The following list of questions to ask speech therapists is inspired by the Voice Unearthed perspective of focusing therapy on keeping kids talking and engaged in the world around them rather than eliminating the stutter/fixing their speech. Thank you to the speech therapists who provided feedback to this process. I hope parents will find these useful in their journey. Keep in mind, the vast majority of children will recover with or without therapy. Good therapy and support is designed to have the best outcomes for the long-term well-being of the children who persist.
Questions parents should ask a speech therapist prior to engaging their child who stutters:
- What outcomes do you strive for with your therapy and how do you achieve those outcomes?
If the outcome is fluency, which is often is, especially for younger children, know that there are risks to that focus, especially for the child who will persist no matter what approach is used. At this point in time, there is no way of knowing which child will persist. Neither intensity nor type of stuttering (blocking, repetitions, drawing out vowel sounds, etc.) is a predictive factor. The Voice Unearthed outcome is for the child to speak freely, regardless of their speech challenges, and to minimize avoidance behaviors and withdrawal that stem from negative thoughts about their speech.
- What is your experience in working with children who stutter?
Relative to other speech challenges, few children exhibit behaviors often labeled as stuttering. Since a therapist is not likely to have a child who stutters on their caseload, it is common (and understandably so) for many therapists to have not invested time focused on this issue. There are 160 therapists in the U.S. who have their ASHA board certification amongst over 165,000 speech therapists – and a handful of those certified are retired. You do that math. At this point in time, any speech therapist can treat stuttering regardless of their background in this area. This is unethical and extremely unfortunate because harm can, and often is, done to these children through an increased sense of shame, silence, and avoidance behaviors, not to mention, increased speech tension. Even therapists who are certified by ASHA can (and do) incorporate approaches that have inherent risks of the negative effects referred to above.
There are many good therapists who are not certified but have invested considerable time and resources into learning about stuttering and safe treatment options. Take the time to educate yourself about these options so you’ll be able to discern the best fit for your child and your family.
- What do you mean by “speech therapy” and “early intervention?’
“Speech therapy” and “early intervention” are catch-all terms for a wide range of interventions. Approaches include (but are not limited to) fluency shaping and/or stuttering modification, Lidcombe, Parent/Child Interaction therapy, and indirect therapy. Indirect therapy can include a varying array of approaches including spending one-on-one time, slowing down your speech, relaxing behavior standards, eliminating stress, and encouraging free-flowing talking regardless of whether or not the child stutters. Many therapists also encourage meditation, yoga, and music as forms of early intervention. Information on each of these approaches are at your fingertips – just Google it. If you have questions, feel free to email me at voiceunearthed.gmail.com.
- What do you do to keep up on the latest findings when it comes to treating children who stutter? What are you most interested in learning more about?
The answer to this question can tell you a lot about a therapist’s outlook. For me, a red flag is if they’re overly-reliant on “evidence-based” research. A recent, highly respected research article comparing Lidcombe to indirect therapy stated throughout that current data is “preliminary, limited, lacking in follow-up data, surprisingly weak, unbalanced, with long-term effectiveness unclear.” 1 Also, the vast majority of outcomes measured focus on fluency or lowering stuttering frequency, which only addresses the “tip of the iceberg.” (Go to http://www.mnsu.edu/comdis/isad6/papers/hicks6.html to learn more about the iceberg theory – it’s important!) You want a therapist who is pursuing knowledge on how to address the challenges that can be far more debilitating than the speech errors including avoidance behaviors, negative self-esteem, and shame. It can be helpful if the therapist participates in the stuttering support community through the NSA, FRIENDS, and/or online support forums.
- What is my role as a parent in this process?
Your role must go beyond attending one or two IEP meetings or just transporting, sitting in the waiting room, and writing out the check. The time a child spends with parents, siblings, friends, relatives, day care providers, and/or teachers will have a far greater impact than the one-half to one hour spent with a therapist. Sadly, the system (at least in the U.S.) doesn’t support incorporating the parent into therapy as insurance will only pay for time spent with the child and school-based therapy doesn’t inherently accommodate parent involvement. Your therapist must be willing and motivated to “get creative” to provide support to you, both in addressing your concerns and fears, and in empowering you to effectively support your child in environments outside of the clinic setting in ways that will contribute increased self-esteem and joyful, free-flowing communication.
You want a therapist who:
Is a really good and nonjudgmental listener – for both you and your child.
Helps you explore ways to keep them talking and engaged in the world around them rather than focusing on fixing the stutter.
Will help you and your child communicate about their speech and how they are feeling, especially if the behavior is causing stress and anxiety for them
Relates well to children and is able to encourage talking without direct pressure.
Helps you help them develop strategies and coping skills in case they are bullied and/or teased.
Helps you to help them learn to respond to peoples’ reactions in productive and healthy ways, both verbally and internally.
- de Sonneville-Koedoot, et.all Direct versus Indirect Treatment for Preschool Children who Stutter: The RESTART Randomized Trial, PLOS/one, DOI: 10.1371/journal.pone.0133758 July 28, 2015