Bullying Prevention and Intervention Laws Could Support Children Who Stutter

 National Stuttering Association (NSA) conventions inspire me to rethink speech therapy. That’s why I love to attend. This year’s convention, held in Tampa, Florida, left me pondering how to place greater emphasis on advocacy as an essential communication skill. Advocacy goals could easily dovetail with America’s growing concern over bullying (1). New local laws in many states require school districts address this problem.

Skill at personal advocacy is a valid therapy objective. It used to be that speech-language pathologists (SLPs) focused on fluency. But success with speech change varies one person to the next and science has not yet figured out why.  In the meantime, therapy outcomes have broadened to include multiple aspects of communication.  Some SLPs take advantage of this trend to justify special education for children who stutter (CWS)(2).Others do not.  I have watched this process over the past 30 years. I witnessed and I read heated arguments between university professors over exactly what the role of the SLP should be. While this divisive dialogue drags on, what can a parent do right now to help the child who stutters?

I propose parents find out if their state has enacted a law regarding bullying.  I expect that when a parent provides the school with brochures from the Stuttering Foundation (3) AND a printout of their district’s legally mandated Bullying Prevention and Intervention Plan, we may see more CWS receive greater attention. Laws to promote a “healthy school climate” benefit all children. This means that when CWS are denied special legal protections because they are denied special education, their parents may have a legal alternative.

The 187^th General Court of the Commonwealth of Massachusetts on May 3, 2010, approved “An Act Relative to Bullying in Schools.” (4) The Department of Elementary and Secondary Education responded with Bullying and Prevention Resources (5) and a Model Bullying and Intervention Plan (6).  My own school district copied this plan, adding details about specific programs (7) and the administrative hierarchy responsible for their implementation.  My district also has a District Improvement Plan that includes “Safe Learning Environment” as a target. I believe presenting this kind of information to school personnel adds weight and credibility to parents’ pleas for support for their children.

 “The finding that the risk of being bullied in adolescents who stutter is high when compared to their fluent peers should be of considerable concern. Speech-language pathologists need to be aware of this information as they often serve as the strongest advocates for students who stutter in the school setting.” (8)  Research indicates that children who stutter “are mimicked, made fun of, called names, physically bullied, and sometimes subjected to threats… It is clear that stuttering is an identifiable difference that invites bullying.” (9) This information is vital because mandatory professional development for school personnel must include “research findings on bullying, including information about specific categories of students who have been shown to be particularly at risk for bullying in the school environment…[with] a particular focus on the needs of students…whose disability affects social skills development.” (10)

Social skills development in adolescents includes “initiating interactions, self-disclosure, and intimacy in conversations and activities…assertiveness, responsiveness, and versatility. These skills allow speakers to make requests, actively disagree, express their feelings, initiate, maintain, and disengage in conversations…in multiple settings and with different conversational partners…” (11) Some school age children who stutter are at risk of falling behind in the development of these social/communicative skills because they avoid situations in which speech is difficult and in which they risk ridicule.

 “For adolescents who stutter, changing motor speech behaviors may not result in accompanying attitudinal and cognitive changes. Programs that reinforce assertiveness skills, positive communication models, acceptance of stuttering, and ways of dealing with stuttering may actually assist in dealing with potential co-occurring issues like bullying.” (12)

Again and again my students avoid advocating for themselves. How many times have I heard children say that teachers and friends understand stuttering already so there is no need to discuss it?!  Everybody knows I stutter and it’s no big deal, they say. Yet these same children report avoidance and negative attitudes on written checklists. They cry about school assignments, allow others to speak for them, ‘forget’ to talk with teachers, limit class participation and/or avoid after school activities because they are experiencing so much stress over their speech. I respond by accepting the client in the moment. But maybe a little confrontation wouldn’t hurt. Exactly how could they handle some of these problems proactively?

Has speech therapy flaunted fluency in a variety of disguises? My lesson plans involve fluency enhancing techniques, voluntary stuttering, desensitization, situation hierarchies, English Language Arts, DAF, Audacity ®, and even concepts of cognitive behavioral therapy. Do all of these perpetuate a promise that the end-goal is greater fluency? When can a CWS share personal experiences, hopes and dreams, thoughts and feelings in a friendly conversational way that would shed light on social skills competency? How can speech therapy allocate time to the complementary goals of speech change and social skills development?

 Activities which blend social skills training with speech therapy could draw from resources approved by the school district, pragmatic language therapy materials already on the SLP’s bookshelf (14), or reader-friendly publications for the layperson (15). For example, scripts and role plays [Model Plan, IV. A. p. 6] could be about a stuttering-related problem. A program specifically for stuttering is available for grades 3-6 from the University of Alberta, Edmonton, Canada. (16)  The point is to be proactive. A person who stutters has the responsibility to “be conscious that he or she has the power to promote awareness about stuttering and its ramifications.” (17) An SLP can facilitate the development of advocacy skills by making it a greater priority and interfacing with bullying prevention programs.

My friend, Marybeth Allen, ran a workshop at the NSA convention for elementary school age children. It was called “What Bugs You?” Marybeth is a Clinical Supervisor at the University of Maine, the sweetest person ever, and my roommate. As I managed a craft hot glue gun, Marybeth charmed the children into making bugs out of styrofoam containers, fuzzy sticks, pompoms, colored paper and markers. Then she gave them a small piece of paper on which to write what bugs them about stuttering. They put their hand-written complaints into the bug. Topping of the list of complaints was teasing and bullying.

New bullying prevention and intervention laws may offer CWS some well-deserved special consideration. These laws may not qualify CWS for special education services, but, hopefully they will enlighten school personnel. Sadly, a publication by National Stuttering Association written specifically for SLPs, parents, teachers, administrators, and CWS is out of print. (18) It explained issues unique to CWS.  I get the feeling that many of these children are “below the radar,” keeping their stuttering and their suffering to themselves. Let’s hope that bullying prevention and intervention programs will improve the lives of our children as depicted in this video shared on the a google group not now available.

 http://www.youtube.com/watch?v=IN0eDJl4M8Q&feature=youtu.be

Thank you,

Judy

(1)  stopbullying.gov http://www.stopbullying.gov/

(2)  Scott, L. (2010) Decoding IDEA Eligibility. [DVD] available at www.stutteringhelp.og

(3)  Stuttering: Straight Talk for Teachers, 8 Tips for Teachers, www.stutteringhelp.org

(4)  Massachusetts General Laws, http://www.malegislature.gov/Laws/SessionLaws/Acts/2010/Chapter92

(5)  Bullying Prevention and Intervention Resources, broken link

(6)   Model Bullying Prevention and Intervention Plan, broken link  

(7)  Open Circle: Getting to the Heart of Learning,  http://www.open-circle.org/ ;

Massachusetts Aggression Reduction Center, broken link

(8)  Blood, G. & Blood, I. (2004) Bullying in Adolescents Who Stutter: Communicative Competence and Self-Esteem. Contemporary Issues in Communication Science and Disorders, 31, p.76.

(9)  Langevin, M & Prasad, N.G.N. (2012) A Stuttering Education and Bullying Awareness and Prevention Resource: A Feasibility Study. Language, Speech, Hearing Services in Schools, 43, p. 345.

(10)               Model Bullying Prevention and Intervention Plan, p. 4, II.B.(iv), broken link  

(11)               Blood G. & Blood, I p. 70.

(12)               Ibid. p. 76

(13)               Massachusetts Department of Elementary and Secondary Education, Guidelines on Implementing Social and Emotional Learning (SEL) Curricula, broken link

(14)               I happen to own Kelly, A. (2002) Talkabout. UK: Speechmark Publishing Ltd.

(15)               Cooper, S. (2005) Speak Up and Get Along! Minneapolis, MN: free spirit publishing.

(16)               Institute for Stuttering Treatment and Research. Teasing and Bullying: Unacceptable Behavior (TAB) http://www.tab.ualberta.ca/

(17)               International Stuttering Association, Rights and Responsibilities of People Who Stutter http://www.isastutter.org/what-we-do/bill-of-rights-and-responsibilities

(18)               Flores, T. Ed. (2004 ) Bullying and Teasing: Helping Children Who Stutter , www.westutter.org

Rating Scales to Measure Change

I just read a speech/language therapy report that contained daily fluency ratings for an entire school year.  Two graphs were attached to the report, one illustrated the teacher’s ratings and one illustrated parent ratings. Quite impressive!

I used to ask parents to jot down a few notes about their children’s fluency at home. I requested they make brief videos and/or audio recordings. Very few parents did so and some were so apologetic about noncompliance that I feared I’d made matters worse. Ideally, speech therapy is supposed to keep track of speech fluency in a variety of settings; but, just how to accomplish this is a challenge.

Rating scales offer a simple way to do this. A rating scale translates a subjective judgment into a number on a continuum, say 1 – 10 for example. Some rating scales have carefully defined the numbers. I adapted this kind of rating scale to supplement my notes for almost every speech therapy session I have with every student. It is a 9-point scale originally developed to measure social interaction. (1)  Points 1-2 have this definition: “Quality of the behavior is poor; there is no evidence of a habit beginning. The quantity and duration of the examples are negligible or inappropriate.” There are five such explanations on this scale. Numbers 8-9 are defined as “Quality of the behavior is outstanding, and the behavior is used creatively in the interaction. Quantity and duration of the examples are appropriate.” I added a blank spaces to write in the behaviors being measured at each session.

There are plenty of relevant behaviors and characteristics worth measuring in the field of fluency. With respect to speech, let’s consider the child who stuttered on 20 percent of syllables in September and still stuttered on 20 percent of syllables in June. One might glance at this data and assume the child had not made any progress.  A decrease in oral-motor tension over this period of time would have been excellent progress, although invisible in a measure of percent syllables stuttered. This hypothetical child could have been experiencing tense blocks and prolongations in September but predominantly relaxed part-word repetitions in June. Let’s take a look at a few rating scales. What do they measure and how?

A rating scale may define only a few numbers along a continuum. The Test of Childhood Stuttering Observational Rating Scales measures Speech Fluency and Disfluency-Related Consequences. (2)  It has only 4 points: 0 = Never, 1 = Rarely, 2 = Sometimes, 3 = Often. There are nine items in the Speech Fluency section including descriptions of blocks, prolongations and repetitions. There are also nine items in the Disfluency Related Consequences section including secondary behaviors, avoidance, and emotional reactions. I use this scale for initial screenings and for monitoring progress. I’m not completely satisfied with the sensitivity of a 4-point scale to reflect the subtle improvements that are characteristic of fluency therapy. Note: this scale is completed by adult listeners.

I used the Assessment of the Child’s Experience of Stuttering (ACES) when it was available in a free draft version (2006). This was a lengthy, 100-item  scale divided into four sections - General Information, Your Reactions to Stuttering, Communication in Daily Situations, and Quality of Life. Each item was rated on a 5-point scale with three definitions: 1 = Always, 3 = Sometimes, 5 = Never. A student’s responses were added to determine Impact Scores that corresponded to Impact Rating definitions: mild, mild-to-moderate, moderate, moderate-to-severe, and severe. I found the ACES was sensitive to therapeutic progress for older teens. It seemed too overwhelming for my elementary school age clients. When the final revision was published commercially (3), I stopped using the draft form. Note: this scale is completed by the speaker.

Some scales define only the endpoints. The Adolescent Communication Questionnaire (12)  is a list of 39 speaking situations rated on a 5-point scale. The directions state: “How much confidence do you have about doing each of the behaviors listed below? Circle the number that best represents your confidence.” 1 = No way. I would be too uptight to speak and  5 = No problem. I would be very confident speaking. (4) Another scale that measures communication attitudes uses seven data points to measure comfort level, confidence, and feelings of success. (5) The word “extremely” appears at the extreme endpoints in one of them: 1 = Extremely Successful and 7 = Extremely Unsuccessful. Note: these scales are completed by the speaker.

There are a few qualitative differences between rating scales worth mentioning. First, for some scales (1, 4), larger values represent greater success. On others (2, 3, 5), larger numbers represent greater severity of a problem.  The Predictive Cluttering Inventory (6) uses a scale with the largest number placed on the left side of the continuum unlike all the other scales I’ve described. Second, it is very important to document who, what, when, and where every time a rating is chosen. Fluency is notorious for its variability. I think it is safe to say that no one stutters all the time in the same way. And third, without training for agreement, everyone creates their own definitions for points along the scale. (7) Very anxious parents or highly sensitive speakers may rate dysfluencies much more severely than an SLP or teacher. How about the pediatricians who counsel parents to wait and see if their toddlers will outgrow stuttering? I imagine they rate dysfluencies quite mildly.

Why use a rating scale? Besides the demand for data in our present educational system, numbers can be easier to compare over time. In the report I mentioned earlier, teacher ratings on a 10-point scale indicated stuttering decreased quite dramatically from the beginning to the end of the school year. I expect this data represents careful collaboration between the teacher and the school-based SLP. My congratulations to everyone involved in this case. It’s always a delight to discover  school district willing to help children who stutter. How can I and others adapt this kind of collaboration to meet the unique needs of other students?

One possibility is to define points along the 1-10 scale. Combined with training for listener agreement, carefully worded definitions may help us compare across listeners with some accuracy. Then we might feel more confident that a teacher rating of 7 could be the same as a parent’s rating of 7. If training is not possible, it is still helpful to pursue the question of why fluency ratings change for one listener over time. This could reveal new and/or confirm known strategies that were especially effective. This is not carefully controlled research, but I would argue it is still beneficial.

A little aside: when data is collected as part of a research study, a statistical analysis determines whether or not change is significant and not due to chance. Well-designed research has many controls in place so that experimental results confirm or deny a specific hypothesis.  For example, well-designed studies have a control group of people who receive no treatment.  If the control group does not change during the course of the experiment yet the treatment group does change after receiving treatment, one might argue that treatment was responsible for the change. Such research is difficult to do with children who stutter because it means withholding treatment for those children in a control group.

Ratings focus our attention on individual issues that affect fluency and communication.  This focus helps us to understand and control for those factors to promote greater fluency, healthy attitudes (8), and more effective communication. Let’s return to our example of measuring of stuttering frequency. Sometimes children may stutter less because they successfully generalize fluency enhancing skills and educate the listeners in their environment.  Or, it might be that greater fluency is the result of a parent/caregiver-implemented, home-based therapy plan. (9)  In these examples, everyone can feel empowered and optimistic about prognosis for improvement.

Alternately, it may be that children stutter less because they are talking less or avoiding difficult words. These are maladaptive speech/language/communication behaviors. Many experts in the field propose that it is healthier for a child to express herself freely while stuttering than to reduce verbal output for the sake of fluency.

Sometimes fluency fluctuates in conjunction with life events. Illness, fatigue, moving to a new home, family changes, academic demands, annual celebrations, and growth spurts in language development can all affect fluency. In these cases, it would be cruel to hold a child accountable for increases in stuttering. Stuttering management is a multifaceted endeavor that requires team work between parents, teachers, caregivers, SLPs and others. It is a puzzling disorder that demands patience, understanding, and kindness from everyone involved.

Here’s what I mean, an infant sibling may keep all the other family members awake at night and impatient during the day. We don’t expect a young child to automatically know how to cope in this situation. A young child is not likely to say, “Hey! Mom and dad! I need help falling back to sleep when that charming new little kiddo wakes me up with his crying in the middle of the night! And, by the way, could we schedule some more time for me!”  However, this child might have more angry outbursts, be less cooperative, and demonstrate more dysfluency instead, IMHO. Does this child need environmental management or direct fluency therapy?  Rating scales may help determine the effectiveness of the chosen treatment.

Perhaps  the older child has discovered his stuttering is affecting his grades.  He may be frustrated by failed attempts to change his speech on his own and has stopped raising his hand in class.  He might be noticing an inability to keep up with the rapid, fluent speech of his peers. This child may need a treatment plan that includes learning more about speech physiology and instructs him in ways to advocate for himself. Rating scales related to quality of life issues, self-confidence and communication attitudes could be crucial to a total treatment program. (10)

Rating scales can be a valuable asset in fluency therapy. (11) We need to consider several choices of what to measure, how to define points along the continuum, and how we expect the results to affect future treatment. I’m looking forward to using rating scales more often and more creatively in my own practice.

On a scale of 1-5 (where 1= most unsatisfactory and 5 = most satisfactory) , I hope you have a 10 kind of day!

(1)  MacDonald, J.D. & Carroll, J.Y. (1992) A Social Partnership Model for Assessing Early Communication Development: An Intervention Model for Preconversational Children. Language, Speech, Hearing Services in Schools, 23, p. 115.

(2)  Gillam, R. B., Logan, K.J., Pearson, N.A. (2009) Austin TX: PRO-ED

(3)  Yaruss, J.S., Quesall, R., Coleman, C. (2010) Overall Assessment of the Speaker’s Experience of Stuttering (OASES), Pearson Education, Inc.,  no link

(4)  Bray, M.A., Kehle, T. J., Lawless, K.A., Theodore, L.A., (2003) The Relationship Between Self-Efficacy to Depression, American Journal of Speech Language Pathology, 12, p. 431.

(5)  Gottwald, S.R. (2011) “Rating Scales as a Clinical Tool” http://www.mnsu.edu/comdis/isad15/papers/therapy15/gottwald15.html

(6)   Daley, D. (2007) “Cluttering: Characteristics Identified as Diagnostically Significant by 60 Fluency Experts” http://www.mnsu.edu/comdis/isad10/papers/daly10/daly10.html

(7)  One teen directed me to his favorite online comic strip, xkcd, one that poked fun at use of a 1-10 rating scale of pain. http://xkcd.com/883/  

(8)  Yaruss, J. S. & Coleman, C., Stuttering Center of Western Pennsylvania, “Helping Children Who Stutter Develop Healthy Communication Attitudes,” broken link

(9)  Lidcombe Program, Australian Stuttering Research Center, link has changed

(10)               Blood, G. The POWERR Game, Stuttering Foundation, broken link

(11)  O’Brian, S., Packman, A., Onslow, M. (2004) Self-Rating of Stuttering Severity as a Clinical Tool, American Journal of Speech-Language Pathology, 13, 219-226.

(12) M. A. Bray, et. al. (2003) The Relationship of Self-Efficacy and Depression to Stuttering. American Journal of Speech Language Pathology, Vol. 12, 425-431, the rating scale is on page 431.

Conversations with Children Who Stutter

Children who stutter might enjoy some support with conversation. A teenage student recently said to me, ‘I’m not very good at putting my ideas into words,’ and I’m willing to bet this is partially from lack of practice. Children who stutter, unable to keep pace with fluent speakers, sometimes withdraw from conversations and miss out on developing this form of self expression. Others forge ahead, speech/language systems struggling, like a car in serious need of a tune up. How can parents and others create conversations that encourage children who stutter to say what they want to say, when they want to say it and do so with easier speech?

1.      Take the time.

            In “The Flight from Conversation”, (1) Sherry Turkle reports that some of us are so plugged-in to technology “we’ve become accustomed to a new way of being ‘alone together.’” People are engaging in fewer extended, face-to-face conversations as they e-mail, text, and twitter to readers in other places. As parents and friends of children who stutter, we may need to plan ahead to deliberately engage our children in conversation during those free moments after school, in the car, in shared activities, at a mealtime, and/or before bedtime.

2.      Practice whenever possible.

“Hello, Gramma? It’s me – Michael.” This conversation appears in the comic For Better or For Worse in my Sunday paper. (2) Michael, about 8 years old, is talking on the phone. “Tell her about your hockey tournament,” prompts his mother, who is sitting nearby. “Uh - we won our hockey tournament,” says Michael. “Thank her for the sweater she sent you,” says Mom. “Thanks for the sweater you sent me,” mimics Michael. And so the comic continues, Michael’s mother coaching him through a conversation with his grandmother.  As adults, we can find ways to show our children how to discuss TV shows, movies, books, video games, school projects, social concerns, family issues, extra-curricular activities, and hopes and dreams. Topics of conversation arise naturally when parents share in their children’s activities.

3.      Learn  new skills.

Adults develop skills for talking with  supervisors, customers,  co-workers, parents, spouses, and friends. They read self-help books to learn the knowledge, jargon, and conversational expectations appropriate for managing conflict, purchasing a car, increasing sales, and nurturing relationships, among other things. How to Talk So Kids Will Listen and Listen So Kids Will Talk is  a time-tested book about talking with children. And, there is a sequel for talking with teenagers. These books are easy reads that  illustrate “new methods of communication…that parents could teach themselves…with hundreds of examples of helpful dialogue…[and] cartoons that …show the skills in action. “(3)  The Stuttering Foundation offers a few tips specifically for talking with children who stutter. (4)

4.      It’s ok to stutter – easier when possible.

Stuttering that a) occurs less frequently and  b) involves less oral-motor tension than your child typically experiences is considered “easy stuttering.” Easy stuttering might take the form of repeating whole words instead of parts of words, as in “game-game-game” instead of ga-ga-game”, or, repeating a sound fewer times, as in “g-game” instead of “g-g-g-ame. “  Blocks and prolongations that are briefer and accompanied by less oral-motor and facial tension may be ‘easy stuttering’ for your child. You might notice easier stuttering once a week, then  twice a week , then every day.  Maybe you’ll notice ways to help your child stutter more easily.

5.      Ask about factors that affect stuttering.

Stuttering can interact with other conditions such as ADHD (6), language demands (7, 8, 9) and thoughts and feelings (10).  Conversations with a speech language pathologist can help you manage situations to support easier speech. ( 5)  A speech hierarchy is a list of speaking tasks that control conditions to make fluency easier for your child. Ask about where your child’s speech homework falls on such a hierarchy so that you can discuss the SLP's long term therapy plan.

6.      Five minutes may need to become ten.

a.      “I have this game at home” may take 2 seconds to say fluently.

b.      “I-I-I-I have th…..is g-g-g-game at home” may take 5 seconds.

c.       “(pause) III (slow/gentle beginning sound) have /(pause) thhhiis (slow/gentle sound) g {freeze} game at home” may take 10-15 seconds.

            A compassionate and patient listener will allow plenty of extra time for a child to reduce oral-motor tension through the use of fluency enhancing techniques such as pausing, slow/gentle beginning sounds, reduced speaking rate, freezing, and cancellation. It is the rare listener indeed who understands that conscious speech-language-motor planning is a time consuming and laborious process at first. When listeners prefer fast and fluent speech, children may avoid words on which they expect to stutter, holding back on all they wish to express. “I used to do that all the time,” a child recently said to me. Now, he talks more and stutters more, which actually gives us more opportunities for conversation and change.

The value of conversation became apparent as I met my students at local retail stores to work on the carryover.  While experimenting with different ways to give feedback about speech goals, I stumbled upon the obvious. The most valuable feature of these lessons is not the feedback about speech. It is the hour-long, sustained conversation. Validating a child’s thoughts and feelings via attentive, sensitive, respectful, and prolonged conversation is the foundation for carry over work. In Turkle’s article,  she writes,  “ A 16-year old boy who relies on texting for almost everything says almost wistfully, ‘Someday, someday, but certainly not now, I’d like to learn how to have a conversation.’”  I think we can start  that lesson today.

(1)     S. Turkle (2012) The Flight From Conversation. New York Times, April 21.

(2)     Boston Sunday Globe, April 22, 2012.

(3)     A. Faber and E. Mazlish (1980) How to Talk So Kids Will Listen & Listen So Kids Will Talk, NY, NY: Avon Books.  p. viii.  See also A. Faber and E. Mazlish (2005) How to Talk So Teens Will Listen & Listen So Teens Will Talk, NY, NY: Harper Collins.

(4)     7 Tips for Talking with Your Child. Stuttering Foundation, http://www.stutteringhelp.org/Default.aspx?tabid=632

(5)     M. J. Cooley Hidecker, R. S. Jones, D. R. Imig (2009). Unsing Family Paradigms to Improve Evidence-Based Practice. American Journal of Speech Language Pathology, 18, 212-221.

(6)     J. Donaher (2011) ADHD and Children Who Stutter.  Stuttering Foundation, broken link

(7)     K. Ntourou, E. G. Conture, M. W. Lipsey (2011). Language Abilities of Children Who Stutter : a Meta-Analytical Review. American Journal of Speech-Language Pathology, 20, 163-179.

(8)     Trautman, L. S., E. C. Healey, J. A. Norris (2001) the effects of Contextualization on Fluency in Three Groups of Children. Journal of Speech and Hearing Research, 44, 564-576.

(9)     C. T. Byrd, K. J. Logan, R. B. Gillam (2012) Speech disfluency in School-Age Children’s Conversational and Narrative Discourse. Language, speech, Hearing Services in Schools, 43, 153-163

(10) L. Scott (2010) Implementing Cognitive Behavior Therapy with Children. Stuttering Foundation, broken link

Reading Fluency: Red Herring or Red Flag?

Reading aloud is an enjoyable and enriching way to spend time with others.  It’s also a way to practice more fluent speech. Children’s books, magazines and websites offer entertaining literacy activities for every interest and age group.  Game playing cards, museum and amusement park brochures, and written conversations between characters of video games are opportunities to practice ‘speech tools’ even for just a few minutes.  Stickers, nickels, smiles, hugs, thumbs-up, shared reading and other small rewards reinforce the notion that easier speech is meant for more situations than just the speech therapy office.

Reading testing is not quite as fun. Reading tests measure accuracy, fluency, words-per-minute, and basic comprehension. Reading fluency in particular, figures prominently in our data driven educational system.  While this data point may be a well - intentioned way to assess reading ability, I’m concerned about how it affects my students who stutter. The National Stuttering Association has a free brochure Stuttering and Reading Fluency (1) which states, “A child should not be penalized for moments of stuttering when assessing reading fluency. Fluency of speech is not the same as fluency of decoding.” We need to inform teachers of this.

 Every student I have ever met has a need for speed when reading aloud. Since reading tests are timed and reading fast is rewarded, it’s important to know that reading rate affects stuttering. (2)  When does reading dysfluency represent a stuttering problem and when does it represent a reading problem? In preparing this article, I came to the conclusion that this question is nearly irrelevant.  The more important question is whether or not a child’s depressed reading scores are warning signs of a more serious problem with grade level literacy.

The definition of reading is a matter of some debate.  A recent proposal, called the “narrow view of reading,” offered this perspective.  “The essence of the proposal [the narrow view] was to change the way in which reading is assessed. If high-stakes assessments differentiated among word recognition, domain-general reading comprehension, and specific subject knowledge, the reading crisis would be over because the focus would change to the true crisis in American education – knowledge deficiencies in the sciences, history, math, literature, and other content domains that are important for success in the 21^st century.” (3) Here we have decoding (word recognition) relegated to one small part of reading while the complexity of comprehension is given greater attention.

Misconceptions about reading include:

a)   “word recognition and reading comprehension are related skills that can be accurately reduced to one measurable score or level,

b)   improvements in word recognition will always lead to improvements in reading comprehension, and

c)    measures of reading comprehension assess the same thing.” (4)

Turns out, a problem with the narrow view of reading lies in its implementation. If reading is defined only in terms of word recognition (decoding), students who decode single words adequately may be dismissed from reading programs, even if they continue to struggle with the deep reading comprehension necessary to perform well at grade level. General education teachers are not trained to teach language skills and comprehension strategies; they are responsible for subject content. “Given the present climate of accountability to curriculum standards, they [teachers] are reluctant to do anything they view as distracting from the teaching of content that will appear on high stakes tests.” (5) Given the narrow view of reading, that means no one is designated to help students with reading comprehension strategies. That is, unless school based speech-language pathologists (SLP) are allowed to provide services that focus “on the language underpinnings of comprehension.” (6)

“Adolescent literacy professionals are trying to counter the popular and oft-quoted ideas that before fourth grade, children are learning to read and after that they are reading to learn…we know there is much to learn about reading past the fourth grade…” (7)

Reading is hard work for some children. Besides problems with decoding, language processing problems may prevent them from fully comprehending increasingly complex material. Some processing problems arise from a lack of background (world) knowledge, unfamiliar vocabulary, complex syntax, and information that is implied but not explicitly stated. Poor readers tend to read less than skilled readers. Children who find reading easy  and fun like to read more. Consequently they can spend hours and hours of time decoding unfamiliar vocabulary, deciphering complex sentences, linking information from one part of a text to another, talking with others about what they have read, and anticipating information in later pages and even later volumes of a story series. All the while, they are absorbing more world knowledge as well.

An emphasis on improving word recognition assumes that “by improving the reader’s overall word knowledge and decoding abilities, comprehension will simultaneously improve.” (8)  Decoding instruction for unfamiliar words can include reading them aloud for the child, reviewing phonetics, rereading, looking-up definitions, and word practice drills. While these teaching strategies have proven useful, research suggests that meaning-based feedback may be even more effective with respect to reading comprehension, oral language, and expressive vocabulary. With meaning-based feedback, “The teacher acts as a mediator who assists in establishing the content of the author’s message before reading, setting the scene, simplifying complex sentences, establishing relationships between and across text units, and discussing or expanding upon unfamiliar vocabulary or concepts in context. The teacher constantly monitors the oral reading for indications that the author’s message is not being understood.” (9)

The larger implications of reading comprehension become apparent when we look ahead to the literacy skills required of the next generation. “Adolescents entering the adult world in the 21^st century will read and write more than at any other time in human history. They will need advanced levels of literacy to perform their jobs, run their households, act as citizens, and conduct their personal lives. They will need literacy to cope with the flood of information they will find everywhere they turn. They will need literacy to feed their imaginations so they can create the world of the future.” (10)

Our journey from word recognition to reading comprehension makes its next stop at “high literacy”. High literacy “includes the ability to use language, content, and reasoning in ways that are appropriate for particular situations and disciplines, involving students’ abilities to engage in thoughtful reading, writing, and discussion about content.” (11) SLPs are well prepared to collaborate with others on this road. They are knowledgeable about the phonological, semantic, grammatic, and pragmatic complexities of communication in speaking, listening, reading, and writing. The Common Core Standards (12) released in June 2010 include language as a unique category, inviting SLPs to address the “underlying language requirements of rigorous curricula and intervene with students directly or work with other professionals to provide differentiated instruction and intervention.” (13)

          At this point, the relevance of reading fluency, and even stuttering, feels like a distant memory. I do not wish trivialize the ability to read or speak fluently at any grade level. But, let’s find some additional meaning in reading test scores. When a child who stutters performs poorly on a reading test, we need to ask questions. What kind of dysfluency was evident: decoding, stuttering, or both? Was the child penalized for stuttering? Was the child given the option to deliberately reduce speaking rate as a fluency strategy? How did the child perform on each comprehension test question and why? How well does the child read,comprehend, and talk about curriculum texts?  Does the child enjoy reading? Does the child seek reading opportunities at home? School districts are surviving shrinking budgets by cutting personnel and services.  When a child is denied services, I wish it was more trasparent whether the decision was truly based on the child’s need or the availability of funded programs.

Reading Resources

·         All about Adolescent Literacy http://www.adlit.org/

·         Boy’s Life: the Official Publication of the Boys Scouts of America 

·         Cobblestone & Cricket: 14 Award Winning Magazines http://www.cricketmag.com/home.asp

·         Highlights: Fun with Purpose http://www.highlights.com/

·         National Geographic Kids http://kids.nationalgeographic.com/kids/?source=NavKidsHome

·         Public Television for Kids  http://pbskids.org/

·         Reading is Fundamental http://www.rif.org/

·         Reading Rockets http://www.readingrockets.org/

References

(1)  broken link

(2)  Vanryckeghem, M. et. al. (1999) The Main and Interactive Effect of Oral Reading Rate on the Frequency of Stuttering, American Journal of Speech-Language Pathology, 8, 164-170.

(3)  Alan G. Kamhi (2009) Solving the Reading Crisis – Take 2: The Case for Differentiated Assessment, Language, Speech, and Hearing in Schools, 40, p. 213.

(4)  Ibid. p. 214

(5)  Barbara J. Ehren (2009) Looking Through an Adolescent Literacy Lens at the Narrow View of  Reading, Language, Speech, Hearing Services in Schools, 40, p. 193.

(6)  Ibid. p. 193

(7)  Ibid. p. 193

(8)  L. K. Crowe (2003) Comparison of Two Reading Feedback Strategies in Improving the Oral and Written Language Performance of Children with Language-Learning Disabilities, American Journal of Speech Language Pathology, 12, p. 17.

(9)  Ibid. p. 18

(10)       B.J. Ehren & K. Murza (October, 2010) The Urgent Need to Address Workforce Readiness in Adolescent Literacy Intervention, Perspectives on Language Learning and Education,3, p.93 (a publication of ASHA SIG 1) with a reference to Moore, D. W. et. al. (1999) Adolescent literacy: A position statement Newark, DE: International Reading Association broken link

(11)       Ibid. p. 93.

(12)       www.corestandards.org

(13)       Ehren & Murza,  p. 97