I have been getting a lot of questions from SLPs and parents that all seem to center around the question "Is this stuttering" or "Does this warrant speech services?"  


Question:  
I am a school based SLP. I just screened a 7 year old girl. Her teacher was concerned that she might be stuttering. She is repeating whole words and phrases quite often. She also used some interjections such as "um". Her teacher has never heard her repeat or prolong sounds. Is this really considered stuttering if a child is only repeating words and phrases? I have been looking on the internet, but most children either repeat syllables or sounds as well as words or else they don't repeat whole words as often as this student. 

I was interviewing for assistant positions at our summer speech and language camp when I first met Ben Goldstein.  Ben is a graduate of the University of Maryland and was in the midst of taking his pre-requisite courses in order to apply for graduate school to become a speech pathologist.  Ben also happened to be a person who stutters (PWS).    As the interview continued he shared that he was introduced to Avoidance Reduction Therapy by Vivian Sisskin at the College Park campus of UMD.  I had already been applying aspects of Avoidance Reduction therapy with my clients,  however Ben helped solidify my feelings on this approach.  Ben was kind enough to answer some questions and walk me through his experience with Avoidance Reduction therapy, which is included below.  

Avoidance Reduction therapy is an approach to stuttering therapy that can be used with both school-aged and adult clients.  This approach views stuttering as an approach-avoidance conflict; a theory that states that a PWS experiences the desire to speak and interact with others while simultaneously experiencing an urge to hide their stuttering.   The result of these competing desires culminates in the maladaptive secondary behaviors that interfere with communication (ex. eye blinking, leaning forward, use of fillers, etc.).  These competing desires also result in a feeling that one can not partake in certain activities and situations due to their speech.  

Avoidance Reduction therapy works towards reducing these maladaptive behaviors, leaving in its place a more comfortable, forward moving form of stuttering.  It also works towards reducing the handicap of stuttering, whereby increasing a person's willingness to participate in various activities and situations, whether or not they show some stuttering.   Unlike other approaches that focus on fluency, this particular approach views a person's strong desire to be fluent as perpetuating the problem and ultimately what contributes to their word and situational avoidances, as well as much of the struggle behaviors you see in their speech.  Avoidance Reduction therapy does not put an emphasis on fluency, but rather on improving a person's ability to successfully communicate in the "real" world.   

How do you incorporate Avoidance Reduction therapy into your sessions?  Start by helping your client to identify their own stuttering patterns and assist them in recognizing how much of their pattern is "true" stuttering and how much of what we see is actually habits they formed in an attempt to mask stuttering.   Challenge clients to allow themselves to show true stuttering (or perhaps use voluntary stuttering), beginning in the safety of the therapy room and eventually branching out to different "real-life" situations.  As you work through these challenges, clients will often discover ways in which their stuttering was holding them back that they may not have realized before.    Read on to learn about Ben Goldstein's first-hand experience with Avoidance Reduction therapy.  

"Trick" is defined by the Merriam-Webster Dictionary as "a crafty procedure or practice meant to deceive or defraud."  So it makes sense why speech pathologists have used the word "tricks"  (AKA secondary behaviors) to describe the behaviors a person who stutters (PWS) uses to avoid, hide or get out of a moment of stuttering.  The clip above is an interview with the actor, Samuel L. Jackson, as he discusses one of his "tricks" as a child to hide his stuttering.  Some common tricks I see amongst my clients are eye blinks, tensing up the face or mouth, pretending to think, yawning, and using a silly voice. It is very important not to confuse "tricks" with strategies (i.e. easy speech, cancellations, etc.)  Strategies are voluntary and intentional changes made to one's speech that work to assist a PWS in creating more forward-moving speech and reducing the frequency and severity of disfluencies.  "Tricks" may initially disguise themselves as helpful strategies, but with time, PWS learn that the very behavior that initially helped them, may actually be causing more harm then good!  Let's walk you through how "tricks" begin and where they go wrong! 

For the sake of example, let's use the behavior of eye blinks.  

Whether or not you are a person who stutters, making and receiving telephone calls can be a source of anxiety.  Whoever invented text messages definitely had people who stutter in mind.  However, has text messages and social media sites helped us communicate more effortlessly, or have they created a way to put off the inevitable and therefore build up more tension around the idea of using the phone?

It's time to look Alexander Graham Bell in the eye (well, figuratively), and pick up that phone. 

1.  Practice, practice, practice!  Call restaurants and ask them their hours.  Call retail stores and ask them if they have a particular thing in stock.  Call when you know someone you're comfortable with is not available so you can practice leaving voicemails.  Call numbers that have voice activated systems and don't cheat and use the keypad option!  The more you practice for the sake of practicing, the less stressful it will be when you actually have to make a phone call because you will know what to expect.