About the presenter: Barry Guitar is a teacher and clinician at the University of Vermont. He has had many years of experience working with children, adolescents, and adults who stutter, using a variety of stuttering modification and fluency shaping approaches. He is a person who stutters and was a client and student of Charles Van Riper. He has published both research and clinical papers in stuttering and is the author of a chapter in the forthcoming book for clinicians on Lidcombe therapy for children who stutter.
About the presenter: My name is Nancy Tozier. I'm an Esthetician living in Central Maine in the United States. My husband and I have two children, ages seven and ten. My husband is a person who stutters, so it came as no surprise that my son started with some disfluency. I made up my mind to find out everything I could about stuttering. I figured that the people who would know, what not to do, were adult people that stuttered. My husband was also very concerned about our son and had very strong feelings due to his love for our son and his own experiences. He felt that, at least for him, therapy drew more negative attention to his stuttering. I couldn't stand by and do nothing. I became involved in a support group for people who stutter and their families called, "Stuttering Support." In my searching, I've made many wonderful friends, who've helped me more than I could have imagined through their experiences and expertise. Barry Guitar was such a friend. He guided me, in how to help my son, and calmed me when I was scared and frustrated in my ability to help my son.

You can post Questions/comments about the following paper to Barry Guitar and Nancy Tozier before October 22, 2002.

A different kind of electronic device for stuttering therapy for children

by Barry Guitar and Nancy Tozier
from Vermont and Maine, USA

We would like to share with you our experience with stuttering therapy conducted primarily over the internet. We think you'll agree that sometimes when therapy is urgently needed and circumstances don't permit face-to-face meetings, therapy by email can be a viable option. It should be noted, however, that the child in this case, Ben, had been evaluated in a real clinic before our therapy began. What's more, video tapes as well as emails were exchanged, and a face-to-face meeting between the parent and clinician took place midway through the therapy. Not all children, not all parents, and not all therapies are suited to therapy via the internet, but in this case the mix of ingredients produced a fine result.

Nancy writes:

Well it was here, the day I'd dreaded . I had to face the fact that like my husband, my son was stuttering. Kids were having trouble understanding him and he was getting very frustrated. Since my husband doesn't like to talk about his stuttering, I've got to figure out how to help him. I've never been so afraid. What if I make the wrong choice?

After having my son evaluated and him earning the title of "moderate stutterer," I arranged to have him start therapy at the best clinic for stuttering in all of Maine. I told my husband. "NO way." he said. Speech therapy had not worked for him and we weren't putting my son through that. I thought I had never been more afraid when I realized Ben stuttered. Every other fear I've had paled by comparison.

I read everything on the Internet available and found that, "Stuttering, an Integrated Approach," by Barry Guitar was the book used to teach many Speech Therapists. I figured I had to learn what to do myself to help my son. After poring through the chapters and making a notebook full of notes, I thought I'd take a chance and ask the author himself which he thought was best for a totally unqualified terrified parent to do. So I found his email address.....

Barry writes:

Nancy's email to me was very powerful: her child was beginning to stutter and she was beside herself with worry. She couldn't take him to the excellent clinic not too far away, but she couldn't just stand by and watch him struggle. At Vermont, we were using the Lidcombe program for preschool children who stutter. In this approach the therapy is entirely done by parents, under the guidance of a clinician, so it seemed appropriate for Nancy and Ben. But would this work at a long distance, with only email and video to connect us? Nancy seemed like such a determined mom, I thought it might work. I remembered that when I was a student at Western Michigan University, Van Riper had done some distance therapy with a parent and a preschool child and had shared the letters back and forth with us students as he was doing it. I can't hold a candle to Van Riper, but I thought I might be able to help Ben.

I asked Nancy to start by charting Ben's level of stuttering each day, for the entire day. A "10" would be the worst she could imagine and a "0" would be total fluency. I also ask her to begin therapy by setting aside 15 minutes every day and praising Ben for every forth fluent sentence. But not to use praise for his fluency at any other time. Most children will enjoy praise, but it has to be done in moderation and in a way that suits the child.

We will need to fine-tune the program for Ben, so I am eager to hear from Nancy after she tries this. I'm thinking that the quick response time of email and the fact that we can be in contact several times a week to start with will really help us work on this together.

Nancy writes:

I can't believe my good fortune. This expert, this author, this man who knows what he's doing is going to help me! I can do this, ( I hope!!!) Faithfully every day, I go in and wake up my son with kisses. This starts our therapy. Next after pulling him up on my lap, we start to decide what we'll play together, in our special time. He REALLY likes to start each day like this. So do I. We start to play and after he says four things fluently, I say, "Boy you say that so smoothly, what a good talker you are!" then drop it. After four more fluent utterances I say, "You talk so smooth! That was great! " and we go on for about a half hour. We make sure we have lots of fun, hugs, kisses, and compliments. My son has an ego the size of a bus, and oh yes he IS talking more smoothly. I chart his level of fluency daily so we'll know what progress we're making. I might actually live through this.

Barry writes:

Nancy is off to a great start. The weekly charts she sends me on email give me a real feel for how Ben is doing. I am also sensing that Nancy is a super-loving mom, so she really makes Ben feel good about himself. When you do Lidcombe, so much depends upon the parents -- how well they can stick to the plan, how thorough they are about reinforcing on a consistent basis, but in moderation, how faithful they are in data-keeping. With many parents, we have to spend a great deal of time helping them become good clinicians, but Nancy is a natural at all of these things.

Nancy writes:

Help! My son's still loving the hugs kisses and playing, but tells me he hates when I say he talks smoothly. He's stuttering more again. I'm up at 3 AM crying again, we had been doing so well. I know now that he's in school, and he has a big learning spurt, it can temporarily give a speech set back ( can't do both well at once!) But I know he'll be fine again as this has happened before. I know Lidcombe therapy is always a little different for each child, just like each child is different. I guess we need a little tweaking, or I need to learn the next step in administering the Lidcombe Program.

Barry Writes:

It's OK! Ben's protests at his mom's praise are letting us know that it has stopped being reinforcing. But it's important to note that Ben really loves the one-on-one time and the games. Again, the key is to adapt the program to suit Ben. So Nancy made some modifications in what she did and found a way to comment that Ben seemed to find reinforcing. Nancy wanted to have longer sessions, but I advised her to keep them to only 15 minutes, once every day. Generalizing treatment to the rest of the day would come soon enough.

During this period, Nancy and I emailed a lot and she sent several videos so that we really shared what was going on. This frequent contact gave me a chance to support Nancy when she was discouraged and it enabled me to help her get the program right for Ben. Nancy really has the energy and dedication to make this approach successful. And she's quite flexible and insightful so we work together well in making just the right changes.

Nancy Writes:

We are having entirely fluent periods! I now can drag my pick ups in to the big world. At school today I told Ben," You are such a smooth talker at school! Good job" ( kiss, kiss, hug!) Here's a Spiderman tattoo for doing such a good job! I know some stuttering will rear it's head again, but it becomes less and less. In "Stuttering Support" (an Internet discussion group) I tried to explain the program to other members. They misunderstood about the praise. They thought it put pressure on the child to speak smoothly, creating anxiety. Nothing could be further from the truth. The child has already heard himself speak smoothly, That's what you are commenting on, not encouraging him to speak smoothly, but acknowledging he spoke smoothly. You are commenting on his accomplishment, not the unobtainable. If you were a child and drew Mommy a picture. If she said," It's SO wonderful, I love the colors it's beautiful, Great job!" you would feel like Picasso and make hundreds of more beautiful painting. This works in the same way. You are giving the child confidence in his speech and an enjoyment of talking. Some other compliments include, " You tell good jokes ha-ha-ha-" You can say big words so well, you're really smart" " You'll make a great president because you speak so well and say such good things...." An ego the size of a bus, I tell you, and NO fear of talking.

Barry Writes:

Nancy and Ben are going well! He's adjusted to school and seems to feel confident about talking in school. Often when children who stutter get some solid fluency, their confidence in speech carries over to other things.

I was a little worried about how other parents on the internet discussion group would respond to Nancy's description of the Lidcombe. This is not a program that a parent can use at home without guidance. It's powerful and really needs to be done carefully and in a manner that helps a child feel really good about himself and his speech. Nancy did a fine job of describing it to the other parents and I hope they can find someone trained in Lidcombe to work with them.

Nancy writes:

I recently had the pleasure of sending my friend Barry Guitar, a tape of my son Ben speaking fluently. I cried when I watched it, or even think about it.

I can't say enough good about the Lidcombe Program. Not only does it give a mother and child an incredible closeness, it makes the child feel they are excellent at speaking. After all, doesn't a fear of speaking make stuttering worse? I feel it's successful because children love attention and love from their parents, and their confidence grows and grows.

An ego the size of a bus!

Barry Writes:

I think Nancy is right on. Several parents, using the Lidcombe, have said to me that they feel empowered by it -- the opposite of guilty about their child's stuttering. In this case, so much of the success with Ben has been Nancy's persistence in sticking with the program and doing it daily in her warm and loving manner that means so much to Ben.

Doing therapy by distance is difficult at best, but this seems to have worked!

You can post Questions/comments about the above paper to Barry Guitar and Nancy Tozier before October 22, 2002.

August 20, 2002