Chapter 16 • Treatment of Adolescents: Advanced Stuttering 369

Figure 16.1 Five stages of change, which adolescents who stutter can move through dynamically.

teen that I worked with realized that he physically braced for upcoming stutters by pressing his lips together right before a target sound he knew he would stutter on, even if the target sound wasn’t produced bilabially. This often altered the tar get sound that came out and would impact his intelligibility. That’s an example of struggle. With this struggle versus stut ter distinction in mind, one of our aims when working with young people who stutter is to guide them in figuring out ways to reduce struggle so they can stutter with greater ease. They can do this by learning about the physiology of talking and stuttering, identifying when and how they stutter, and then figuring out ways to work with their speech mechanism rather than fight against it. Learning About the Speech Mechanism One of the most important precursors to making any sort of behavioral speech changes is to learn how the speech mecha nism works to produce talking and stuttering. A helpful way to start this discussion is to find or make an age-appropriate drawing of the speech mechanism that includes everything from the diaphragm up—lungs, vocal folds, articulators (tongue, teeth, lips, jaw), nose, and don’t forget the brain that decides what to say and directs parts of the speech mecha nism to move in certain ways. Creative clients may be inter ested in making a 3D model of the speech mechanism using modeling clay, Legos, origami paper, household objects, or other resourceful materials. Once a common vocabulary about speech anatomy has been established, it’s time to understand how the different parts work together. It’s useful to start by explaining how the parts work together seamlessly most of the time to produce

easy, fluent speech: The brain sends a signal to the body to inhale, which sends the diaphragm down to make room for the lungs to fill up with air. Once we’ve inhaled, we start talk ing as we exhale. The air moves up from the lungs into the windpipe and then through the vocal folds, which starts their vibration so that the voice can turn on. The air then moves into the mouth where the articulators shape the air to make different sounds. Once the teen understands the path of airflow, it’s help ful to explore with them where and how different sounds are made. Have them produce different sounds: labials /p, b, m, w, f, v/, alveolars /t, d, n, l, s/, velars /k, g/, and those that occur at the vocal folds including vowels and /h/. The clinician should model each one first, producing each of these sounds easily and then increase the tension by, say, 25% → 50% → 75%. When playing around with differ ent tension levels, this is a natural time to talk about and experiment with the three core behaviors of stuttering— repetitions, prolongations, and blocks. From single sounds, you can start producing single words and simple phrases with the same approach (first easily, then gradually add ing tension). In the spirit of Dr Dean Williams (one of the renowned giants of stuttering therapy at the University of Iowa from the 1950s to 1980s), prompt the client to really “feel what you’re doing”—recruiting their cognitive and physical attention so they are moving mindfully and inten tionally. This is educational, kinesthetic, and desensitizing as it builds their behavioral awareness of where and how they may get stuck when they stutter. Try to tap into your own curiosity and creativity to make this activity engaging and interesting for your adolescents; model the type of intrigue and excitement that the complexity of speech production

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