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From: Darrell Dodge
Date: 10 Oct 2004
Time: 22:26:31 -0500
Remote Name: 64.12.116.79
Hi Katie: Thanks for your excellent question. There are some key indications that we need to move to a more integrated approach. These indications are more important than age in deciding when to use more direct stuttering modification in therapy. They include (but are not limited to): more articulatory and laryngeal tension when speaking, obvious fear of speech or stuttering, the regular use of escape behaviors (pitch rise, neck craning, etc.), evidence that fluency shaping techniques are not helping the child work through his/her stuttering, etc. It's critical that we put ourselves in the child's (and parents') place when considering the effect of such behaviors on his/her life. They are living this every day and if we stick with fluency shaping techniques that are not working for weeks going into months, a tremendous amount of negative conditioning is happening. There is such variation in children that prescribing a specific age for any type of therapy is not wise. It is very difficult sometimes because young children can be resistant or oppositional to requests for, or models of, direct manipulation of speech. It just means we have to be as creative as we can be. And it also means we may have to be more direct -- sometimes going out of our own comfort zone. Fluency and stuttering modification techniques are actually very similar when applied to young children, especially if we make a game out of them, which is easier to do with youngsters. (And sometimes it's hard to tell the difference.) A real key, of course, is whether our therapy is helping the child to feel more confident in his/her speaking ability. If we're asking too much or not implementing an approach that is fun and even exciting, then we need to re-evaluate and make adjustments. I sense in your search for age guidelines an understandable fear: if I try something too early, I may hurt or damage the child. Fortunately, we are lucky that children are pretty resilient, and a brief and unsuccessful foray into an activity that doesn't work is not the end of the world -- for them or for us -- as long as we stay awake to what is going on. Thanks again. - Darrell