From: Anne Bothe
Date: 10/6/00
Time: 4:26:34 PM
Remote Name: 128.192.22.206
One of my very favorite topics: how to define stuttering! Just perfect for a Friday afternoon.
On the whole, I agree entirely with the first part of your paragraph, about how a parent's label is not a diagnosis in the full formal professional sense of the word "diagnosis." I hope I didn't imply something that I didn't mean to imply when I wrote that, as a working assumption, I start from the belief that if a parent has been concerned enough about what she is calling her child's "stuttering" that she has made and attended an appointment with an SLP then that child is probably stuttering. There will certainly be exceptions, and obviously if the family comes in and the professional sees perfectly completely normal speech, or possibly sees expressive language problems or dyspraxia or some other reason for disfluent or nonfluent spech, then the formal and complete diagnosis is part of the professional's job. I think I'm more concerned about parents who are correct (the child is stuttering) and who are told that their children are "going through a phase" or some such, as if all disfluencies are acceptable when you are 4 years old. Thanks for the help in clarifying this.
And as far as stopping children when they stutter – I hope I didn't imply that I would force everyone to always stop all children every time they stutter! On the whole, I agree entirely with everyone who says that we should listen to what other people say, not to how they say it; that we should not interrupt other people, that we should do our part to model polite communicative interactions, that we should help children to feel good about themselves, etc. The place where I will often disagree with other SLPs, and I know that I am in the minority on this one, is because I tend to say that all that polite communication stuff is great but it is not a treatment for stuttering, whereas stopping the child occasionally and teaching him to use nonstuttered speech is a treatment for stuttering. In other words – stopping children when they stutter, mixed with reinforcers for their nonstuttered speech, usually works to reduce and then eliminate many children's stuttering, when a clinician does it a few hours a week, or when parents do it 10 minutes a day, for a few months. I'm not aware of anybody ever testing an "immersion model" where all stutters all day every day are interrupted, and I think the data that we do have suggest that such a thing would be completely unnecessary – the positive reports have been around for 30 years now, and they come from treatment programs that take up something on the order of an hour or two a week of the child's life for a few months. And the kids enjoy treatment times, too – it's special one-on-one time with a parent or with a very fun clinician, talking and playing and getting lots of stickers for all their good speech, and all kinds of good stuff.
Anyway – I think that part of why we all have different opinions on this one is because we start from different assumptions, we have different goals, we've seen and done and read and experienced different things – and so on. I definitely have some different opinions from those held by some other people, but please don't anybody conclude that I think we should all completely ignore what a child is saying in favor of interrupting him every single time he stutters all day every day – what an awful way to deal with another human being.