This is a threaded discussion page for the International Stuttering Awareness Day Online
Conference paper, Enhancements To Integrated Approaches For Treating Stuttering, by
E. Charles Healey, Janet Norris, Lisa Scott Trautman, and Michael Susca. 

Theoretical basis for enhancements

From: Hans-Georg Bosshardt
Date: 9/30/98
Time: 3:05:38 AM
Remote Name:


Dear Charlie, Janet Norris, Lisa Scott, and Michael Susca, 

I have taken advantage from reading your interesting paper. I sympathize with your proposal to
use thematic, topic-centered speech contexts in a structured way. In my work with adults I am
already using thematic contexts but I have not yet used scaffolding. I will see how I can integrate
this in my therapy. 

I also share with you the conviction that it is appealing to look at stuttering from a dynamic
perspective as proposed by Anne Smith, Ellen Kelly and others. 

But I have difficulties to see how your therapeutic proposal is related to dynamic theory. I know
other theories that are much more directly related to your proposal than approach. I cannot see
how your enhancements follow or can be derived from any dynamic principle. 

Thank you again for your interesting paper. Hans-Georg

Re: Theoretical basis for enhancements

From: Charlie Healey
Date: 10/5/98
Time: 4:04:10 PM
Remote Name:


Hans-Georg: Thanks for your comments. I'm glad to see that you use theme-based topics in your therapy.
We believe it helps bring about realistic communicative interactions within the therapy sessions. I hope you
try to use some of the scaffolding procedures that we described. 

I am interested in your comments about the dynamic models. What other models were you thinking about
that applied to our proposal? We attempted to show how the one my Smith and Kelly and the recent one by
Smith support the notion that stuttering involves a dynamic process at many levels. Although specific
techniques do not emerge from their model, we tried to show how using a topic for discussion and
supporting that topic with a number of scaffolding techniques assists a client in managing the interaction and
synchrony that must take place among the cognitive, linguistic, emotional, motor, and social factors of any
interaction. These factors are changing from one moment to the next and with different types of listeners in
various speaking situations. We are trying to emphasize the dynamic interaction among these factors and felt
the Smith and Kelly model concepts fit well into this framework. The Demands/Capacities model fits this
concept too but I find it doesn't emphasize the dynamic interactions that take place among the demands and

I would be interested in your reactions to these comments. 


Re: Theoretical basis for enhancements

From: Hans-Georg Bosshardt
Date: 10/13/98
Time: 2:54:33 AM
Remote Name:


Dear Charly, the description of the dynamic interplay of factors which determine the occurrence of stuttering
events at particular moments of time is one of the most promising recent developments in our field. In
addition to the dynamic approach as originally proposed by Zimmerman and Anne Smith information
approaches have also stressed this point. Among the investigators whose work is related to this latter
tradition I would mention among others Perkins, Kent and Curlee (1991), Bernstein Ratner (1997) and my
own work. It seems to me that the enhancements that you propose are well founded on the assumption that
the demands imposed by a speech situation continuously change during communication. But I wanted to
stress that the dynamic approach you were referring to is not the only theoretic framework to account for this
temporal variablity. Hans-Georg 

Moving into the classroom?

From: LH
Date: 10/3/98
Time: 7:48:17 AM
Remote Name:


Interesting article! 

Most of the scaffolding procedures that you recommend are already part of the classroom teacher's bag of
tricks -- or should be at any rate. It seems to me that it should be fairly easy to involve the classroom teacher
in the stuttering child's speech program by developing approaches such as this that use techniques of
communication enhancement that the teacher already understands. 

So, my question, not just to the authors but more generally: has anyone yet tried to involve the teacher in this
kind of program, and if so, how has it worked? 

Lou H.
Healey, Norris, Trautman, and Susca

[ Contents | Search | Post | Reply | Next | Previous | Up ] 

Re: Moving into the classroom?

From: Charlie Healey
Date: 10/5/98
Time: 4:13:37 PM
Remote Name:


We use the scaffolding techniques with teachers AND parents. We find them helpful in structuring the
interaction that takes place between the child and the adult. Scaffolding is a good way to help those who are
not clear on how to manage the conversation with a child who stutters and many teachers are unsure about
how to help the child who stutters. I think you would find though that some teachers are receptive to these
suggestions and conversational prompts, while others are not. I would be very surprised if it didn't work for
those teachers willing to try. 


From: jeff in Iowa
Date: 10/5/98
Time: 1:35:06 PM
Remote Name:


Good article, and good review of the integrated model. I like the use of material which tends to minimize the
emotional content of communication when working on fluency enhancement. My question would be how do
you manage the transition from the therapy room to the real world--the school etc. Who do you involve?

Re: enhancements

From: Charlie Healey
Date: 10/5/98
Time: 3:05:37 PM
Remote Name:


Thank you for your comments. The transition to other speaking environments from the clinic room is rather
easy when using theme-based communication and scaffolds. Whatever is talked about in the therapy room
can be shared with teachers and parents. I think you could see how this would be done at any stage of
therapy from listing and describing to complex discourse on the topic. For example, the child could go from
therapy (using a pullout model of TX) and go into the classroom and share the topics of discussion at some
point with the teacher using the semantic maps developed as a guide through the topic. The social,
emotional, cognitive, linguistic, and motor reponses will change when the child talks with the teacher but
with the theme and scaffolds, it should make the discussion easier (and less stuttered) for the client.
Transitions are not a big problem if you try to make the conversations taking place in therapy as realistic as
possible. That's what our enhancements are meant to do. 

Integrated treatment

From: Ed Feuer
Date: 10/8/98
Time: 1:53:35 AM
Remote Name:


You have said: “Generally, an integrated treatment philosophy involves teaching individuals with
intermediate and advanced stuttering a combination of fluency skills and stuttering modification procedures
as well as how to modify negative feelings and attitudes about stuttering.” What really is there in the
standard training of SLPs that would given them credible expertise in modifying negative feelings and
attitudes about stuttering?” Why not consider real integrated treatment — a collaborative team made up of an
SLP and others with relevant expertise — a coordinated multidisciplinary team approach? — Ed

Re: Integrated treatment

From: Charlie Healey
Date: 10/12/98
Time: 2:24:51 PM
Remote Name:


It goes without saying that SLPs who have access to other professionals should use them when needed.
However, most SLPs are not in settings where they have easy access to a team of professionals. Moreover,
I'm not sure that in the majority of cases, an SLP needs the guidance of a psychologist, a social worker, or
whomever to help a person who stutters deal with the emotional/attitudinal/social aspects of stuttering if an
integrated approach is used. Some children and adults who stutter are in need of professional help beyond
what the SLP can provide. I would think that a clinician would make appropriate referrals with these types
of cases. 

Integrated model

From: Harsha Kathard
Date: 10/15/98
Time: 3:48:18 AM
Remote Name:


Dear Colleagues 

Thank you for a most interesting article. you have made very valuable suggestions for practicle
implementation of your model. I teach at a University in SOuth AFrica and have made similar observations
regarding the clinical process and its "disjointedness" Do you think that thismodel allpies equally to intensive
and less intensive programmes? also, do you think that certain aspectare more or less emphasised for
individual clients ie. whilst emphasis for a client may be greater on the attitudinal dimension, for another it
may be on the motoric aspect?

Re: Integrated model

From: Charlie Healey
Date: 10/15/98
Time: 12:10:23 PM
Remote Name:


Thank you for your question. Indeed, the concept that the treatment of stuttering should involve an
integration of several factors holds true regardless of whether you treat stuttering intensively or not. Also,
you are correct in suggesting that some clients will need more time to work on one factor than another but
the key is to keep in mind what changes occur in the other factors even when you focus on just one. For
example, you may need to spend some time working on motor skills to improve fluency but you do so by
controlling the linguistic complexity of the interaction, by tapping into the client's emotional
awareness/reactions of how it feels to talk in a modified way, having the client develop a different
perceptual/cognitive set while using the new speech method and making the interaction socially meaningful.
With older child, adolescents, and adults who stutter, there probably will be some need to spend lots of time
on the emotional reactions to the stuttering. However, we would not suggest that you work on
emotions/attitudes/feelings in isolation and without regard to the cognitive, motor, and social aspects of that
person's stuttering. 

Enhancements to Integrated Approaches

From: Jean O'Conor
Date: 10/16/98
Time: 8:18:23 AM
Remote Name:


This approach seems adaptable for use with very young children although you refer mostly to older children
and adults. At what age would you recommend starting with it?
Re: Enhancements to Integrated Approaches

From: Charlie Healey
Date: 10/16/98
Time: 3:22:01 PM
Remote Name:


There really isn't any age limitation when you consider stuttering from a multidimensional point of view.
Even with preschool children, we cannot assume that focus on a technique such as reducing speech rate to
improve fluency will not have a direct effect on other factors. With young children, the cognitive awareness
of stuttering may be minimal and a clinician may have to approach the treatment of stuttering in a very
indirect way. However, a clinician can incorporate an integrated approach by using topic-centered speech
activities as well as various types of scaffolding during treatment. Selecting a topic that interests the child
will make speech fun, build self-esteem, and assist in realistic, social interactions within a session. An
integrated approach can work with all ages. The key is knowing how the various factors interact and finding
a way to adapt the enhancements we suggest to the age of the client. 

Enhancements to Integrated Approaches

From: Valerie Johnston
Date: 10/17/98
Time: 2:23:03 PM
Remote Name:


Thank you for an interesting article and a lot of practical suggestions. I know there are many other factors
invloved, but I'm wondering if one of the reasons we are able to achieve better outcomes for our younger
clients who stutter, even severely, might be that we have to use this type of approach to maintain their
interest and cooperation. 


Re: Enhancements to Integrated Approaches

From: Charlie Healey
Date: 10/19/98
Time: 9:45:50 AM
Remote Name:


Yes, I think you are right that the approach helps keep the interests of the younger child. However, the
approach and our enhancements work with adults as well. The treatment of adults takes longer and is more
complicated because there are so many issues that need to be addressed within each factor. Children are a
little more amenable to change.

The Clinical Relationship

From: Chuck Goldman
Date: 10/17/98
Time: 4:42:22 PM
Remote Name:


Your points were welcome and well detailed. The job of every clinician is to lead his client toward a more
decontextualized success. Inherent in the integrated approaches of Guitar and Cooper I have alweays
thought lies the multifactorial philosophy you've enhanced. The treatment difficulty however seems to lie
in the "art" of therapy rather than in the procedural conceptualizations. We've all dealt with clients with
whom we don't particularly click. The clinical relationship however is essential in successfully
negotiationg the scaffolding and decontextualization you rightly espouse. 

Re: The Clinical Relationship

From: Charlie Healey
Date: 10/19/98
Time: 9:48:24 AM
Remote Name:


I agree that the clinical relationship is important and there isn't any approach that will work unless the
clinician finds a way to connect with the client.

Stuttering and articulation

From: ELisa Elena Palumbo
Date: 10/20/98
Time: 9:34:25 PM
Remote Name:


I will like to make 3 questions about stuttering and articulation problems. Maybe, my English won't be
great, but I will try to do my best. I am from Venezuela. 

1) Should I stop thumb sucking on a Stutter 6 years old child? Should I wait? And if the thumb is interfering
me to treat articulation, because of the poor movement of the tongue? 2) Should I work on articulation or
begin with stutter on a 5 years old child who has a lot of articulation problems? 3) Should I work the /r/ on a
Down Syndrome 15 years old adolescent or do not pay any attention to it? It seems to bother him a lot and
he stops speaking each time he finds one /r/ Thank you so much! Elisa Elena Palumbo

Re: Stuttering and articulation

From: Lisa Scott Trautman
Date: 10/21/98
Time: 10:17:47 AM
Remote Name:


Hi. In response to your questions, I think I would stop the thumb sucking in the 6 year old. I would choose
to do this because it is socially inappropriate. This would be my reason more than worrying about how the
thumb sucking interferes with speech treatment. Second, with the 5 year old child, I would work on
stuttering first before articulation. The reason for this is because the child will need to have some control
over his fluency before he tries to make changes with his articulation. Finally, an adolescent with Down's
syndrome may be difficult to treat for an /r/. If he has awareness of the misarticulation, you could try to
make a change with him. However, we know that children with Down's syndrome have difficulty with
articulation in general, and also have a hard time cognitively understanding aspects of therapy. If he has
good awareness when he is distorting the /r/, I think he would be a good candidate for trying to work on the
/r/. Lisa Scott Trautman