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. 

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. 

Much like, cancellations and pull-outs, a prep set is a speech tool I use with clients as they gain the ability to monitor their speech.  Prep sets help a person who stutters (PWS) make changes to their speech so that their speech can be more forward-moving and so that they can stutter more comfortably.   Once a client demonstrates the ability to use cancellations and pullouts, I will introduce the idea of prep sets.  

Above is a video created by Pamela Mertz, a person who stutters and the host of the website, www.stutterrockstar.com/.   In this video, she articulately describes and provides examples of voluntary stuttering (stuttering on purpose). 

There are three main rationales for using voluntary stuttering.  

1.  To desensitize, or get used to, a moment of disfluency.  
When a person stutters, they often have an immediate and sometimes negative reaction to the moment of disfluency.   This reaction may manifest as eye blinks, head nods, tension in the lips, tongue or cheeks, lip smacking, irregular breathing etc.   Voluntary stuttering can help a person work towards reducing that reaction and tension, leaving a more comfortable form of stuttering.  A person may also choose to purposefully use “hard” stuttering to reduce their reaction to moments of tense disfluency.   

A pull-out is a speech tool I use with clients as they gain the ability to monitor and change their stuttering.   Once a client demonstrates the ability to use cancellations, I will introduce the idea of pull-outs.  It is important to note that a person does not "graduate" from using cancellations to pull-outs, but will rather integrate the two strategies.  A person will call upon one tool over the other depending on how quickly they "catch" a particular disfluency.   

WHAT IS A PULL-OUT? 

• A speech tool used in the moment of a disfluency
• This strategy is considered a "stuttering modification" tool.  
• It requires you to catch a word that you are stuttering on and slide/stretch out of it (AKA “get on the sound”).

WHAT IS EASY BOUNCING? 
WHY DOES IT WORK? 
WHAT DOES IT SOUND LIKE?

Although we all look forward to the summer, June through August can bring with it some changes that impact the fluency of a person who stutters.  Changes in routine,  taking a prolonged break from speech therapy, and the stresses of a new environment and people (such as a new summer camp group) can act as triggers.   However, these "changes" are learning experiences (both for the child who stutters and their parent) in how to cope with both easy and hard speech days!  

Don't shy away from these new experiences, just go into them prepared!  

Below is an example of an assignment I give to clients who are taking a break from speech therapy over the summer months.  Going into each week with a speech challenge, no matter how small it may seem, is essential to easing into the changes of summer and maintaining good speech habits!  I usually encourage students to email me each week with a speech update and in doing so they begin to take ownership of their speech work.  Even if you're not a student of mine, go ahead, email me how you're doing each week!

This is a speech tool I use with clients as they begin to gain the ability to monitor their own speech.   Every child reaches this point at a different time, but I find that this often begins to happen around 7-8 years of age.  Instead of modifying every phrase/sentence (as seen in Easy Speech), cancellations are only modifying speech that is disfluent.  

WHAT ARE CANCELLATIONS?

• Classified as a stuttering modification strategy
• Used after a disfluency occurs 
• Produces a less tense and more "forward-moving" disfluency 
• Requires you to pause following a moment of disfluency
• In the time that you pause, you can identify where the tension occurs (i.e. mouth, tongue, jaw, etc.) and work on releasing it
• Requires you to initiate speech again in a more forward-moving way (i.e. may use light contact or a stretch when initiating speech again after the pause, if necessary).  

Easy Speech (aka Turtle Talk or Stretching) is a technique I use with pre-school and early elementary children who do not yet have the awareness or control to use techniques specifically on disfluent words.  Easy Speech can be shaped into more advanced techniques such as a cancellation or pull-outs.    

WHAT IS EASY SPEECH? 

• A slight prolongation or stretch of a sound into the next sound 
  
• Used on the initial sound of the first word of a sentence or phrase, not necessarily on a disfluent word.