Stuttering and young people - the missing perspective
Most modern therapy programs offer one variant for children who stutter and one for adults. With regards to children, most clinicians and/or researchers (among others Bloodstein, 1987; Conture, 1982; Dell, 1980; Emerick, 1970; Fraser (ed), 1964; Irwing, 1981; Luper & Mulder, 1964; Onslow, 1996; Perkins, 1964; Peters & Starkweather, 1989; Rustin, 1991; Starkweather, 1987, Van Riper 1973 and 1982; Yairi, 1983) describing stuttering in childhood, divide the problem into different phases or levels. Mostly we see different variant on the theme of beginning stutterers and confirmed stutterers. But adults are just one kind, when therapy is discussed. Generally speaking there are but two clinical perspectives, one regarding children and the other adults.
There are therapy programs for teen-agers, however, the Rustin Program at the Michael Palin Centre for Stammering Children (Rustin, 1995) being the most famous one. It seems however clear that the perspective, is more an adaptation of the one originally designed for children. The staff requires for instance that both parents participate in the interview process, thereby only covering the situation for the younger adolescents, living in the basic family structure. Many young persons don't live in, and don't want to live in that social pattern.
This view on adolescence as an extension of childhood leading into adult life should, in our view, be questioned also in the field of logopedics/speech-language pathology. Schwartz (1993) is pointing directly to this, when he advocates that the adolescent part of life be viewed as a separate entity. Fraser & Perkins (Stuttering Foundation of America, 1987) in their booklet Do You Stutter: A Guide for Teens discussed this period as a unique period in life, but their examples in describing this period in life had the flavor of adults observing the young and using descriptions and advice not gathered from their realities. And slowly, authors are beginning to view this period differently than traditionally has been done.
Fawcus (1995), in her set up for describing therapy for adolescents states that although this period in life means storms and stress to some, "many individuals pass through this period relatively unscathed". The period "is not by definition problematic". Very rarely, however, have the young persons been asked to describe what is theirs; to our knowledge only one such study has been performed in a systematized sense, namely the Swedish thesis work by Franzén and Krüger (1993). Their results give some depth to the understanding of the disorder among the young; a necessary knowledge before constructing treatment for people in this period of life. Another Swedish worker, Hampus-Risberg (1993) has interviewed extensively two teenage girls regarding their view on life, stuttering included. Unfortunately for the international public, the last two studies are only available in Swedish.
Conditions for young persons today in terms of society
The youth period, as we see it today as a period of its own, came to life at the birth of mass secondary schooling in the US, the emergence of rock'n roll, and other ways of enjoying the new young life style at the middle and the end of the fifties. The great market of young people came to life and many companies prosper with the young as the basic target. They have recognized the needs of the young and created them as well.
The youth period of life was considered for a long time to be parallel to the teens. This is no longer valid. The period of youth, as we see it today, starts later and ends later. The ever-prolonged educational process, (in Sweden, most young people see 12 years as the minimum for basic education as compared to nine years twenty years ago), the increasing unemployment for the young, the possibilities of delaying pregnancies to a later period in life, the problems in setting up a home of your own and perhaps other elements are, we believe, crucial in prolonging this period of life.
When we mention the time between 15 and 25 as typical for this period, this might seem as a long time, and may be this is not correct, at the lower end. We definitely do not view the first two years in the teens as the time of "youth" in this sense. Socially speaking they are more to be viewed as older children, well tied up in the stage of childhood, both regarding school and in most legal aspects. At the higher end it is also dubious, of course. Many aged 25 live adult lives even though many 25-year-olds also live a life much more connected to youth than to adulthood, considering that they still study on a basic university level, live single and with a very restricted economy, which in turn affects their living standard and power to change life (Hörnquist 1994). In many aspects measures taken by Swedish authorities to guide and help the younger people have 25 or even 27 as the upper time limit between young age and adulthood.
The demands on the, say, 20-year-olds are not the same today as they were twenty years ago, and we believe that this mostly has to do with demands on longer education, higher unemployment, all leading to less private economic power (Levy 1988). In turn this also leads to an upward moving social mobility, sociologically speaking, and we have known since long that the higher on the social stratification an individual is the older he or she will be before marriage and child rearing. We can most certainly see, however, that this period of life covers more time than it did during the sixties and seventies.
The development of theories in stuttering
Why, then, has speech pathology or logopedics not participated in development and why has the field so gravely neglected what has been so obvious in other fields? One cannot but speculate. However, when looking back a few decades with theory development in focus, one can see that the major therapy ideology development really is quite old. Now, reaching fluency as the sole goal for therapy is almost as old as man himself. Reaching a smoother way to stutter and aiming at a non-avoidance attitude also is quite old - beginning in the 1930's. Both the development of the Iowa (Johnson) and the Western Michigan University schools (Van Riper) of stuttering therapy, if we may call them that, are older than the birth of the teen age and youth revolution. At the growth of these therapy ideas and ideologies, the processing from childhood into adulthood was seen as a dichotomy and not as the triad of childhood - youth - adulthood as we see it today.
Different conditions
Let us make an attempt to systematize. We have stated that we do believe this time is not a megalomized childhood, nor is it to be seen as an underdeveloped adulthood. This is a period in its own right and rules of its own. We can see different prerequisites in life in terms of maturity or capacities, and specify those into intellectual, cognitive and social abilities, ability to postpone rewards, and economic capacity or maturity.
Perhaps it is all a part of growing up, a tormented rite of passage, a dark valley of adolescent shadows, a wretched hormonal cathecism, a teenager of sorrows. - Kate Atkinson in her novel Behind the Scenes of the Museum.
Besides the sad fact that there is no theory or adapted methodology for the treatment of stuttering young persons they have often been described as hopeless cases because of their very age and problems hypothetically associated to that fact. Generally speaking, they are in "a logopedic latency phase" more depending on undeveloped theoretical and administrative systems than on their needs. The school system define them quite often belonging to the hospital system and the logopedic clinics often prefer to put them into the school responsibilities. The young people end up in a no man's land, quite like the situation for patients with combined psychiatric and logopedic disorders. When they come to therapy they are no less help-seeking than adults in severe crises.
Is this worth the trouble?
Then, is the time of youth a time in itself, is it worth the trouble of analyzing in order to develop a different therapeutic perspective? We do think so. There are quite a few myths in the professional establishment regarding the characteristics of these young people, especially when it comes to their suitability to stuttering therapy. The most prevalent of those says that young people are unfit for therapy because their lives are in such turmoil anyway. Another myth states simply that young persons simply are not motivated; they do not want to talk, to confront and they are just generally troublesome. True that many "firsts" are experienced during these years, but most days just pass by just the way most days pass by for adults. Young people think many thoughts, perform some experiments and most of all, they often experience that adults do not listen to them very well - don't see behind their markers of young life and group belongingness, hair styles, attention seeking clothing and the like. We have to expand our knowledge regarding most areas in this period of life, just as we did with children during the 20th century in order to meet them where they really are, not where we hope they would be or where we, the adults are. And why not, we, as adults, survived this period of life. Some better than others, however!
So, thank you for the opportunity to be a part of this on line presentation for ISAD-98. We hope to be able to come back at some other time and present some ideas of therapy based upon the attempts to find a merging between theories of young persons situation in life and developing stuttering problems.
Bloodstein, O.: A Handbook on Stuttering, 4th edition. National Easter Seal Soc. Chicago. 1987
Conture, E.G.: Stuttering. Prentice-Hall, Englewood Cliffs, N.J. 1982.
Dell, C.W.: Treating the School Age Stutterer - A Guide for Clinicians. Speech Foundation of America. Memphis, TN. 1980.
Emerick, L.L.: Therapy for Young Stutterers. Interstate Publichers Inc., Danville Ill. 1970.
Fawcus, M.: Working with Adolescents. In Fawcus, M. (ed) Stuttering - From Theory To Practice. Whurr Publishers Ltd, London, 1995.
Franzén, C. & Krüger, M.: Stuttering During The Teens: A Study About Thoughts, Feelings And Experiences Connected To Stuttering. Thesis in logopedics, Dept. Of Logopedics and Phoniatrics, University of Göteborg, 1993. (Available only in Swedish: Stamning Under TonÅRstiden - En EnkäTstudie Om Tankar, KäNslor Och Upplevelser Knutna Till Stamning. Examensarbete i logopedi, Institutionen för logopedi och foniatri, Göteborgs universitet. 1993.
Fraser, M. (ed): Treatment of the Young Stutterer in the School. Speech Foundation (Stuttering Foundation) of America. Memphis, TN. 1964.
Hampus-Risberg, M-A: To be a stuttering teen ager (Hampus-Risberg 1994). Report from College of Falun Borlänge (1995). Available only in Swedish: "Att vara en stammande tonåring".
Hörnquist, M.: "To Grow up in different Generations" in Fritzell, J & O. Lundberg (eds) Everyday Life: Living Conditions in Sweden during Three Decades. Stockholm: Brombergs 1994. Available only in Swedish "Att bli vuxen i olika generationer" Vardagens villkor - Levnadsförhållanden i Sverige under tre decennier.
Irwing, A.: Stuttering. Practical Help for All Ages. Penguin Books Ltd. 1980.
Levy, F.: Dollars and Dreams. The Changing American Income Distribution. New York: W W Norton & Company, 1988.
Luper, H.L. & Mulder, R.L.: Stuttering Therapy for Children. Prentice-Hall Inc. N.J 1964.
Onslow, M.: Behavioral Management of Stuttering. Singular Publishing Group, Inc. 1996.
Perkins, W.H. (ed): Current Therapy of Communication Disorders: Stuttering Disorders. Thieme-Stratton, New York. 1964.
Peters, H.F.M. & Starkweather, C.W.: Development of Stuttering Throughout Life. J. of Fluency Dis., 14, 1989.
Rustin, L., Cook, F. & Spence, R.: The Management of Stuttering in Adolescence. Singular Publishing Group, Inc., London 1995.
Rustin, L.: Parents, Families, and the Stuttering Child. London: Whurr. 1991.
Schwartz, H.D.: Adolescents Who Stutter. J. of Fluency Dis. Vol 18, No 2&3. 1993
Starkweather, C.W.: Fluency and Stuttering. Englewood Cliffs, N.J. Prentice-Hall. 1987.
Van Riper, C.G.: The Treatment of Stuttering. Prentice-Hall Inc. N.J. 1973.
Yairi, E.: The onset of stuttering in two- and three-year old children: A preliminary report. J. of Speech and Hearing Dis., 48. 1983.