ASU offers peer group support, therapy for children who stutter

Every classroom is filled with chattering children, but for some kids, the words don’t flow effortlessly.

Arizona State University is offering a five-week program this summer for children who stutter, where they will not only learn strategies but also share experiences with other kids like them.

The Among Friends stuttering group, for children ages 6 to 12, begins June 28 and runs twice a week over five weeks. The group, offered by the ASU Speech and Hearing Clinic, is also offered weekly in the fall and spring semesters over 10 weeks.

The goal is to empower the kids to deal with stuttering the best way for them, according to Victoria Clark, a clinical assistant professor in the College of Health Solutions who runs the program.

Children who stutter can feel different from their peers not only because they speak differently but also because stuttering is relatively uncommon, said Clark, who has worked as a speech and language pathologist in schools.

“In schools, I may have 60 to 80 children on my caseload, but often only one or two kids who receive services for stuttering,” she said.

“There just aren’t that many, and so some children have never met another person who stutters. This is why we wanted to provide a group experience to bring together children and facilitate positive peer interactions.”

According to the American Speech-Language-Hearing Association, between 1% and 5% of the population experiences stuttering at some point in their lifetime, with 5% to 8% of children newly identified each year. Stuttering is a communication disorder that disrupts the flow of a person’s speech, with disfluencies such as repeating or prolonging sounds, syllables or words, along with experiencing blocks where they are not able to produce a sound, according to the National Stuttering Association.

Clark said that according to current research, it is believed that stuttering occurs at about the same rate across every language in the world, though there are differences in how stuttering is viewed across cultures.

“It’s considered a genetic and a neurological (brain-based) condition, and while treatment can be very helpful, it is not considered ‘curable’ and we counsel our clients and families that they may benefit from therapy as needed over the course of their lives,” she said.

In the Among Friends group, ASU graduate students who are training to be speech-language pathologists deliver the therapy, under Clark’s supervision. The group is a good addition to therapy, she said.

“One thing we notice is that when children work with adults individually, they don’t always carry those skills outside of the therapy session.

“We wanted to give them a chance to talk to other kids about being a person who stutters and give them strategies to use when they want to stutter less,” she said.

Clark answered some questions from ASU News about stuttering and the Among Friends group.

Question: What is stuttering?

Answer: You’ll hear people refer to stuttering as “disfluency” because it’s a problem with speech fluency. But in working with kids, I’ve discovered that it’s better to use the word “stuttering” to reduce the stigma about speaking with disfluencies. We use strategies and activities to increase confidence in communication and desensitize children and their families to speech disfluencies. The more we can overcome that shame, the better.

For facts, the best place to look is ASHA.org, the national organization that certifies speech-language pathologists and the first stop for evidence-based practice.

Stuttering can be repetition of sounds or of syllables. We all have some speech disfluencies, but when these disfluencies rise above specified thresholds, it can be considered a speech disorder. What goes along with this is what the speakers report of their experience. Maybe a person’s stuttering is not noticeable to listeners, but they experience a lot of struggle to speak fluently. They may avoid talking.

When a person resists stuttering, they can experience “secondary behaviors," which consist of physical tension, eye blinking and other unnecessary movements that can increase over time and interfere with communication beyond the impact of the original stutter. We practice easy, relaxed speech to reduce these secondary behaviors.

Q: Can stuttering be cured?

A: There are some programs that make claims about curing. But the best available evidence is that stuttering is lifelong, though most people experience increases and decreases in disfluencies over time. In fact, in the schools, when kids train to overcome a speech sound difference like a lisp, we dismiss them from our services. For kids who stutter, we tend keep them on our caseload, even if it’s just to check in with how their communication is going at home, at school, with friends, etc.

Stuttering can increase or recede over time unexpectedly and in response to stress. We emphasize to families that there is nothing that’s considered to be a cure. And while that can feel frustrating, it can also take some of the pressure off of that child to try to cure it.

Even speech-language pathologists who stutter report that with all of their training, they find that sometimes fluency strategies work and sometimes they stop working as effectively. Research on stuttering continues to try to give us insight into these mysteries.

Q: When should parents consider therapy?

A: The incidence of stuttering among preschoolers is about 5% to 8%, but most of these children stop stuttering within a year or two. It’s more prevalent in boys than in girls, and there are other factors. If they have a parent or close family member who stutters, they may be less likely to stop. If it lasts at least a year, they may be more likely to continue. Most start before 4 years old, and the later they start stuttering, the less likely they are to grow out of it.

Some factors that would lead you to seek help would be if the stuttering lasts at least six months or if it seems to bother them. Often, it seems to families like the stuttering doesn’t bother the child, but often the child just doesn’t have the words to describe it, and if no one speaks openly with them about it, they may conclude that speaking about the stutter is not an option.

Q: What do you talk about during the Among Friends sessions?

A: We cover four areas: Feelings and attitudes about communication, the physical mechanism of speech, speech fluency strategies, and family discussion and coaching to be good listeners to kids who stutter.

Q: How do you teach those strategies?

A: The focus for that has changed in recent years. It used to be that they would learn fluency strategies in order to not stutter. But the truth is that using those strategies takes a lot of attention and a lot of practice while they’re also trying to think of what to say.

So we do teach strategies, but we also give the person who stutters a lot of control and input about how they want to use those outside of the therapy session. It’s up to them and we try to give them that choice as early as possible.

As they get older, we practice things like self-disclosure, or telling people that they are a person who stutters, so it breaks the tension for the listener and it’s not an unspoken question in their interactions. They can say something like, “Sometimes I stutter on some words, but don’t worry, I’m fine,” and just move on.

Q: Can children who stutter face bullying?

A: Many kids have never met someone who stutters. You can imagine it would be very isolating to feel like you’re the only one who struggles to speak fluently. And yes, sooner or later most people who stutter report that they experience negative reactions or comments from other people.

We address this by asking children to identify where and when they feel comfortable talking and where they don’t feel comfortable. We discuss what others have said to them about their speech.

We help them to understand what helps, and what doesn’t help them communicate. We make sure that they have the facts about stuttering. In the popular view, stuttering is often associated with nervousness. Nervousness can make it worse but it doesn’t make you into a person who stutters.

Unfortunately, in movies, shows and books there are other negative qualities associated with characters who stutter.

Q: How can they feel more comfortable with speaking?

A: We work with building confidence through practice and desensitization by coaching and calibrated exposure. In school, for example, for presentations, a student might do better with an accommodation of presenting just to the teacher rather than to the whole class, or by recording the presentation. The goal will always be full participation, but sometimes a temporary accommodation is helpful.

We are also fortunate in speech and hearing sciences to have Joshua Breger (clinical assistant professor in the College of Health Solutions and director of the ASU Speech and Hearing Clinic), who works with adults who stutter, and Dr. Ayoub Daliri, who conducts research on the neural processes of speech production during stuttered speech.

The first, last and most important thing is that a person’s message and what they have to say is the most important part of their communication. The way they say it is less important, whether it is fluent or incorporates disfluencies. Anyone can be a good listener to a person who stutters by listening patiently with no interruptions, not finishing a person’s sentences, maintaining natural eye contact and focusing on the message that is being communicated.

The Among Friends stuttering group, which will be held at the ASU Speech & Hearing Science Pediatric Communication Clinic in the Community Services Building, 200 E. Curry Road, Tempe, costs $180 and scholarships are available. For information, call 480-965-2373.

Top image courtesy iStock