COMPONENT 12. PARENTAL INVOLVEMENT

Rationale: As the child is in therapy only two-three times weekly, 
the parents must involve themselves in the treatment process to
assure maximum progress.  Parental communicative style and
communicative feelings of guilt, fear and anger must be dealt 
with through the therapeutic process.

Research: 

Conture (1990) - "All the good that is done in therapy can be offset,
in a relatively short time, by parents who cannot, or will not,
understand their role in their child's speech development. "

Gregory (1991) - feels strongly that parents need to understand the
stuttering problem, its variability, factors associated with this
variability, and how the child responds to fluency disruptions. 

Gregory & Hill (1993) - success of the therapy depends to a great 
extent on the commitment of parents.

Kelly and Conture(1991) - stuttering results from complex 
interactions of constitutional and environmental factors.  
Intervention with children who stutter should include attention 
to these factors.  Therefore, establishment of parent-child 
fluency groups may provide an opportunity for clinicians to assist
parents in better understanding the disorder and ways they can 
help their child. 

Perkins (1992) - implies that parents are part of the environment 
that maintains the child's disfluent speech; therefore, their 
direct involvement in working with the child is critical to 
effective treatment. 

Ramig (1993)  - "Involving parents in the intervention process is an
important step toward facilitating the changes for improvement in the
young child who stutters" (pg.226).

Botterill, Kelman & Rustin (1991) - stuttering arises out of a complex
interplay between the child's environment and the skills and abilities
the child brings to this environment. Intervention programs should 
incorporate a dimension of environmental change that will facilitate 
fluency development. 

Van Riper (1973) - "parents feel a profound sense of guilt".


Wall and Meyers (1984) - "it's important to assure parents they did
not cause the stuttering; also, there are many things they can do
to enhance fluency". 

Zebrowski and Schum (1993) - Discuss the counseling aspects involved
when working with children who stutter and their families. 
Acknowledging the attitudes, beliefs, and feelings of the family 
unit is an important component to the intervention process. 

Activities/Techniques:

 1. Several parent-clinician conferences should be scheduled.  During
    these conferences, parental fears, guilt and anger should be
    assessed and managed appropriately.  Parents must be given the
    time and freedom to express their feelings.

 2. Discuss normal disfluency and normal language development, 
    focusing upon the following developmental areas necessary for the
    production of fluent speech:

        a)  motor coordination and timing
        b)  linguistic and cognitive knowledge
        c)  emotional maturity

 3. View the film "Stuttering and Your Child" (Speech Foundation of
    of America, 1977) with the parents, providing feedback and answers
    to any questions which may result.

 4. Ask parents to assess how they are responding to their child's
    dysfluencies.  Present Cooper's Parent Attitudes Toward Stuttering
    Checklist (Cooper, 1986) or Zwitman's Child Management 
    Questionnaires and Checklist (Zwitman, 1978).  These checklists
    are helpful to facilitate parental awareness and change.

 5. Explain the importance of parental involvement.  Be sure to 
    provide concrete examples of how parents can become effectively
    involved in the therapeutic process.

 6. View the film "Prevention of Stuttering - Part II" (Speech
    Foundation of America).  When their child stutters, he/she can
    detect the listener's reaction through both their words and their
    non-verbal actions.  If the child detects negative feelings, the
    result may be a negative attitude about himself/herself, their
    speech, or both.  This may cause the child to stutter more
    severely and more frequently.  Therefore, it is important for the
    parent to react the same for both fluent as well as dysfluent
    utterances from the child.  An increase in attentiveness when the
    child stutters may reinforce the behavior.

 7. The clinician can assist the parents in structuring a "talking time"
    (Botterill, Kelman, & Rustin, 1991) in which the parents make a
    commitment to spend three, four or five minutes: four, five or 
    six times per week playing with their child.  This should be done 
    in a quiet room as to not allow for any interruptions.  During 
    this "talking time", the parents do not make any demands or 
    comments on the child's speech.  Listening to the content of 
    the child's message is the primary emphasis.  If parents are
    unable to complete this assignment (over a two week period), the
    clinician should discuss with them their role in the therapy 
    process and factors which influence speech change.  

 8. Early in the intervention process, the parents should become 
    familiar with the speech model used with their child.  Often, 
    the clinician will instruct the parents to slow their speaking 
    rate. However, this task is not as easy as it appears.  Parents 
    also need to practice with the clinician as to ensure consistency
    between the therapy model and home model. This inclusion, even if
    brief or periodic, assists in increasing the parents understanding
    of how difficult changing speech patterns can be and will aide in 
    the therapy program. 

 9. Establishing evening "Parent Support Group" meetings for parents of
     children who stutter is one way to reach out to parents who cannot
     attend in-school therapy sessions.  Bennett (1990) discussed how
     one school district organized such meetings, with baby-sitters 
     and translators, in order to train parents on issues around the
     disorder of stuttering, environmental factors which influence 
     one's speech, and treatment considerations.  This atmosphere 
     also provides parents with an opportunity to share their feelings
     and attitudes with other parents in an accepting, warm environment.

10. Provide the parents with information they can take home.  Booklets
     and pamphlets are invaluable sources of information.  The 
     following are suggested reading for parents and teachers:

          (a) “If Your Child Stutters:      Speech Foundation of America
                A Guide for Parents”        P.O. Box 11749
                                            Memphis, TN  38111
                                            (800) 992-9392

         (b) "A Brochure for Parents        John Ahlbach
                of Children Who Stutter"     National Stuttering Project
                                            1269 Seventh Avenue
                                            San Francisco, CA  94122
                                            (415) 566-5324

        (c) "The Stutterer in the           Ellin S. Rind, M.S.
               Classroom"              Stuttering Resource Foundation
                                            123 Oxford Road
                                            New Rochelle, NY  10801
                                            (914) 632-3925 

        (d) "To the Parents of the          Peter R. Ramig, Ph.D
                Nonfluent Child"            Dept. of Communication 
                                         Disorders and Speech Science
                                            University of Colorado
                                            Campus Box 409
                                            Boulder, CO  80309
                                            (303) 492-3049
                    
         (e) "To the Teacher of the     Peter R. Ramig, Ph.D - as above
                  Nonfluent Child"

        (f) "Does Your Child Stutter?"  Peter R. Ramig, Ph.D. - as above

         (g) Stuttering and Your      Stuttering Foundation of America
              Child: Questions and           P.O. Box 11749
              Answers                     Memphis, Tennessee 38111 
                                             (800) 992-9392