366 Section III • Treatment of Stuttering

In this chapter, once we establish common ground on the unique challenges and opportunities for young people, we will explore some therapy approaches and activities that are well suited for helping adolescents codevelop their therapy goals, learn ways to stutter more easily, develop healthier thoughts and feelings about themselves and stuttering, and reduce avoidance of sounds, words, and situations. This is all in service of helping adolescents cultivate responsibility and autonomy over their change journey —the process that an adolescent goes through as they learn new ways to think about and act upon stuttering. BACKGROUND ON ADOLESCENCE Adolescence has historically been thought to “begin in biol ogy and end in culture”—that it is bookended by the onset of puberty on one side, and the achievement of culturally expected milestones of adulthood on the other (things like marriage and gainful employment) (Conger & Peterson, 1984). Contemporary models of adolescence harness recent neuro biological evidence that reveals that puberty is starting earlier and earlier, and neurological development continues well into one’s 20s. This has inspired recent calls to expand the age range of adolescence to be 10 to 24 years (Sawyer et al., 2018). What makes adolescence such a unique period of one’s life that it warrants its own literature base, its own research questions and methods, its own approach to stuttering therapy? Because adolescents are not simply older children nor younger adults, so regarding them is a disservice to the exceptional challenges and possibilities that are unique to this period of great risk and opportunity. The challenges of adolescence stem from the drastic changes in social-emotional networks in the brain that ren der adolescents exceptionally sensitive to their social world. While highly active limbic regions are amplifying emotional experiences, the less mature prefrontal regions are still devel oping self-regulation abilities (Shulman et al., 2016). Dur ing this time, adolescents are shifting their dependence on their parents to their peers instead, and this shift toward peers happens at a time when social fears and worries natu rally escalate. In fact, social anxiety typically begins around 13 years of age (Kessler et al., 2007), and there is evidence that reveals higher rates of social anxiety among people who stutter than those in the general population (Bernard et al., 2022). Therefore, it is reasonable to expect the adolescent years to be a particularly vulnerable and tumultuous time for those who stutter. The common, intense desire to fit in is challenged by stuttering—a part of them that sets them apart from their peers. On top of the great lengths that many young people who stutter go to hide this part of themselves, they may not be particularly receptive to well-intentioned clini cians recruited to help them. Some young people view cli nicians as extensions of their parents— here is another adult telling me what to do —and this attitude of not needing or wanting help can strain a budding therapeutic relationship.

Adolescence is simultaneously a time of tremendous possibilities. Those same neurobiological changes that make adolescence a difficult time also prime them for learning, particularly self-directed learning. In fact, the surge in neu roplasticity we see during the adolescent years is second only to that observed in the first 3 years of life (Cohen Kadosh et al., 2013). It is a time when identities and lifelong habits take root as young people make sense of who they are and find their place in the world. This is a crucially pivotal time for young people to have supportive experiences that allow them to flourish and develop healthy ways of coping, because toxic environments and experiences can have long-lasting damag ing effects on their livelihood (Steinberg, 2014). Clinicians can help facilitate these positive experiences by working with adolescents’ natural tendencies for independence, novelty seeking, exploration, and peer connection. SETTING THE TONE FOR THERAPY From the outset of therapy, the clinician’s primary mission is to establish a strong therapeutic relationship that is based on mutual trust and respect. To earn an adolescent’s trust, take genuine interest in understanding what they like and care about—what they like and dislike about school, what they do in their time outside of school, what their family is like, who their friends are, what they’re looking forward to or nervous about. Take notes and use these details in conversations that follow, as that signals to the adolescent that you are invested in them, and you truly care about them as people.

Creating a Safe Stuttering Space Clinicians must not only set an honest tone that stuttering is ok but also demonstrate that this is true. There is underesti mated power in four simple words: “it’s okay to stutter.” Say this often and mean it by the intentional use of verbal and nonverbal actions. Keep neutral eye contact, facial expres sions, and body language, especially during moments of stut tering. Nod along naturally. It’s helpful not to remind them to use their “speech tools” when they are just sharing about their life and not intentionally practicing a new skill; offering such reminders sends the message that you are more concerned about how they talk rather than themselves as people. If they are practicing some sort of speech change during a structured activity later in the session, then that confined activity would be an acceptable time to offer guidance and reminders in a supportive, nonpunitive way. If, in conversation, you notice that the client is spontaneously fluent—that they are speaking easily and fluently without control or conscious effort—it is oft en not helpful to comment on this because the ease was not the result of anything they were doing intentionally. Regard less of how the client delivers their message and how much they stutter, it is always useful to praise them for sharing their ideas. Many young people come to avoid sharing what’s on Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

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