Both parents and speech therapists alike find themselves struggling to decide when therapy is complete for someone who stutters. Therapy for a child who has difficulty saying their "r"s has a distinct beginning and end (i.e. when a child meets criterion for 90% accuracy in conversation), however, stuttering is much more variable, by nature. In fact, once a child reaches the age of 8, it is much more likely that their stuttering is going to persist, in some form. Does this mean that therapy will continue forever?? The idea of therapy continuing indefinitely is daunting to both the therapist who has to continue to think of new and exciting activities and the parent who has to both make room in their schedule and in their budget!
Preschool aged children:
Many children go through a period of "temporary" disfluency as they begin to place more demands on their language system. Preschool-aged children often have not developed the negative reactions to disfluencies that play a role in persistent stuttering that we see in older children and adults. As a result, for a chid this age, it makes sense for a therapist (and parent) to aim to eliminate stuttering. I believe that a period of stutter-free speech is necessary to warrant dismissal from therapy for a young child (minimal "typical" disfluencies such as phrase repetitions or sentence revisions may persist). Following a month (or more) of stutter-free speech, therapy should be slowly faded, going from weekly visits to monthly visits and finally entering into a monitoring period. This is a period where parents should keep in touch with their therapist to discuss how their child is doing at home and school. I think it is important to educate parents that stuttering is highly variable and that if a child does not stutter for weeks or even months, the parents should still continue to follow the program the therapist has set up for them and monitor changes in fluency so that they can quickly address a "reoccurance", should it occur.
School- aged children/adolescents:
As a child enters school and begins to demonstrate a more complex stuttering pattern, total elimination of stuttering may not be a realistic goal. Instead, it is more reasonable for a child this age to have a goal of improving their communication skills to include more forward-moving speech, although maybe not completely stutter-free. In addition a goal should be put in place to reduce the negative impact of stuttering on the child's academic and social life. With these types of goals, it is much harder for a parent or therapist to assess when a child meets criterion for discharge from therapy. A child should not be discharged unless a therapist determines that stuttering is no longer having a negative impact on how the child is participating in activities, interacting with others and communicating messages. Benchmarks for success can not be solely based on frequency of stuttering, as a child who stutters on 50% of their syllables may be less impacted by their speech than a child who only stutters on 10% of syllables. The amount of impact is largely dependent on the severity of disfluencies (i.e. blocks vs whole word repetitions), length of disfluencies (i.e. fleeting vs 5 seconds), degree of secondary behaviors (i.e. eye blinks, tension in lips, loss of eye contact), and child's temperament. Even a child who is not demonstrating any obvious disfluencies may be in great need of intervention. It takes a carefully observant therapist and parent to detect if the child that is seemingly fluent is actually masking disfluencies by avoiding words or situations. I suggest that therapy for school-aged children who stutter be ongoing and, at the very least, be on a consult basis. A child may comfortably get through 5th grade, with stuttering having relatively little impact on them, however, that same child may begin 6th grade, in a new school, and suddenly stuttering may play a very different role in their daily life. Having a speech therapist monitoring your child will allow for you to quickly catch any changes that may warrant more direct and intensive therapy.
Adults
With maturity, the adult can decide for themselves if they are going through a period of time that speech has become a priority for them (i.e. when interviewing for a job, gaining a new responsibility at work that involves speaking, dating, relocating, etc.)
Still have questions/concerns about length and duration of therapy? Comment below!
This article was also featured on the American Speech Language and Hearing Association's blog, ASHAsphere.
Many children go through a period of "temporary" disfluency as they begin to place more demands on their language system. Preschool-aged children often have not developed the negative reactions to disfluencies that play a role in persistent stuttering that we see in older children and adults. As a result, for a chid this age, it makes sense for a therapist (and parent) to aim to eliminate stuttering. I believe that a period of stutter-free speech is necessary to warrant dismissal from therapy for a young child (minimal "typical" disfluencies such as phrase repetitions or sentence revisions may persist). Following a month (or more) of stutter-free speech, therapy should be slowly faded, going from weekly visits to monthly visits and finally entering into a monitoring period. This is a period where parents should keep in touch with their therapist to discuss how their child is doing at home and school. I think it is important to educate parents that stuttering is highly variable and that if a child does not stutter for weeks or even months, the parents should still continue to follow the program the therapist has set up for them and monitor changes in fluency so that they can quickly address a "reoccurance", should it occur.
School- aged children/adolescents:
As a child enters school and begins to demonstrate a more complex stuttering pattern, total elimination of stuttering may not be a realistic goal. Instead, it is more reasonable for a child this age to have a goal of improving their communication skills to include more forward-moving speech, although maybe not completely stutter-free. In addition a goal should be put in place to reduce the negative impact of stuttering on the child's academic and social life. With these types of goals, it is much harder for a parent or therapist to assess when a child meets criterion for discharge from therapy. A child should not be discharged unless a therapist determines that stuttering is no longer having a negative impact on how the child is participating in activities, interacting with others and communicating messages. Benchmarks for success can not be solely based on frequency of stuttering, as a child who stutters on 50% of their syllables may be less impacted by their speech than a child who only stutters on 10% of syllables. The amount of impact is largely dependent on the severity of disfluencies (i.e. blocks vs whole word repetitions), length of disfluencies (i.e. fleeting vs 5 seconds), degree of secondary behaviors (i.e. eye blinks, tension in lips, loss of eye contact), and child's temperament. Even a child who is not demonstrating any obvious disfluencies may be in great need of intervention. It takes a carefully observant therapist and parent to detect if the child that is seemingly fluent is actually masking disfluencies by avoiding words or situations. I suggest that therapy for school-aged children who stutter be ongoing and, at the very least, be on a consult basis. A child may comfortably get through 5th grade, with stuttering having relatively little impact on them, however, that same child may begin 6th grade, in a new school, and suddenly stuttering may play a very different role in their daily life. Having a speech therapist monitoring your child will allow for you to quickly catch any changes that may warrant more direct and intensive therapy.
Adults
With maturity, the adult can decide for themselves if they are going through a period of time that speech has become a priority for them (i.e. when interviewing for a job, gaining a new responsibility at work that involves speaking, dating, relocating, etc.)
Still have questions/concerns about length and duration of therapy? Comment below!
This article was also featured on the American Speech Language and Hearing Association's blog, ASHAsphere.
