to the ISAD! Where are you in grad school? Congrats on getting to grad school and pursing Speech Language Pathology!

    You ask a great question, which has many options and perspectives attached to it. As a professional, and PWs, I have learned (from kids, parents, adolescents, adults, students, and peers) that we can follow the client’s lead. The first thing we follow is if a client is engaged and wants to be in therapy. If they are not (for ANY reason) the therapy is not going to be effective. That does not matter if the clinician is a world-class caring expert in stuttering or not. If the client does not want to attend, doesn’t care, is scared of therapy, or any for any other reason is not ready at that time in their life, the HELP will do very little.

    The above is true for anything. For example, if someone is not motivated to learn violin, they will not do it. People need buy in for themselves in order to take action.

    The other part of your question is the parents. Parents seem to be typically more concerned about their children in so many ways. This is natural. Kids live in kid worlds, while parents live in the adult world. These worlds are vastly different from where each one stands from a social, cognitive, and mental perspective (to say the least). So perhaps at this moment, the child is functioning socially, and succeeding in his/her life. That is fantastic! AND, perhaps at some point down the road the child will be motivated or want help. We (as adults) need to realize that motivations for improvement eb and flow like anything else. Our desires, hesitations, fears, comforts, change daily depending on where we are. So do a child’s. This is where conversations and process of accepting a child where they are, and knowing their attitudes will change, comes in.

    I have had several clients whom I have seen over years. They came in at 6 for a year or two. Came back at 11 or 12. And came back again in high school. Why? Life changes. Priorities change. Activities change. Times change for each person.

    Sorry for the long answer. You ask a great question that has no solid one answer, but rather a conversation that we can have with clients, families, and peers.
    Have a great conference!
    With compassion and kindness,
    Scott

  2. Hi Nicole,

    What immediately came to mind was a personal story I read by David Shapiro entitled “A Way Through the Forest: One Boy’s Story With a Happy Ending” (available here: https://www.mnsu.edu/comdis/kuster/PWSspeak/shapiro.html).

    There is so much you can glean from this story, but it highlights the importance of client-centered treatment – meeting them where they are, empowering them to talk freely, and really listening to them (their interests, wants, desires, needs, aspirations). There is so much value in being heard and understood! If our treatment is not helpful or enjoyable to the client, then we must step back and evaluate why. Would love to hear you thoughts on Shapiro’s story… 🙂

    Ana Paula

  3. Nicole-
    Thank you for asking this question of the professional panel, as it is such a great question. I second my colleagues opinion with this- if the kiddos doesn’t want therapy and there is no buy-in so to speak, then as clinicians we can actually cause more harm than good and it can be quite the traumatizing experience for the child. If we qualify a child for therapy just on the basis of stuttering alone- the child or adult that stutters will qualify for therapy until the day they die…. that’s not the point of it. 🙂 We must approach each person we serve holistically and meet them where they are at with their goals in therapy- and at some points, if stuttering isn’t having an effect on their world- then they are ready for a break. 🙂
    Thanks,
    Steff

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