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Helping Children Develop Healthy

AttitudesToward

Stuttering

tuttering

CS enterof

estern ennsylvaniaW PA partnership betw een C hild ren's H o spital o f P it tsburg h and the D epartment o f

C o mmunicat io n Science and D iso rders at the U niversity o f P ittsburg h

J. Scott Yaruss, Ph.D.

Stuttering Centerof Western

Pennsylvania

University of Pittsburgh

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Wait a minute!!!

What do you mean by,

“Healthy AttitudesToward

Stuttering” ?!?

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Attitude Matters

Stuttering can have a profound impact on children’s ability to succeed in life»But…it doesn’t have to be this way!

As NSP parents, you know that the most successful adult speakers are those who have been able to accept their stuttering»Like stuttering, the process of

developing healthy attitudes can begin in early childhood

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It is not stuttering that holds people back...

It is how people react

to their stuttering

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How should we expectchildren to react

to stuttering?

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Feelings about Stuttering

It is normal for children to have emotions and feelings about their stuttering

»It is also normal for you to have emotions about feelings about your child’s stuttering Children don’t always understand

their feelings…you can help!

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The Traditional Role of Parents

In speech therapy, parents typically receive lots of advice about how to help children speak more fluently»“Slow down your own speech”

»“Pause before speaking”»“Shorten and simply your sentences”

»“Don’t interrupt the child”»“Don’t tell the child to ‘slow down’”

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Helping children speakmore fluently is good...

…but it’s not enough!!!

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So…what elsecan parents do?

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Parents Can Also Help Children...

Understand what they are doing when they stutter and how to change it

Learn how to react to stuttering and how to deal with other people’s reactions

Interpret what it means to have a speech disorder and (for older children) accept it

Feel acceptance regardless of their speech

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Parents Can…WHAT?!?

Many parents have their own issues and concerns about stuttering, making it difficult to react supportively

Plus, parents are consistently told not to react to their children’s stuttering…» “Do nothing at any time, by word or deed or

posture or facial expression, that would serve to call attention to interruptions in (your child's) speech.

» (Johnson, 1962)

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The Parent’s Dilemma

Watching children stutter is hard!

» It is nearly impossible to watch our children struggle with any difficulty without trying to do something--anything--to help them

So...the advice to “just ignore it” is in direct conflict with our parental instincts»The advice is wrong...our instincts are

right!

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Is It Really Okayto Talk about Stuttering?

In a word…YES!» “There are no published reports of a relationship

between discussing...stuttering and sustained increases in the frequency or severity of stuttering”

» --Zebrowski & Schum (1993)

» Children who stutter do not respond adversely when parents provide feedback about their speech fluency.

» --Lincoln & Onslow (1997)

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Keeping Talking in Perspective

Talking is just another motor skillyoung children need to develop

It is perfectly normal for young childrento make mistakes when learning to talk»Children make mistakes when learning every

other motor behavior and we accept it without concern

For older children who stutter, we need to recognize that stuttering is normal for them

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Why Talk about Stuttering?

This problem is so awful that my parents can'tbear to talk... about it.

I felt isolated and frustrated…

like stuttering

was something

to be ashamed of

Some quotesfrom adultswho stutter

--Rustin & Cook (1995)

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Why Talk about Stuttering?

Break the “Conspiracy of Silence”(Starkweather & Givens-Ackerman, 1997)

Help children understand stuttering

Help children feel more comfortable about their speaking abilities

Help children learn how to react to stuttering

Help to normalize stuttering

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Okay, So…

What Should We Say?

(It depends…)

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Child Factors DeterminingWhen and How to Talk

to Young Children about Stuttering

Child’s awareness of stuttering

Child’s concern about stuttering

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Children’s Awareness of Stuttering

Most young children are probably aware of their stuttering at some level» Most of the time they are able to speak fine,

but sometimes it just doesn’t “work right”

» The same is true for nearly every other motor behavior they are learning how to do

Awareness is not necessarily a problem, but we probably don’t want to increase it if we don’t have to

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Some Signs of Awareness

Mild word substitution

Mild tension or struggle

Mild frustration during or after stuttering

Trying different ways to speak fluently

Questions such as “why can’t I talk?” asked in a matter-of-fact manner

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Guidelines for Talking with Children Who Are

Aware Don’t over-react…it’s normal for children

to be curious about their developing skills»Children learn how concerned to be from you

Respond to questions in a matter-of-fact way»“Everybody has trouble talking sometimes…

it’s just part of learning.”»“Sometimes we have trouble talking, just like

sometimes we have trouble walking.”

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Children’s Concern about Stuttering

As children’s continue to stutter, they may become concerned about their speech» Increased tension and struggle

»Avoidance of words or speaking situations

»Nonspeech behaviors (e.g., hitting mouth)

»Embarrassment in talking about speech

»More questions about their speech

»Fear about speaking

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Help children express their beliefs, feelings, and concerns about their speech

Help children develop constructive ways of thinking and talking about stuttering

Decrease the chance children will develop shame, embarrassment, or guilt about speech

Help children accept themselves, their speaking abilities, and their stuttering

Goals for Talking withChildren Who Are

Concerned

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A Word about Acceptance

Accepting stuttering does NOT mean you are giving up on improving their fluency

»To help older children who stutter, we need to look at the big picture -- this involves more than just their speech fluency

Acceptance of stuttering reduces the chance children will develop the negative reactions that make stuttering more severe

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Think about it this way…

If your child were to continue stuttering…

How would you like him to respond?

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Stuttering can bevery stubborn...

If we continue to emphasize only fluency,

we may end up contributing to the

development of guilt and shame that affect

many adults who stutter

…not every child will be able to overcome it

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General Guidelinesfor Achieving these

Goals Model…

…appropriate responses to stuttering

Listen……to children’s concerns about talking

Talk……with children about their stuttering

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Modeling a Calm Response to Stuttering

Modeling a calm response to stuttering will help the child learn to do the same

To do this successfully, you need to be aware of your own reactions to stuttering»Affective: How do you feel about stuttering?

»Behavioral: What do you do when he stutters?

»Cognitive: What do you think about stuttering?

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Modeling DifferentWays to Stutter

For children with significant tension, it may be helpful to model easy, relaxed disfluencies»Shows the child a different way of stuttering

that has less impact on his communication

»Helps desensitize the child (and parent)to the occurrence of disfluencies in speech

This is more advanced…check with a stuttering specialist to see if this is right for your child» Real desensitization work is best done by the clinician

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Modeling EffectiveResponses to Adversity

Children may develop distorted perceptions about their stuttering and speaking abilities»Over-estimation of stuttering (“I always stutter”)»Over-estimation of other people’s reactions

(“Nobody likes the way I talk”)»Loss of perspective (“I can’t do anything right”)

Parents must challenge these perspectives to help children develop healthier reactions

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Explanatory styleTemporary

Permanent

Specific

Pervasive

(Peterson, Buchanan, & Seligman, 1995)

Modeling EffectiveResponses To Adversity

Examples

» “Sometimes learning takes a little while.”

» “That word was kind of bumpy” (or tense)

» “You sure have a lot of good things to talk about.”

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Listening to Children

Content versus manner: Listen to what children say rather than how they say it

Affirm any emotions children express»You do not need to solve their problems

or try to make them feel better…just let them know that you hear them and are with them

»This paves the way for an open dialogue about stuttering and other topics

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Talking about Stuttering

Respond to children’s questions

Label speech-related behaviors and feelings

Reassure and encourage concerned children

Reframe the child’s experiences

Promote discussion by giving the child the opportunity to talk about his feelings

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Responding to Questions

If the child is aware enough to ask about his speech, it’s important to respond» “Why do I stutter?” / “Why am I made this way?”» “Will I always stutter?” / “Will it ever go away?”

Think about what to say before he asks

Present stuttering in a matter-of-fact way that:»conveys your acceptance of the child»helps to normalize stuttering (either as a normal

part of learning, or as normal for your child)

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Examples of Other Responses

Type Description Examples

Labeling Factual statements aboutchild’s behavior

That word sounded bumpy.

Informing Explanations of child’sfeelings

Sometimes we feel frustratedwhen things are hard to do.

Assuring Parent reassures childabout acceptance

It’s okay with Mom if yourepeat words.

Reframing Parent helps child seebehavior in positive light

This is a good chance tolearn …

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Summary

Children don’t know how to react to stuttering»Left to their own devices, there is a good

chance they will over-react or react negatively

»Parents can play a critical role in shaping children’s responses so they will develop healthy attitudes

Healthy attitudes help minimize thenegative consequences of stuttering»Parents must also exhibit healthy

reactions to stuttering

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Some Tough Questions

How do you feel about stuttering?

Can you accept your child’s stuttering?

Can the other parent or other family members accept your child’s stuttering?

What if the stuttering doesn’t go away?

Could you stutter on purpose in public to see what it feels like for your child?

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Questions for Discussion

How does your child feel about stuttering?

What situations have you faced with your child’s reactions to stuttering?

What roadblocks do you see to using these suggestions in your life?

What other suggestions do you have for helping children develop healthy attitudes?

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Questions? Comments?Please contact me!

J. Scott Yaruss, Ph.D., CCC-SLPAssistant Professor, University of PittsburghCo-Director, Stuttering Center of Western PA

Address: 4033 Forbes TowerPittsburgh, PA 15260

Phone: (412) 647-1367Fax: (412) 647-1370Email: jsyaruss@csd.upmc.edu