Adolescent/Adult Fluency Treatment

What is the overall goal of adolescent/adult stuttering therapy?

Help clients change their relationship with stuttering by improving communication, confidence, participation, and quality of life—not simply increasing fluency.

Why don't we write fluency goals for adults who stutter?

Adult goals should focus on communication participation, counseling, confidence, disclosure, and reducing struggle—not percent syllables stuttered.

What role does the family play in adult fluency treatment?

Families should be included in treatment planning, heard, and involved in supporting therapy goals

According to Van Riper, what defines successful treatment?

Success occurs when clients better understand their stuttering and make choices that improve their relationship with it.

What is Sheehan's "one-third rule"?

• One-third make excellent progress

• One-third make moderate progress

• One-third make little or no progress (often due to dropout)

What is the difference between awareness and desensitization?

• Awareness: Recognizing "I stutter."

• Desensitization: Gradually becoming comfortable facing stuttering without avoiding it.

Why are adolescents often difficult clients?

They frequently minimize the impact of their stuttering, making motivation and continued attendance important treatment goals

Why are adults over 50 less likely to seek treatment?

Many no longer view their stuttering as disabling and continue living as they always have

Why is disclosure an important therapy goal?

It increases the speaker's sense of control, reduces fear, and supports acceptance of stuttering

What are the advantages and disadvantages of intensive treatment?

Advantages

• Intensive practice

• Rapid improvement

Disadvantages

• Expensive

• Time-consuming

• High relapse rate

Often best used as a supplement to ongoing therapy.

Why is self-monitoring important in adult therapy?

It helps clients recognize speaking patterns, monitor listener reactions, and become independent communicators

What is proprioceptive feedback?

Paying attention to the movements and sensations of the speech muscles instead of relying only on auditory feedback

What are the three major Van Riper stuttering modification techniques?

• Cancellation

• Pull-out

• Preparatory set

What is a cancellation?

After stuttering, pause and repeat the word using an easier, more relaxed stutter.

What is a pull-out?

While stuttering, ease through the remainder of the word instead of forcing it out.

What is a preparatory set?

Before an anticipated stutter, intentionally approach the feared word slowly and calmly.

What does Guitar recommend regarding feared words?

Say the word you actually want to say—even if you stutter—instead of substituting easier words.

Why should clients avoid word substitutions?

Avoidance increases fear, while confronting feared words gradually reduces fear and avoidance.

Name four desensitization activities.

• Voluntary stuttering

• Journaling

• Writing stories

• Interviewing others about stuttering

Besides speech techniques, what problems should clients learn to solve?

Real-life communication challenges such as teasing, presentations, advocacy, and educating others about stuttering.

What are Van Riper's four self-therapy tips?

1. Become an expert on your own stuttering.

2. Have the courage to stutter openly.

3. Reveal yourself as a person who stutters (disclosure).

4. Become your own speech clinician

What is a "no-tolerance" policy for word substitutions?

Always say the words you intend to say instead of replacing them with easier words.

Should clinicians prepare clients for relapse?

Yes. Relapse is common and should be expected as part of the therapy journey—not viewed as failure.

According to Van Riper and Silverman, how common is relapse?

Very common (approximately 40–90% probability); relapse is considered the rule rather than the exception

Compare Fluency Shaping (Speech Restructuring) and Stuttering Modification

Fluency Shaping	Stuttering Modification
New speech pattern	Easier stuttering
Targets fluency	Targets attitudes & struggle
Strong research evidence	Mostly case-based evidence
Little effect on fear/avoidance alone	Reduces avoidance & improves confidence

Why is speech therapy alone often insufficient?

Fluency may improve, but fear, avoidance, and social anxiety often remain.

What benefits do CBT and ACT add to stuttering therapy?

• Fewer negative thoughts

• Less avoidance

• Reduced fear of negative evaluation

• Greater acceptance

• Improved quality of life

What does research suggest about telepractice?

It produces outcomes comparable to in-person therapy while improving access.

What benefits do support groups provide?

They improve disclosure, reduce negative beliefs, and provide ongoing support.

What is the biggest takeaway from adolescent/adult fluency treatment?

The goal is not perfect fluency—it's helping people communicate confidently, reduce avoidance, accept stuttering, and participate fully in life.