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.
Judy
(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 broken link
(4)
Specialty Board on Fluency Disorders, now out of date
(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
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