|About the presenter: Kelly Jones, M.A., CCC-SLP works as a speech-language pathologist in a pediatric private practice in Chapel Hill, NC. She received a Master's degree in Speech-Language Pathology from the University of Florida.|
|About the presenter: Kenneth Logan, Ph.D., CCC/SLP is a member of the Department of Communication Sciences and Disorders at the University of Florida, where he teaches, conducts research, and supervises clinical activities related to fluency disorders. He has presented many papers and authored a number of articles that deal with the nature and treatment of stuttering.|
The purpose of this paper is to describe how juvenile fiction (i.e., fictional stories that are written for children and teens) can be used as a tool within the context of a comprehensive stuttering management program. Juvenile fiction has been used with a variety of clinical populations (cf. Lyneham & Rapee, 2006; McKendree-Smith, Floyd & Scogin, 2003; Shechtman, 1999); however, its use in the treatment of stuttering, to date, appears to be limited. The application of fictional stories to therapeutic settings has been termed bibliotherapy. In its broadest form, bibliotherapy refers to the sharing of books or stories for the purpose of helping a person gain insight about and/or deal with a personal problem (Heath, Sheen, Leavy, Young, & Money, 2005). Forgan (2002) listed several motivations for using bibliotherapy in therapy settings. These include: showing an individual that others have encountered the same problem, helping an individual to discuss his or her problems more freely, improving an individual's self-concept, and helping an individual to develop constructive solutions to the problems they face. Many authors have presented bibliotherapy as a self-contained approach to intervention. Because stuttering is a multi-dimensional problem (Logan & Yaruss, 1999; Murphy, Yaruss, & Quesal, 2007), however, we think it is preferable for clinicians to regard these book-based activities as but one of many resources that a clinician can use to address treatment goals.
A variety of studies have examined the effects of bibliotherapy and other forms of directed reading on patients' functioning. Directed reading programs that use professionally-authored manuals/texts have been found to improve functioning for depressed and anxious patients (Lyneham & Rapee, 2006; McKendree-Smith, Floyd, & Scogin, 2003). Also, activities derived from juvenile fiction books have been linked to improvements in students' self-concept ratings (Lenkowsky et al. 1987) and use of insightful and self-disclosure statements (Shechtman, 1999). Other studies have demonstrated the effectiveness of bibliotherapy in promoting exploration of personal attitudes, feelings, and emotions with other populations of children, including adopted children, children of divorce, and children with a diminished self-concept (Heath et al., 2005).
The depiction of stuttering in juvenile fiction
Since the 1960's, over 50 juvenile fiction books featuring characters who stutter have been published. Such books are potentially useful in the treatment of stuttering because they provide a venue for exploring the various ways that people experience, react to, and cope with stuttering. Logan, Mullins, and Jones (2008) reviewed the depiction of stuttering in 29 juvenile fiction books that were published between 1989 and 2007. The books encompassed a variety of literary styles (e.g., fantasy, fable, realistic fiction) and the reading levels ranged from early elementary school through young adult. Logan et al. noted that many of the books provided detailed accounts of stuttered speech and its impact on daily life. Depictions of teasing, bullying, and other listener reactions were common, and several books provided poignant accounts of the attitudes, feelings, and emotions that can accompany chronic stuttering. In general, books that were written for older readers addressed stuttering in much greater depth than books that were written for younger readers.
With many of the books in the Logan et al. (2008) review, a character's challenges with stuttering coincided with other problems, e.g., dealing with the loss of or separation from a parent, struggling to gain social acceptance from peer groups. Only 4 of the 29 books depicted scenes from speech therapy sessions; yet, nearly all of the books included examples of accomplishments that the characters had made in communication and/or general life activities. Logan et al. concluded that most of the 29 books would be suitable for use in stuttering therapy activities, particularly activities that are designed to (1) build children's background knowledge about stuttering; (2) validate children's stuttering-related experiences; (3) promote children's willingness to disclose their experiences with stuttering to others; and (4) develop more effective ways to manage stuttering, respond to listener reactions, and cope with feelings and emotions.
General attributes about the characters in 16 contemporary juvenile fiction books (organized by reading level and author) are presented in Table 1. The listed books are by no means an exhaustive review of stuttering-related juvenile fiction books nor are they necessarily recommended for use with all children who stutter. It is essential that a clinician read a book carefully before using it in a therapy activity, to determine what situations, if any, are applicable to their particular client(s). Additional details about these and other stories can be found in the following sources: Bushey and Martin (1988), Logan et al. (2008), and the Stuttering Homepage (http://www.mnsu.edu/comdis/kuster/).
As can be seen, the books in Table 1 (at the end of the article) feature both male and female characters and a variety of ages and severity levels. Each of the books features examples of stuttered speech and the ways in which stuttering symptoms vary across contexts. All but one of the books (The Flimflam Man) addresses the attitudes, feelings, and emotions that commonly accompany stuttering. Several of the books also provide descriptions of coping strategies (e.g., word substitution, situational avoidance) and listener behaviors (e.g., bullying, interrupting) that often aggravate stuttering. Generally, the books are successful at promoting hopefulness in the reader, as each of the characters makes some type of positive change (though not necessarily improved speech fluency) during the course of the story.
Example of a treatment activity
It has been suggested that children respond best to bibliotherapy when it is based upon a story that has personal meaning for the student (Heath et al., 2005; Silverman, 2004). Thus, clinicians should consider a client's age, gender, background, personality, and unique personal challenges when selecting a book to use in a fluency therapy activity.
The recently published book Love Puppies and Corner Kicks, by R.W. Krech, is examined here with regard to its potential use within an intervention program for a child who stutters. The book tells the story of a 13-year-old girl named Andrea who stutters. Andrea moves with her family to Scotland for a year and must deal with the challenges of making friends in a new school and new country while addressing her speech difficulties. Andrea begins at her new school pretending to have laryngitis so she won't be called upon. She finds acceptance from the other students through her talent for playing soccer, but finds it hard to talk to a boy she likes because she is afraid she might stutter. Andrea tries to hide her stuttering from her classmates and the boy throughout the story, but realizes at the end that her friends are not concerned about whether or not she stutters.
Children who stutter often experience negative attitudes, beliefs, and emotions as a consequence of their difficulties with communication (Logan & Yaruss, 1999; Murphy et al., 2007). A stuttering intervention activity that utilizes Love Puppies and Corner Kicks to address such issues might proceed by using the following 4-step process, adapted from Forgan, 2002, to create a suitable activity.
'Gak'-- A noise emerges from my throat. I was trying to say something and not say something at the same time, and 'gak' came out. I look like a total fool! But--Wait! Brainstorm! I point at my throat and shake my head no.
Mrs. Watkinson gets it. 'Oh no! You have laryngitis on the first day?!' I nod vigorously and make sad puppy eyes.
'Oh, bad luck. Well, I'll introduce you. Class, this is Andrea DiLorenzo from New Jersey in America. Welcome, Andrea.'
I give a half-smile and nod. My heart is still racing. I can feel the blood in my temples. I'm relieved but also ashamed that I chickened out so quickly." (p. 40)
Options for documenting progress and measuring outcomes with book-based activities are numerous. The selected approach will depend largely on the goals associated with a particular activity. Heath et al (2005) described a five-part framework that is well suited for documenting evidence of attitude change during the course of book-based activities. With this approach, the clinician would collect information about the number and nature of statements made in the following areas during the course of an activity:
The many examples of stuttering-related experiences in juvenile fiction books offer clinicians a context for helping children to build their knowledge of stuttering, validate and explore their communicative experiences, and expand their repertoire of stuttering management strategies. There are many contemporary books that are available to clinicians for this purpose. Although book-based activities will usually constitute just one aspect of a multi-pronged approach to stuttering treatment, the open-ended nature of such activities allows for their use in activities that address a wide range of clinical goals.
Bushey, T., & Martin, R. (1988). Stuttering in children's literature. Language, Speech, and Hearing Services in Schools, 19, 235-250.
Forgan, J.W. (2002). Using bibliotherapy to teach problem solving. Intervention in School and Clinic, 38, 75-82.
Heath, M.A., Sheen, D., Leavy, D., Young, E., & Money, K. (2005). Bibliotherapy: A resource to facilitate emotional healing and growth. School Psychology International, 26, 563-580.
Lenkowsky, R.S., Barowsky, E.I., Dayboch, M., Puccio, L., & Lenkowsky, B.E. (1987). Effects of bibliotherapy on the self-concept of learning disabled, emotionally handicapped adolescents in a classroom setting. Psychological Reports, 61, 483-488.
Logan, K.J., Mullins, M.S., & Jones, K.M. (2008). The depiction of stuttering in contemporary juvenile fiction: Implications for clinical practice. Psychology in the Schools, 45, 609-626.
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Murphy, W.P., Yaruss, J.S., & Quesal, R.W. (2007). Enhancing treatment for school-age children who stutter I. Reducing negative reactions through desensitization and cognitive restructuring. Journal of Fluency Disorders, 32, 121-138.
Shechtman, Z. (1999). Bibliotherapy: An indirect approach to treatment of childhood aggression. Child Psychiatry and Human Development, 30, 39-53.
Silverman, E.M. (2004, October). Using story to help heal. Paper presented at the International Stuttering Awareness Day Online Conference. Retrieved July 17, 2010, from http://www.mnsu.edu/comdis/isad7/papers/silverman7.html