Stuttering

328 Section III • Treatment of Stuttering

ideas and to support one another. As members of a group, parents receive support from one another and can share ideas for helping their children. e clinician’s role is to help the group members develop a sense of mutual trust by modeling concern, acceptance, and respect for all group members and their ideas and feelings. Generally, the group talks about top ics they select, although the clinician may also suggest topics that are o en concerns of most members, such as regression during treatment and termination of treatment. Modifying the Child’s Speech e other major component of Gottwald’s therapy—besides working with the parents or caregivers to change the child’s environment—is modi cation of the child’s speech. is involves parent and clinician modeling and reinforcement, as well as the clinician’s instruction when needed. Instruc tion in changing stuttering with older preschool-age children is a natural outgrowth of the parents and clinician talking openly about stuttering with the child. e procedures that the authors use to modify a child’s speech are as follows. Children Who Stutter With Minimal Struggle First, the clinician talks and plays games with the child in a very uency-enhancing setting. is situation includes the clinician talking slowly in a relaxed way with plenty of pauses and silences. en, the clinician teaches the child to talk in a slow, relaxed way. is is done with very little linguis tic demand on the child; for example, a game they play may require only simple short sentences. Gradually, as the child becomes more and more uent in this situation, demands are gradually increased. is may entail games and conversation involving longer and more complex utterances, or the clini cian may speed up their speech rate. For those children who continue to stutter in this low-pressure situation, Gottwald teaches them to stutter using “easy bounces” at the beginning of an utterance, li-like this. For those children who stutter with noticeable tension and struggle, Gottwald begins therapy by talking with them about stuttering, so that they will recognize what they are doing when they stutter and thereby increase their acceptance of it. By playing games that reward stuttering, the child changes their feelings about their stuttering and may even begin to stutter on purpose. is then leads to changing the stutters so they become gradually looser and looser. Gottwald encour ages these children to use bouncy speech (re-re-repeating sounds easily and loosely) or stretchy speech (lllllllllike this) in which easy, loose prolongations take the place of strug gled stutters. As she works on helping the children change their stutters, Gottwald also works to help them express their Children Who Stutter With Moderate to Severe Struggle

feelings as a way of leading to improved attitudes about their stuttering and a better understanding of it.

Termination Individual and group parent counseling and modi cation of the child’s speech continue until the family environment and the child’s speech have met the following two criteria. First, the environment has changed enough so that major stresses have diminished and the family seems to understand the dynamics that may exist between environmental stresses and the child’s stuttering. Second, the child’s stuttering has decreased to the point at which they are normally dis uent, with an occasional mild instance of stuttering. Starkweather et al. (1990) reported that most of the children they have treated have regained normal uency. Of 39 chil dren whom they treated using this approach, 7 dropped out, and of the remaining 32 children, 29 recovered completely, and 3 were still in treatment at the time of the report. e average child requires about 12 sessions of therapy using this approach, although some children require much more before therapy can be terminated. Gottwald and Starkweather (1999) treated an additional 15 families with their approach. Although 1 family dropped out, the children of the remaining 14 families achieved nor mal uency and reported maintaining it a year a er the chil dren were dismissed from treatment. Further data on her approach were provided by Gottwald (2010) involving the children of 27 families. Again, 1 family dropped out, but 26 families reported their children had normal uency 1 year or more following dismissal from treatment. Compared to LP, Gottwald’s treatment based on the Demands and Capacities model appears to be equally e ec tive and, on average, takes fewer sessions (12 in Gottwald’s approach; 18 in LP). However, LP has generated many more outcome studies of their treatment program and has used randomized control trials (the “gold standard” of treatment outcome measures) to assess treatment e ectiveness. I rec ommend both to clinicians working with preschool children from 3.5 to 5 years old. However, if a clinician chooses LP, it is important that they receive formal training and follow-up mentoring by LP trainers. Supporting Data on Gottwald’s Multidimensional Approach

TREATMENT OF CONCOMITANT SPEECH AND LANGUAGE PROBLEMS

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Fluent speech is a ected by many variables, including lan guage and phonology. For example, there is evidence that many children who stutter also have language and/or pho nological problems (Bloodstein et al., 2021; Hall et al., 2022;