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From: Ken St. Louis
Date: 15 Oct 2004
Time: 14:12:03 -0500
Remote Name: 157.182.12.221
Dear Catherine, You ask a good question, but a hard question. Whenever there are extenuating circumstances like mental impairments or other coexisting disorders, stuttering treatment is affected. I presented a case study many years ago at our state convention on a mentally impaired stutterer with Down Syndrome. In that case study, we found that perseverence was the key. After years of therapy in our university clinic, when many had given up, including me, the young adult began to make limited progress. I took over the case again and found that he did reasonably well using cancellations and pull-outs. Prior to that, he had received about every combination of contingent management, fluency shaping, desensitization, and stuttering modification you might imagine. He eventually learned to use the strategies, but it took a *long* time. Gene Cooper wrote a chapter in a book I edited in 1986 entitled "The Atypical Stutterer." His chapter was on the "Mentally Retarded Stutterer" wherein he recommended using the Cooper approach (now Cooper and Cooper approach) with this population. This approach combines work with attitudes or feelings with fluency shaping. In the latter case, "fluency initiating gestures" (FIGS) are taught. There may be more recent clinical articles available, but I am not immediately familiar with any. An on-line search may turn up some good sources, however. My advice is to adjust your prognosis and accept success in smaller increments than you might with your other stuttering clients with normal intelligence. And, in spite of the example I provide above, I would first consider teaching a slower, easier speech pattern through a combination of modeling/imitation and contingent management. My answer may not be much help, but it's about the best I can do with the information you provide. Good luck. Ken