Chapter 14 • Treatment of Older Preschool Children: Beginning Stuttering

the parents to reduce stresses in the child’s environment and treatment focused on the child to strengthen the child’s u ency. Gottwald carries out her assessment and treatment by working to understand the family’s and child’s needs, work ing with their strengths, and supporting them deeply as they deal with their challenges. Modifying the Environment Gottwald is very sensitive to each family’s needs as she works with them to help them modify the child’s environment. She describes her orientation this way: “Families bring their own individual needs for emotional support; until their feelings of sadness, guilt, frustration, and other emotions are addressed and acknowledged, it will be so much more di cult for them to make the changes necessary to support their child’s uency. We discover what families need by talking with them about their hopes, observations, feelings, and needs” (Gottwald, personal communication, July 2018). e initial component of treatment—parent counseling— provides parents with a simpli ed version of what we cur rently know about the nature of stuttering. Figure 14.5 was drawn from a video clip of Gottwald counseling a mother and father whose child is stuttering. A series of video clips illustrating Gottwald’s approach is available on Lippincott Connect for Chapter 14. Some of the information that Gottwald shares is that stut tering is highly variable and that many factors may in uence its ups and downs, including factors that the family may be able to change. e family is also introduced to an etiologi cal (focusing on what the cause might be) model of stutter ing, which explains stuttering as emerging from interactions between the child’s capacities and the demands placed on the child. e clinician also helps the family nd ways of talk ing about stuttering with their child. ey learn to support the child by commenting sensitively when the child has di - culty getting a word out. Open acknowledgment of stuttering

is intended to reduce the child’s and the family’s negative feelings about stuttering. For example, a parent might say to a child who has just stuttered and appears frustrated or ashamed, “Sometimes those words really get stuck. It’s OK. I’m here to listen.” is conveys to the child that the parent has the time and is focused on listening patiently. During individual counseling, families are also taught to change other aspects of their behavior that may be a ect ing their child’s uency. For example, family members may learn to respond to the child’s stuttering without interrupt ing, looking away, or otherwise conveying impatience. To decrease pressure from the family’s speech and language environment on the child, family members may be taught to slow their speech rates, pause more frequently, and simplify their language when talking with the child. To increase the child’s self-esteem, families may be urged to create times each day when the child has a parent’s full attention. Sometimes, family members may be bombarding the child with questions or otherwise pressing them to speak. As a remedy, they are shown how to talk about what they are thinking and doing as they play with the child, thereby modeling the behavior they want to encourage. Table 14.3 lists some of the things that family members can do to facilitate uency. In addition to changing behavior directly related to speech, families are also counseled about other stresses in the home. For example, Starkweather et al. (1990) have noted that a hectic family lifestyle can exacerbate a child’s stutter ing. Once parents understand that a too-busy family sched ule may be a factor in their child’s stuttering, they are o en able to reduce the hustle and bustle in the home and are grati- ed when their child’s stuttering subsequently diminishes. In addition, a slower pace and more relaxed lifestyle can o en provide increased satisfaction for all family members. Gottwald sometimes supplements individual family coun seling with group therapy in which two to four other couples whose child stutters are involved, when that can be arranged. is gives families an opportunity to share experiences and

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Figure 14.5 A clinician counseling a family about treatment for their child.

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