Therapy for Children Who Stutter:
Putting the Language Back into Speech-Language Pathology
South Carolina Speech Language and Hearing Association
February 2018
Rita D. Thurman, M. S.,CCC—BCS-FD
Speech-Language Pathologist
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What we want to know….
Use Your Words!
How preschoolers describe their stuttering: bumpy, sticky, can’t say the word when I want.
How school age children describe their stuttering: embarrassing, frustrating, makes me panic, awkward
How teens and adults describe their stuttering: unpredictable, unrelenting, exhausting,
makes you vulnerable, shameful
Developing “Language” for treatment
Language must include:
the speech motor function…. What is happening physically?
the affective reaction…What the child is thinking?
the emotional reaction…How is the child feeling?
Speech Motor –Fluency Shaping
IEP goal found for a 4-year-old:
Given models and cues as need, P will demonstrate fluency shaping strategies and stuttering modification techniques in the therapy setting in 4/5 opportunities.
Progress: P uses light touch, stretchy speech, slow speech, easy speech in structured activities.
Fluency Shaping? What is the goal?
Used controlled speech in all speaking situations
Anticipate difficult speaking situations and use “fluency enhancing tools”
Develop understanding of the speech mechanism—
voice onset,
articulatory posture,
respiration for speech
WARNING: Most aberrant behaviors in children who stutter result from fluency shaping gone bad
Language in Fluency Shaping
Easy onset
Continuous phonation
Light touch
Language developed by children
Start my voice
Turn on my speech motor
Start the speech engine
Make the words touch
Goals for F.E.
F. will use will use fluency enhancing strategies including, but not limited to easy onset, continuous phonation, cancellation, appropriate breathing patterns in a) sentences, b) structured conversation, c) unstructured conversation to result in 90% fluency.
(Video)
New goals:
F. will describe the speech motor function for fluent and stuttered speech to three different listeners.
F. Will demonstrate voice onset in structured sentences..
Faith will identify stuttered syllables by….
F. will “release” a block and initiate voice in 5 speaking situations….
F. will maintain eye contact during a block ….
Cognitive -Affective Goals
- F. will describe her blocks and “reaction” in three different parameters (motor function, thought process and emotional response) to stuttered syllable in 5 out of 5 trials during ten different situations in the therapy setting and at home.
- F. will describe three ways to respond to bullying and teasing about her stuttering from a peer in 3 out of 3 simulated scenarios.
- Others???
SpeechMotorBehavior—Stuttering Modification and Cognitive Goals
Requires a child to modify a stuttered syllable and change it to a fluent production
Requires that a child analyze his/her stuttered speech
Use “Pullouts, Cancellations, Preset”
Incorporates pseudo stuttering.
Goal
Analyzing/identifying the moment of dysfluency and developing language around those incidents that enable E. to understand the stutter,
I will know when I stutter by catching it. I will understand my stuttering by using words to describe it. I will turn on my voice to stop a block or repeating sound.
Stuttering Identification
Catch it…… Change it
Before (what you say to yourself) go slow, get into the word, say it, slide into vowel or voice, move to the vowel.
During (what you say to yourself when a stutter sneaks up on you) Get into the vowel or first sound, start your voice vibrating, relax.
The “Don’ts” of Change it: use a different word, start over, push it out
How do we “condense” the thought.
(Video)
When Children Can’t “Catch it”
My student doesn’t know that he is stuttering.”
“My student doesn’t care that he is stuttering.”
My student isn’t ready for speech therapy.”
Identification—Modification
Can’t have one without the other.
Must be able to identify in the moment, not after—videos ineffective
Is the child in denial?
Start to identify avoidance behaviors
Is the child unaware?
Either way…pseudo stuttering should be increased until child is able to complete this independently.
(video)
Teaching “Change it”
Pseudo stuttering allows the child to gain understanding of:
The tension associated with the stutter
How that stutter changes across time (freeze and ease)
Starts to help the child desensitize to the moment of stuttering
Goals for Transfer—which starts the first day your child walks into your therapy room
1. Shelly will make 10 phone calls, including the homework line, that include greeting, question/message and closing.
2. Shelly will complete four levels on her speech hierarchy and document each in her journal with at least 5 sentences.
3. Shelly will attend 2 group sessions and discuss her stuttering as either a mentor or peer for practice.
Language Used to describe Feelings—Emotional component
Can feelings and reactions to speech really be made “without judgement”
How can we get away from “bad and good” when in reality, it feels “bad” to stutter?
We need to be aware of how this feeling affects a child’s ability to react appropriately to his stuttering.
Brings us back to the Dragon!!
Stuttering Organizations and Resources
1. National Stuttering Association—support groups and extensive materials
2. American Board of Fluency and Fluency Disorders
www:StutteringSpecialists.org
3.Stuttering Foundation of America--
4. The Stuttering Home Page
5. Division 4 ASHA–Fluency and Fluency Disorders (Perspectives on Fluency and Fluency Ds)
6. StutterTalk: Podcasts on
7. Make Room for Stuttering—Pamela Mertz--
8. NC-DPI Module on Perry Flynn’s website:
9. Stuttering Therapy Resources, Inc J. Scott Yaruss and Nine Reardon Reeves
10. International Stuttering Awareness Day: October 2018
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