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From: Charlie Healey
Time: 3:11:50 PM
Remote Name: 188.8.131.52
The goals for therapy differ for each client. There isn't one program or approach that will work for all people who stutter. Differential diagnosis of the disorder will assist a clinician in developing appropriate goals for each client. In my evaluation, I explore detailed aspects of five factors that I believe relate to stuttering. These include Cognitive, Affective, Lingistic, Motor, and Social factors. Knowing the strengths and weaknesses of the person who stutters in each of these areas will assist the clinician in developing appropriate goals for therapy. So, for some, considerable attention may be on the Cognitive and Affective aspects of the disorder, while others might need more time spent in helping them manage muscle tension levels and coordination of respiration, phonation, and articulation. Certainly, there are those that need some therapy in all five areas. With preschoolers, the focus is on managing lingusitic demands and facilitating an easier style of talking through reduced speech rates and understanding how to change bumpy and stickly speech into smooth speech. With school-age children, I think all five areas need some attention. With adults, most of the treatment is in the Cognitive, Affective, Motor, and Social areas.
Your comment that most adults are comfortable and less self-conscious about their stuttering than children differs from my own and many others' professional experience. Most adults who stutter are NOT comfortable with their stuttering and are very self conscious about their speech. Because of this, they begin to try to hide the stuttering from others. Avoidance and other compensatory behaviors emerge. I believe these issues need to be addressed in therapy. I believe many clinicians ignore these issues because they don't know how to address them in therapy. So, they focus their therapy on the mechanics of talking via a variety of fluency shaping strategies in which the DAF is one such method. The problem with working on speech mechanics only is that it may not address what's really at the heart of the fluency problem. Stutterers can develop "fluency" in a variety of ways but I don't believe that it will last unless the Cognitive and Affective components of talking are addressed. As you can see, the treatment of stuttering is a multidimensional problem that takes time to address a number of issues. The SDS model is a way to faciliatate the interactions that take place in therapy process.