Motivation: The child should be motivated to seek therapy and participate in it. Caregivers should help children understand the therapy process and share positive information.
Identification: The child should identify her individual stuttering moments in order to build awareness.
Desensitization: The child's "negative" emotions regarding stuttering are addressed to reduce the stress associated with stuttering. Techniques may include relaxation and stuttering on purpose.
Variation: The child will modify her stuttering. This may involve using a word repetition ("book-book") instead of a sound repetition ("b-b-b-book"). This is meant to increase a child's control over stuttering/speech.
Approximation: Modifying the child's speech in order to decrease stuttering and increase fluency. The strategies of cancellation, pull-out and preparatory set techniques are discussed in the previous posting.
Stabilization: The child gains self-confidence and the ability to monitor her own speech/use therapy strategies independently.
Next, I would like to address how parents and other caregivers in the Pittsburgh area can work on these components. In terms of motivation, J. Scott Yaruss (a Ph.D. level SLP) notes that we should envision goals more broadly, and explain to children that the purpose of speech therapy is to increase communication (not simply to eliminate stuttering). Here is a link to the piece Yaruss wrote, "Why School-age Children Who Stutter Aren't Motivated for Therapy": http://www.speechandlanguage.com/stories-from-the-field/why-school-age-children-who-stutter-arent-motivated-for-therapy. One way to increase motivation would be to find out from your child what they are having trouble with in terms of communication. Is it talking on the phone? Reading aloud? Speaking with friends at recess? Whatever it is, that should be used as a target in therapy. So, if your child finds that she stutters more on the phone and this then decreases her ability to communicate, target having her speak on the phone. She can start by calling a family member, and then progress to more complex calls to friends, acquaintances, and institutions. Here are some tips for people who stutter regarding telephone usage from The Stuttering Foundation: http://www.stutteringhelp.org/using-telephone
Since cell phones are probably most popular, I recommend having your child practice phone usage at a location she feels comfortable in. This may be her bedroom, on school grounds, at a quiet cafe, etc. Once she is ready to broaden her horizons, a great Pittsburgh place to practice would be in a phone booth. The Citizens Bank Building at 525 William Penn Place has some old-fashioned telephone booths much like the one pictured below.
In terms of identification, have your child identify moments of stuttering during a task she is invested in. If your child wants to have more fluent speech when reading aloud, ask her to read something she is interested in, then discuss with her the particular types of stuttering she encounter (allow her to lead the conversation).
"Pittsburgh Magazine" is an excellent source of news and human interest that may provide a good starting point for children of middle school and high school age. Magazines are great for oral reading because their stories are often concise and are filled with a lot of visually interesting pictures.
For desensitization, the goal is to reduce anxiety about speech. One technique is relaxation, whereby you may instruct your child to pretend her body is a melting ice cube; the idea is to let her body ease out of tension. Practice this with her regularly so that it comes naturally; the body and mind should be relaxed. Another technique is to ask your child to stutter on purpose. Stuttering on purpose can signal to her that she can be in control of her speech, and can also demonstrate that even when she stutters, nothing "bad" will happen.
To encourage your child to engage in relaxation techniques while out in the real-world with all of its distractions, pick a public place that is welcoming. According to Pittsburgh Magazine, "Knit One" is the best yarn store to visit if you enjoy crafts and talking with friendly people, or just sitting down and soaking up the scenery. I recommend visiting the Buhl Planetarium at the Carnegie Science Center.
Image retrieved from http://www.carnegiesciencecenter.org/planetarium/buhl-planetarium-skywatch/
To practice variation, review with your child different ways to stutter. There are part word repetitions ("wh-wh-where"), sound prolongations ("sssssister") and interjections ("I, um, you know, want to see a movie") to name a few. Try these out at home during preferred activities so that your child will continue to be motivated throughout the whole process.
You can help your child with the approximation stage by cueing her to use cancellations, pull-outs and preparatory set techniques. (See previous post for detail.)
Finally, aid your child with the stabilization phase by praising her for monitoring her speech, whether she is successful or not. Also, try to keep her motivated by reminding her of the big picture and reinforcing positive self-esteem.
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