About
once a month, I write long e-mail response to parents’ concerns. After writing
such an e-mail today, it occurred to me that some of these e-mails would make good
blog entries. Of course personal identification has been removed. This e-mail
is about a first grader.
Hi Mrs. _____,
Thank
you for sharing your concerns. I’m glad that _____ was talking so much on her play
date. That is the real success story for any child who stutters.
If
_____ is feeling more comfortable about her stuttering (this is called
desensitization), she will be able to stutter with friends and participate
confidently in other peer group activities. This also means she will feel fine
about telling children who ask about her speech that sometimes she stutters and
it’s no big deal. She will need support for the occasional situation in which
she may be teased. It takes feeling comfortable about your speech and very
confident about yourself to stand up to kids who tease.
Other
listeners may be in a better position to judge word retrieval skills than I,
since _____ doesn’t talk that much with me. So, I’m glad you feel this is not
an issue for _____. Indeed, she performed exceptionally well on The Listening
Comprehension Test 2 yesterday. I gave _____ stickers for answering the
questions because I was afraid she wouldn’t talk for that long and tedious
test. She did and she revealed a high level of listening skills. I waited until
she was paying attention before presenting each item. I talked in a somewhat
slower manner, which is how I talk most of the time anyway. If ______ appears
to “lose her place in conversations sometimes” in other settings, it may be due
partly to the many visual and auditory distractions of real life.
People
in my position are in danger of jumping to the wrong conclusions about people
who stutter when they do not talk. That’s why I suggested we do some
testing. Some adults who stutter recall
being placed in special education classrooms as children because
“professionals” misinterpreted their silence as an indication of some kind of
special needs. A person who stutters has extra difficulty turning on her voice,
which is called initiating voicing. That lag time can appear very unusual in a
competitive world where fluent speakers respond very quickly. The definition of
a person who stutters is someone who knows exactly what they want to say and
cannot say it.
Research
suggests that, for some children who stutter, organizing thoughts into precise
and grammatically correct sentences is more challenging than for fluent
children. A child who stutters can have a huge vocabulary but have some subtle
difficulty getting it from their brains to their mouths in sentence form. In
fact, some children and adults who stutter have extensive vocabularies so that
they can substitute a word that is easier to say for the word they really want
to say. This develops into a habit that can be difficult to change, which is
why we try to desensitize children to stuttering – so they will not develop
unproductive habits like word switching. For example, I recall the picture
guessing game that _____brought in called Headbandz. Compared to other children
who I’ve played similar games with, _____’s clues, guesses and language during
that game made me wonder if she was having difficulty with talking, with word
retrieval, or with following the language of the game. When she would whisper
to herself in other games, I wasn’t sure if this was to make talking easier
(which it does) or if _____ needed extra time processing the language of the
game. I needed to wait and watch her language in future sessions.
The
speech tools are the easy onset, pausing, a slower speaking rate, continuous
voicing, bouncing, and cancellation that we have practiced in speech therapy.
Some SLPs write the names of these strategies onto pictures of tools and put
them in a tool box to get across the idea that these are sometimes called
“speech tools.” _____ has done an excellent job of using easy onset (slow/gentle
beginning sounds), bouncing and cancellation in single words.
I
think she may be fluent in speech therapy because of the quiet one-on-one
setting and because she speaks fairly slowly. Her responses to all the
questions on the Listening Comprehension 2 test were spoken somewhat slowly
(and I should calculate speech rate to document it). I heard two sound
repetitions which she moved slowly through with no apparent reaction and this
was really nice to see. In general, _____’s learning style seems to be somewhat
slow and methodical in speech therapy, IMHO. She seems to take longer to
understand and follow the rules of games and what she is expected to do, as if
her language processing proceeds at 40 mph while the rest of the world is going
60-80 mph. Young children tend to move and play very quickly and I wondered if
this might have something to do with _____ making friends. I wonder if she will
gravitate toward the gentler, slower moving, and more thoughtful kinds of
children?
On
Saturday, we’ll do the Expressive Language Test 2. Would it be possible to
record a speech/language sample with _____ at home? She could talk about a book
she’s read, an art project she is working on, a family trip, whatever. It would
be helpful for me to hear more spontaneous language. I suggest being proactive
about asking the teacher for specifics about how _____ is doing at least twice
a month. If there are questions by mid-year, you could ask for language testing
in January (or sooner if you feel appropriate). Wait and see if any issues
arise.
I’ll
give you some specific things to watch for as _____ plays with peers, which is
what pragmatic language is all about. All children need help with peer
interaction, which is why her last homework was reading dialogue between
characters in the book Friends. You already have the experience of raising two
older siblings, so I’m sure you are already well versed in some of these
issues!
I
look forward to _____’s visits and I am happy to have her continue. I’m worried
that there is something about speech therapy that is still intimidating her and
maybe you can help me out with that. If you would like to try having her attend
by herself, that’s fine. You can wait outside the door or run an errand. If she
continues to test well, make friends, participate in class, and keep talking
even when she’s dysfluent, then I think 2-3 times a month speech therapy is
fine. I would like her to practice easy onset, pausing, and slower speaking rate
in structured speech homework. This is like playing the piano in a way. She
needs to practice a smoother way of talking, step by step in homework, even
though daily life may be too demanding for her to be fluent. She has a young,
developing brain in which we hope to establish pathways for fluent speech.
_____’s
speech can be so hoarse that it would be unethical for me not to recommend an
ENT consult, even if her pediatrician is denying a problem. (Pediatricians are
still telling parents of toddlers who stutter to ignore it.)
My
goodness, this is a long note and e-mail can be incomplete. I hope I responded
to all your questions. Thanks again for your e-mail and let’s plan for all of
us to be present for the Expressive Language Test next week. After that, we can
have _____ attend by herself and I am going to increase the material we are
working with to a 2nd and 3rd grade level. If _____ is a Gifted/Talented child,
then this gives us a new way to view her behavior. You can visit www.nagc.org and www.hoagiesgifted.org
for more information on this topic.
Thanks
again,
Judy
Judith
V. Butler, M.A., LLC
https://sites.google.com/site/judithvbutlermaccc/
Be
The Change
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