A Multi-Dimensional Approachfor the Treatment of School-

Age StutteringThe Center for Stuttering TherapyThe Center for Stuttering Therapy

Patty A. Walton, M.A., CCC-SLP, BRS-FDPatty A. Walton, M.A., CCC-SLP, BRS-FDWhitney D. Whitney D. NovenNoven, M.S., CCC-SLP, M.S., CCC-SLP

Julie A. Demes, M.S., CCC-SLPJulie A. Demes, M.S., CCC-SLP

Working with Children WhoStutter in the School Setting

AdvantagesAdvantages–– Provides the child with consistent support in a veryProvides the child with consistent support in a very

important environmentimportant environment–– School SLP has consistent teacher contactSchool SLP has consistent teacher contact–– More opportunities for group therapyMore opportunities for group therapy–– Excellent setting for transfer and maintenanceExcellent setting for transfer and maintenance

LimitationsLimitations–– Limited contact with parentsLimited contact with parents–– Limited one on one contact time with the childLimited one on one contact time with the child–– Increased vacation/therapy breaksIncreased vacation/therapy breaks

What makes therapysuccessful?

•• ZebrowskiZebrowski•• 40% of change is attributed to what the40% of change is attributed to what the

client/family bring to therapyclient/family bring to therapy•• 30% of change is attributed to what the clinician30% of change is attributed to what the clinician

brings to therapybrings to therapy•• 15% is attributed to the techniques and15% is attributed to the techniques and

strategies employed for changestrategies employed for change•• 5% is the result of an 5% is the result of an ““expectation for changeexpectation for change””

The Clinician’s 30%

•• Understanding the diagnostic processUnderstanding the diagnostic process•• Understanding the basic components ofUnderstanding the basic components of

therapytherapy•• ““HowHow”” we teach, reinforce and strengthen we teach, reinforce and strengthen

therapy techniques is just as important astherapy techniques is just as important as““whatwhat”” we teach we teach

•• Being comfortable with stutteringBeing comfortable with stuttering•• Being empowered and passionateBeing empowered and passionate•• Sending the message to the child that weSending the message to the child that we

know how to helpknow how to help

Assessing School AgeStuttering

•• Formal MeasuresFormal Measures–– Test of Childhood Stuttering (TOCS) Pro-Test of Childhood Stuttering (TOCS) Pro-

Ed, 2009Ed, 2009–– Riley Stuttering Severity Instrument (RSSI-Riley Stuttering Severity Instrument (RSSI-

4) Pro-Ed, 20084) Pro-Ed, 2008–– Standardized District Rating ScalesStandardized District Rating Scales

Bennett (2006)

•• Describes assessment of fluency as a Describes assessment of fluency as a““detailed, thought-engaging processdetailed, thought-engaging process””where the goal of assessment is where the goal of assessment is ““totounderstand thoroughly the clientunderstand thoroughly the client’’ssspeech behaviors, thoughts, andspeech behaviors, thoughts, andfeelingsfeelings””

In Addition to Formal Testing:

•• Important Questions to AnswerImportant Questions to Answer–– What is the child doing physiologically when he isWhat is the child doing physiologically when he is

stuttering?stuttering?–– How is the child reacting to moments of stuttering?How is the child reacting to moments of stuttering?–– What role do the childWhat role do the child’’s attitudes and emotionss attitudes and emotions

play in the severity of his stuttering?play in the severity of his stuttering?–– How do parental attitudes and beliefs impact theHow do parental attitudes and beliefs impact the

childchild’’s stuttering?s stuttering?

Assessing for TreatmentPlanning:

•• Information obtained during yourInformation obtained during yourassessment should help you determine:assessment should help you determine:–– Which fluency shaping strategies to employWhich fluency shaping strategies to employ–– The need for modification strategiesThe need for modification strategies–– The focus of working on attitudes andThe focus of working on attitudes and

emotions with the childemotions with the child–– The need for and extent of parentalThe need for and extent of parental

education and counselingeducation and counseling

Assessing PhysiologicalComponents

•• What is the child doing with his speechWhat is the child doing with his speechsystem that is interfering with smooth,system that is interfering with smooth,fluent speech production?fluent speech production?–– Breathing ComponentsBreathing Components–– Voicing ComponentsVoicing Components–– Articulatory ComponentsArticulatory Components

Breathing Components

•• Assess forAssess for–– Clavicular Clavicular breathingbreathing–– Irregular/aperiodic Irregular/aperiodic respiratory cyclesrespiratory cycles–– Audible exhalationsAudible exhalations–– GaspingGasping–– Talking on exhausted breathTalking on exhausted breath–– Excessive air pressureExcessive air pressure

Vocal Components

•• Assess forAssess for–– Hard vocal onset/glottal attacksHard vocal onset/glottal attacks–– Dysrhythmic Dysrhythmic phonationphonation–– Laryngeal blockingLaryngeal blocking–– Changes in pitch/loudnessChanges in pitch/loudness–– Difficulty maintaining phonationDifficulty maintaining phonation–– Vocal fryVocal fry

Articulatory Components

•• Assess forAssess for–– Hard Hard articulatory articulatory contacts on plosivescontacts on plosives–– Articulatory blockingArticulatory blocking–– Difficulty making Difficulty making articulatory articulatory transitionstransitions–– Reduced Reduced articulatory articulatory movementmovement

Assessing the Child’sReaction to Stuttering

•• How is the child coping with the threatHow is the child coping with the threatand experience of stuttering?and experience of stuttering?

•• How is negative emotionality impactingHow is negative emotionality impactingthe childthe child’’s stuttering?s stuttering?

•• Is the child struggling & tensing duringIs the child struggling & tensing duringstuttering moments?stuttering moments?

•• Child may avoid or postpone stutteringChild may avoid or postpone stuttering•• May exhibit fear, shame, humiliationMay exhibit fear, shame, humiliation

How do we assess reactionsto stuttering?

•• Observe the child when they areObserve the child when they arespeaking, look for secondary behaviors,speaking, look for secondary behaviors,struggle and tension, and avoidancestruggle and tension, and avoidance

•• Discuss with the child how he reacts toDiscuss with the child how he reacts tomoments of stutteringmoments of stuttering

•• Use worksheets and pencil and paperUse worksheets and pencil and papertaskstasks

Assessing Attitudes andEmotions

Chmela Chmela & Reardon (2001) and Murphy& Reardon (2001) and Murphy(1999)(1999)

•• How does the child feel about hisHow does the child feel about hisstuttering?stuttering?

•• How do these attitudes and emotionsHow do these attitudes and emotionsimpact the childimpact the child’’s stuttering?s stuttering?

•• How does the child perceive othersHow does the child perceive others’’reactions to his stuttering?reactions to his stuttering?

Talking with kids aboutstuttering

•• Bennett (2006) suggests Bennett (2006) suggests funnelingfunnelingwhen talking with kids about stutteringwhen talking with kids about stuttering–– General discussionGeneral discussion–– Talking about the childTalking about the child’’s interestss interests–– General discussion about speechGeneral discussion about speech

experiencesexperiences–– Discussions about stutteringDiscussions about stuttering–– Discussions about the childDiscussions about the child’’s stuttering ands stuttering and

examples of strategies usedexamples of strategies used

Basic Therapy Components

•• Combining Fluency Shaping and ModificationCombining Fluency Shaping and ModificationTherapiesTherapies

•• Using an Increased Length and Complexity ofUsing an Increased Length and Complexity ofUtterance FrameworkUtterance Framework

•• Using Modeling and ReinforcementUsing Modeling and Reinforcement•• Teaching Self Monitoring SkillsTeaching Self Monitoring Skills•• Transferring and Maintaining New SpeechTransferring and Maintaining New Speech

SkillsSkills

Combining Fluency Shapingand Modification Therapies

•• Diametrically opposed philosophiesDiametrically opposed philosophies•• Fluency shaping helps the child produce moreFluency shaping helps the child produce more

fluent speech through the use of compensatoryfluent speech through the use of compensatorytechniques. These techniques are chosen basedtechniques. These techniques are chosen basedupon what the child is doing physiologically whenupon what the child is doing physiologically whenhe stutters.he stutters.

•• Modification teaches the child to stutter moreModification teaches the child to stutter moreeasily, change moments of stuttering, and reduceeasily, change moments of stuttering, and reduceavoidance. These strategies are dependant uponavoidance. These strategies are dependant uponthe degree the child is negatively reacting to histhe degree the child is negatively reacting to hisstuttering.stuttering.

•• The ratio varies from child to child, and will changeThe ratio varies from child to child, and will changeover time.over time.

Guidelines for Practice inStuttering Treatment (1995)

•• Suggests when treating stuttering thatSuggests when treating stuttering that““management goals include fluencymanagement goals include fluencyshaping strategies (recommended forshaping strategies (recommended forreducing the frequency of stutteringreducing the frequency of stutteringbehaviors) and stuttering modificationbehaviors) and stuttering modificationstrategies (recommended to reduce thestrategies (recommended to reduce theabnormality, severity and duration ofabnormality, severity and duration ofstuttering behaviors)stuttering behaviors)””

Using Increased Length andComplexity of Utterance

•• Based upon GILCU (Ryan, 1984); ELUBased upon GILCU (Ryan, 1984); ELU(Costello, 1980)(Costello, 1980)

•• Children stutter more on longer, moreChildren stutter more on longer, morecomplex utterances (Riley & Riley, 1983)complex utterances (Riley & Riley, 1983)

•• Strategies are first taught at the single wordStrategies are first taught at the single wordlevel and progress through conversationlevel and progress through conversation

•• Provides immediate success in therapyProvides immediate success in therapy•• Allows maximal productions early in therapyAllows maximal productions early in therapy•• Imitative responses followed by spontaneousImitative responses followed by spontaneous•• Use a Use a ““Fluency StaircaseFluency Staircase””

Use of Modeling andReinforcement

•• Clinician models techniques throughoutClinician models techniques throughouttherapy.therapy.

•• Provides a model of fluency as well as betterProvides a model of fluency as well as betterstuttering.stuttering.

•• Positive reinforcement is important toPositive reinforcement is important tostrengthen new behaviors, both in thestrengthen new behaviors, both in theproduction of fluency and better stutteringproduction of fluency and better stutteringbehaviors.behaviors.

Teaching Self MonitoringSkills

•• Self monitoring helps the child better Self monitoring helps the child better ““stay instay inthe momentthe moment””

•• Must be able to identify rapid rate, tension,Must be able to identify rapid rate, tension,and disrupted speech to make appropriateand disrupted speech to make appropriatechangeschanges

•• The child needs to understand his reactionThe child needs to understand his reactionpatterns and how they impact his stutteringpatterns and how they impact his stuttering

Transfer and Maintenance

•• Transfer should occur across peopleTransfer should occur across peopleenvironments, and situationsenvironments, and situations

•• Develop a transfer hierarchyDevelop a transfer hierarchy•• Group therapyGroup therapy•• Maintenance should occur over time with theMaintenance should occur over time with the

gradual reduction of therapy time/visitsgradual reduction of therapy time/visits

Setting Therapy Goals

•• Goals should be functionalGoals should be functional•• Child should take part in goal settingChild should take part in goal setting•• Goals should be more about communicationGoals should be more about communication

than fluencythan fluency•• Help the child be realistic about goals andHelp the child be realistic about goals and

scaffold when possiblescaffold when possible•• Some goals may not be measurableSome goals may not be measurable

(reduction of fear, increased risk taking)(reduction of fear, increased risk taking)

Therapy Components andTreatment Planning

EducationEducationFluency ShapingFluency ShapingModificationModificationAttitudes & EmotionsAttitudes & EmotionsParent CounselingParent Counseling

Education

•• Important first step in therapyImportant first step in therapy•• Dell (2000) Dell (2000) ““We want the child to knowWe want the child to know

what happens and what it feels likewhat happens and what it feels likewhen he has these blocks and towhen he has these blocks and torecognize that he can do somethingrecognize that he can do somethingabout themabout them””

Understanding Stuttered andFluent Speech Production

•• Garden Hose Analogy (Garden Hose Analogy (ContureConture, 1991), 1991)•• Diagrams and pictures of the speech systemDiagrams and pictures of the speech system•• Gear system (Walton, 2013)Gear system (Walton, 2013)•• The House that Jack Built (Bennett, 2006)The House that Jack Built (Bennett, 2006)•• The Speech Machine, (The Speech Machine, (Chmela Chmela 2004)2004)•• Teach the child important terminology forTeach the child important terminology for

therapytherapy

Identifying Stuttering

•• Identification of stuttering behaviors inIdentification of stuttering behaviors inthe clinicianthe clinician’’s speechs speech

•• Identification of stuttering in the childIdentification of stuttering in the child’’ssspeechspeech

•• Duplicating real stuttering (Dell, 2000)Duplicating real stuttering (Dell, 2000)•• Comparing hard and easy productionsComparing hard and easy productions

in in diads/triads diads/triads ((Ramig Ramig & Dodge, 2005)& Dodge, 2005)

Fluency Shaping Components

•• Help the child produce more fluent speechHelp the child produce more fluent speech•• Therapy is structured around an Therapy is structured around an ““easyeasy

speech frameworkspeech framework”” (Williams, 1979) (Williams, 1979)•• Main technique is stretchingMain technique is stretching•• Other techniques are introduced if specificOther techniques are introduced if specific

stuttering behaviors persist such as hardstuttering behaviors persist such as hardvocal onset, hard vocal onset, hard articulatory articulatory contacts orcontacts ordifficulty maintaining voicingdifficulty maintaining voicing

What fluency shapingstrategies can we teach

children?

•• Stretching (easy speech)Stretching (easy speech)•• Easy voice (easy onset)Easy voice (easy onset)•• Slides (soft Slides (soft articulatory articulatory contacts)contacts)•• Hooking-on (sound blending)Hooking-on (sound blending)•• Voice-on (continuous voicing)Voice-on (continuous voicing)•• Big Speech (over-articulation)Big Speech (over-articulation)

Stretching (Easy speech)

•• Slight elongation of the first part of a word orSlight elongation of the first part of a word orphrase (stretch through the first transition)phrase (stretch through the first transition)

•• Child uses stretches at the beginning ofChild uses stretches at the beginning ofutterancesutterances

•• Helps to slow rate, reduce air pressure, andHelps to slow rate, reduce air pressure, andallow transitional movementallow transitional movement

•• Stretching may be the only technique theStretching may be the only technique thechild needs to improve fluent speechchild needs to improve fluent speech

•• Focus on the use of stretches at theFocus on the use of stretches at thebeginning of phrases in conversationbeginning of phrases in conversation(chunking and phrasing)(chunking and phrasing)

Easy Voice

•• ““Easy onsetEasy onset”” (Perkins, 1984) (Perkins, 1984)•• Appropriate for the child who exhibitsAppropriate for the child who exhibits

laryngeal blocking and has difficultylaryngeal blocking and has difficultyinitiating/maintaining airflow and voicinginitiating/maintaining airflow and voicing

•• Enables the child to initiate voicing byEnables the child to initiate voicing byreducing sub-glottal air pressure and gentlyreducing sub-glottal air pressure and gentlyinitiating phonationinitiating phonation

•• Reduces laryngeal blocking, laryngeal tensionReduces laryngeal blocking, laryngeal tensionand helps the child maintain voicingand helps the child maintain voicing

Suggestions for TeachingEasy Voice

•• Airplane-Rocket Ship Analogy: helpsAirplane-Rocket Ship Analogy: helpsthe child to reduce sub-glottal airthe child to reduce sub-glottal airpressurepressure

•• Easy voice drills: sustained /ah/Easy voice drills: sustained /ah/•• Single word production of wordsSingle word production of words

beginning with vowelsbeginning with vowels•• Contrast drills: hard / easyContrast drills: hard / easy

Slides

•• ““Soft Soft articulatory articulatory contactscontacts”” (Van Riper, 1971), (Van Riper, 1971),(Wall & Meyers, 1982)(Wall & Meyers, 1982)

•• Appropriate for the child who exhibitsAppropriate for the child who exhibitsarticulatory articulatory blocking (and/or blocking (and/or articulatoryarticulatorytension in the production of tension in the production of /p/p,b,t,d,k,,b,t,d,k,g/g/..

•• Changes manner of production from plosiveChanges manner of production from plosiveto fricative by maintaining airflow throughoutto fricative by maintaining airflow throughoutthe productionthe production

•• Stresses reduced oral tension andStresses reduced oral tension andconstriction of the articulatorsconstriction of the articulators

Suggestions for TeachingSlides

•• Begin at sound level and move to singleBegin at sound level and move to singlewordswords

•• Exaggerate productions so the child canExaggerate productions so the child canfeel the airflow and voicingfeel the airflow and voicing

•• Gradually introduce into longerGradually introduce into longerutterancesutterances

•• Contrast drills: hard / easyContrast drills: hard / easy

Hooking-On

•• ““Transitional movement and soundTransitional movement and soundblendingblending”” (Perkins, 1984) (Perkins, 1984)

•• An airflow skill that is used to An airflow skill that is used to ““close theclose thegapgap”” between sounds and words between sounds and words

•• The blending of one sound smoothlyThe blending of one sound smoothlyinto the other allows for no breaks ininto the other allows for no breaks inairflow and voicingairflow and voicing

Suggestions for TeachingHooking-On

•• For use with children who have difficultyFor use with children who have difficultymaintaining voicing or who stop theirmaintaining voicing or who stop theirvoice before hard wordsvoice before hard words

•• Practice first in two and three wordPractice first in two and three wordutterancesutterances

•• Practice hooking-onto hard wordsPractice hooking-onto hard words

Voice-On

•• Continuous VoicingContinuous Voicing•• For use with children who exhibit:For use with children who exhibit:

–– excessive laryngeal tensionexcessive laryngeal tension–– disrupted breathing patterns (such as disrupted breathing patterns (such as inspiratoryinspiratory

gasping, asynchronous breathing, and audiblegasping, asynchronous breathing, and audibleexhalations)exhalations)

–– choppy or fragmented speechchoppy or fragmented speech–– excessive pausingexcessive pausing–– bursts of phonationbursts of phonation

Suggestions for TeachingVoice-On

•• Contrasting disrupted and continuousContrasting disrupted and continuousphonationphonation

•• DroningDroning•• Chunking and phrasingChunking and phrasing

Big Speech•• ““OverarticulationOverarticulation””•• For use with children who mumble, have jawFor use with children who mumble, have jaw

clenching, or who speak with little movementclenching, or who speak with little movementZimmerman (1980)Zimmerman (1980)

•• Encourages the child to speak more deliberately toEncourages the child to speak more deliberately toincrease sensory feedback by requiring him to speakincrease sensory feedback by requiring him to speakwith more deliberate movement and jaw openingwith more deliberate movement and jaw opening(which automatically reduces speech rate).(which automatically reduces speech rate).

•• May teach at any level of therapyMay teach at any level of therapy

Modification Components

•• (Van Riper (1973), (Dell 2000)(Van Riper (1973), (Dell 2000)•• Enables the child to develop better copingEnables the child to develop better coping

strategiesstrategies•• Desensitizes the childDesensitizes the child•• Reduces negative emotionalityReduces negative emotionality•• Reduces secondary behaviors, avoidance andReduces secondary behaviors, avoidance and

struggle and tensionstruggle and tension•• Increases a sense of control over stutteringIncreases a sense of control over stuttering•• Gives the child tools to change real moments ofGives the child tools to change real moments of

stuttering before and during its occurrencestuttering before and during its occurrence•• Encourages the child to be Encourages the child to be ““goodgood”” at stuttering at stuttering

Who Will Benefit fromModification Therapy?

•• The child who:The child who:–– Exhibits struggle and tension behavior which is negativelyExhibits struggle and tension behavior which is negatively

impacting the severity of the stuttering.impacting the severity of the stuttering.–– Anticipates stuttering (thinks he is going to stutter before heAnticipates stuttering (thinks he is going to stutter before he

actually does).actually does).–– Is avoiding words (Is avoiding words (circumlocutingcircumlocuting, substituting or not, substituting or not

talking)or situations (using the phone, introducing himself, ortalking)or situations (using the phone, introducing himself, ordoing things with friends)doing things with friends)

–– Exhibits fear when talking.Exhibits fear when talking.–– Uses linguistic secondary behaviors such as fillers (ah, um),Uses linguistic secondary behaviors such as fillers (ah, um),

starters (Well, you know) or postponements (delay in sayingstarters (Well, you know) or postponements (delay in sayinga word) to delay stuttering.a word) to delay stuttering.

Desensitizing the ChildDell (2000) suggests:Dell (2000) suggests:•• Clinician should proceed at a slow pace to build trustClinician should proceed at a slow pace to build trust

with the childwith the child•• Direct, gradual, and successful confrontation ofDirect, gradual, and successful confrontation of

stuttering (talking about it, listening to it)stuttering (talking about it, listening to it)•• Putting it back in our mouths (by stuttering easily onPutting it back in our mouths (by stuttering easily on

purpose or by stuttering in a harder way) will allowpurpose or by stuttering in a harder way) will allowthe child to toughen themselves to the experience ofthe child to toughen themselves to the experience oftheir stuttering.their stuttering.

•• The main goal of desensitization therapy is to preventThe main goal of desensitization therapy is to preventthe child from reacting to their stuttering throughthe child from reacting to their stuttering throughavoidance or tension.avoidance or tension.

Activities and Techniques forDesensitization

•• Clinician modeling of stutteringClinician modeling of stutteringbehaviorsbehaviors

•• Clinician modeling of self-correctionsClinician modeling of self-corrections•• Catching stuttering (identifyingCatching stuttering (identifying

stuttering in the clinician and childstuttering in the clinician and child’’ssspeech)speech)

•• Purposeful stutteringPurposeful stuttering•• Contrasting Hard and Easy SpeechContrasting Hard and Easy Speech

Easy Bouncing•• Bouncing is the easy, effortless repetition of wordsBouncing is the easy, effortless repetition of words

and parts of words, (usually 2-3 repetitions perand parts of words, (usually 2-3 repetitions perinstance) which gives the child the experience ofinstance) which gives the child the experience ofcontrolled, tension free stuttering.controlled, tension free stuttering.

•• ““When the child stutters on purpose in an easier way,When the child stutters on purpose in an easier way,they learn that it is possible to have control over it atthey learn that it is possible to have control over it attimestimes”” (Guitar, 1998). (Guitar, 1998).

•• As the child experiences stuttering free of struggleAs the child experiences stuttering free of struggleand tension, their patterns will begin to change toand tension, their patterns will begin to change tobetter, less forced stuttering.better, less forced stuttering.

Pushing On Purpose

•• Negative practice (Van Riper, 1982)Negative practice (Van Riper, 1982)•• Can help reduce or eliminate negativeCan help reduce or eliminate negative

behaviors in the child's speech by increasingbehaviors in the child's speech by increasingthe child's awareness of what they are doingthe child's awareness of what they are doingwhen they stutter.when they stutter.

•• Putting more Putting more ““real-likereal-like”” stuttering back in his stuttering back in hismouth will help the child feel the effectmouth will help the child feel the effectpushing and tensing have on exacerbatingpushing and tensing have on exacerbatingthe severity of his stuttering.the severity of his stuttering.

Modifying Stuttering

•• Variation of real stuttering (Van Riper,Variation of real stuttering (Van Riper,1973; Dell, 1979), such as slowing1973; Dell, 1979), such as slowingdown, easing out of, or changingdown, easing out of, or changingmoments of real stuttering allows themoments of real stuttering allows thechild to experience feelings of increasedchild to experience feelings of increasedcontrol over their speech.control over their speech.

•• Modification procedures work best forModification procedures work best forchildren when they are kept simple.children when they are kept simple.

Modification Techniques

•• VariationVariation–– The child will insert a different behavior, such as aThe child will insert a different behavior, such as a

bounce in place of a blockbounce in place of a block

•• Pull OutPull Out–– The child will hold onto tension, reduce it, andThe child will hold onto tension, reduce it, and

move forward through the wordmove forward through the word

•• CancellationCancellation–– Following a moment of stuttering the child willFollowing a moment of stuttering the child will

immediately say the stuttered word fluentlyimmediately say the stuttered word fluently

Working with Attitudes andEmotions

•• Thoughts on Dairy QueenThoughts on Dairy Queen……....•• Encourage the child to talk about stutteringEncourage the child to talk about stuttering•• Focus of therapy should be on the child firstFocus of therapy should be on the child first•• Empower the child over their stutteringEmpower the child over their stuttering•• Teach the child how to self-advocateTeach the child how to self-advocate•• Pair up with other kids who stutterPair up with other kids who stutter•• www.www.FriendswhostutterFriendswhostutter.org.org

Suggestions for Working onAttitudes and Emotions

•• Speech RingsSpeech Rings•• Pen and Paper TasksPen and Paper Tasks•• DrawingsDrawings•• StoriesStories

Writing IEP GoalsIdentify:Identify:•• Treatment techniqueTreatment technique•• Level of the language hierarchyLevel of the language hierarchy•• Communicative environmentCommunicative environmentSample:Sample:•• Student will use Student will use stuttering modificationstuttering modification

techniquestechniques at the at the multiple sentence levelmultiple sentence levelduring during structured therapy activitiesstructured therapy activities with 90% with 90%accuracy.accuracy.

Mutliple disabilties: When dowe prioritize fluency?

•• ADHDADHD•• Oral MotorOral Motor•• LanguageLanguage•• Phonological/Articulation DisorderPhonological/Articulation Disorder•• AutismAutism

Parent Counseling

•• Educate the parents about stuttering and theEducate the parents about stuttering and thetherapy processtherapy process

•• Deal with guilt, anger, and frustrationDeal with guilt, anger, and frustration•• Encourage open discourse at home aboutEncourage open discourse at home about

stutteringstuttering•• Talk about whatTalk about what’’s s ““rightright”” with the child with the child•• Monitor for increased focus on fluency andMonitor for increased focus on fluency and

use of speech tools at homeuse of speech tools at home

Working with Teachers

•• Educate teachers about stutteringEducate teachers about stuttering•• Provide suggestions for classroomProvide suggestions for classroom

management:management:•• Talk to the child about his stutteringTalk to the child about his stuttering•• ““What can I do to help you in class?What can I do to help you in class?””•• Have the children do choral readingHave the children do choral reading•• Provide opportunities to do oral presentations in privateProvide opportunities to do oral presentations in private•• Manage teasingManage teasing•• Make arrangements to call on the child only if his hand isMake arrangements to call on the child only if his hand is

raisedraised•• Classroom presentations on stutteringClassroom presentations on stuttering

Doing a ClassroomPresentation on Stuttering

•• What is stuttering?What is stuttering?•• Famous people who stutterFamous people who stutter•• What do we do in therapy?What do we do in therapy?•• Teach the children how to stutter on theirTeach the children how to stutter on their

namesnames•• Bring treats!Bring treats!•• Watch Watch ““Stuttering for Kids by KidsStuttering for Kids by Kids”” (SFA) (SFA)•• How the children can be the best listenersHow the children can be the best listeners

•• What should I do about the child whoWhat should I do about the child whodoes not want to be in therapy butdoes not want to be in therapy butneeds to be? Or the child whoseneeds to be? Or the child whoseparents want him to be, but the childparents want him to be, but the childdoesndoesn’’t?t?

Helpful Resources:

•• Stuttering Foundation of AmericaStuttering Foundation of America–– www.www.stutteringhelpstutteringhelp.org.org

•• DVD DVD ““Stuttering for Kids by KidsStuttering for Kids by Kids””•• DVD & Booklet DVD & Booklet ““Stuttering: Straight Talk for TeachersStuttering: Straight Talk for Teachers””•• DVD DVD ““Working with Attitudes and EmotionsWorking with Attitudes and Emotions”” by Kristen by Kristen

ChmelaChmela•• DVD DVD ““Therapy Strategies for School Age Children WhoTherapy Strategies for School Age Children Who

StutterStutter””•• DVD DVD ““Working with Teens Who StutterWorking with Teens Who Stutter””, , ZebrowskiZebrowski•• Workbook Workbook ““Working with Attitudes and EmotionsWorking with Attitudes and Emotions”” by by

Chmela Chmela & Reardon& Reardon•• Booklet Booklet ““Trouble at RecessTrouble at Recess””

Resources:

•• ““Treating the School Age Treating the School Age StuttererStutterer””•• Carl Dell, 2000, Stuttering FoundationCarl Dell, 2000, Stuttering Foundation

•• ““Focus on FluencyFocus on Fluency””•• Kristen Kristen ChmelaChmela, 2004, Super Duper, 2004, Super Duper

•• ““Fun with FluencyFun with Fluency””•• Walton & Wallace, 1998, Pro-EdWalton & Wallace, 1998, Pro-Ed

•• ““Fun with Fluency for the School-Age ChildFun with Fluency for the School-Age Child””•• Walton, 2013, Pro-EdWalton, 2013, Pro-Ed

Specialty Board on FluencyDisorders

•• Pilot Program in Colorado to findPilot Program in Colorado to findinterested school based interested school based SLPSLP’’s s totofunction as the function as the ““fluency specialistfluency specialist”” in intheir districts.their districts.

•• Training and support will be providedTraining and support will be provided•• Contact Patty @ paw7757@aol.comContact Patty @ paw7757@aol.com

References

•• American Speech-Language-Hearing Association, (1995). Guidelines for practice in stuttering treatment.American Speech-Language-Hearing Association, (1995). Guidelines for practice in stuttering treatment.ASHAASHA, 37(Suppl.14), 26-35., 37(Suppl.14), 26-35.

•• Bennett, E.M. (2006). Bennett, E.M. (2006). Working with people who stutter: A lifespan approach. Working with people who stutter: A lifespan approach. Upper Saddle River, NJ:Upper Saddle River, NJ:Pearson.Pearson.

•• ChmelaChmela, K. (2006). , K. (2006). Focus on fluencyFocus on fluency. Greenville, SC: Super Duper Publications.. Greenville, SC: Super Duper Publications.•• ChmelaChmela, K., & Reardon, N. (2001). , K., & Reardon, N. (2001). The school-age child who stutters: Working effectively with attitudesThe school-age child who stutters: Working effectively with attitudes

and emotions. and emotions. Memphis, TN: Stuttering Foundation of America.Memphis, TN: Stuttering Foundation of America.•• ContureConture, E.G. (1991). Young stutterers, E.G. (1991). Young stutterers’’ speech production: A critical review. In H. F. M. Peters, W. speech production: A critical review. In H. F. M. Peters, W. HulstiijnHulstiijn

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