What do we lose when we (try) make a child who stammers fluent?

Mind your Ps and Qs is an English language expression meaning "mind your manners", "mind your language", "be on your best behaviour", "watch what you're doing".

• To our self.
• To others.
• How we talk about children who stutter.
• How children who stutter hear us talk about stuttering generally.

Action: helpful self talk to counter stereotypes.

• Gather evidence in real-life situations will lead to generating more balanced thoughts on the basis of their findings.
• People can identify helpful self-talk that will positively influence their emotional reaction and behaviour in a situation.
• Helpful self-talk can also be generated by reflecting on previous experiences that have gone well and what the person was saying to himself or herself at the time.

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For the Speech and Language Therapist

• Be aware of own thoughts, feelings and expectations around stuttering and our role as an SLT.
• Communication trumps fluency.

Action: helpful self talk.

• Handouts for teachers.
• Powerpoint for school presentation.
• Advice leaflet for parents (Generate discussion about what works in therapy  and helpful versus unhelpful advice).

The Questions we need to ask

Who needs to change? What do they/we need to change?

Acknowledging the natural variation, the unique skills, experiences and traits of neurodivergent children.

— Constantino (2018)

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Client who stutters

What do they understand about stuttering? And their stuttering in particular?

Cons for the Client

• Exposure: "I stutter".
• Risk of failure.
• Lack of acceptance by self and others .

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The Speech and Language Therapist

What do we understand about stuttering? Turn the tables on the process of normalising judgement As therapists we need to enquire into what a person thinks of the judgement they have been assigned. What if stuttering was the norm? If stuttering was cool…

Cons for the Therapist

• Exposing beliefs contrary to the medical model.
• Perceived risk of ‘failure’.
• Lack of acceptance by peers, clients and client's families.

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Who needs to change?

How do we do this? Is this our responsibility alone?

• Ourselves as SLTs
• Families.
• Parents.
• Teachers.
• Employers.
• School systems.
• Health services.
• Shop keepers.

• A hypothetical scenario involving a child, Conor and his parents who go to see SLT, Róisín.
• While hypothetical, it is based on a range of real-life experiences of the author.
• It highlights the parents’ desire that part of SLT professional identity be “able to cure”.
• SLT resistance of that identity and choice to be an ally to Conor.
• The process of considering available evidence and seeking support from those with more experience in order to negotiate an identity regarding the type of alliance she will offer.
• Resistance of normalising discourse regarding fluency.

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Brian and Sandra – parents of Conor aged 3.4

• Conor – advanced language development, no concerns re speech errors.
• One day, out of the blue, Conor begins to repeat words and part-words.
• Sandra is surprised, then worried and… she reacts.
• Brian remembers his mother saying that one of his brothers had difficulty with speech but grew out of it.
• Conor continues to repeat, begins to prolong sounds and sometimes no sound comes out when he tries to say a word. 
• Sandra and Brian decide it's time to go to a speech and language therapist and they meet Róisín.
• Their story about Conor – about their role - about Róisín and her role – their expectations.

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Róisín

• Róisín is 25 – has been working in same job since 21 – first class honours – manager affirms her excellence  - more complex cases – wider range. 
• Anne, specialist in stuttering/fluency disorders is on maternity leave so case is assigned to Róisín.
• Róisín consults the evidence – Fluency shaping approach with lots of evidence. 
• Has notes from in-service Anne gave – decides to go with indirect approach and start with education – but assessment first including taking case history.
• And the plot thickens – Sandra ..(and Brian) want stuttering gone asap  - yes parent sessions are fine – but when is she going to see Conor and fix his speech?

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Conor

• Conor loves fun – he likes lots of things, running, painting, lego, and he has lots to say.
• He has noticed that some words seem to have a mind of their own recently and it’s like they get stuck.
• Mom and Dad have said nothing -  he has noticed they go very quiet and just look at him.
• One day last week, Granny Annie was minding him in the car and he was talking to her when a word was getting him stuck.
• She told him to “slow down, take a deep breath and start again”. 
• He could not see her face, but she sounded a bit something different.
• Note to self – try to not let words get stuck! 
  

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Assessment day for Conor

• Went   lovely place with loads of toys and met Róisín who played with me and talked to Mom and Dad.
• She made a video of me.
• Mom does that sometimes too.
• I wonder why? 
• Róisín seems to get stuck on some words too – not sure why I am here but Róisín has the best Lego and I am making an amazing bridge.
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Roisin's dilemma

• Wants to help – who? Conor? But parents want fluency.
• Her CPD, while limited, has her thinking that focusing on fluency might not be best choice. 
• She takes her dilemma to supervision.
• She Googles and finds StutterTalk. 
• She contacts the SIG/CEN.
• She decides that she needs to talk with parents about some of the difficulties she sees with focusing on fluency. 
  

We want to affirm, especially for the young people out there, that it is okay to stutter. We believe that not only is it okay to stutter, but people who stutter should be empowered to speak however is most comfortable for them – even if that speaking style contains pauses, repetitions, and blocks.

— NYC Stutters (2020)

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• Educators to integrate the diversity agenda into speech and language therapy training to enable future therapists to consider the philosophical underpinnings of their role and approach.
• Forums for therapists to examine their underlying values, role and scope of practice.
• Meaningful collaboration to rethink the scope, focus and role of future stammering therapy for CYP & adults.
• Open, public debate about social and ethical implications of research in the fields of neuroscience and genetics.
• Research into what matters for people who stammer.
• Balanced investment of funding.
• Accessible research findings & conferences.

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Still it appears to us that the answer will be forthcoming if we as a field are serious about engaging in a partnership between researchers and the population of people who stutter, for people who stutter can provide the most meaningful metric for determining whether a treatment is viable.

— Yaruss & Quesal (2004)

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It is critical for professionals to realise that people with lived experience are best situated to drive the effort for changing how our society thinks about stuttering. Professionals bring resources and credibility to the table which can be very important for public attitude change, and they can play a supportive role to improve social conditions. However, people who stammer themselves are best positioned to promote the agenda of their community in terms of actions and policies that effect their lives.

— Boyle (2019)