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From: Dale Williams
Date: 10/9/02
Time: 8:57:18 AM
Remote Name: 131.91.248.210
Good question Ardell. Your concerns are well-founded, given the anecdotal reports of stuttering beginning and/or escalating during phonological therapy. This isn’t an area of research for me, but I have a few comments based on my own hits and misses. Keep in mind that I don’t know the child, so these are general thoughts. You’re the expert and, as such, can apply (or not apply) them as appropriate.
If I can work on the sounds indirectly, I try this first. Yes, there is a cost (the sounds are slower to remediate), but the smooth, fluency-enhancing speech you want is more consistently reinforced. Direct practice of plosive production may include hard onsets and other techniques inconsistent with smooth speech. That sends the kid mixed messages.
Also, discuss it with the parents. Put all the cards on the table. “Here’s what I want to do…here’s why…here are the benefits and costs…etc.” For most parents, fluency is the top priority. In this case, they will know why the misarticulated sounds are slow to resolve. If, however, the parents really want the child’s intelligibility increased, they’ll understand how important it is to monitor fluency, given that it might decrease once the additional therapy goals are added. They’ll also understand why you’ll back off these new goals if this happens.
With stuttering and additional disorders, there are no perfect solutions. Each has a potential cost. That makes these tough cases. I wish you the best.
Dale