I recently had a new client’s mother discuss with me her concerns for some disfluencies (stuttered speech) her son has. The client’s mother was bothered because other therapists that had worked with her son had said, “We can’t treat it because he never does it around us.”
This frustrates me a little, but I actually understand the therapist’s difficulty. It is incredibly hard to treat something you don’t hear yourself. But the truth of the matter is, that just because the therapist doesn’t hear it, doesn’t mean it is not a problem.
It is often common for children with disfluencies to be more aware of their speech around others that they are less familiar with (i.e. a speech teacher). They might work extra hard (even subconsciously) to appear fluent. They might talk around the words/sounds that they would typically stutter on and try to avoid them completely.
However, when these same children are in a more relaxed environment where they feel they can let their guard down and be more themselves (i.e. at home), they might produce more disfluencies. This is because they might not care as much how their stuttering is perceived by close family and friends. They assume their loved ones will look past it. Or – they just want to relax when they are at home. All of these things are understandable.
The problem however, is that sometimes these types of children never receive appropriate treatment because they have a way of hiding their disfluencies from professionals who can help.
I have dealt with this many times in my practice and have come up with a few tips that you can try when working with a client who has disfluencies (whether you hear them or not).
1. Always trust what the parent is telling you.
It has been my experience that some parents feel like no-one believes them when they say their child stutters. If a parent is concerned – you (as a therapist) should be too. Parents don’t tend to make up concerns about their children. They don’t want their children to struggle. Why would they pretend their child is stuttering if they aren’t? I always tell my parents “I am the professional – but you are a professional too when it comes to your child. You know your child better than anyone – so if you tell me something about your child – I am going to believe you.”
2. Get as much detailed information from the child’s parent/other family members as you can.
Ask specific questions about the child’s stuttering habits. Approximately how often do they stutter in a 5 minute conversation? Do you notice their stuttering habits change in different environments? Do you notice their stuttering habits change around different people. Which environments do they speak the best in, or the worst? Which people do they speak the best around, or the worst? Can you imitate what your child sounds like when he/she is stuttering? Are there specific sounds, words, phrases, or sentences that seem to increase your child’s disfluencies?
3. Try to get a video of the child stuttering.
With cameras built into almost every mobile phone now-a-days, this should be easy. Just have the parents on alert to try to capture the child’s true stuttering habits. I prefer for this to be done without the child’s knowledge – if possible. Children are going to automatically work extra hard to conceal their stuttering habits if they know they are being taped.
4. Observe the child in their natural environment.
If the only way to observe the child in their natural environment is to view a video taken by the child’s parents – then use it. However, there are other ways to see the child’s true stuttering habits. Drop in on the child’s classroom (especially during an activity that requires verbal communication). Observe the child during lunch time or during recess. You can begin to see how the child communicates in a variety of settings, and this information will become very beneficial to you as treat the child.
5. Stress the child out.
I know this sounds harsh – but stuttering is often triggered by stressful situations. If the child is never stressed around you – it is likely you will never hear any stuttering. When I say stress the child out – I am not implying that you be mean to the child or make them feel bad. Just put them in everyday situations that may cause slight panic. Some ideas are: public speaking (set up some kind of activity that requires the child to speak in front of other people), talking on the phone (have the child call a local pizza shop and ask about the specials), ordering food (take the child out for ice-cream and have them order their own). Anything that might take the child slightly out of his/her comfort zone – you can use these opportunities to both observe disfluent speech, and work on correcting it. When observing it – take notes about what type and frequency of stuttering you hear. When working on correcting it – you can discuss the scenario ahead of time. Practice what the child will possibly say. Work on keeping the child calm. Role play the situation ahead of time.
6. Help the child become more aware of stuttering by having them keep track of your (pretend) stutters.
Often times children who stutter a lot – don’t even realize when they are doing it. It is key to increase their awareness of their stuttering habits. To do this – you (as the therapist or parent) need to model what disfluent speech looks like. Carry on a conversation with the child, play a game with the child, read a story with the child – during one of these activities – produce random but noticeable disfluent speech (imitate the child’s stuttering habits if possible) and have the child track your disfluencies. This will not only help make the child more aware of disfluent speech in general, but will help them understand how stuttering can interfere with communication.
7. Help the child become more aware by keeping track of his/her own stutters.
Complete any one of the activities mentioned in #6 – but track the child’s stutters during the activity. Both you and the child should track the child’s stutters and then compare your results and the child’s results. This will help you see how aware the child is of their own stuttering. This will also help the child realize how aware/unaware they are of their own stuttering. You can also video record or tape record the child’s speech and them watch/listen to it together later and track the stutters heard. Then compare your results.
8. Teach the child how to prevent/correct stuttering by practicing pretend stuttering and specific stuttering techniques to overcome it.
This tip is especially helpful when working with children who don’t stutter around you (the therapist) – but who do in fact stutter. Model disfluent speech and then model how to fix it using a specific technique (gentle onset, pull-outs, reduced rate of speech, etc.). Have the child practice pretend stuttering and fix it by using a specific technique. If they have practiced fixing disfluent speech (even when it is not real) they will have the tools to fix disfluent speech when it is real.
Good Luck and I hope some of these tips help!!!