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).  

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!  

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.  

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.  

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! 

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.   

I recently came across an article written in the NY Times about a student, Philip Garber Jr., and his experience with a particular college professor at the County College of Morris.  The article, Professor's Response to a Stutterer-Dont Speak, highlights how Garber was asked to hold questions for the beginning and end of class so he "does not infringe on other students' time."   He was also asked to respond to questions on paper, rather than raise his hand like the rest of the students.  He advocated for himself to the dean and was transferred to another class, where he is now able to speak freely. 

Although this is quite an extreme situation and there are many wonderful teachers that are very sensitive to the needs of students who stutter, this article still brings up the importance of educating teachers on stuttering.  Like parents, teachers are often trying their very best, but quite simply may not be aware that some things they are saying or doing are, in fact, not helping at all. 

Here are some tips for teachers: 

In the 1930's, Dr. Wendell Johnson decided to create an experiment to test out his theory that stuttering is a learned behavior and occurs as a result of a child being told that they stutter.
Johnson was quoted to have said that stuttering ''begins not in the child's mouth but in the parent's ear.''  His research assistant, Mary Tudor, went on to take a group of children who stutter and a group of children that were fluent and separate them into groups to determine if children who were fluent would begin stuttering if they were told they stuttered and if children who stuttered would stop stuttering if they were treated as a fluent child.  Some of the children (both fluent and disfluent children) received praise in regards to their speech and some were provided harsh criticism to include statements such as "Don't ever speak unless you can do it right."  The results of the study indicated that the children (both fluent and nonfluent) receiving harsh criticism demonstrated reduced speech, shorter utterances and negative feelings about speaking.  However, in my opinion, this did nothing to prove that stuttering is caused by telling a child that they stutter, rather demonstrated how verbal abuse can result in social anxiety! The study was never published and later dubbed "The Monster Study" due to how unethical it was. (Reynolds, 2003)  Unfortunately, remnants of Johnson's theory still remain and many parents worry about the possible negative effects of drawing attention to their child's stuttering.  

Not only do I disagree with Johnson's premise that labeling a child's speech as disfluent could induce stuttering, I venture to say that NOT labeling it and ignoring a child's disfluencies can potentially be harmful.