[ Contents | Search | Post | Reply | Next | Previous | Up ]
From: David Shapiro
Date: 14 Oct 2008
Time: 12:48:56 -0500
Remote Name: 72.71.67.203
Hi Stacy, You are asking a really good question, one that is more complex than might appear. At its heart, you are asking about behavioral change. There are many ways to change behavior. Typically, clinicians seek to eliminate unwanted behaviors, such as learned reactions to stuttering behavior (i.e., secondary behaviors). Here is another idea for you to consider. Even in the speech of people whose disfluency is frequent and/or severe, there are islands of fluency. I recommend before eliminating the disfluent and secondary behaviors that you consider working to increase the child’s awareness of his fluency. Specifically, by heightening the child’s awareness of what he does (and thinks and feels) when he is fluent, he becomes aware of what he already is doing that is fluent and what he can do even more often. For example, when I converse with a school-age child and hear him demonstrate an instance of fluency (e.g., an easy onset or gentle stretch), I highlight it by saying, “That’s it. You just did it.” Then I will model and describe what the child did (e.g., “When you said the word ‘boy,’ I saw that you put your lips together very gently on boy. That is great. That’s what we want to do even more often.”). We do this repeatedly, whereby I identify the instance of fluency, model it back, and describe for the child what he did. Given that children (i.e., and adults) have come to expect a focus on disfluency, they are surprised when I focus on what they already are doing right. Eventually, I step back as follows. When I hear the child demonstrate a fluent instance, I identify the moment (“That’s it; you just did it again.”) and follow up with a question (“What did you do?”). The child might say, “I said sssee gently.” To this, I follow up and model and describe more completely. You see how the child’s role in the treatment process becomes increasingly active, engaged, and positive. Here, the next logical step is for the child to become his own clinician, by identifying, modeling, and describing. The child might say, “Did you see what I did?” to which I would respond, “You bet I did; Tell me about it.” Then I add to the child’s description and model back what the child did, celebrating all the way. Daily home practice is built around this sequence as well (i.e., focusing on what the child has done correctly; that would take me a while to explain). The point is that by increasing the child’s focus on fluency and his understanding of what he does when he is fluent, he becomes more aware of the fluent elements and produces them more often. In other words, both the absolute and relative frequency of fluent productions increase; the absolute and relative frequency of disfluencies and secondary behaviors decrease. Only then would I target the disfluencies. All the while, I collect data on the speech behaviors, in addition to comments that reflect changes in thoughts and attitudes (i.e., usually they move from negative to neutral to positive; e.g., they move from I can’t to I can and from I am controlled by the outside to I am in control). Another essential point is that accentuating the positive is very different than negating the negative. In this way, treatment remains collaborative, successful, and fun. I didn’t intend to be so long winded, but I hope these ideas might resonate with you. All of us are motivated to do more of what we feel we are good at and what, by our own experience and by accountable data, we discover we can do. Hope this helps. Thanks for your excellent question. Good luck. David Shapiro