Helping Children Develop Healthy Attitudes Toward Stuttering

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Helping Children Develop Healthy AttitudesToward
Stuttering

• 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
  childrens ability to succeed in life
• Butit doesnt 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 reactto their stuttering

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How should we expectchildren to reactto
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 childs stuttering

• Children dont always understand their
  feelingsyou 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
• Dont interrupt the child
• Dont tell the child to slow down

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Helping children speakmore fluently is good...

• but its not enough!!!

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Sowhat 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 peoples 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 CanWHAT?!?

• 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 childrens 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 Parents 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 wordYES!
• 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?
I felt isolated and frustratedlike stuttering
was something to be ashamed of
This problem is so awful that my parents
can'tbear to talk... about it.
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 Talkto
Young Children about Stuttering

• Childs awareness of stuttering
• Childs concern about stuttering

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Childrens 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 doesnt 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 dont want to increase it if we dont
  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 cant I talk? asked in a
  matter-of-fact manner

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Guidelines for Talking with Children Who Are Aware

• Dont over-reactits normal for childrento 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 sometimesits
  just part of learning.
• Sometimes we have trouble talking, just like
  sometimes we have trouble walking.

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Childrens Concern about Stuttering

• As childrens 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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Goals for Talking withChildren Who Are Concerned

• 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

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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...
not every child will be able to overcome it

• 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

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General Guidelinesfor Achieving these Goals

• Model appropriate responses to stuttering
• Listen to childrens 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
  stutteringthat has less impact on his
  communication
• Helps desensitize the child (and parent)to the
  occurrence of disfluencies in speech
• This is more advancedcheck 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 peoples reactions
  (Nobody likes the way I talk)
• Loss of perspective (I cant do anything right)
• Parents must challenge these perspectives to help
  children develop healthier reactions

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Modeling EffectiveResponses To Adversity

• Explanatory style

• 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.

(Peterson, Buchanan, Seligman, 1995)
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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 betterjust 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 childrens questions
• Label speech-related behaviors and feelings
• Reassure and encourage concerned children
• Reframe the childs 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, its 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
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Summary

• Children dont 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
  childrens responses so they will develop healthy
  attitudes
• Healthy attitudes help minimize thenegative
  consequences of stuttering
• Parents must also exhibit healthyreactions to
  stuttering

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Some Tough Questions

• How do you feel about stuttering?
• Can you accept your childs stuttering?
• Can the other parent or other family members
  accept your childs stuttering?
• What if the stuttering doesnt 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 childs
  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-SLP
• Assistant Professor, University of
  PittsburghCo-Director, Stuttering Center of
  Western PA
• Address 4033 Forbes Tower Pittsburgh, PA 15260
• Phone [phone]Fax (412)
  647-1370Email jsyaruss_at_csd.upmc.edu