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From: Lynne Shields
Date: 17 Oct 2009
Time: 09:36:16 -0500
Remote Name: 76.215.118.209
Frank, Good question, and one that needs further research. Spontaneous recovery means that a child gains normal fluency skills over time with no intervention by a speech therapist, a parents or anyone else. Their fluency improves over time due to maturation and growth. If one tries to speed this recovery up, then one is intervening, and it would be difficult to say that any improvement was due entirely to spontaneous recovery. Even without formal therapy, it may be difficult to decide-did the parents intervene in some way? Did the child notice disfluencies and figure out a way to manage on their own (self-therapy)? Both of these are also possible outcomes. How do we know which kids will recover and which will develop stuttering? There is not, to date, a set of indicators that will predict the answer 100% of the time. But, there are known risk factors for stuttering, based on research. When I evaluate a young child for fluency, I look at a variety of factors, some of which are indicators for the development of stuttering and others suggesting that the child has high likelihood of becoming normally fluent with no intervention. If the latter is the case, then I do not recommend therapy. Instead, if the parents so desire, I help them develop a simple tracking system to evaluate their child's disfluencies. We chat by phone or email periodically to review their evaluations. If the child's number of disfluencies decreases over time and the types of disfluencies become more typical (versus stuttering-like), then follow-up can be discontinued when the parents are confident that their child is showing normal levels of fluency. For this outcome, I typically follow up with a family for anywhere from 3-12 months. If, over time, the child's disfluencies become more frequent and severe in nature, then intervention can be considered. I often begin with a short term treatment program, where the parents and I try to identify fluency-enhancing situations or behaviors for their child and the parents focus on those. If the child's fluency improves, we still won't know if it is due to the intervention or maturation--it's likely to be some of both. I don't take credit for the improvement--it is the parents and child who did the work. For that matter, when I work with an older child or adult, I still don't take credit when improvement occurs. I'm just there for organizational support--it is the client who made the changes in their speech. They did it themselves. I'm sure others on this panel will have input on this issue. Regards, Lynne