Stuttering through the Lifespan: Questions and Answers
24. August 2018 (online)
Today's rising clinicians are evolving. They are collaborative; they share ideas and work together well. They value community and have a positive outlook on life. Some of us are observing a shift in the mindset of speech–language pathologists (SLPs), evident in the topics that interest them, the questions they ask, and the kinds of professional development activities they value. They understand something about the factors that influence persistence of stuttering, and want to know more. They observe that the problem of stuttering is more complex than what meets the eye. They are discovering that not all disfluency is stuttering, and not all stuttering is disfluent. They seek to comprehend an individual's unique experience of stuttering, and are aware that some of this they will never fully understand. Finally, they embrace a broad definition of neurodiversity, and consider identity and self-acceptance in the context of treatment. This is refreshing, and perhaps, long overdue.
In this issue of Seminars in Speech and Language, we focus on the questions raised by this “new wave” of clinicians who no longer responds to the question of “what causes stuttering?” with a flat, “we don't know.” They are curious, and have the tools to expand their sphere of learning in the digital world. They are soaking up findings from neuroimaging studies, stepping into the psychology literature to learn about temperament and cognitive behavioral therapies, and examining models from the autism community to consider person-centered assessment and treatment.
In the spirit of this shift in thinking, each article in this issue addresses a potential question posed by today's SLPs. The shift in perspective is significant, and represents fundamental changes in thinking about the nature of stuttering and our roles as practitioners.
First, we explore the varied pathways to persistence, with the understanding that they will differ. The question, “What are predictors for persistence in childhood stuttering?” is answered by colleagues from the Purdue Stuttering Project, providing new evidence pointing to atypical functioning in language and motor processes, and severity at age 4 to 5. They leave us with a “cliff-hanger” suggesting that future refinements in multidimensional assessment of young children who stutter may include predictions of persistence.
Without a crystal ball for recovery and persistence, clinicians need to weigh multiple factors to decide when to treat and how to treat young children who stutter. SLPs are interested in multiple options for long-term positive outcomes. They strive to meet the individual needs of their clients and their families. Rosalee Shenker and Gissella Santayana respond to “What are the options for the treatment of stuttering in preschool children?”
Next, we address an important aspect of differential diagnosis. Courtney Byrd responds to the question, “Assessing bilingual children: Are their disfluencies indicative of stuttering or the byproduct of navigating two languages?” An unbiased differential diagnosis requires that we look beyond frequency counts. We learn that using criteria designed for monolingual English speakers may not be valid for speakers of more than one language, and, in fact, may result in overdiagnosis of stuttering in some populations.
Lynne Shields provides the specifics for multidimensional assessment and treatment in her response to the question, “What constitutes a multidimensional treatment approach for school-age children who stutter?” The shift away from queries about specific tests and techniques reflects a growing understanding that measuring frequency and type of disfluency does not inform social, emotional, cognitive, and behavioral components of the problem; and in fact, for some people, stuttering may not be a problem at all.
Scott Yaruss, Nina Reardon Reeves, and Caryn Herring respond to the question, “How can speech–language pathologists minimize bullying of children who stutter?” They point out that SLPs do not consistently respond to bullying, even though they can do something about it. They provide a model for talking to children about stuttering and about bullying. They use a realistic case study and numerous treatment examples as they guide readers through a six-step plan to develop self-advocacy and confidence in children who stutter.
Clinicians are increasingly asking questions about unobservable features of stuttering—those below the surface. Eric Jackson, Hope Gerlach, Naomi Hertzberg Rodgers, and Tricia Zebrowski address the question, “My client knows that he is about to stutter: How can we address stuttering anticipation during therapy with young people who stutter?” The authors provide an assessment tool, counseling strategies, and exploratory exercises to help children respond to anticipation, rather than react to it.
Kristin Chmela and Laura Johnson combine their expertise to provide a comprehensive explanation of three important challenges for SLPs as they respond to the question, “How can we overcome the challenges of providing school-based fluency services?” They provide ideas, solutions, and “nuggets” from SLPs working collaboratively with their colleagues in their role as fluency consultants to improve outcomes for students who stutter.
Finally, Chris Constantino brings us up-to-date on the various models of disability and the neurodiversity movement, as he responds to the question, “What can stutterers learn from the neurodiversity movement?” Writing in identity-first language, he explains that some stutterers (and autistics) believe that medical and social models of disability have created the discrimination and stigma that lead to emotional stress and other negative impacts on well-being we often address in treatment.
The responses to the questions posed in this issue offer options rather than prescriptions; they broaden the scope of treatment to include self-advocacy and self-acceptance, and they offer research to inform improved diagnoses and prognoses. They encourage us to explore issues beyond the therapy room: for example, stigma and bullying, which contribute to the problem in varying degrees for those who stutter. They may help us approach assessment and treatment of stuttering with a new understanding of desirable outcomes and notions of disability.
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