By Brooke Leiman, Katie Gore & Rita Thurman
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Dealing with fluency issues can be confusing and frustrating for the client and family. Navigating health insurance reimbursement for stuttering treatment can also present challenges for them. In our extensive work with clients who stutter, we’ve learned several tips for getting treatment covered—either initially or through an appeal if the insurance company denies coverage.
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Ease your clients’ and your own anxiety by learning how to navigate through (or around) these four common insurance roadblocks.

By Alex Whelan 
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Back to school season fills children with a mixture of excitement and anxiety. They may feel eager to reunite with friends, participate in clubs, sports or other extracurricular activities, and to continue learning (even if they refuse to admit it!) On the flip side, they might be nervous about making new friends, getting accepted socially by peers, and if new teachers will be nice or mean. As children get a bit older, they might also worry about achieving good grades.

Inevitably, the first day of school arrives. Take a minute and try to put yourself in the shoes of a 4th grader on the morning of that first day:

In an effort to help everyone get to know each another, your teacher decides to go around the room for everybody to introduce themselves and share a fun summer break story. The anxiety builds as your turn approaches. “Hi, I’m…”, but to your dismay, your name doesn’t readily come out. You try starting with a different phrase, “My name is…”, again, nothing. You want so badly to say your name, a seemingly rudimentary task, but you are a child who stutters and your name happens to be one of the most difficult things for you to say. Finally, your name comes out after what seems like an eternity. How will your friends react to what they just heard? Will this set the tone for how you choose to participate for the rest of the year?

As speech-language pathologists, we can offer a child who stutters and their family several tools to help them minimize the negative impact of stuttering and develop healthy communication attitudes. This often starts with education and advocacy. For young children, the parents might take on much of the educating and advocating, while also exposing their child to useful approaches to help school staff “get it.” However, as they get older, parents can gradually relinquish this role to their child.

The following examples offer our students or clients who stutter ways to take an active role in creating a safe and nurturing environment within their school. I always share or remind students or their parents of these tips around this time of year:

By Jessica Safer MS, CCC-SLP 
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As children grow and develop language, many may display “typical disfluencies” in their speech. These disfluencies are natural as the young child’s language is emerging, and his or her speech system is working hard to put together new words in a variety of ways. 
 
Typical disfluencies occur between the ages of 2 ½ and 5. They can include:

• Multisyllabic whole word repetitions (e.g.  “Gimmie gimmie the cookie”)
• Interjections (e.g. “I um, went to the kitchen”)
• Phrase repetitions (e.g. “I want I want I want a cookie”)
• Phrase revisions or abandoned utterances (“I want.. Can I have a cookie?”)

 
Typical disfluencies are common among young children and are not cause for concern.
 
The disfluencies characteristic of Childhood Onset Stuttering are different than typical disfluencies.
Some examples of the disfluencies seen in Childhood Onset Stuttering include:

Stuttering is a fluency disorder that is defined as a disruption in the forward flow of speech. It is commonly characterized by repetitions (ex. ba-ba-baseball), sound prolongations (ex. mmmommy), or blocks (i.e. no sound). Disfluencies may also be accompanied by negative thoughts and feelings about stuttering, avoidance of sounds, words or situations and physical tension or struggle behaviors (ex. eye blinking, lip tension, head nodding, etc.). Stuttering is NOT an emotional disorder, but stuttering can certainly have an emotional impact. As children get older, they may develop “tricks” for hiding their stuttering by swapping out words or planning and rehearsing what they are going to say before speaking. Other children may avoid speaking in certain situations altogether. These “tricks” may make it look like the child is stuttering less or has eliminated stuttering altogether, however this fluency comes at a significant cost to their emotional and social wellbeing as well as their ability to thrive in an educational setting. There are many young children who demonstrate disfluencies in their speech as they go through the natural process of developing language, however these disfluencies look and sound different than stuttering. Consult a speech/language pathologist if you are unsure if what you’re seeing is “true stuttering.” If a differential diagnosis is made early on, the family can make use of the critical window of time that therapy is most effective.

HOW CAN TEACHERS HELP?

• Saying things like “slow down”, “think about what you want to say” or “take a deep breath” may help fluent speakers when they are stumbling on their words. However, children who stutter are disfluent for different reasons and these remarks often add more pressure and thus trigger more disfluencies. Instead slow your own rate of speech by adding pauses within your sentences at natural breaks, between your sentences and after the student finishes their thought to reduce pressure. 

The following are tips for enhancing your child’s fluency and promoting healthy communication attitudes and enjoyment for speaking:

• Reduce the overall pace of your interaction with your child.  Do this by slowing your rate of speech and adding pauses within your sentences at natural breaks within a sentence, between your sentences and after your child finishes their thought.  

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• Follow your child’s lead in play in order to match the pace of their interaction, reduce language demands and promote creativity and development of problem-solving skills.

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In 1988 Ronald Reagan declared the 2nd week of May as National Stuttering Awareness Week (NSAW)- a week dedicated to educating our communities about stuttering and its impact on peoples' lives.  Members of the National Stuttering Association (NSA) played a huge role in establishing this week so what better way to celebrate it than to hear from current NSA members? The following excerpts come from the social media accounts of 4 NSA members (with permission).  

Speech Pathology Australia (SPA), Australia's professional organization for speech-language pathologists (SLPs), recently submitted a proposal that suggests that SLPs working in clinics run by the Australian government must be trained in the Lidcombe Program in order to treat pre-school aged children who stutter.  SPA is also supporting legislation that would extend this mandate to private practitioners and require them to provide the Lidcombe Program in order to be reimbursed by Medicare.  Although the SPA’s intentions may be to increase access to treatment for young children who stutter, we must not overlook the ramifications of having the government and private insurance companies intervene with clinical decision-making.  

The first thing to consider is that there are multiple factors that are known to contribute to the onset of stuttering.  Each child has a unique set of abilities and vulnerabilities that determine if and how stuttering is going to persist. Those different circumstances demand different approaches to treatment.  A speech pathologist cannot be expected to develop a treatment plan that is specifically tailored to the client when the SPA is using Medicare reimbursement to limit them to one approach. Speech pathologists could be faced with the unfortunate dilemma of deciding whether to use an approach that best fits the child and families’ needs or to use the approach that will get reimbursed. 

Question: Do you have a sequence in which you like to introduce techniques to students who stutter?  

I do not believe there is a "right" sequence. Each child and family experiences stuttering in a different way due to their temperament, home environment, communities, etc. and their treatment plan has to reflect that.  However for new clinicians or clinicians who have little experience with treating a child who stutters, it is understandable that you may want a blueprint of what therapy should look like. 

There are more than 3 million people in the United States who stutter. Pediatricians and teachers are often the first professionals that a parent will go to for advice. In order to determine when to refer to a speech/language pathologist, these professionals are faced with the challenge of differentiating between typical disfluencies and true stuttering.

Research suggests that anywhere between 75 to 80 percent of children who go through a period of disfluency will outgrow stuttering. This statistic can often lead teachers and pediatricians to suggest that the family “wait and see” before consulting a speech/language pathologist.

However, one must also consider the risk of missing a critical window in which treatment is optimal. Early intervention plays a vital role in reducing the likelihood that a child will continue to stutter and can minimize the impact of stuttering on a child’s life--both socially and academically. There are certain risk factors that professionals, as well as families, should consider when deciding what’s best for the child.

Read the rest of this article at:  www.expertbeacon.com

Very excited to be helping to facilitate a FRIENDS workshop on March 28, 2015 in Washington, D.C.  There will be sessions for children, teens, siblings, parents and speech-language pathologists .  You can learn more about this wonderful organization by visiting their website at http://www.friendswhostutter.org/.