Earlier this year, I met Judy Kuster at a conference, and was asked to write a summary of my group treatment programs for Kids who Stutter. It is such a privilege to work with these children, and I continually change and hopefully improve on the services. In this article, I discuss the After-School Fluency Group and the Summer Fluency Camp programs. I welcome questions, comments, and suggestions.
AFTER SCHOOL PROGRAM
At University of Memphis, we operate an after-school program every Wednesday. This program has served an average of 6 children at a time ages eight to 14 years. Graduate assistants create the lessons and activities, and provide one on one coaching during the sessions. The graduate assistants also participate in every activity along with the kids. The grad assistants develop speech goals, self-evaluate, and receive feedback from the group. As the supervisor, I "direct" the activities and provide a model for facilitation of each childs particular goal. Sometimes I can supervise with a very "hands-off" approach, other times I provide more direct assistance.
A typical session consists of a snack, a sharing or creating activity, and one or two talking activities of various levels of complexity. Here, I will describe several observations that create the backbone of our session planning.
Children can be in charge of their speech therapy. By watching other children and viewing/listening to themselves on video/audio, they learn what aspects of their speech they would like to change. Through the therapy process, they learn how to change. Every session includes a time for the child to state goals, and they also write and illustrate their goals. Initially, most children need guidance and suggestions, but eventually they come in to the sessions with an "agenda" of their own.
Children can determine how they want to give and receive feedback. We continually encourage the children to give each other feedback, particularly positive feedback. Each group member gets to determine what type of feedback they want, such as gestural, verbal, or written. The graduate assistants and I model the use of feedback, making statements such as "I really noticed John using his slower speech rate", and giving thumbs up or other pre-determined gestures. Eventually, we see the children doing the same for each other. The kids are amazingly supportive and sensitive. As cruel and insensitive as school children can be with their peers, these kids seem to go to the other extreme to support each other.
Children can self-evaluate. Given enough opportunities and structure, children become very comfortable evaluating their own performance, and they do so accurately. In the early stages of this process, some kids are entirely negative about themselves and their speech. They may not be ready to self-evaluate. Other children have very low levels of self-awareness as far as the physical and acoustic aspects of their speech. They may report "I havent stuttered this week" while presenting with a great deal of overt stuttering. Opportunities to observe other children and adults self-monitoring and self-evaluating help these children become more realistic about themselves in a very non-threatening manner.
Children mix well. I have been amazed at how, when grouped, children who are diverse in size, age, cultural background and cognitive ability, will find their common ground.
Children love to eat snacks! They appreciate us providing snacks they like, and it seems to be a great transition from school to therapy. The discussion that takes place during opening snack time can help shape the session that follows.
Children love to create. Give them any task such as: writing a skit; making up a rhythm; creating poems; and they do it. As long as we create a substantial amount of structure, providing examples, materials, and basic ideas, the kids come up with some fantastic results.
Children have mixed feelings about being videotaped. Many of them report their least favorite part of therapy is the videotapes. However, used correctly, it is one of the most important aspects of treatment and assessment.
Children love to plan field trips. Field trips are terrific for encouraging carryover. Groups have to prepare really well for field trips in order for them to be more than just a diversion from the therapy room.
Children trust adults more when the adults participate. The graduate assistants do everything the kids do, and so do I. We set goals, play the games, eat the snacks, stutter on purpose, share experiences, and do the creative activities alongside the kids.
There are hundreds of ways to target speech goals. Below, I share some of our favorite and most successful activities.
1. Who wants to be a Millionaire? Fashioned after the popular television show, the children take turns being Regis, the contestant, the lifeline, and the audience while targeting their speech goals. Continual commenting and cueing takes place. This is a lot of fun, too. We use questions from Trivial Pursuit Junior, and we put up a row of signs with the dollar amounts on it, and someone holds an arrow at the current amount being pursued.
2. Bowling: Using a simple childs bowling set, we attach questions and speech tasks to the bottoms of the pins. When a pin is knocked down, the tasks are read from the bottom of the pin and then completed. Types of questions include: Explain what kind of car would you like to have someday, elaborating on color, features, etc.; Tell 3 different uses for a broom; What is the best vacation you have ever taken?
3. Joke Telling: There is a great website from Britain, found by doing a search for "Jokes for Kids". This site has knock-knock, doctor-doctor, animal jokes, school jokes and tons of other joke categories. They are generally clean and appropriate. We separate into small groups and practice the jokes, and then come back together to tell them to the whole group. Jokes provide special challenges in timing and inflection, which can be excellent practice. Many times the kids tell the jokes to their friends at home, creating a nice carryover task.
4. Teasing Role Play: This activity is always helpful, and it often brings out spontaneous sharing from the kids. We talk about the types of teasing they encounter, and then we brainstorm responses. The responses they come up with range from serious to funny. Examples include : "Just because I stutter doesnt mean there is something wrong with me"; " Would you like to know more about stuttering?"; "Deal with it, I have to"; "No, you didnt do that stutter right, see its like this ". One girl used elaborate hand motions and finger snapping with someone who picked on her, which was cute and sophisticated, and diffused the teaser. My camp group turned this activity into a skit, which I videotaped and showed to a group of school therapists.
5. Class Presentations: The kids create short presentations designed to inform about stuttering. We practice in front of a large group, bringing in parents, and kids from other therapy programs. We also videotape, providing an atmosphere which is stressful and/or pressurized, so the child gets a feel for what it could be like to present to their class. We encourage kids to get together with their school therapist, teacher, and maybe a best friend, and actually give an informational presentation about stuttering to their class.
6. Creative Writing: We share the newsletters from NSA and expose kids to the Stuttering Home Page so they can see examples of articles and poems written by other kids who stutter. They have the option of writing something to submit for publication. We also give each child a copy of the SFA book "Sometimes I Just Stutter", or the book "Straight Talk for Teens".
7. Progressive Story: This is a really fun activity used when we have a few minutes left in a session. One person starts off a story with one or two sentences, then each person adds on to it. These get to be very fun and silly, and provide a great way to encourage self-monitoring of speech in a spontaneous speaking task.
8. Food Preparation: It is easy to make food preparation and snack time into a learning experience. We make "Stuttering Sundaes". The ice cream is placed in the bowl, then chocolate sauce is slowly poured on, and we call this the proooooooooooolongation. M&M candies or gummy bears are the rep-rep-repetitions. A can of whipped cream illustrates the blocks. When no air is moving out of the can, we get no whipped cream. As soon as the valve is opened, air will flow and the whipped cream squirts on to the sundae!
9. Posters and Banners: We provide kids with opportunities to illustrate their ideas when they do a presentation, skit, or role play. Working together on a poster to decorate the room is a nice group-builder. A great activity for a group of kids who are new to each other is to have each child make a poster "All About Me". Colored paper, markers, and magazines serve as materials for the poster. Each person then shares their poster with the group. This is a good way to emphasize that the person is separate from his or her stuttering, in effect "Stuttering is something I do, not who I am".
10. Trips: Our after-school kids have gone bowling, to the mall, to the park, and to a nursing home. A parent once provided a limousine to drive the kids to and from the field trip activity. That was very memorable! Field trips are structured to work toward the same level of performance in the outside setting that we get in the therapy building. This means preparation and practice. For each activity, the kids set their goals, cue strategies, and feedback requests ahead of time. We ask the kids to come up with trip ideas, and then we narrow the ideas down to the most feasible and affordable. At the bowling alley, each child had a clear plastic cup with their name on it, and a large bag of gum and candy was provided. The kids had to catch each other using their speech goals, and then could go to the candy bag and put something in that childs cup. They had to support each other in order to get the tangible rewards, and they were in charge of the reinforcement. We also made them take most of the candy home, so they couldnt eat it all while bowling. Another time at the bowling alley, we had a big poster with everyones name and goal on it, and each kid could walk up to the poster and put a star by someones name when they heard/saw them use their speech strategy. At the mall, they had a list of talking activities to complete. Beforehand, each talking activity was discussed and practiced. Afterwards, the activity was "processed" as a group.
The nursing home activity was designed to give the kids practice telling people about stuttering.
For two summers, we have organized a "camp" type program. The second camp took place in July-August 2000. Our campers came to campus from 9:00 to 12:30, 3 mornings a week for 3 weeks. We provided programs for campers and parents together, campers alone, and parents alone. Dr. Walt Manning, professor, worked with the families along with me. We had graduate assistants as well. This year we enrolled 6 children in camp, but only 4 attended. We had family involvement from 2 of the 4 families. We are trying hard to increase family involvement, but so far have not come up with any magic solutions.
The goal of the camp was to provide an intensive but fun program for concentrating on all aspects of stuttering management, including the physical, social/emotional, and academic impact of the disorder. Emphasis was placed on peer and family support, use of resources, and empowering the child to be "in charge".
Campers, families, and graduate assistants were provided with a manual for the camp. Daily schedules, informational handouts, and lists of resources were included. There were also places for the participants to record goals and set carryover tasks. This year, each evening after camp, the families completed a "Home Discussion". This was designed to increase family involvement for parents who could not attend during the day and also to involve siblings. Discussion topics included concepts such as anxiety, encouragement, and taking risks. Parents could tell about their experiences in life which might parallel a childs experiences with stuttering.
Dr. Manning led parent discussions, covering basic concepts of stuttering treatment, recognizing progress, and supporting children through teasing and other peer group difficulties.
This year, I found that 9 sessions was an ideal number for accomplishing the goals of the camp. The participants got to know each other well, and had plenty of time to develop and begin mastering their goals. They became familiar with many concepts of stuttering therapy, and came to understand their particular patterns of stuttering by tapping into their own creativity and style. Families had many choices of ways to participate in the camp, and we were able to go on 2 outings.
We had special guests for camp. The first year, we had a local artist, Elizabeth Childress, direct a mask-making activity. The "mask" symbolism was discussed in different ways, for example the "mask" we wear when we try to hide stuttering from others, the way we feel when we stutter, the feelings we may have about stuttering, or the changes in our face and expression as we learn to manage stuttering.
We also had a recreational specialist, Dr. Stan Walls, direct group-building games with the children. This was a big hit and we plan to do this every year. We also now have a local person who runs a ropes course, and think that this could be a nice addition to our program.
A new addition to the camp experience this year was drumming. We hired a teaching artist from the Memphis Arts Council for Arts in Education, Gregg Hansen, who specializes in djembe drumming. Gregg brought hand drums for the children, and taught them the basics of djembe drumming. We used the drums to talk about the speech mechanism, voicing, rate of speech, and level of effort. We taught concepts such as air moving versus air stopping, easy versus hard attack or onset, and even concepts of prosody. In addition, we used the drum to create responses to teasing. The kids were asked to "play" on the drum what they would like to "say" to someone who teases or bullies them. We then added the words to the hand movements. Some strong emotions were tapped into with this format. One childs drum and word response was "I want to beat him up". It became important here to recognize this as a valid feeling, and to shape this response through the music and rhythm. With assistance from the counselors and Gregg, this became a "song-chant". It went like this:
I want to beat him up
But Im smarter than that
I think Ill walk away
But what if he follows?
I think Ill get my bike
Or Ill find a friend
By Cameron D.
The drum experience was probably the favorite activity for most of the kids. This type of activity could easily be duplicated with smaller hand-made drums or even pots and pans.
In camp, the children had extended time to create, act out and videotape 2 skits about teasing. The first skit took place in a pizza restaurant. The customers were 2 kids who stutter, and the workers were mocking them as they stuttered while ordering. The customers responded by informing the workers about stuttering, and the workers apologized.
The second skit took place in the classroom, with a child reading aloud and stuttering and the other children laughing and pointing. The teacher redirected the teasing and had all the children try stuttering on purpose, so that they could see how difficult it is to stutter.
The creative aspect of stuttering treatment really came to the forefront as one of the strongest vehicles for change. Skits, presentations, artwork, creative writing, and drumming all brought about spectacular results in terms of speech improvement as well as increased confidence. I think each child left camp with a greater belief that he could deal with the stuttering moments and situations effectively.
In continuing to develop our programs for Kids who Stutter, I find I learn by trying new things and watching these wonderful, open children tell me what works and what doesnt! Empowerment, validation, and creativity are at the core of our treatment philosophy.