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From: Bob Quesal
Date: 22 Oct 2005
Time: 13:28:53 -0500
Remote Name: 64.6.6.4
Hello Liz: It figures that the toughest question would be the last one posed. I think there are two things to consider here. First is empathy for the parents. We often feel that because we don't see disfluency in the clinic setting, that the parents are either mistaken in their observations or that the parents are doing something wrong at home to make the child more disfluent. We have to put ourselves into the parents' shoes and realize the frustration they must feel when their child struggles at home and then comes to work with us and is fluent. The second thing, however, is to "raise the bar" in therapy. If the child is fluent in the clinic setting, therapy has to be moved to more challening settings. A hierarchy has to be developed based on situations in which the child is more disfluent, and then the child has to enter those situations and practice whatever skills he or she has been taught. We all realize the importance of carryover of skills, and if the child is fluent in the clinic setting, it is time to work on carryover. In the situation you describe, working with the child at home could have a lot of value. I hope this helps. Bob Q.