Treatment for School-age Chilrden

Characteristics of school-age CWS

• more likely to continue stuttering

• more at risk of experiencing negative reactions

• increasing independence from caregivers

• increasing dependence on peers

Overarching goal of treatment

Child can speak freely and effectively, whether or not stuttered disfluencies are produced

Therapy is individualised for the child

• based on comprehensive Ax process - more than observable stuttering

• select from and adapt available tx options

Comprehensive Tx approach

• stuttered disfluencies or sensation of being stuck

• ABCs of stuttering - child’s reactions and avoidances

• environment’s reactions

Addressing stuttered disfluencies - common goal

Help children identify and navigate sensation of feeling stuck

Strategies:

• Speech modification/speech restructuring e.g. syllable-timed speech - all speech modified

• Stuttering modification/easing out - only moments of stuttering modified

Addressing stuttered disfluencies - specific goals examples

1. child will understand what they are doing during a moment of stuttering - e.g. describe speech machine and where physical tension occurs

2. child will be able to identify moments of stuttering in their own speech

3. child will be able to ‘freeze’ while producing moment of stuttering and remain in it

4. child will use pull-out stuttering modification strategy

Addressing ABCs - common goal

Achieve more neutral reactions to stuttering and speaking

• reactions shouldn’t interfere with communication, no need to achieve 0 negative reactions

Strategies:

• desensitisation to stuttering/exposure therapy

• cognitive therapy

Addressing ABCs - specific goals examples

1. child will demonstrate reduced negative reactions to stuttering

2. child will demonstrate reduced physical tension during moments of stuttering

3. child will engage in situations and activities that are currently avoided

4. child will believe that it’s ok to stutter and be a person who stutters

Addressing environment’s reactions - common goal

Educate people in child’s environment about stuttering

Strategies:

• talk openly about stuttering

• connect child and family with support organisation

Addressing environment’s reactions - specific goal examples

1. child will discuss basic facts about stuttering with family, teachers and friends

2. child will acknowledge stuttering openly when talking to a friend (self-disclosure)

3. child will demonstrate appropriate responses to negative comments made by others

Additional considerations

• Empathy and therapeutic alliance is key - asking client to do hard things, important that they feel safe

• Generalisation to real-world settings needs to be integrated throughout Tx

• Create expectation that stuttering may require some types of intervention at various points across the lifespan