Treatment Strategies for 5-8 Year Old Children Who Stutter

Treatment Strategiesfor 5-8 Year OldChildren Who Stutter J. Scott Yaruss, Ph.D., CCC-SLP Stuttering Center of Western Pennsylvania University of Pittsburgh Presentation to Allegheny Intermediate UnitSeptember 24, 1999

Last time, we discussedthe complexity of thestuttering disorder Stuttering is a multifaceted disorder, involving more than just the production of speech disfluencies

Since stuttering is a multifaceted disorder, treatment strategiesmust also be multifaceted

Recall also that stuttering can be very stubborn… Some children recoveron their own, but not all...

Purpose • To discuss strategies for treating stuttering in 5- to 8-year-old children • In this age range, children are transitioning from “beginning” to “intermediate” stuttering…it is less likely that they will recover completely • As the nature of stuttering changes, the goals and strategies for treatment must also change • To practice techniques for working on both children’s fluency and their stuttering

Stuttering Treatment Overview: Preschool Children • For preschool children (less than 5 or 6), the goal of treatment is to improve their fluency • Help parents and teachers provide afluency-facilitating environment • Help the child develop normal speech fluencyby changing the child’s speech patterns • Help maintain healthy, appropriate attitudestoward communication and speaking

Stuttering Treatment Overview: School-Age Children • For school-age children, the goal of treatment expands to address both fluency AND stuttering • Working on fluency: help children learn to speak more fluently so they stutter less often • Working on stuttering: help children manage stuttering so it does not affect communication • The goal is for children to be able to say what they want, when they want, to whom they want • Fluency criteria are irrelevant. Communication matters

Working on Fluency • Most techniques for improving fluency focus on changing timing or tension Timing Tension Reducing Speaking RateIncreasing Pause Time Easier Beginnings Easier Beginnings,“Easing In” Cancellation, Pull-out

Changing Timing: Speaking Rate • One of the most common techniques for helping preschoolers speak more fluently is to help them slow their speaking rate • This technique becomes LESS usefulas children grow older • Use it sparingly and realistically • Make sure speech sounds natural

Changing Timing: Rate and Pausing • Guidelines for slowing speaking rate • Use natural intonation and rhythm • Do not use “choppy” or “robot” speech or s t r e t c h out words • Practice using slow rate before you attempt it — get a feel for too slow and not slow enough • Can be incorporated into all activities as a model • A more natural way of slowing down is increasing pause time-- the lengthof time between words and phrases

Exercise: Speaking Rate 1) Read the passage in your handout to your partner at a normal rate 2) Re-read the passage using a slower rate • Try slowing down by stretching out the sounds, then try slowing down by using pauses • Which one sounds more natural? 3) Re-read the passage going VERYslowly 4) Finally, return to the rate you used in #2. How does it sound now?

Reading Passage Once upon a time, there was a young boy whose name was Joe. Joe liked to play with his friends in the sandbox. One day, Joe lost his shoes in the sandbox. He looked and he looked and he looked, but he could not find them. Later that day, Joe found out that one of his friends had hidden his shoes as a joke. Joe was relieved to find his shoes, and he had a good laugh about the practical joke. Joe was a good sport.

Changing Timing AND Tension • Easier Beginnings: Reduce speaking rate and physical tension at the beginning of phrases • Use phrasingand pausing to give multiple opportunities to reduce the physical tension • Focus on naturalness throughout the phrase -- only the beginning of the phrase is modified • Requires lots of practice • Can also be used when a speaker knows he is about to stutter (“easing in”)

Exercise: Easier Beginnings 1) Notice that the second passage in your handout can be easily divided into phrases. 2) Read the passage, using an easier beginningat the beginning of each phrase • Be sure to change both the timing and tension of your speech at the beginning of phrases • Make sure the rest of the phrase sounds natural • What else changed about your speech when you used the easier beginnings?

Reading Passage Once upon a time // there was a young boy // whose name was Joe // Joe liked to play // with his friends // in the sandbox. One day // Joe lost his shoes // in the sandbox. He looked // and he looked // and he looked // but he could not find them // Later that day // Joe found out // that one of his friends // had hidden his shoes // as a joke // Joe was relieved // to find his shoes // and he had a good laugh // about the practical joke // Joe was a good sport.

Working on Stuttering • If we work on fluency, the child will become more fluent (particularly in therapy). BUT, no fluency technique is perfect...the child will still stutter sometimes. • If children avoid stuttering, or only use fluency techniques, they will be in bigger trouble when they do actually stutter in the real world • In order to more directly address stuttering, we also have to help children become more comfortable with the stuttering

Staying in the Block • The goal is to help children change their stuttering so it doesn’t affect communication • First, help them learn what they do when they stutter by staying inand exploring blocks • What are their “speech actors” or “speech helpers” doing during stuttering? • How can they move their speech actors differently to change the stuttering? • In addition to helping children learn about stuttering, this also helps to desensitize them

Exercise: Learning about Stuttering 1) Turn to your partner and pretend to stutter. • Try to mimic the stuttering that one of your young students might produce • What kind of affective, behavioral, or cognitive reactions do you have during this exercise? • This type of exercise is a good way to help your student (and you) overcome these negative reactions 2) Explore what muscles are involved and how they are involved in the physical tension during your pretend stuttering

Don’t just tell… ...EXPLORE

Reduce Tension with Negative Practice • The tension that occurs during stuttering is a learned reaction (an attempt to not stutter). • Over time, it becomes automatic and involuntary • Therefore, children require PRACTICE to learn how to reduce this tension • The negative practiceexercise can help • Pretend to stutter with lots of physical tension, then repeated the stuttering with reduced tension The goal is to learn to control and modify tension

Exercise: Negative Practice 1) First, pretend to stutter on the word “go” • Try to make the stuttering realistic -- try to stutter the same way your student does • Also try varying your stuttering so it does not become stereotyped 2) Next, repeat the word with roughly half the physical tension (don’t just repeat it fluently) 3) Finally, cut the tension in half again • Don’t just say it fluently...Modify the tension

Easy Stuttering • Children can also learn “easy stuttering” • Easy repetitions (real or voluntary) that reduce the tension in their speech musculature • This helps them learn that they can have control over their stuttering • Voluntary stuttering reduces children’s tendency to try to “pass themselves off” as fluent speakers • The more people who stutter try to be fluent, themore likely they are to experience increased stuttering • If children are comfortable with their their stuttering, they can use voluntary stuttering to release tension in the middle of a conversation and prevent big blocks.

Exercise: Easy Stuttering 1) Read the passage to your partner usingeasy voluntary stuttering 2) Try to use both repetitions and prolongations 3) Again, evaluate your affective, behavioral, and cognitive reactions. • You and your students should be able to use easy stuttering without any negative reactions • If your students still feel negative reactions, they need more practice (and so do you)

Working onFluency AND Stuttering • Cancellation:Replace stuttered speech with more “fluent” (controlled) speech • After stuttering, repeat the stuttered phrase using less physically tense speech • The repeated speech should not simply be repeated -- the point is to change the tension • Pull-out:Reduce tension during stuttering to be able to continue speaking more fluently

Exercise: Cancellation • To practice cancellation, you will need to use some pseudostuttering (so you have some tension to modify) 1) Pretend to stutter in conversation or reading 2) Repeat the stuttered phrase using modifiedphysical tension (not completely fluent) • Don’t rush through it Cancellation helps with tension and desensitization

Planning Therapy • For most children, I begin with strategies designed to address stuttering • If we work on fluency, they are more likely to become “too” fluent in the treatment room • Then, we have no stuttering left to work on • And, we have trouble with transfer • After the child can modify stuttering events,I introduce the fluency techniques • I typically start with techniques for reducing tension so we don’t over-emphasize fluency

Summary • As children move from beginning to intermediate stuttering, treatment strategies also need to change to address both fluency and stuttering • Neither strategy can succeed alone, but together, they can be very helpful for 5- to 8-year-old children! • Strategies for changing fluency attempt to reduce speaking rate and physical tension during fluent speech • Strategies for changing stuttering attempt to reduce physical tension during blocks and improve children’s control over speech

Questions? Comments?Please contact me! J. Scott Yaruss, Ph.D., CCC-SLP Stuttering Center of Western PA University of Pittsburgh 4033 Forbes Tower Pittsburgh, PA 15260 Phone: (412) 647-1367 Fax: (412) 647-1370 Email: jsyaruss@csd.upmc.edu

Mission of the Stuttering Center • Provide effective client-centered treatment for individuals who stutter • Conduct meaningful research on the nature and treatment of stuttering • Provide on-going education for student clinicians as well as practicing SLPs • Provide support for individuals who stutter, their families, and their clinicians

Treatment Strategies for 5-8 Year Old Children Who Stutter