How do I treat stuttering? 1
Can we improve fluency training programs for school speech-language pathologists?
Glen Tellis, Ph.D., College Misericordia, Dallas, PA -
Bressler, L., Emerick K. College Misericordia
Summary
This paper provides information for 255 school speech-language pathologists (SLPs) from 16 counties who responded to the 49 question survey about stuttering.
Findings
· Of the total respondents, 87.8% had MA/MS degrees and 9.4% had BA/BS degrees
· 64.7% had their Certificate of Clinical Competence (CCC)
· A majority (95.0%) had previously taken courses in fluency disorders.
o From this total, 15.2% took a half semester of and 46.9% took a full semester of undergraduate coursework in fluency disorders and 34.3% had no coursework or a few lectures.
o From this total, 17.6% had no lectures or a few lectures of graduate coursework in fluency disorders, 11.1% had a half semester of graduate coursework, and 67.1% had taken a full semester of graduate work
o With regard to half day workshops, 44.7% had never attended a workshop; however, 16.9% had attended 1 half day workshop, and 15.5% had attended 2 half-day workshops.
o With regard to full day workshops, 40.9% had never attended a workshop; however, 21.1% had attended 1 full day workshop, and 19.0% had attended 2 full day workshops.
· Average SLP experience was 16.37 years and average experience working with PWS was 10.96 years
· On average, the SLPs had only treated 12.12 children who stuttered throughout their careers and on average had 2.02 children who stuttered on their caseloads.
· Average yearly caseload of all children in therapy was 47.64
· The SLPs had only attended an average of 1.68 half day fluency workshops since graduating from college and 1.60 full day workshops
· 46.3% of respondents had never heard of ASHA’s SID in Fluency Disorders - Fluency Specialist Certification and 68.4% did not know how to contact a Fluency Specialist
· The SLPs noted that the majority of CWS on their caseload are White/Non-Hispanic (72.9%), 11.9% are Hispanic American, 10.2% are African American, and 1.7% are Asian American.
· Of SLPs who had taken a full semester of graduate course work in stuttering (N=145) – a cause for concern is that:
o 66.4% did not know how to contact a Fluency Specialist
o 36.6% indicated that they would not treat initially because the child may spontaneously recover (Q3)
o 53.1% indicated that they would not treat when disfluencies are first noticed (Q7)
o 27.7% agreed that parents should tell children who stutter to speak slower to reduce stuttering (Q10)
o 64.4% do not use attitude scales to assess stuttering (Q14)
o 69.2% do not know about intervention techniques to address bullying (Q16)
o 33.3% could not identify the core behaviors of stuttering (Q18)
o 43.5% were not comfortable with working with children who stutter (Q21)
o 42.5% could not differentiate between the two main approaches (fluency shaping and stuttering modification) to stuttering therapy? (Q26)
o 92.9% did not know about Silverman’s Three Wishes Task (Q33)
o 52.4% did not know how to contact support groups for stuttering (Q42)
· Of licensed SLPs who had ASHA’s CCC (N=163) – a cause for concern is that:
o 64.5% did not know how to contact a Fluency Specialist
o 39.3% indicated that they would not treat initially because the child may spontaneously recover (Q3)
o 55% indicated that they would not treat when disfluencies are first noticed (Q7)
o 22.3% agreed that parents should tell children who stutter to speak slower to reduce stuttering (Q10)
o 68.1% do not use attitude scales to assess stuttering (Q14)
o 71.5% do not know about intervention techniques to address bullying (Q16)
o 32.6% could not identify the core behaviors of stuttering (Q18)
o 43.8% were not comfortable with working with children who stutter (Q21)
o 47.7% could not differentiate between the two main approaches (fluency shaping and stuttering modification) to stuttering therapy? (Q26)
o 95.0% did not know about Silverman’s Three Wishes Task (Q33)
o 54.3% did not know how to contact support groups for stuttering (Q42)
· Of SLPs who had attended one or more fluency workshops (N=150) – a cause for concern is that:
o 39.3% indicated that they would not treat initially because the child may spontaneously recover (Q3)
o 47.3% indicated that they would not treat when disfluencies are first noticed (Q7)
o 58.0% do not use attitude scales to assess stuttering (Q14)
o 67.3% do not know about intervention techniques to address bullying (Q16)
o 28.6% could not identify the core behaviors of stuttering (Q18)
o 38.6% were not comfortable with working with children who stutter (Q21)
o 42.6% could not differentiate between the two main approaches (fluency shaping and stuttering modification) to stuttering therapy? (Q26)
o 88.6% did not know about Silverman’s Three Wishes Task (Q33)
o 71.3% heard about the Speech Easy device to treat stuttering, however; 73.3% did not know about the long-term effects of assistive devices (Speech Easy, etc.) to treat stuttering (Q45,46)
Section I / %Agree / % Undecided / %
Disagree
1. / Stuttering is caused because a person talks faster than he or she can think / 14.3 / 14.3 / 71.4
2. / Many children who stutter do not become fluent because they do not try hard enough / 1.6 / 1.2 / 97.2
3. / When a child first begins to stutter, SLPs should not treat initially because the child may spontaneously recover / 40.9 / 23.6 / 35.6
4. / Children who stutter get lower test scores than children who do not stutter / 4.8 / 17.5 / 77.7
5. / Parents should tell children who stutter to take a breath before speaking / 17.6 / 16.4 / 66.0
6. / Stuttering is caused by psychological problems / 19.2 / 18.4 / 62.3
7. / SLPs should treat children as soon as stuttering disfluencies are first noticed / 26.6 / 20.2 / 53.2
8. / Persons who stutter are less intelligent that normally fluent people / 1.2 / 0.8 / 98.0
9. / SLPs should begin with direct therapy as soon as a child first begins to stutter / 10.4 / 20.5 / 69.0
10. / Parents should tell children who stutter to speak slower to reduce stuttering / 29.3 / 14.5 / 56.2
11. / When a child first begins to stutter, SLPs should begin with indirect therapy / 68.0 / 20.4 / 11.6
12. / Parents should tell children who stutter to think before they speak / 7.2 / 14.5 / 78.3
Section II / %
Yes / %
No
13. / Do you know how to accurately identify the onset characteristics of stuttering? / 62.7 / 37.3
14. / Do you use attitude scales to assess stuttering? / 33.6 / 66.4
15. / Can you analyze a speech sample to determine different types of stuttering disfluencies? / 85.5 / 14.5
16. / Do you know about intervention techniques to address bullying? / 29.3 / 70.7
17. / Are you aware of websites that pertain to stuttering? / 71.5 / 28.5
18. / Can you identify the core behaviors of stuttering? / 64.9 / 35.1
19. / Do you know what the incidence of stuttering is in the general population? / 24.9 / 75.1
20. / Do you know how to identify secondary behaviors (accessory behaviors, associated motor behaviors)? / 88.0 / 12.0
21. / Are you comfortable working with children who stutter? / 53.5 / 46.5
22. / Can you identify the difference between stuttering and normal disfluencies? / 92.3 / 7.7
23. / Do you know about the attitudes of various groups toward persons who stutter (teachers, speech-pathologists, parents, etc.)? / 80.6 / 19.4
24. / Do you know how to score the Stuttering Severity Instrument? / 73.0 / 27.0
Section II / %
Yes / %
No
25. / Have you heard of the National Stuttering Association? / 85.4 / 14.6
26. / Can you differentiate between the two main approaches (fluency shaping and stuttering modification) to stuttering therapy? / 49.2 / 50.8
27. / Do you know whether stuttering treatment is covered by insurance? / 19.3 / 80.7
28. / Do you know whether intensive (40 hours for 2 weeks) or gradual treatment (twice a week for 6 months) is more effective to treat stuttering? / 16.6 / 83.4
29. / Do you know how to tally stuttering disfluencies? / 77.9 / 22.1
30. / Do you know how to teach a client to freeze during a block? / 25.4 / 74.6
31. / Do you know how to teach stuttering modification techniques? / 68.8 / 31.2
32. / Can you differentiate between indirect and direct therapy? / 90.9 / 9.1
33. / Do you know about Silverman’s Three Wishes Task? / 6.4 / 93.6
34. / Do you know how to teach easy speech and stretchy talk? / 88.4 / 11.6
35. / Do you involve teachers in stuttering therapy? / 81.5 / 18.5
36. / Have you heard of the Stuttering Foundation of America? / 88.8 / 11.2
37. / Do you involve parents in therapy? / 88.4 / 11.6
38. / Have you heard of the Stuttering Home Page? / 31.5 / 68.5
39. / Do you know how to teach cancellations when conducting stuttering modification therapy? / 40.0 / 60.0
40. / Do you know about the latest genetic research in stuttering? / 12.7 / 87.3
41. / Do you know how to teach pull-outs when conducting stuttering modification therapy? / 48.8 / 51.2
42. / Do you know how to contact support groups for persons who stutter? / 47.2 / 52.8
43. / Do you know how to teach preparatory sets when conducting stuttering modification therapy? / 31.5 / 68.5
44. / Have you heard of the Lidcombe Program for treating childhood stuttering? / 21.8 / 78.2
45. / Have you heard about the Speech Easy device to treat stuttering? / 75.0 / 25.0
46. / Do you know about the long-term effects of assistive devices (Speech Easy, etc.) to treat stuttering? / 22.1 / 77.9
Conclusion: A majority of respondents were unaware of: (1) how to contact a Fluency Specialist, (2) the three wishes task to assess childhood stuttering, (3) how to use attitude scales to assess stuttering, (4) intervention techniques to address bullying, (5) the incidence of stuttering, (6) whether stuttering treatment is covered by insurance, (7) how to teach most stuttering modification techniques, (8) genetic research about stuttering, (9) how to contact support groups, and (10) long-term effects of assistive devices. It is encouraging to note, however, that most participants indicated that: they could identify the difference between stuttering and normal disfluencies, they involved parents and teachers in therapy, stuttering is not caused because people talk faster than they can think, parents should not tell CWS to take a breath before speaking, parents should not tell children who stutter to think before they speak, and stuttering is not caused by psychological problems. Even though a majority of the speech-language pathologists indicated that they were comfortable with treating stuttering, they indicated that were not aware about specific assessment (3 wishes task, attitude scales, etc.) and treatment methods (cancellations, pull-outs, prep-sets, bullying intervention programs).
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