326 Section III • Treatment of Stuttering

Praise and, if needed, tangible rewards are used to help the child build con dence. When the child is able to produce slow and loose stutters, the clinician can let the parents know, in the child’s presence, about this accomplishment, focusing on the child’s ability to teach the clinician. If the child seems proud of this accomplishment, the clinician can take advantage of this opportunity and have the child show intentional stutters to the parents. is not only desensitizes the child to stuttering with the parent, but it also desensitizes parents to the child’s stutter ing and models acceptance of the child’s stuttering for them. e Child Changes eir Own Real Stutters For many young children whose stuttering uctuates between mild and severe levels, these more direct therapy activities focused on stuttering modi cation, combined with a facili tating environment provided by parents, may be enough to advance their uency into the typical range within a few months. For those whose stuttering persists, still another stage of stuttering modi cation may be necessary. In such cases, I look for opportunities when the child seems ready to modify their own stutters. I begin by responding to a few of the child’s real stutters with accepting comments to help the child feel comfortable with their stutters. I might say, with an accepting voice, “Oh, that one was a little bumpy on ‘my-my-my car…,’” and then return to the business of playing. A er further play, when the child stutters again, the clinician can model an easier and slower style of stuttering on the same word and comment positively about it. I then ask the child to imitate my easier stutter and praise them for doing so, using reinforcements and guidance to shape their stuttering to a slow, relaxed style. I look for slightly slower and easier stutters in the child’s speech and reward them. Even if the child intentionally stut ters, but in an easier way than they stuttered previously, I reward them. From this point on, the clinician uses a com bination of modeling and reinforcement to shape the child’s stuttering. It is the deliberate slowness and “easiness” with which the child produces repetitions or prolongations, along with the sense of playing with stuttering, that make it pos sible for the child to begin feeling a sense of control . is in turn should reduce their frustration and fear, further dimin ish tension, and enable them to move through stutters with minimal e ort. A er the child is able to make their stutters slower and easier in the clinic, generalization may occur away from the clinic without the need for formal transfer activities. Such “spontaneous” generalization may be a result of the child’s increased self-esteem from gaining mastery over behavior they previously felt uncomfortable about and felt was out of their control. Consequently, emphasis should be placed on the stutters that a child handles successfully, rather than when they lose control. If generalization is not occurring automatically, I work with family members to make the child’s ability to play with and modify stutters a point of pride at home. Initially, the

child can teach parents and siblings to stutter in the clinic under the clinician’s guidance. en, the clinician can work with the child at home and involve family members if pos sible and if needed, so that the parents learn to use positive reinforcement selectively to increase the child’s slow and easy stutters and let the child know that they are appreciated. Even though the emphasis here is on slow and easy stutters, the e ects of speech and language maturation and the increasing con dence that the child feels in their speech as a result of reduced frustration should result in typical uency. Sometimes a beginning stutterer may not be able to get to mastery over their tense stutters and turn them into easy ones. en, the clinician and family need to be sure to help the child realize that stutters are OK and that they can go ahead and talk anyway and communicate e ectively, using good eye contact with their listeners and openness about their stuttering. One nal note about direct therapy with young children who stutter: Van Riper once told me that one of his daughters began to stutter quite severely at a young age and he found a way to help her, using direct therapy. Van Riper and his wife used what now might be called “rhythm therapy.” ey had their daughter speak short sentences in a rhythmic manner, accompanied by clapping her hands. In fact, all the family talked this way for several weeks, a er which his daughter became completely uent, despite a minor relapse or two. 4 I present Sheryl Gottwald’s approach to working with stut tering in preschool children because it has good outcome data indicating that it is e ective. is is not data from an isolated lab, but the ndings of a clinician as she did therapy. It is a well-rounded “multidimensional” (to use her adjective) approach that helps parents change the home environment, helps the child change feelings and attitudes, and guides the child in changing the way they stutter, to an easier way of stuttering that typically leads to uent speech. Gottwald (2010) has re ned an approach rst developed at Temple University by Starkweather et al. (1990) and extended by Gottwald and Starkweather (1999). ey designed it for children ages 2 to 6 who stutter. is treatment popularized their concept of “ demands and capacities ,” described in Chapter 6, that ascribed stuttering to a combination of the demands placed on a child by their environments (internal and external) interacting with their innate capacity for u ent speech. Because there are many factors maintaining the child’s stuttering, Gottwald terms her approach “multidi mensional.” Among the dimensions are treatment focused on ANOTHER CLINICIAN’S APPROACH: SHERYL GOTTWALD

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4 Compare this with the syllable-timed speech approach for preschool chil dren who stutter, reported by Trajkovski et al. (2009).

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