“…the use of medication continues to demonstrate results that are not merely promising but that may prove to be outstanding, even revolutionary.” Without Hesitation: Speaking to the Silence and the Science of Stuttering by Gerald A. Maguire, MD with Lisa Gordon Wither ©2010, p. 8
I am always delighted when one of my students can attend the National Stuttering Association (NSA) annual convention. I have attended five conventions and found them to be of consistently high quality with a balance of fun, intimate sharing, and informative workshops. One of my teen students attended the 2010 convention and brought me back the new book, Without Hesitation. This book describes the use of medication to treat stuttering. All proceeds from the sale of the book benefit the NSA. I recommend it without hesitation.
This is a thin book and an easy read because Dr. Maguire wrote it for the layperson. It includes a very succinct history of treatments for stuttering, description of brain research, several case studies, a review of medications, and message of hope. Dr. Maguire invites anyone and everyone to contact him for speech therapy at The Kirkup Center for the Medical Treatment of Stuttering, http://www.kirkupcenter.uci.edu.
In an earlier post, I referred to a theory of developmental stuttering in which a child is repeatedly unsuccessful at repairing a speech problem and that this can results in increasing tension, both oral-motor and emotional. Without Hesitation wonders why such a speech difficulty occurs and makes a crucial statement: “We consider stuttering to be a multifactorial disorder; which means it’s a condition that has multiple causes” such as: (p. 12)
• Genetics
• PANDAS – Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strptococcal Infections
• Brain development during childhood
My understanding is that most brain research is done with adults who stutter, not children. So, there is an ongoing debate over whether brain research reflects what happens to a brain that has spent a lifetime stuttering, or, what a brain looks like in childhood as well as adulthood. Given the theory that the brain is “plastic” and changes continuously in response to learning and environment, fMRIs of adult brains may represent how stuttering impacts brain function over time.
Brain research has revealed at least three major discoveries.
1. “…the striatum performs as the brain’s natural timer and initiator of speech. People who stutter most often have trouble with the beginning of a phrase or word, but the speech flows more easily once they overcome this verbal block.” (p.28)
2. “…the left-hemispheric speech areas in individuals who stutter are low in functioning compared to…the right hemisphere…increased activity within the right hemisphere may represent overcompensation…” (p. 29)
3. Persons who stutter “often have too much dopamine in the brain, which may affect the brain’s ability to initiate and time speech. This surplus…is related…to striatal hypometabolism, a condition in which the striatum functions at an abnormally low rate.” (p.29)
If a neurological cause can be identified, then perhaps a medication can be designed to target that specific neurological issue. Studies suggest that lowering dopamine levels in the brain improves fluency. Several of the medications described in Without Hesitation, act to reduce brain levels of dopamine and showed both positive results and negative side-effects.
Another avenue for drug research is a neurotransmitter called GABA, gamma-aminobutyric acid. A medication called pagoclone “has shown particularly hopeful outcomes.” (p.42) A large scale study of pagoclone was underway as of March 2009 (p. 48).
Chapter 7 describes case studies of children trying medication therapy. My impression is that this is experimental in nature and there is no FDA drug currently approved for the treatment of stuttering. Nevertheless, parents wrestle with difficult decisions about their children’s educational, social, emotional, and medical health all the time. There are not many easy, clearly defined answers anywhere, IMHO. For some children, stuttering has a dramatic impact on quality of life and experimental therapies may make sense.
Parents are also making serious medication choices for their children for other chronic conditions. I want to highlight ADHD in particular:
“We know that chemical substances called dopamine agonists can make stuttering worse by enhancing the brain’s dopamine activity and diminishing the brain’s ability to time and initiate speech. Central nervous system stimulants, such as methylphenidate, and amphetamines that are used to treat attention deficit disorder and narcolepsy, are examples of dopamine agonists.” (p.34)
We remind our children that stuttering is not their fault while at the same time encouraging them to learn self-management. I wonder if the parents of children who have other chronic conditions such as juvenile diabetes, asthma, and learning disabilities also wonder how to encourage empowerment in the face of such circumstances. It’s my pleasure to watch parents do the best they can and children’s confident smiles in response!
7/16/11
7/10/11
Games - A Big Picture Perspective
Today’s topic is games. There are more than 60 games in my basement including four versions of Monopoly, two versions of Clue, two versions of Stratego, both adult and junior versions of Pictionary and Labyrinth and both an original and travel version of Scrabble. We have 2 cloth bananas full of letter tiles, a game called Bananagrams, because the extremely bright and highly competitive members of my family need enough letters to make long words that, trust me, you would not encounter in everyday conversation. All the toys, boxes of K’NEX projects, Legos, Playmobile castles, dozens of picture cards, puzzles, art supplies and shelves full of books make my basement look like a children’s consignment store.
I have collected games ever since becoming a speech-language pathologist, 29 years ago. I’ve culled the collection over the years, so I can locate things without a filing system. Some games were gifts, others purchased at yard sales and consignment shops, a few came from catalogues, and some were scavenged from the Barnes and Noble clearance tables just about this time of year. I couldn’t resist buying a set of colorful children’s puzzles at BJ’s just this past Friday. Many of the games kept my growing, very active son occupied. Even now, family games are one way we share time during school vacations.
I have a reputation for changing the rules. My son and I made games more challenging. For example, instead of playing a Memory game with say 20 cards, we would play it with 30, 40 or more. Instead of circling the path of a game board once, we would do it twice to decide the winner. For students, I usually make games less challenging. One game of Candyland, in which a player can select a picture card that sends her back nearly to the beginning of the game, was enough to start me thinking of ways to make games more successful and fun. For example, sometimes we roll multiple dice instead of only one, so game pieces can get to the finish line faster. Instead of struggling to hold on to cards in our hands, we sometimes place them on the table, face-up in front of us during a game like “Go Fish”. My all-time favorites are teaching parents how to inconspicuously let their kids win sometimes and making games cooperative instead of competitive.
Why do I encourage changing the rules? A July 4th article in the New York Times highlighted the importance of fairness. The title of the article was “Thirst for Fairness May Have Helped Us Survive,” (authored by Natalie Angier.) She wrote, “…by the age of 6 or 7, children are zealously devoted to the equitable partitioning of goods, and they will choose to punish those who try to grab more than their arithmetically proper share of Smarties and jelly beans…” My students tend to experience the unfairness of life, so,when we re-design game play, the rules become more fair for them and therefore more fun.
Another aspect of game design is “feedback.” Feedback relates to how present behavior affects future behavior. So for example, when we walk, a feedback system is at work to help us maintain our balance and stay upright as we move along this smooth carpet or down the stairs and out across the uneven parking lot. Artificial intelligence is partially about computers learning based on feedback. My parents e-mailed me the link to a game in which an all-knowing genie could guess any famous character I was thinking of just by asking me several yes-no questions. You see, every time someone plays the game, it adds to data bases it has accumulated, or, it is learning the characteristics of the new person you are teaching it. If it didn’t guess the character you were thinking of, it gives you several choices of who it might be. Your answer is its lesson. My son says that the advertisements on his Facebook page change as he types, because a computer program is using feedback from his conversations to find ads that would interest him.
I work with children who stutter and research indicates that some children who stutter may hear their own speech differently than you and I hear our own speech. The auditory feedback that helps us to monitor how we talk by listening to ourselves, may not work adequately for some children who stutter. Also, children who can identify simple shapes just by feeling them in their mouths show better improvement in stuttering therapy than children who cannot identify shapes in this way. The sensory feedback from the mouth, which would suggest knowledge of how the tongue moves around in the mouth to make speech sounds, may be inadequate for some children who stutter.
What kinds of feedback are in games? Video games have children collecting virtual coins, special powers, and special tools that become useful at a later time. Board games allow players to collect sets of cards, money, opponents’ game pieces, and points as rewards for correctly spelling words, answering questions, drawing pictures, or solving a mystery. Some internal kinds of feedback are skill improvement, personal satisfaction, public recognition and companionship.
An article in the July/August issue of the Atlantic Magazine, “How to Land Your Kid in Therapy”, challenges my practice of changing games so that my students will receive generous amounts of positive feedback. Apparently telling a child “Great Job!” not just the first time a he puts on his shoes but every single morning, teaches him that everything he does is special. Likewise, children who earn stickers for “good tries” never get beneficial negative feedback on their performance. Growing up in a culture “…where everyone gets a trophy just for participating … is ludicrous and makes no sense when you apply it to actual sports games or work performance,” (p. 72) the article states.
The main idea of the Atlantic magazine article is to challenge those who believe children’s games should be designed to nurture happiness and build self-esteem. The argument in the article is based on research that shows “… predictors of life fulfillment and success are perseverance, resiliency, and reality-testing – qualities that people need so they can navigate the day-to-day.” – not happiness and self-esteem. (p. 76) Therefore, some children’s games should be difficult and allow for failure. Children need to fail so that that they can discover and develop their ability to survive hardship and emerge more competent.
I’m not too worried about this because most of my students have accumulated plenty of negative experiences already. New game rules give them a fair chance at finally winning. But, now I’m confused. Are we talking about play or are we talking about work?
I consider the “games” I play as an adult:
I have been playing an old game called ‘the on again, off again diet’ for decades. When I was growing up, the rules around eating were: finish everything on your plate and then you can have dessert. My mother made delicious dinners and scrumptious desserts. Feedback from the scale was always the same. However, when I was pregnant, the scale went to 200 pounds and it’s been a struggle to lower it ever since. The rules for eating changed when I wasn’t paying attention. The new rules include getting to the gym several days a week and nearly eliminating entire food groups – I believe chocolate is a food group. Fortunately, there is digital feedback on the treadmill telling me to keep walking or else feedback from my body would convince me to sit down!
I’m also playing a game called “talking with your teenager.” Where’s the rulebook when you need one? In this game, conversation can be interrupted by a phone text at any time, at which point I am to place an invisible conversational bookmark in my mind for as long as it takes for my son to complete his texted interaction; after which we can resume our conversation.
As I get older, I discover that there are many complex, high-stakes games being played all around me and it’s about time I paid more attention to them. The US Supreme Court ruled last month that banning violent video games for children was a violation of free speech. As a parent who has spent the last 10 years monitoring video game violence in my own home, I am very interested in reading this decision. And now I’m even more confused – video violence is fun?
Now I’m even more convinced that a valuable lesson learned with games is that it’s ok to change the rules. Living in a democracy, at least theoretically, grants me this priceless privilege. I can influence the rule-makers by contacting my government representatives and donating money to organizations that advocate for issues I support.
As my own personal playing piece gets closer to the finish, I’d like to sort out the difference between games that are play and games that are work and be sure I am spending at least some of my time just having fun.
I have collected games ever since becoming a speech-language pathologist, 29 years ago. I’ve culled the collection over the years, so I can locate things without a filing system. Some games were gifts, others purchased at yard sales and consignment shops, a few came from catalogues, and some were scavenged from the Barnes and Noble clearance tables just about this time of year. I couldn’t resist buying a set of colorful children’s puzzles at BJ’s just this past Friday. Many of the games kept my growing, very active son occupied. Even now, family games are one way we share time during school vacations.
I have a reputation for changing the rules. My son and I made games more challenging. For example, instead of playing a Memory game with say 20 cards, we would play it with 30, 40 or more. Instead of circling the path of a game board once, we would do it twice to decide the winner. For students, I usually make games less challenging. One game of Candyland, in which a player can select a picture card that sends her back nearly to the beginning of the game, was enough to start me thinking of ways to make games more successful and fun. For example, sometimes we roll multiple dice instead of only one, so game pieces can get to the finish line faster. Instead of struggling to hold on to cards in our hands, we sometimes place them on the table, face-up in front of us during a game like “Go Fish”. My all-time favorites are teaching parents how to inconspicuously let their kids win sometimes and making games cooperative instead of competitive.
Why do I encourage changing the rules? A July 4th article in the New York Times highlighted the importance of fairness. The title of the article was “Thirst for Fairness May Have Helped Us Survive,” (authored by Natalie Angier.) She wrote, “…by the age of 6 or 7, children are zealously devoted to the equitable partitioning of goods, and they will choose to punish those who try to grab more than their arithmetically proper share of Smarties and jelly beans…” My students tend to experience the unfairness of life, so,when we re-design game play, the rules become more fair for them and therefore more fun.
Another aspect of game design is “feedback.” Feedback relates to how present behavior affects future behavior. So for example, when we walk, a feedback system is at work to help us maintain our balance and stay upright as we move along this smooth carpet or down the stairs and out across the uneven parking lot. Artificial intelligence is partially about computers learning based on feedback. My parents e-mailed me the link to a game in which an all-knowing genie could guess any famous character I was thinking of just by asking me several yes-no questions. You see, every time someone plays the game, it adds to data bases it has accumulated, or, it is learning the characteristics of the new person you are teaching it. If it didn’t guess the character you were thinking of, it gives you several choices of who it might be. Your answer is its lesson. My son says that the advertisements on his Facebook page change as he types, because a computer program is using feedback from his conversations to find ads that would interest him.
I work with children who stutter and research indicates that some children who stutter may hear their own speech differently than you and I hear our own speech. The auditory feedback that helps us to monitor how we talk by listening to ourselves, may not work adequately for some children who stutter. Also, children who can identify simple shapes just by feeling them in their mouths show better improvement in stuttering therapy than children who cannot identify shapes in this way. The sensory feedback from the mouth, which would suggest knowledge of how the tongue moves around in the mouth to make speech sounds, may be inadequate for some children who stutter.
What kinds of feedback are in games? Video games have children collecting virtual coins, special powers, and special tools that become useful at a later time. Board games allow players to collect sets of cards, money, opponents’ game pieces, and points as rewards for correctly spelling words, answering questions, drawing pictures, or solving a mystery. Some internal kinds of feedback are skill improvement, personal satisfaction, public recognition and companionship.
An article in the July/August issue of the Atlantic Magazine, “How to Land Your Kid in Therapy”, challenges my practice of changing games so that my students will receive generous amounts of positive feedback. Apparently telling a child “Great Job!” not just the first time a he puts on his shoes but every single morning, teaches him that everything he does is special. Likewise, children who earn stickers for “good tries” never get beneficial negative feedback on their performance. Growing up in a culture “…where everyone gets a trophy just for participating … is ludicrous and makes no sense when you apply it to actual sports games or work performance,” (p. 72) the article states.
The main idea of the Atlantic magazine article is to challenge those who believe children’s games should be designed to nurture happiness and build self-esteem. The argument in the article is based on research that shows “… predictors of life fulfillment and success are perseverance, resiliency, and reality-testing – qualities that people need so they can navigate the day-to-day.” – not happiness and self-esteem. (p. 76) Therefore, some children’s games should be difficult and allow for failure. Children need to fail so that that they can discover and develop their ability to survive hardship and emerge more competent.
I’m not too worried about this because most of my students have accumulated plenty of negative experiences already. New game rules give them a fair chance at finally winning. But, now I’m confused. Are we talking about play or are we talking about work?
I consider the “games” I play as an adult:
I have been playing an old game called ‘the on again, off again diet’ for decades. When I was growing up, the rules around eating were: finish everything on your plate and then you can have dessert. My mother made delicious dinners and scrumptious desserts. Feedback from the scale was always the same. However, when I was pregnant, the scale went to 200 pounds and it’s been a struggle to lower it ever since. The rules for eating changed when I wasn’t paying attention. The new rules include getting to the gym several days a week and nearly eliminating entire food groups – I believe chocolate is a food group. Fortunately, there is digital feedback on the treadmill telling me to keep walking or else feedback from my body would convince me to sit down!
I’m also playing a game called “talking with your teenager.” Where’s the rulebook when you need one? In this game, conversation can be interrupted by a phone text at any time, at which point I am to place an invisible conversational bookmark in my mind for as long as it takes for my son to complete his texted interaction; after which we can resume our conversation.
As I get older, I discover that there are many complex, high-stakes games being played all around me and it’s about time I paid more attention to them. The US Supreme Court ruled last month that banning violent video games for children was a violation of free speech. As a parent who has spent the last 10 years monitoring video game violence in my own home, I am very interested in reading this decision. And now I’m even more confused – video violence is fun?
Now I’m even more convinced that a valuable lesson learned with games is that it’s ok to change the rules. Living in a democracy, at least theoretically, grants me this priceless privilege. I can influence the rule-makers by contacting my government representatives and donating money to organizations that advocate for issues I support.
As my own personal playing piece gets closer to the finish, I’d like to sort out the difference between games that are play and games that are work and be sure I am spending at least some of my time just having fun.
7/2/11
What Do I Say?
One of the first questions that parents ask me is, “What should I say to my child when she stutters?” Parents are familiar with saying things to their children that are instructive, comforting, or otherwise helpful. Parents respond to children’s speech by imitating an infant’s babbling, teaching a toddler new vocabulary, and expecting ‘please’ and ‘thank you’ from teens. Consequently, it can feel quite natural to respond to stuttering by saying, “Slow down and take your time.; Think about what you want to say first.” When this response is not helpful, they wonder what to say instead.
Speech therapy approaches this problem by asking, “What does the child know?” Some children are not aware of their stuttering, so an adult’s advice to change how they speak can be confusing and frustrating. This goes for the preschooler with mild, typical disfluency and for the older child caught up in sharing ideas, momentarily oblivious to fluency. Indirect therapy dodges the question altogether. It “involves changes in the speech environment” (1): reducing communicative time pressures, modeling a new/easier way of speaking, and changing aspects of certain troublesome speaking situations, for example.
A child “may perform many repetitions, but may not be aware of the relationship of speech to the feeling that he is ‘stuck’ or that ‘something’ is holding him back. It is important to acknowledge this distinction. Although the child may not perceive his speech productions as distorted words, he is aware of a difficulty in speaking – specifically, of feeling stuck.” (2)
The speech language pathologist (SLP) needs to find a way to help the child understand what is going on and speak in a way that feels easier. “Incidentally, the emphasis on feeling here is intentional. The powerless feeling that results from a loss of control often concerns children more than the actual speech disfluencies.” (3). Friendly play and conversation are a part of every session to reveal a child’s learning style and interests, which eventually become woven into lesson plans.
Early lesson plans begin with the SLP voluntarily stuttering in the same way as the child (perhaps with less muscular tension) and then using stuttering modification to change the stuttered words into “easier” ones. If the child comments on this, a conversation about stuttering has begun. If the child does not notice the SLP stutter, then she will describe it and reward the child for noticing it. She might say something like, “When I get stuck, it sounds like this: ‘Th-th-th-the boy is walking his dog…Would you help me by telling me when I get stuck so I can get unstuck?” (4)
Every step of speech therapy involves teaching the child greater awareness AND options for change. “What do I say?” is very specific: praise for speech changes that the child learned how to perform in speech therapy. When the child learns light contacts and easy onsets (gentle beginning sounds), then the parent can praise the child’s use of these skills both in structured homework and in spontaneous conversation. When the child learns to resist time pressure by pausing within sentences (5), the parent can say “I like how you used pauses when you said…”
Note: the adult also uses everything the child is learning. This can be explicit as in, “Let’s play this game so we both can practice pausing.” or; the parent can focus on her own speech privately, pausing as frequently and naturally as possible during a game. For some children, “Disfluencies may be acknowledged with neutrality, compassion, or empathy…or gentle requests for repairs that are distributed at a rate that is considerably less than that for praise.” (6) For children who’s speech therapy program includes corrective feedback, praise must greatly outnumber corrections.
What can you say to your child who is stuttering? You have some choices.
1. Listen carefully to what your child is saying and respond to that content,and/or,
2. Resist time pressure, pausing before any response, and/or,
3. Imitate the stuttered words by using a speech technique to illustrate how they can be spoken easier, and/or,
4. Ask how she feels, ‘opening the door’ for some emotional support, and/or,
5. Manage the environment by scheduling some ‘down time’ instead of another planned activity.
We all experience varying success with children. We cannot expect to say the perfect thing all the time. I recently took a risk by asking about a young teen’s moment of stuttering only to have her burst into tears. Moments like this come with the territory. You know your child better than anyone else. Now you know a little more about stuttering therapy so that you can know what to say.
I recently joined a new blog about stuttering. You might appreciate the July 1 post written by a mom, It’s a Blessing to Raise A Child Who Stutters.broken link
1. Ramig, P.R. & Dodge D.M. (2010) The Child and Adolescent Stuttering Treatment and Activity Resource Guide p. 67
2. Ibid., p. 69
3. Ibid., p 70
4. Ibid. p. 71
5. P. Reitzes (2009) Pausing and Stuttering, http://www.mnsu.edu/comdis/isad12/papers/therapy12/reitzes12.html 6. Ibid., p. 71
Speech therapy approaches this problem by asking, “What does the child know?” Some children are not aware of their stuttering, so an adult’s advice to change how they speak can be confusing and frustrating. This goes for the preschooler with mild, typical disfluency and for the older child caught up in sharing ideas, momentarily oblivious to fluency. Indirect therapy dodges the question altogether. It “involves changes in the speech environment” (1): reducing communicative time pressures, modeling a new/easier way of speaking, and changing aspects of certain troublesome speaking situations, for example.
A child “may perform many repetitions, but may not be aware of the relationship of speech to the feeling that he is ‘stuck’ or that ‘something’ is holding him back. It is important to acknowledge this distinction. Although the child may not perceive his speech productions as distorted words, he is aware of a difficulty in speaking – specifically, of feeling stuck.” (2)
The speech language pathologist (SLP) needs to find a way to help the child understand what is going on and speak in a way that feels easier. “Incidentally, the emphasis on feeling here is intentional. The powerless feeling that results from a loss of control often concerns children more than the actual speech disfluencies.” (3). Friendly play and conversation are a part of every session to reveal a child’s learning style and interests, which eventually become woven into lesson plans.
Early lesson plans begin with the SLP voluntarily stuttering in the same way as the child (perhaps with less muscular tension) and then using stuttering modification to change the stuttered words into “easier” ones. If the child comments on this, a conversation about stuttering has begun. If the child does not notice the SLP stutter, then she will describe it and reward the child for noticing it. She might say something like, “When I get stuck, it sounds like this: ‘Th-th-th-the boy is walking his dog…Would you help me by telling me when I get stuck so I can get unstuck?” (4)
Every step of speech therapy involves teaching the child greater awareness AND options for change. “What do I say?” is very specific: praise for speech changes that the child learned how to perform in speech therapy. When the child learns light contacts and easy onsets (gentle beginning sounds), then the parent can praise the child’s use of these skills both in structured homework and in spontaneous conversation. When the child learns to resist time pressure by pausing within sentences (5), the parent can say “I like how you used pauses when you said…”
Note: the adult also uses everything the child is learning. This can be explicit as in, “Let’s play this game so we both can practice pausing.” or; the parent can focus on her own speech privately, pausing as frequently and naturally as possible during a game. For some children, “Disfluencies may be acknowledged with neutrality, compassion, or empathy…or gentle requests for repairs that are distributed at a rate that is considerably less than that for praise.” (6) For children who’s speech therapy program includes corrective feedback, praise must greatly outnumber corrections.
What can you say to your child who is stuttering? You have some choices.
1. Listen carefully to what your child is saying and respond to that content,and/or,
2. Resist time pressure, pausing before any response, and/or,
3. Imitate the stuttered words by using a speech technique to illustrate how they can be spoken easier, and/or,
4. Ask how she feels, ‘opening the door’ for some emotional support, and/or,
5. Manage the environment by scheduling some ‘down time’ instead of another planned activity.
We all experience varying success with children. We cannot expect to say the perfect thing all the time. I recently took a risk by asking about a young teen’s moment of stuttering only to have her burst into tears. Moments like this come with the territory. You know your child better than anyone else. Now you know a little more about stuttering therapy so that you can know what to say.
I recently joined a new blog about stuttering. You might appreciate the July 1 post written by a mom, It’s a Blessing to Raise A Child Who Stutters.broken link
1. Ramig, P.R. & Dodge D.M. (2010) The Child and Adolescent Stuttering Treatment and Activity Resource Guide p. 67
2. Ibid., p. 69
3. Ibid., p 70
4. Ibid. p. 71
5. P. Reitzes (2009) Pausing and Stuttering, http://www.mnsu.edu/comdis/isad12/papers/therapy12/reitzes12.html 6. Ibid., p. 71
6/23/11
Summer Support
Summer vacation is a chance to change communication habits and improve fluency. In the summer, you probably have more influence over the pace of life and content of your child’s day. The many stressors associated with school are replaced with days of sleeping in, reduced time pressures, fewer interruptions, greater control over diet, and more parent-child fun time. Let’s talk about that parent-child fun time. I encourage you to plan for moments of “down-time” so that you can talk with one another in fluency enhancing ways. Children often look forward to this special time, especially on the days when chaos overrides our best intentions.
“Down time” is can be an opportunity for reviewing speech therapy lessons. My lesson plans are often variations on games you can buy at the toy store, material from children’s magazines, arts and crafts, and home-made “let’s make up a game” activities that mix-and-match game boards, playing cards, and pieces from different games. This is so that parents can experience this process and take it home with them. If you understand the basic philosophy of treatment for stuttering, you can take a familiar family game and modify the rules: slow it down (remove the timer), make it cooperative to reduce the stress of competition (eliminate the rule that says “The first one to….wins”), and add your own content by drawing your own game board, playing cards, or score card. Enforce turn-taking and allow silence for thinking.
If you would like to purchase activities to foster language skills, you can shop the catalogues used by speech-language pathologists. I encourage my students to buy Easy Does It for Fluency: Intermediate by LinguiSystems .It is easy to read and includes a variety of attractive activities. I recently received copy write permission from LinguiSystems to use this workbook to record a practice CD or DVD for my students who also own the book.
LinguiSystems also has workbooks and materials that you could use for parent-child fun time. For example, there are “Quick Play Folder Games” for $15.95 each that practice word associations, categories, concepts, rhyming and vocabulary. There are “Early Social Behavior” books for ages 3-6 and “That’s Life” books, cards and game for middle- and high-school ages, for example. The “100%” workbooks are $43.95 and great for sitting together for 30 minutes of more structured focus. Spice up the activities by checking off each item on a page using colored markers or stickers. Share a snack and use the lessons for topics of conversation. Don’t feel like you need to do every item on every page. Have fun!
I do not have a financial interest in LinguiSystems – except that I spent a lot of money there! It is just one of many online opportunities that offer much more educational choice than you will find in the toy or book stores. I would love to know where your family finds online books, games, and other fun stuff.
Here is a list of things that can be helpful throughout the summer:*
• Minimize interruptions
• Speak slower
• Respect silence
• Minimize rushing & hurrying
• Ask one question at a time
• Avoid “show & tell”
• Talk about topics meaningful to your child
• Talk about stuttering
• Lessen conversation when there is more disfluency
• Insert short, easy, stutter-like mistakes in your speech
• Teach turn-taking
• Build self-confidence
*Ramig, P.R. & Dodge, D.M. (2010) The Child and Adolescent Stuttering Treatment and Activity Resource Guide , Delmar, Cengage Learning p. 15
“Down time” is can be an opportunity for reviewing speech therapy lessons. My lesson plans are often variations on games you can buy at the toy store, material from children’s magazines, arts and crafts, and home-made “let’s make up a game” activities that mix-and-match game boards, playing cards, and pieces from different games. This is so that parents can experience this process and take it home with them. If you understand the basic philosophy of treatment for stuttering, you can take a familiar family game and modify the rules: slow it down (remove the timer), make it cooperative to reduce the stress of competition (eliminate the rule that says “The first one to….wins”), and add your own content by drawing your own game board, playing cards, or score card. Enforce turn-taking and allow silence for thinking.
If you would like to purchase activities to foster language skills, you can shop the catalogues used by speech-language pathologists. I encourage my students to buy Easy Does It for Fluency: Intermediate by LinguiSystems .It is easy to read and includes a variety of attractive activities. I recently received copy write permission from LinguiSystems to use this workbook to record a practice CD or DVD for my students who also own the book.
LinguiSystems also has workbooks and materials that you could use for parent-child fun time. For example, there are “Quick Play Folder Games” for $15.95 each that practice word associations, categories, concepts, rhyming and vocabulary. There are “Early Social Behavior” books for ages 3-6 and “That’s Life” books, cards and game for middle- and high-school ages, for example. The “100%” workbooks are $43.95 and great for sitting together for 30 minutes of more structured focus. Spice up the activities by checking off each item on a page using colored markers or stickers. Share a snack and use the lessons for topics of conversation. Don’t feel like you need to do every item on every page. Have fun!
I do not have a financial interest in LinguiSystems – except that I spent a lot of money there! It is just one of many online opportunities that offer much more educational choice than you will find in the toy or book stores. I would love to know where your family finds online books, games, and other fun stuff.
Here is a list of things that can be helpful throughout the summer:*
• Minimize interruptions
• Speak slower
• Respect silence
• Minimize rushing & hurrying
• Ask one question at a time
• Avoid “show & tell”
• Talk about topics meaningful to your child
• Talk about stuttering
• Lessen conversation when there is more disfluency
• Insert short, easy, stutter-like mistakes in your speech
• Teach turn-taking
• Build self-confidence
*Ramig, P.R. & Dodge, D.M. (2010) The Child and Adolescent Stuttering Treatment and Activity Resource Guide , Delmar, Cengage Learning p. 15
5/30/11
Executive Function: Behavioral Inhibition
One of my students generously gave me the second edition of Executive Skills in Children and Adolescents (P. Dawson & R. Guare, 2010) which prompted me to re-think speech homework.
Executive skills develop throughout childhood. Let’s think about just one of them. “The cornerstone…is behavioral inhibition, which begins to emerge in the 5- to 12-month age range. This first executive function …helps us to think before we act and to decide when and if we will respond.” (p. 5) The three components of behavioral inhibition include the ability to:
1. delay or prevent a response,
2. stop ongoing behaviors,
3. manage distraction and interruptions.
At the beginning of direct speech therapy, a child is asked to prevent her usual pronunciation of sounds in favor of a pause followed by slower, gentler articulation. With lots of practice in very simple, repetitive games, children can learn to do this when everyone else is too. It is not easy bringing speech under conscious control like this.
Carryover activities add the demand of stopping familiar rapid or stuttered speech in situations that include distraction and interruption. As an example, let’s imagine going out for ice cream.
If the homework is to practice single words, then, the child and her mom might practice saying the names of ice cream flavors. Since the child has never used slower rate and gentler articulation in the ice cream store before, it is very likely that she will be able to do so on only some of the names, maybe 3 out of 6 names at first.
Practice with these 6 names means she needs to prevent saying “Minty Magic”, for example, with a normal “Minty” and say it after a pause and with loosely relaxed mouth and a slight prolongation as in “Mmmiiinty.” The child working on change will need to stop production of “M-m-minty” and either pull-out or cancel it with a pause, slightly slower speaking rate, and perhaps also loosening tension in the lips.
The parent’s role is to manage distraction and interruption by saying the ice cream names using a pause, gentle articulations and slower rate so the child can imitate the model. It is the parent who will make the entire 5-10 minute carryover opportunity a private affair, perhaps by placing an arm around the child or waiting until they are sitting with their ice cream away from the other customers.
Children look to their parents for direction. Most children are not likely to say, “When we get ice cream today, I want to practice easy speech.” I hope you can enjoy looking for times and places to show your child how easy speech can be fun to practice at the park, the ball game, the pool, the movies, on a walk, visiting the museum, working on a home project, and just hanging out together. Your encouragement and praise will help nurture your child’s courage and sense of personal accomplishment.
Executive skills develop throughout childhood. Let’s think about just one of them. “The cornerstone…is behavioral inhibition, which begins to emerge in the 5- to 12-month age range. This first executive function …helps us to think before we act and to decide when and if we will respond.” (p. 5) The three components of behavioral inhibition include the ability to:
1. delay or prevent a response,
2. stop ongoing behaviors,
3. manage distraction and interruptions.
At the beginning of direct speech therapy, a child is asked to prevent her usual pronunciation of sounds in favor of a pause followed by slower, gentler articulation. With lots of practice in very simple, repetitive games, children can learn to do this when everyone else is too. It is not easy bringing speech under conscious control like this.
Carryover activities add the demand of stopping familiar rapid or stuttered speech in situations that include distraction and interruption. As an example, let’s imagine going out for ice cream.
If the homework is to practice single words, then, the child and her mom might practice saying the names of ice cream flavors. Since the child has never used slower rate and gentler articulation in the ice cream store before, it is very likely that she will be able to do so on only some of the names, maybe 3 out of 6 names at first.
Practice with these 6 names means she needs to prevent saying “Minty Magic”, for example, with a normal “Minty” and say it after a pause and with loosely relaxed mouth and a slight prolongation as in “Mmmiiinty.” The child working on change will need to stop production of “M-m-minty” and either pull-out or cancel it with a pause, slightly slower speaking rate, and perhaps also loosening tension in the lips.
The parent’s role is to manage distraction and interruption by saying the ice cream names using a pause, gentle articulations and slower rate so the child can imitate the model. It is the parent who will make the entire 5-10 minute carryover opportunity a private affair, perhaps by placing an arm around the child or waiting until they are sitting with their ice cream away from the other customers.
Children look to their parents for direction. Most children are not likely to say, “When we get ice cream today, I want to practice easy speech.” I hope you can enjoy looking for times and places to show your child how easy speech can be fun to practice at the park, the ball game, the pool, the movies, on a walk, visiting the museum, working on a home project, and just hanging out together. Your encouragement and praise will help nurture your child’s courage and sense of personal accomplishment.
5/10/11
Transfer Step 2: Desensitization
Parents who call me for speech therapy are usually upset. Nine times out of ten, they are parents of elementary school age children denied school services or disappointed by them. The rest are frightened parents of preschoolers. My practice is one of many that do not accept insurance because the amount of time spent on paperwork and following-up denied claims is simply unmanageable. So everyone that steps through my door with a check in hand is emotionally invested in change.
The emotion that motivates families to make and keep appointments becomes a liability when it’s time to work on identification and behavior change. It is too frightening, embarrassing, or even disheartening for them to examine the stuttering closely. Children who fear stuttering have been known to cope in ways that increase emotional and physical stress, so turning down the emotional temperature is an important first step. A stuttered sound is pronounced with unexpected, excess physical tension and (often) a feeling of loss of control. To relax this articulatory tension, the child must slow down speech dramatically and find a new feeling of loose, deliberate articulation. And so step 2 in transfer is desensitization – reducing the emotional reactions.
Desensitization is what allows a child to CHANGE stuttered sounds instead of avoid, hide, or fight them. He can ‘play’ with the moment of stuttering to study just what in the world his mouth is doing and how to move his tongue, lips and jaw differently. Reducing the fear of stuttering gives a child permission to talk, express his thoughts and feelings, even if talking more means stuttering more. The more talking a child does, the more opportunities he has to transfer new skills. When a child will not talk in school because he would “rather be the quiet kid than the stuttering kid,” those lovely, loose stuttering modification techniques he performs in the speech room are a long way off from being transferred to the classroom.
A child needs to talk about stuttering with her teachers, friends, and relatives in order to set up a hierarchy of homework activities. Negative feelings can get in the way of this happening. It’s difficult to talk about issues that cause us to feel embarrassed or inadequate. Stuttering is one of those issues. Becoming aware of these feelings, talking about them, and investigating ways to reduce their powerful effects is another target of desensitization.
Ideas based on Peter R. Ramig & Darrell M. Dodge (2010) The Child and Adolescent Stuttering Treatment and Activity Resource Guide, 2nd ed., Clifton Park, NY: Delmar Cengage Learning.
The emotion that motivates families to make and keep appointments becomes a liability when it’s time to work on identification and behavior change. It is too frightening, embarrassing, or even disheartening for them to examine the stuttering closely. Children who fear stuttering have been known to cope in ways that increase emotional and physical stress, so turning down the emotional temperature is an important first step. A stuttered sound is pronounced with unexpected, excess physical tension and (often) a feeling of loss of control. To relax this articulatory tension, the child must slow down speech dramatically and find a new feeling of loose, deliberate articulation. And so step 2 in transfer is desensitization – reducing the emotional reactions.
Desensitization is what allows a child to CHANGE stuttered sounds instead of avoid, hide, or fight them. He can ‘play’ with the moment of stuttering to study just what in the world his mouth is doing and how to move his tongue, lips and jaw differently. Reducing the fear of stuttering gives a child permission to talk, express his thoughts and feelings, even if talking more means stuttering more. The more talking a child does, the more opportunities he has to transfer new skills. When a child will not talk in school because he would “rather be the quiet kid than the stuttering kid,” those lovely, loose stuttering modification techniques he performs in the speech room are a long way off from being transferred to the classroom.
A child needs to talk about stuttering with her teachers, friends, and relatives in order to set up a hierarchy of homework activities. Negative feelings can get in the way of this happening. It’s difficult to talk about issues that cause us to feel embarrassed or inadequate. Stuttering is one of those issues. Becoming aware of these feelings, talking about them, and investigating ways to reduce their powerful effects is another target of desensitization.
Ideas based on Peter R. Ramig & Darrell M. Dodge (2010) The Child and Adolescent Stuttering Treatment and Activity Resource Guide, 2nd ed., Clifton Park, NY: Delmar Cengage Learning.
Transfer Step 1: Identification
This blog entry is about transfer, learning to use new communication skills in everyday life. (1) Transfer is a long term goal. We must be careful not to blame the child for failure to transfer new speaking skills because there really is no such thing as failure. When the child, parent, teacher, and speech language pathologist (slp) design a transfer task, the outcome is always just another learning opportunity. Life is unpredictable, so transfer activities will probably not proceed exactly according to plan. But by understanding that many tiny little successes eventually add up to bigger, long-term accomplishments, we become better at recognizing and rewarding transfer success when we see it.
Transfer can begin immediately in the form of identification tasks. These are times when the parent and child observe what the stuttering behaviors look and feel like and when they occur. The role of the slp is to help the family talk about the “elephant in the room,” the stuttering. In a speech therapy session, the slp talks sensitively and without judgment about this frightening and confusing speech problem called stuttering. Hopefully, the child and parents become more comfortable talking about stuttering as a result.
This is an especially delicate process with very young children because parents are afraid that talking about stuttering will make it worse. In this situation, the slp may comment on her own voluntary disfluency and wait for the child’s response. In some cases, it will be appropriate to talk about bumpy speech with a preschooler. In other cases, it will not. With the older child, the slp models “an attitude of inquiry and curiosity about stuttering” (p.93) while at the same time demonstrating voluntary stuttering and sharing basic information about speech production. She chats comfortably about how every child experiences stuttering a little bit differently and how stuttering is no one’s fault. The first step in therapy involves discovering what kind of stuttering the child is doing, how it changes day-to-day, and if it is affecting the child’s thoughts and feelings about talking.
The child and parent may identify stuttering quite differently. I have observed young children block and react by pausing, whispering, and even raising a hand to the mouth while the parents insist he/she is unaware of a speech problem. I have listened to parents describe stuttered speech that their elementary school age child did not know was happening. And teens have described experiencing mild blocks accompanied by overwhelming anxiety that no one else seems to notice.
When everyone involved feels safe sharing their own perspective about stuttering, a more comprehensive picture of the problem can unfold. This identification process happens intermittently over the entire course of speech therapy, in my opinion. Every time a child makes progress, he/she must admit the need to keep moving forward. And this means identifying yet another problem area. With growing maturity and awareness, the child must identify not only the stuttering problem, but also the thoughts, feelings, and distractions that make transfer tasks difficult. For example, talking with teachers and peers about stuttering seems to be a gargantuan undertaking. Yet these are key people in a network of support necessary for transfer.
(1) Peter R. Ramig & Darrell M. Dodge (2010) The Child and Adolescent Stuttering Treatment and Activity Resource Guide, 2nd ed., Clifton Park, NY: Delmar Cengage Learning.
Transfer can begin immediately in the form of identification tasks. These are times when the parent and child observe what the stuttering behaviors look and feel like and when they occur. The role of the slp is to help the family talk about the “elephant in the room,” the stuttering. In a speech therapy session, the slp talks sensitively and without judgment about this frightening and confusing speech problem called stuttering. Hopefully, the child and parents become more comfortable talking about stuttering as a result.
This is an especially delicate process with very young children because parents are afraid that talking about stuttering will make it worse. In this situation, the slp may comment on her own voluntary disfluency and wait for the child’s response. In some cases, it will be appropriate to talk about bumpy speech with a preschooler. In other cases, it will not. With the older child, the slp models “an attitude of inquiry and curiosity about stuttering” (p.93) while at the same time demonstrating voluntary stuttering and sharing basic information about speech production. She chats comfortably about how every child experiences stuttering a little bit differently and how stuttering is no one’s fault. The first step in therapy involves discovering what kind of stuttering the child is doing, how it changes day-to-day, and if it is affecting the child’s thoughts and feelings about talking.
The child and parent may identify stuttering quite differently. I have observed young children block and react by pausing, whispering, and even raising a hand to the mouth while the parents insist he/she is unaware of a speech problem. I have listened to parents describe stuttered speech that their elementary school age child did not know was happening. And teens have described experiencing mild blocks accompanied by overwhelming anxiety that no one else seems to notice.
When everyone involved feels safe sharing their own perspective about stuttering, a more comprehensive picture of the problem can unfold. This identification process happens intermittently over the entire course of speech therapy, in my opinion. Every time a child makes progress, he/she must admit the need to keep moving forward. And this means identifying yet another problem area. With growing maturity and awareness, the child must identify not only the stuttering problem, but also the thoughts, feelings, and distractions that make transfer tasks difficult. For example, talking with teachers and peers about stuttering seems to be a gargantuan undertaking. Yet these are key people in a network of support necessary for transfer.
(1) Peter R. Ramig & Darrell M. Dodge (2010) The Child and Adolescent Stuttering Treatment and Activity Resource Guide, 2nd ed., Clifton Park, NY: Delmar Cengage Learning.
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