Did you know that the way you listen or react - verbally and nonverbally - to moments of stuttering can have an adverse effect on the speaker? You may be, with good intentions, giving advice that may not offer any solutions and could, in reality, be furthering the problem. How do you listen and respond- verbally or nonverbally- to people who stutter (pws)?

This article is aimed at helping parents, teachers, speech-language pathologists (SLP), siblings, and all other listeners better assist a person who stutters. In 15 years of stuttering therapy and counseling families and teachers I have found that people have a style of feedback that is generally reactive or proactive. I personally endured several reactive styles (i.e., teachers telling me to slow down in front of my peers).

In the business world, there is a golden rule in managing people: "Praise in public and critique in private." No one likes to be criticized around others; this rule also applies for how we speak. Making negative remarks about how a person speaks or inferring they are not trying to improve is bad enough when done to their face. Stuttering is not taboo and there is a supportive, positive way to discuss it.

Take this survey and see if any of these Reactive habits pertain to you. Do you:

• Remind the pws to use his strategies immediately after you hear stuttering (i.e., "Just slow down and think"). Praising success may seem foreign to you.
• Say: "You must use the strategies all the time...not just in speech class!"
• Reflect: "If he'd just try harder, he wouldn't stutter....he doesn't seem to care!"
• Remark: "The world out there is cruel and I just want to protect you (get fluent!)"
• State: "You'll need to have that stuttering under control to get a good job."
• Jab: "You know we pay a lot of money for this speech therapy. You need to try."

Members of the reactive parent group may be 1) trying to fix their child, or 2) have no real involvement but sit on the sidelines and critique. Some parents report a feeling of guilt to fix it and others may feel embarrassment for their child. One parent of an 11 year-old who had a pattern of severe speech blocks described feeling shame and guilt while watching her son stuttering while ordering lunch in the food court at the local shopping mall. This desperate parent was constantly correcting him and badgering him to use what he learned in speech therapy. When we SLPs understand what it is like to be a parent of a child with a very noticeable stutter we become more congruent as therapists.

Those parents who have mentally checked out often have no real involvement in therapy. The reactive parent may not know his child's goals and may have never communicated with the therapist involved. They may expect stuttering to be "fixed" by the speech therapist similar to a dentist putting a filling in a tooth. It is easy to sit on the side line and critique when one is ignorant of the process of stuttering recovery. One uninvolved parent who is paying for private therapy can assert a lot of pressure on the therapist, the committed spouse, and the child to quickly improve. I have been thrust into the extremely awkward and depressing situation of divorce situations in which one parent is refusing to support therapy for his child as part of a vendetta about money and a strained relationship. I wish I had Dr. Phil on my speed dial some days! Dr. Phil might say: "How dare you attempt to get leverage on your ex and punish her by depriving your child of therapy, you maggot!"

Some of the classic reactions to moments of stuttering are: "slow down," "start over," "take a deep breath," and "think before you talk." I have parents complete the Cooper Parent Assessment (Cooper and Cooper, 1985c) and discover that nearly all parents report trying at least one of these verbal reactions. Parents acknowledge that when they react to a stutter and give one of these commands that their child will stop for a moment but then resume stuttering. So, this style of quick advice is not a solution and does fall under the reaction category. Many times these comments come with facial expressions and voice tone of frustration or disappointment that are obvious to the pws. If you keep giving a person advice that does not help you will lose credibility and you will frustrate or anger them. The definition of insanity is to keep doing the same thing and expect different results.

Parents, SLPs, and teachers must consider first, second, and third perceptual positions (Bodenhamer and Hall, 2000) and put ourselves in the other person's shoes. Perceptual positions are as follows: First position is associated; only your view and opinion of the interaction. Second position is imagining we were the other person and their opinion of interacting with us. Third position is disassociated; imagining we can watch and see ourselves and the other person from the side.

Here is an exercise for communication mastery: if you desire to maximize your interactions, imagine watching a past conversation from the side view. Watch it like a video as you replay what you said and then watch the reactions of your listener. Be sure you look at facial expressions, tone of voice, and other factors of nonverbal communication. You will be able to see and hear the communication breakdowns and find opportunities to improve. Third perceptual position can also be used to imagine, or role play, conversations before they happen.

Enabling stuttering is another form of reaction. Ordering food for your child, making telephone calls, and allowing him to be excused from talking in the classroom are all short-term thinking. You are reacting to a pending moment of stutter and trying to prevent it. Your positive intention is to protect him from a moment of potential frustration or embarrassment. The child can begin to believe: "My parents and teachers think I can't speak properly, so I get excused from reading or oral reports."

Children learn secondary gains for stuttering: "stuttering gets me out of responsibilities." If you keep protecting and enabling stuttering until age 18, will you develop the kind of person who is assertive enough to make phone calls for interviews, find a job, and be independent?

My excusals (enabling) from reading and public speaking through grade school developed a phobia that led to my dropping college classes that involved classroom participation. Other teachers forced extra talking on me trying to help me. A proactive style is getting a child as prepared as possible and helping them do their best. Rather than reacting to a possible moment of frustration this week we want to think long term and proactively work on effective participation skills for a life time.

In the book No Excuses (Maynard, 2005), student-athlete Kyle Maynard and his parents discuss how they raised a boy who is a congenital amputee. Born with no arms and no legs, Kyle refused prosthetic legs and arms. His parents said: "The word disabled is a dirty word in the Maynard household." Kyle made his high school wrestling team! Reflecting on losing his first 40 matches, he stated: "Getting my butt kicked paid off." Kyle had a 25-10 record with eight pins (yes, he pinned people) his senior year. He was awarded an ESPY by ESPN and has appeared on numerous talk shows. Kyle is now a junior at the University of Georgia and is independent. How proactive were his parents? They thought with the end in mind, didn't they?

Ultimately, stuttering is what it means to the person who stutters. The definition of the word meaning comes from German and translates to "to hold in mind." Who helps a child set the meaning he attaches to stuttering? Do we want them to hold in mind that they are disabled and need special provisions, or that they are independent and worthy? The adults in his environment are a very large part of what meaning a child assigns to stuttering.

Jump in and get involved. If you have a child who is diabetic or dyslexic, for example, you better jump in. Learn the difference between a child who is simply stuttering and largely unaware and the child who has the identity of a stutterer. Preschoolers may have very noticeable symptoms of stuttering but few have significant thoughts and feelings solidified (Guitar, 1998). The ABC's of stuttering refers to Affect, Behaviors, and Cognitions. Is the young child stuttering but largely oblivious? Or, does your child change words, ask you to speak for him, or show other avoidance habits? Parents and teachers need to know the ABC's of the child who stutters.

Attributes of the Proactive parent includes knowing:

• Does your child only stutter? Or, does he have affect and cognitions about it. Is your child being teased, bullied, or corrected by others?
• The goals for speech therapy and attend meetings (IEP) at school.
• How to talk unconditionally with your child about stuttering.
• How to do home exercises to facilitate carry-over of speaking skills into the real world.
• The exercise on third perceptual position.

Here is what I have found is best for teasing. Let's say your child comes to you with affect in his voice, face, and eyes and states: "When I read in school today and stuttered some kids laughed." With a neutral voice tone and neutral affect (not kinesthetic and emotionally charged), you want to say with sincerity: "I'm sorry that happened." Notice the purposeful use of past tense to invite them to see it as done. Now pace their affect and say: "What do you want to do about it?" Perhaps you help your child formulate a reply such as "Stop teasing. I do not like that."

Since we want to teach life skills and consequences for retaliation, this will open up a discussion of options such as telling the bully to quit, getting teachers involved, etc. We cannot fight our children's battles forever. Since we want them to learn how to handle teasing and adversity themselves when they are older, we want to validate them and discuss possible remedies.

If you are a teacher or parent, you will want to take advantage of resources like the Stuttering Foundation of America, National Stuttering Association, and Friends for children who stutter (see bibliography).

Teachers reading this are asked to meet with parents and the other teachers involved with the child. I hear children's reactive stories on a weekly basis. One told me of a drama teacher shortening and changing his lines in an attempt to prevent stuttering. Another child told me that a teacher at his school asked him to sit down when he started stuttering while campaigning for class president; he was removed as a candidate due to his stuttering. In summary, consider long term implications of reactions to stuttering and enabling. Be like Kyle Maynard's parents and nurture independence. Learn about stuttering, the therapy process, recovery milestones, and be proactive. Validate your child when he comes to you in confidence. Advocate for your child in his environment.

Bibliography

1. Bodenhamer, Bob and Hall, Michael (2000). The User's Manual for the Brain I. Wales, UK. Crown House Publishing. pp. 55-57
2. Cooper, E. B., & Cooper, C. S. (1985c). Personalized fluency control therapy kit‹revised. Allen, TX: DLM.
3. Guitar, Barry (1998). Stuttering: An Integrated Approach to Its Nature and Treatment-2nd Edition. Baltimore, MD. Lippincott Williams & Wilkins. pp.110-113
4. Maynard, Kyle (2005). No Excuses: The True Story of a Congenital Amputee Who Became a Champion in Wrestling and in Life. Washington, DC. Regnery Books

Resources

• Stuttering Foundation of America. www.stutteringhelp.org
• National Stuttering Association. www.westutter.org
• Friends www.friendswhostutter.org
• Stuttering Home Page www.stutteringhomepage.com
• Find a specialist in stuttering therapy www.stutteringspecialists.org

You can post Questions/comments about the above paper to the author before October 22, 2006.