COMPONENT 6. DESENSITIZATION THERAPY Rationale: To desensitize the child to the fear and expectancy of the stuttering moment. Appropriate desensitization procedures will also be effective in reducing negative emotionality. Research: Dell (1979) - advocated three ways of teaching a child to say a word: the fluent way, they hard stuttering way, and the easy stuttered way. Ham (1986) - defines desensitization in terms of client hypersensitivity's to normal nonfluencies, stuttering, people, situations, and/or specific words. Therapy should incorporate activities which reduce one's fears and anticipatory behaviors. Peters (1991) - emphasizes desensitization to fluency disrupting stimuli, such as interruptions, competition to speak, or excitement that may produce increased moments of stuttering. Reducing negative feelings and attitudes and eliminating avoidances need to be incorporated for some children who stutter. Van Riper (1973) - "Since the fears, avoidance and struggle which characterize advanced stuttering stem from it's unpleasantness, an unpleasantness which tends to grow stronger, no therapy can hope for success unless it seeks directly to reduce it." Van Riper (1973) - "another essential and difficult thing to do is to help the child to understand what he/she should do differently when he/she fears or experiences stuttering." Activities/Techniques: 1. During therapy activities, model easy stuttering behaviors. By reacting to your dysfluencies without struggle and tension or negative emotionality, the child learns a new way of reacting to his/her own dysfluent speech. 2. While employing an increased length and complexity of utterance framework, encourage easy bouncing and stretching behaviors. Teach the child he/she can stutter without struggle and tension. 3. Structure therapy activities which provide the child with opportunities to "catch" the clinician bounding. The clinician reacts to being caught in a positive manner, which facilitates increased acceptance of the stuttering, as well as providing an easy model of dysfluent speech. 4. Activity number three may be expanded to include the clinician catching the child bounding, the child imitating the clinicianÕs bounce, or the child providing an "easier" way to say the dysfluent word. By incorporating activity number three prior to the above, the child reacts more positively to his "being caught." The following is an example of the dialogue associated with these activities: Child: "I heard you bounce." Clinician: "Good! What word did I bounce on?" Child: "Marshmallow" Clinician: "Good! Can you show me how it sounded?" Child: "M-m-marshmallow" Clinician: "Good! Now show me an easy way to say that word." Child: "Marshmallow" (The child produced the word with a stretch on the first syllable). 5. The clinician instructs the client to read or speak using easy pseudo-stuttering. The client may be given general or specific instructions as to what words or place of the sentence to pseudostutter. The client learns an easier, unforced form of stuttering while approaching his/her dysfluency. 6. After the child experiences success with easy stuttering, encourage him/her to use easy bouncing and stretching on real stuttering. Variation, such as slowing down, easing out of, or changing moments of real stuttering provides the child with feelings of increased control over their speech. For example, if the client is exhibiting silent laryngeal blocks with complete cessation of airflow, suggest (or model) that the child tries to "bounce out of the hard speech." Or, if the child exhibits multiple-part word repetitions, slowing them down and stretching them out may be particularly successful. 7. For the older client, Ham (1986) recommends two approaches to desensitization: "1) desensitization to stuttering by repeated exposure to stuttering in a variety of modes and situations, and 2) desensitization to fears by exposure to a hierarchy of situations, ranked for their anxiety-causing, stuttering potentials" (pg.134). This exposure to a "stuttering bath" reduces spasm frequency, severity, and complexity while increasing tolerance and objectivity.