This is the third in a series of six blog posts in response to the series of StutterTalk podcasts focusing on whether SLPs should treat people who stutter. Episode 631 features Jim McClure, a person who stutters and a former consumer member of the American Board of Fluency and Fluency Disorders. He serves on the National Stuttering Association’s advisory board and was a director and chapter leader for many years. Highlights for me included:
Speech tools and techniques: McClure acknowledges that “we’ve known for a long time that most SLPs get very little training and experience with stuttering.” He goes on to say, “expecting a child to use techniques every time he opens his mouth borders on child abuse.”
I’m sure that most speech therapists will deny that they would ever expect a child to use a tool every time they speak in order to not stutter, but children naturally want to please the adults in their lives. One sticker or a round of applause for using a technique, especially with a younger child, screams “we would really rather you didn’t talk this way.” McClure admits that he tried using speech tools in his 20’s and concluded, “it was a difficult thing to do.” Why oh why do we think this is a good idea for children?
Finding the right therapist: I appreciated their conversation around how hard it is for consumers to assess the competency of a therapist. McClure points out that “it’s hard to kick to tires” and relays an interesting story:
“I did experiment years ago. I wanted a refresher but did not want to drive across Chicago to my original therapist. I asked him if he could recommend somebody. He suggested I call therapists and ask them about their experiences with stuttering. I called about six clinics and they were not comfortable being questioned about their qualifications. All admitted they had no experience, but all told me they were well-qualified to work with me.”
Reitzes agrees that therapists are being told, “even though you might not have worked with a person who stutters, you have the training, you are the expert, you understand the speech mechanism.” He says, “I’ve heard it 100 times!” As have I – and the potential for harm is breath-taking.
The parents’ burden: NSA and others place this burden for finding a competent therapist squarely on the parent’s shoulders on their website. They state, “It is up to you to make sure your child is getting treatment that is specifically tailored to his or her needs…The most important thing you can do is find a knowledgeable, caring stuttering specialist or clinician with expertise in stuttering who can help you make informed decisions about which treatment approaches will be best for your child.”(http://www.westutter.org/who-we-help/nsa-family-programs/parents/overview-speech-therapy-preschool-children-stutter/) Are you kidding me?? They make absolutely zero effort to educate parents on the controversies, the staggering differences in training and experience, and the lack of agreement on goals and outcomes. That is unbelievably irresponsible and unethical.
McClure uses the analogy of going to a doctor with a heart murmur. “He’s going to pack me off to the cardiologist. If he didn’t, he could get sued.” He admits that for SLPs there are no consequences for not sending a PWS who stutters to a specialist and Reitzes points out that “ the consequence is in reverse. If they do refer out, they may lose their job!” And once again in this series, litigation is mentioned. McClure states that “perhaps districts would be more inclined to hire a specialist or let their SLP make referrals if parents sued.
Not a frivolous lawsuit: Reitzes suggests a public campaign designed to educate parents on the reality of finding a therapist who is comfortable treating stuttering. McClure’s response is “It would be a major strategic shift to ASHA – if that was a settlement to a lawsuit. Reitzes responds with, “ We’re not talking about a frivolous lawsuit, but part of a settlement could be educating the public better about stuttering.”
Once again I will point out that so many of these points are made in my book, Voice Unearthed: Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter, published in 2011. I am pleased that these concerns are being discussed in this forum by influential leaders in the field – finally. It should not have taken this long, but hopefully, it will be the push that ASHA needs to regroup and stop allowing well-intentioned therapists to provide interventions that run the risk of doing more harm than good.
You can listen to the entire episode at http://stuttertalk.com/?s=McClure.