Online Conference About Stuttering
The ISAD Conference is an interactive online event taking place from October 1 - 22. Please take advantage of this remarkable chance to chat with the authors of several papers on stuttering. There is even an Office Hours – the Prof In link at which you can post any question about stuttering. Look for the ISAD conference link by visiting the Stuttering Home Page, www.stutteringhomepage.com. I have a Clinical Nugget this year called Fluency Lessons for Window Shopping. It is co-written with a high school student and describes our visits to local retail stores as a method of carryover of new speech skills.
As I prepared to chat with people from around the world, I reflected upon my 30 years as a speech-language pathologist. Sixteen of them were almost exclusively working with children who stutter. Why? Well, let’s begin with a memory.
My paternal grandmother died of Parkinson's when I was about nine years old. I can close my eyes and recall her dark green home, the small galley pantry, the living room where we watched Art Linkletter’s talent show, the screened porch that wrapped around the front of the house, the push button light switches, and the toad who lived in a hole beside the foundation. And, I recall my grandmother’s slurred and stuttered speech. The connection between the warmth I felt in her presence and my decision to specialize in fluency therapy startled me one afternoon in the 1980’s during casual conversation with an elderly woman. Long lost memories of my grandmother flooded my mind and I experienced one of those ethereal moments when one’s life seems to make sense.
Early in my career and for far too many years, I counted stuttered syllables and tried to implement highly structured and apparently logical speech therapy. I basked in the glow of hard-earned diplomas from intense and expensive higher educational institutions. Over time, I discovered that therapy was very different from classroom work and research projects. When a dedicated student experienced relapse, I was forced to question my education and my attitude. Confused and humbled, I had learned that work with clients is not described well using logic or percentages.
For licensed, certified health care professionals, the client -clinician relationship is defined by the American Speech Language Hearing Association (ASHA) Code of Ethics. (1) There are ASHA publications on recommended best practice. Continuing education and clinical practice requirements for ongoing recertification and license renewal keep professionals current. But sometimes one wonders what is real and what is paperwork.
In the past 20 years, my own therapeutic method has become more personal at the same time in which the profession of speech language pathology moved in a different direction. The profession has become more efficient. Data collection – for the benefit of insurance and educational institutions – seem to be paramount now. Experts continue to press for large scale research studies in stuttering to accommodate the medical trend toward evidence based practice. (2)
What influences treatment method and outcome? Research suggests there may be subtypes of stuttering. Attention deficit, phonological disorders, dyslexia and other issues can co-occur with stuttering. The transfer of more fluent speech to daily life is still the lock without a key. While the latest research in genetics is promising, how does this change the lesson plan? (3) Every client comes to therapy as a unique individual. I worry about demands for efficiency with an emphasis on data collection because therapy is not about stuttering – it’s about people. It seems to me that any data used to promote a treatment approach would need to include detailed descriptions of the individuals for whom it was “successful.” Will that happen?
My transition to a more personal treatment approach was nurtured by conventions of the National Stuttering Association and Friends: The Association of Young People Who Stutter. Attendees at these meetings expressed frustration with speech therapy. I was taken aback, discouraged and then grateful. I would come home and listen to my clients more carefully. My lesson plans changed to be more conversational and fun. But, new referrals to my practice were confused: why didn’t I have more rigorous demands for fluent speech? They were at the beginning of a journey that I and a few other SLPs had been traveling for a while. A small group of exceedingly dedicated SLPs (I was not one of them.) established the first ASHA Specialty Commission (4) and worked hard to address the multiple issues that make for a comprehensive approach to speech therapy for stuttering. There’s no quick fix, only a personal path of ups and downs and variable results. (5)
Now I ask about my clients’ lives and share a little of my own. Students get small prizes for just showing up. Homework expectations are replaced by congratulations for any evidence of personal responsibility. I match the efforts of my clients. Those who attended regularly and reliably receive highly individualized lesson materials. Attention to affective and cognitive issues equal that of speech motor change. Written reports are lengthy and include footnotes (very inefficient and time consuming!) My role is one of giving my very best to the few who are invest the same. Is this effective? Clients decide. Informal, annual data collection and ongoing conversation keep us focused on collaborative goals. Unsatisfied clients move on to other service providers.
Fluency enhancing strategies haven’t changed for many years and dissatisfaction with them has become more public. (6) I feel the most significant change has been a lowering of expectations for fluency to avoid rewarding covert behavior. This therapy option coincides with a greater appreciation of the client’s perspective, exquisitely documented in the film Transcending Stuttering (7). Treatment methods are controversial to this day, as demonstrated by articles published in 2012 issues of the ASHA journal Language Speech Hearing Services in Schools.
Talking is different from playing the piano, hitting a baseball, or learning to read, IMHO. Speech sounds are elusive and invisible. Listeners make snap judgments about a speaker’s competence, cultural identity, and eligibility for future relationships based on how they speak. It is societal expectations that drive clients into speech therapy. A Ted Talk titled The Disabled Listener (8) extols the profound value of respectful listening. Watch it and ask yourself how you might become a better listener.
Now the client trumps any specific treatment approach. My clients assume complete responsibility for scheduling sessions. They are equal partners in treatment design and implementation. Quite frankly, this is a horrible business model, and so, I continue studies in the field of literacy to expand my practice caseload. The warmth I felt listening to the stuttered speech of my grandmother returns whenever I put relationship before data and (illusions of) efficiency. My small contribution to the 2012 ISAD conference reflects this commitment to the individual.
Many grateful thanks to A. C. for his contribution to this effort.
(2) Nippold, M.A. & Packman, A. (2012). Managing Stuttering Beyond the Preschool Years. Language Speech Hearing Services in Schools (43) p. 340.
(3) Rowden-Racette, K. (September 18, 2012). In Search of Stuttering's Genetic Code. TheASHALeader http://www.asha.org/Publications/leader/2012/120918/In-Search-of-Stutterings-Genetic-Code.htm
(4) Specialty Board on Fluency Disorders http://www.youtube.com/watch?v=hrAxNijdJVY
(5) Schnieder, P. (2004) Riding the Fluency Instability Roller Coaster. http://www.mnsu.edu/comdis/isad7/papers/schneider7.html
(6) Voice Unearthed: Hope, Help, and Wake-Up Call for the Parents of Children Who Stutter http://www.voiceunearthed.com/
(7) Schnieder, P. (2005). Transcending Stuttering: the Inside Story http://www.mnsu.edu/comdis/isad8/papers/pws8/schneider8.html
(8) Lansing, S. E. (June 8, 2011) The Disabled Listener: They can talk, they can hear, they just don’t listen. TEDxTalks http://www.youtube.com/watch?v=hrAxNijdJVY