This paper is being written from two perspectives: one, from my experiences as a speech-language pathologist who worked in the public schools for 28 years and, most significantly for me personally, as the mother of a son who stuttered. My son as well as the children at school challenged me and provided the insight and motivation to help develop school-based strategies for working with students who stutter.
Through the years, I have become disheartened when individuals who stutter have reported negative experiences regarding therapy received in a school setting. It is most discouraging to hear speech-language pathologists employed in other professional settings make disparaging remarks about school service delivery for children who stutter. It is my strong belief that the school setting provides unique opportunities for the assessment and treatment of fluency disorders through collaboration and consultation within a child’s natural environment. Not only can fluency intervention in a school environment be effective, it can also be a positive and rewarding experience for all involved.
In this paper, strategies which enable the speech-language pathologist to enlist the involvement and assistance of school personnel in the assessment and treatment of fluency disorders will be presented. Suggestions for observation of students in a variety of academic and social situations as well as ways to facilitate communication between members of the educational team will be discussed. A fluency-enhancing program emphasizing school-wide participation, including the involvement of the child’s classmates, to build self-esteem and foster positive attitudes toward stuttering will be described.
During my years working in the schools, there were times when a student was referred for a fluency evaluation by a teacher concerned about the child’s perceived stuttering. No observable stuttering behaviors were noted during the formal evaluation. However, given the variable nature of stuttering, it was evident that what was needed was a collaborative assessment. The school setting provides an opportunity to assess a child’s fluency through collaboration and consultation through a variety of speaking situations to observe how the child and others react to stuttering.
In addition to a formal test battery administered in the therapy room, information is collected through interviews and written checklists completed by classroom teachers and others with whom the child interacts in school (i.e. librarian, school secretary, music teacher, physical education teacher). The information gathered regarding how teachers view the student’s stuttering in relation to academic and social skills enables the clinician to learn about teacher and school expectations regarding oral skills and to determine whether or not stuttering interferes with academic performance. The process provides an opportunity for the clinician to become familiar with the academic and social climate and expectations of the school as they relate to oral speaking skills.
Observation of the student in a variety of school-wide situations is a critical component of a natural assessment process. In addition to observing the student in the classroom during such activities as oral reading, answering questions in class, and presenting oral reports, the clinician is also encouraged to eat with the students in the school cafeteria and to interact with the child during playtime. These methods of collecting data in a natural environment provide valuable information about the student’s unique stuttering syndrome. The process enables the clinician to observe how the teachers and peers react to the child’s disfluencies as well as observing how the child responds. The information obtained and feelings shared between the student, parents, teachers, other school personnel, and the speech-language pathologist throughout the collaborative process may be used in determining whether or not the student is eligible for school speech services and may further be used in the development of intervention strategies. The process serves as a foundation for building a common vocabulary for the language of fluency.
Once the student has been determined to be eligible for school speech services, a "reality-based" intervention program, which includes affective, behavioral, and cognitive components, is developed.
When reviewing various methods used to modify and control stuttering, we were able to identify six common fluency enhancing techniques which we labeled the "Universal Fluency Initiating Gestures (FIGs)." These FIGs focus on altering the coordination between phonation, respiration, and articulation. We looked for ways to communicate these techniques to young children in a manner which was motivating and culturally non-biased. As usual, it was our son who came to the rescue! He had the idea of a "Super Hero" cartoon character dedicated to helping children who stutter. Using our son’s creativity, enthusiasm, and guidance as inspiration, we developed the characters of "SuperFIG and Friends" consisting of a central character(SuperFIG) and six FIG friends (Slow FIG, Deep FIG, Easy FIG, Loud FIG, Beat FIG, Smooth FIG), each representing one of the six universal Fluency Initiating Gestures (FIGs). SuperFIG and friends are an integral part of the direct intervention process to help students achieve fluency control.
The school curriculum is a source for FIG practice. It is more meaningful to ask a child to practice FIGs at the word or sentence level using class spelling or vocabulary lists than to use arbitrary words that the child will rarely use and which have little or no meaning in the child’s real world. Fluency practice at the reading level makes use of the student’s reading, science, or social studies texts and skill books. Requiring oral answers to questions from class textbooks facilitates realistic practice in the use of FIGs during responses. Curriculum-based materials may be used at any point in the therapy process- either in the therapy room using a direct pull-out model of service delivery within a structured therapy resource room or within a classroom using a collaborative/consultative or inclusive model. The use of classroom material makes fluency practice more meaningful in school and at home. It usually enhances academic performance as well. Active participation of parents and teachers is an integral part of the success throughout the process.
Facilitating the transfer of fluency control skills from the therapy room into the real world of a child is a challenge. How often have you encountered a student who has achieved acceptable levels of fluency control (including more positive attitudes and feelings toward stuttering) in the therapy resource room, but who leaves the safe haven of the therapy room only to become disfluent in the classroom? School practitioners have an opportunity to structure fluency transfer and maintenance within the school environment over a long period of time and to gradually phase the child out of therapy by redefining service delivery to meet the child’s changing needs as progress is made.
A Collaborative/Consultative approach is one option which is highly effective in facilitating transfer of fluency control into the classroom. The speech-language pathologist and the classroom teacher work as a team to provide consistent monitoring and reinforcement of the use of Fluency Initiating Gestures within the classroom. It is recommended that the speech-language pathologist first demonstrate specific use of FIGs within the context of a language arts lesson team-taught with the classroom teacher. The teacher can later implement appropriate fluency maintenance activities within the daily curriculum or through activities and worksheets provided at Classroom Activity Centers set up within the classroom.
An Environmental Approach facilitates the transfer and maintenance of fluency control further into the "real world" of the school as a community. The focus of therapy shifts from the therapy room to a variety of school settings, utilizing the entire school faculty and staff as well as the child’s peers. Following are a few examples of environmental monitoring and reinforcement of fluency control:
Bring A Friend to Speech Days: A student in therapy is encouraged to invite a classmate to a speech session. The speech student "teaches" the friend FIGs and the two engage in FIG worksheet or activity practice. The child who stutters assumes the role of "FIG Teacher" or "FIG Expert." The friend (called a "Speech Buddy") is asked to remind the speech student, through use of a "secret code" created by the students, to use fluency controls in the classroom or other school settings.
Cafeteria Helpers: The school cafeteria workers are trained to listen for use of FIGs while the student is asking for food in the cafeteria and to reinforce use of FIGs. (An added benefit is that my children who stutter usually received extra servings of food as reinforcement!)
Library Time: The school librarian, while engaging the student in conversation about a book, listens for and reinforces use of FIGs.
Sharing Time: Students are encouraged to discuss their favorite therapy activities, display their speech notebooks, and demonstrate their proficiency in use of FIGs to classmates during classroom "Sharing Time."
Speech Parties: At the end of the school year, the students enrolled in the speech program host parties for classmates who do not receive speech services. Special invitations are designed and sent by the speech students. Speech skills are practiced in a social context. For example, students may practice using designated FIGs or appropriate eye contact while serving snacks to their guests. Speech students demonstrate and teach their favorite speech activities to their friends. Each student may invite one friend to the party. The main stipulation is that no one who makes fun of anyone who stutters or who is "different" may be invited. It is a good lesson in tolerance and sensitivity!
Speech Honors and Graduation: During the school-wide Honors Assembly at the end of the year, students enrolled in the speech program are recognized and "honored" for their hard work and willingness to meet the challenges of speech therapy. Students being dismissed from the program are called to the stage and awarded with a "Graduation Certificate" signed by the speech-language pathologist and the school principal.
Some of the positive outcomes of using a school-wide environmental approach are:
A positive team-approach to the development of school-based strategies for working with children who stutter is challenging and rewarding. The process requires flexibility, shared decision-making, and expansion of the roles of all members of the school community. Positive outcomes typically result in effective transfer and maintenance of fluency control in addition to facilitating academic and social growth. Through cooperative efforts, we can make a significant difference in the lives of children who stutter.
I’d like to close with a wonderful example of the positive, intangible outcomes of the school-based program described in this paper. One day, as I worked at my desk in my office after school, a young boy in the second grade came to my door. He was not enrolled in the speech program. He asked me if he could be enrolled in "speech" like his friend, Jeff. I told him that not everyone gets the opportunity to come to speech. He wanted to know why Jeff could go to speech. "What does Jeff have?" he asked. I told him Jeff stuttered. He pleaded, "Well, could you teach me how to stutter so I can go to speech?" I told him that I was sorry, but not everyone can stutter. His eyes filled with tears. I quickly told him that although he didn’t stutter, I was sure he had other talents! He replied, "Maybe, but I still wish I could stutter like Jeff!" and walked away. What a long way we’ve come from the days when children were ridiculed for stuttering and for receiving speech services!