Stuttering

324 Section III • Treatment of Stuttering

stuttering (since that sometimes occurs), I occasionally may produce a longer than usual stutter and say, “Sometimes they go on for a long time. at makes me mad sometimes.” I con tinue to try to sense what the child is feeling and to empathize as naturally as possible. I use this empathic focus not only when I am modeling easy stutters but throughout treatment. For children who evidence periods of acute frustration with their stuttering, parents should be coached on how to make empathetic statements in a calm, soothing, slow style when the child is going through a di cult time. As I do ther apy, I try to involve the parents in appropriate activities both at home and in the clinic. If their indirect treatment has not been e ective, I need to be sure that the parents do not feel pushed aside by my direct therapy with the child. ey need to remain active participants. e Child Begins Active Participation: “Catch Me” When I sense that a child is comfortable with my easy stut tering models, I see if the child will take part. I may say, for example, “Can you help me? Sometimes when I get stuck on a word, it goes on and on. en, I try to make my stuck words real slow and loose, and it helps me get unstuck. But some times I forget. If you hear me go on and on like thi-thi-thi thi-thi-this, just say, ‘ ere’s one,’ and then I’ll try to change it to make it slow and loose with slidey speech.” When the child catches me, I will change a fast, tight repetition to a slow, loose one. As I model stuck words, I choose a style of stutter ing similar to the child’s. Praise should ow liberally when the child catches one of my modeled stutters. is provides the child with a sense of accomplishment that is associated with something they previously felt to be out of control, even though now it is in my speech. For many children, tangible rewards, such as small snacks or turns at a game, are important motivators and should be used along with praise to establish the child’s ability to catch the clinician’s stutters. Figure 14.4 illustrates “Catch me.” e Child Begins Active Participation: Play

Stuttering Modification Treatment M ORE D IRECT T REATMENT ON S TUTTERING FOR B EGINNING S TUTTERING

Some preschool children who stutter are beginning to have negative feelings about their dis uencies but are not showing the full-blown signs of struggle or escape behaviors that char acterize most beginning stuttering. Still, they may occasion ally express real frustration with their stuttering. Typically, I work with these children using stuttering modi cation for about 45 minutes each week. I also con tinue to provide encouragement and support to the family in helping them make the child’s environment as facilitating to uency as possible. Our treatment activities are presented in a hierarchy that the clinician and child ascend as far as is necessary to bring the child’s dis uencies into the “typical dis uency” range. Progressive steps are taken when the clini cian senses that a child is feeling competent at the current step. us, improvement may be rapid or slow and sudden or gradual, depending on the child’s feeling of comfort and mastery with the tasks at hand. ere is no need to hurry this process. It should take place within the context of games and activities that make the focus on stuttering casual and are, above all, fun. e clinician needs to remain alert to the child’s immediate sense of con dence and self-esteem in selecting the moment to move the child to the next step in the treatment hierarchy. Modeling Easy Stutters I begin this approach to stuttering modi cation rather indi rectly by providing models of easy stuttering in my speech. If the child’s repetitions are fast and abrupt, my models are slow with gradual endings. If the child has many repetitions or long prolongations, I repeat or prolong sounds brie y. ese models are done casually during play with the child. I don’t produce them immediately a er the child stutters but insert them randomly, about once every two or three sentences, as if I were stuttering as I talked. Once the child has become acclimated to the models of easy stuttering a er 10 or 15 minutes of play, I begin to make, occasionally , accepting comments about them. I might say, for example, “Hmmmm, I used slidey speech on that word, didn’t I?” or “ at word stuck a little, but that’s OK and I slid right out of it.” Most children appear to be shyly interested in what I am talking about, and this approach can continue to develop. A few children, however, may react negatively and say such things as “Don’t do that!” or “I don’t like it when you do that.” For them, this approach needs to proceed slowly to allow my acceptance of them as they are and my support dur ing play activities to gradually counteract the child’s anxiety. If the child has begun to experience the rst pangs of frustration from stuttering, which can be inferred from their questions or complaints about getting stuck on words, I will try to help them express this. Even though I am making com ments that show acceptance of my own pretend and real

is stage can either follow or precede “Catch Me.” It depends on the clinician’s judgment about which activity would be more comfortable for the child. Sometimes you may start one of these stages but nd the child is not ready and you switch to the other. e playing with stuttering stage engages a child in following the clinician’s lead in playfully imitating dis uencies that are similar to their own, such as repeated or prolonged sounds. e purpose is to desensitize the child to the frustration that sometimes arises in more severe border line stuttering. It is a process that may take place because play can give a child a sense of mastery without the risk of failure. e concept of play is quite interesting. Scientists speculate that children’s play is an opportunity for them to practice and master skills that are needed in adulthood. Playing with stuttering may take advantage of children’s natural tendency to play and provide them with the pleasure of mastery and Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.