About the presenter: Bill Murphy is a clinical professor at Purdue University. He has worked for over 30 years with children and adults who stuter. Bill is a member of both the National Stuttering Association and Friends of Children and Adolescents Who Stutter. He is a past member of the Steering Committee of ASHA's Special Interest Division of Fluency and Fluency Disorders and is recognized as a Fluency Specialist. He has given numerous state and national presentations regarding the treatment of stuttering. Bill believes that successful stuttering therapy incorporates both the modification of speech behavior as well as emotional and attitudinal changes.
About the presenter: Peter Ramig is Professor and Associate Chair at the University of Colorado where he specializes in the treatment and research of stuttering in children and adults. He prides himself as being a clinician and teacher who makes a difference. His writings include research articles, book chapters pertaining to the topic of stuttering, and a 2005 published book with co-author Darrell Dodge, The Child and Adolescent Stuttering Treatment and Activity Resource Guide. In addition, he annually presents numerous workshops focused on many practical ideas for working with children and adults who stutter.

You can post Questions/comments about the following paper to the author before October 22, 2008.

Stretches and Smashes

by Bill Murphy, from Indiana, USA, and Peter Ramig, from Colorado, USA

Stretching Stutters -A Fun Activity for Teaching Children to Stretch Stutters - by Peter Ramig

Most clinicians understand the importance of teaching the disfluent school-age child to begin an utterance with an easy onset, especially on the first sound of a sentence where stuttering often occurs. In this paper however, I'm going to describe how I teach kids in the treatment room to tolerate a longer and unforced stretch of the sound as a technique to use when a short easy onset in isolation does not effectively work for the child. I typically reserve this technique for kids who are reacting to their stutter by resorting to recoiling and/or pushing and forcing through the stuttered moment, and one's who have made little progress with fluency shaping techniques. The purpose in teaching longer stretches is to help the child eventually feel more comfortable in holding on to a real stutter as he/she continues with the stretch in a forward flowing fashion while maintaining air and sound. In addition, I also emphasize holding the sound while trying to minimize the urge to push or force through it.

For a child to actually apply this technique in everyday, on-going conversation requires a great deal of practice within the treatment room. Similar to virtually all techniques that clinicians teach clients who stutter, there are a multitude of different activities that one can use to teach longer stretches. My favorites include those that involve items that stretch, such as clay, Play Doh (see Bill Murphy's recipe for making Play Doh in his write-up called "Smashing Stutters"), or Silly Putty. I like these items because as they are stretched out more than a few feet, they will break. The importance of this fact is explained below.

I always first model whatever it is I'm expecting the child to do next. In this case, for example, using clay as my stretchable material, I slowly pull it in opposite directions while simultaneously drawing out the first sound of a word as I say it. Next, I want the child to practice the stretch along with me. After modeling a few more times, I then give him/her a quarter-size piece of the same clay I'm using and ask him/her to imitate in unison what I'm doing. Initially, we do a short verbal stretch together as we simultaneously stretch out our individual pieces of clay; however, as the practice progresses we both begin to lengthen our stretch until the clay breaks. Most of the time this is an enjoyable activity because both of us laugh at our silliness in dragging out sounds until the clay we are holding breaks as it is stretched out a few feet or more. This is particularly the case when we progress to using only one piece of clay between us, each grasping the same piece as we pull in the opposite direction while holding on to our sound stretch until the clay breaks.

There are many possible activities that clinicians can use to help a child feel more comfortable as they are practicing how to more easily stretch through stuttering. I personally like using the clay or other similar stretchable materials because it is something that kids tend to enjoy. They can actively hold the material and manipulate it as we 'play' with a way to change some of the learned avoidant reactions that often develop as a result of the unpleasantness of stuttering. I believe that one's normal reactions to stuttering can often lead to continued struggle and avoidances, and these responses can maintain or exacerbate stuttering. Teaching and showing the child that there are many different ways to stutter, ranging from hard to easy, can increase his/her chances of stuttering less and with more control.

In addition to teaching sound stretches in a way that's enjoyable for the child, this activity is also desensitizing. Over time the child begins to better tolerate and change real stuttering by keeping air and sound activated as he transitions from the stretched sound into the next sound of the word. Similar to what Bill Murphy describes in his paper, stretching out and tolerating longer stretches helps to reduce the negative feelings that are often associated with stuttering.

Smashing Stutters - Externalizing Stuttering: Desensitization - by Bill Murphy

A fun and therapeutic activity I do with children who stutter is smashing clay stutters. I begin by asking the child if sometimes he/she feels bad when they stutter. It doesn't really matter how they respond and I continue to say "there's a way to get back at those darn stutters; let's make a piece of clay look like a stutter" Children are very creative and they come up with all kinds of shapes. When they finish I ask the child to imitate how their stutter sounds and then add " Ok now let's smash that old stutter" (I have various items on the table that they can use to aid the " smashing" ). Most clients really get into demolishing their clay model. Below I've described what I believe this activity does.

Activities such as smashing clay stutters, popping balloons labeled as big and small stutters, and stomping out wadded newspaper " stutters" require some explanation, in order to make sense to parents and practitioners. These procedures fill several functions. First, they desensitize the child client to mentioning stuttering, which may formerly have been an uncomfortable or taboo topic. Second, the activities serve to separate stuttering from the child's sense of self. By externalizing stuttering -- placing it momentarily outside of the child's sense of who he/she is the client may be free for the first time to attribute feelings and emotions to stuttering which are incongruent with a strong, positive self concept. By temporarily setting stuttering apart, the child client may be able to freely connect emotions which are negative, like embarrassment, anger and frustration, to stuttering. As the child expresses some of the negative feelings he/she has understandably accumulated towards stuttering (but not towards him/herself), the child may experience a release of tension. Last, when the clinician suggests smashing and stomping out stutters, or representing stutters with artwork created by the client, he/she is cueing the child that they are not terrible, fearful or frightening things. The child is invited to engage in an activity, which treats stuttering with a bit of humor and levity, thus minimizing it for the moment. In standing apart from stuttering, minimizing it and mocking it, the elementary school ages child has an opportunity for mastery -- for using his/her skills, intellect and ability to fantasize, to assume a powerful position relative to stutters, which can be represented, mocked and momentarily destroyed.

And as an addendum to this article, an easy and inexpensive recipe for Play Doh! 1/2 cup salt
2 T. cooking oil
1 T. alum
2 cups boiling water
2 cups flour
food coloring

Dissolve salt and alum in boiling water. Add cooking oil and coloring. Stir in flour and knead until smooth. Store covered in refrigerator.

You can post Questions/comments about the above paper to the authors before October 22, 2008.

submitted September 12, 2008
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