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From: Scott
Date: 18 Oct 2012
Time: 19:58:21 -0500
Remote Name: 76.17.183.48
Hi Amy - Thanks for your post. You've asked an outstanding question, and one that I think about a lot. I think the first issue we have to address is whether a child really NEEDS therapy... the mere fact that a child stutters does not necessarily mean that he needs to be in therapy at that time. Of course, I know that parents and others will want him to be in therapy, but if he is able to communicate effectively and say what he wants to say without fear, then one might wonder whether he could be said to have a stuttering problem. If he doesn't, then he shouldn't be on our caseloads just yet. The sad thing is that the time will probably come when he DOES have a problem, and that will be the time to treat him. Of course, most children who stutter do experience negative consequences from their stuttering. This is the adverse impact that we're supposed to document and treat in the school setting. Even still, some of those children just aren't motivated to work on their speech - and for good reason. Changing speech is very hard work...i think that many clinicians forget just how difficult it is for kids to do what we are asking. Here's the way I like to think of it: if what we're asking him to do is harder than what he's doing already, then he won't want to do it. (I typically express this by saying that if the pain of change is greater than the pain of staying the same, then changes won't occur...). It's not that we want the children to experience a lot of pain/discomfort/anxiety - but if they aren't, you can see why it might be difficult for them to want to engage in therapy. One answer to this problem is to "bring down the pain of change" by making the therapy process easier for the kids. And, not just easier, but also more focused on what is important for the child (see the discussion on generalization earlier in the thread). Another thing we can do is help the child become more READY for therapy. Readiness is a key concept - Dr. Tricia Zebrowski at the University of Iowa and her colleagues have written about this topic, as have others... The idea is to help our students become more ready for the process of therapy by recognizing where they are in their process of facing stuttering. if they're not ready to face it, they'll not make progress in therapy. As they become more ready, then it is easier for them to put in the time and extreme effort that is required to modify their attitudes and their speech. Thanks again for the question - great topic! S