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. 

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).  

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/.  

When a child who stutters is demonstrating the ability to make changes to their speech in the therapy room, it seems obvious that they’d want to use the same strategies to improve their speech outside of the therapy room as well.  Children, especially teenagers, rarely want to stand out in a way that can stigmatize them, provoke questions or increase the chances of teasing.   The question then arises, “Why aren’t they using their tools?!”

Speech and stuttering modification techniques are often learned quickly and easily within the therapy setting.  However, speech/language pathologists and parents often feel discouraged when knowledge of these techniques seem to disappear as fast as it takes for the child to get to their car in the clinic’s parking lot.  Is it laziness on the part of the child?  Is it the fault of the family for not following through with home assignments?  Is the speech/language pathologist not teaching the correct strategies?  Instead of pointing fingers at each other, let’s uncover why speech/stuttering strategies can be difficult and determine how we can best navigate these challenges. 

If you had a chance to go back in time, would you do things differently?  Is there advice you might give your younger self, knowing what you know now? Why not put it in writing?  Simon Walsh, a person who stutters and the host of the blog "Diary of a Stutterer", did just that. After reading his post, I immediately knew I wanted to use this idea in my own therapy room.  The purpose of this assignment is not to dwell on "mistakes" of the past, but rather to help identify all the positive changes that have been made.  This is a fun way to get students talking about the consequences of previous unhelpful thoughts or habits so that if they were to reappear, which habits so often do, the student might be better equipped to identify and extinguish them.  For younger students and students that are new to therapy, this assignment can be adapted by having them write a letter to their future self. Instead of focusing on how things have changed and what they have learned, instead this assignment allows students to ask questions they may have about stuttering and identify things that they want to change. 

This is one of my favorite therapy activities!  With permission from the student, I have posted an example of one of these letters.  Do you have any similar activities you have done with your student, your child or something you did for yourself?  Post below!