A common suggestion made by support organizations and within Facebook groups is “find someone who specializes in stuttering.” Turns out this is not as easy as it sounds.
According to the Bureau of Labor Statistics, there are 146,900 licensed therapists and approximately 140 are certified by ASHA to treat stuttering. That’s .001%. Good luck finding one of those needles in the hay stack. I personally know a handful of certified therapists and even they disagree over what the most effect strategies for treating children who stutter and working with families. The reason there are so few therapists who specialize in this area is three-fold:
- Compared to other speech impediments, stuttering is rare, and its cause and reasons for persistence is still mostly a mystery.
- A speech therapist to have their graduate degree and Certificate of Clinical Competence (CCC) awarded by ASHA – with very little or even absolutely no training or experience with stuttering. (Someone recently asked me if that was a typo. It is not.)
- A speech therapist is hard-pressed to invest in the rigorous, time-consuming, and costly ASHA certification to specialize in an area of treatment that serves so few and is most often dependent on geographic proximity for building a client base.
(But wait, you say, isn’t everyone providing teletherapy these days? Can’t we just Zoom with whatever therapist trips our trigger? No, you can’t. Therapists must be licensed in the state where their clients reside. The cost and requirements vary – sometimes significantly – in every state.)
Here’s my vision for an ideal world. It’s a world where it makes sense for speech therapists to invest resources and energy into specialization and experience with stuttering. It is a world where a speech therapist can easily access and maintain a client base utilizing remote technology that makes it professionally satisfying and worthwhile. It’s a world where children play, explore, learn, laugh, and live freely while parents work with these specialists to become empowered with strategies for:
- Nurturing joyful communication within the home for ALL of their children.
- Minimizing everyone’s anxiety around communication and future well-being.
- Engaging in healthy conversations with their child about their speech tension and the feelings and negative messages that may arise.
- Advocating for themselves and their children within the school setting and the outside world.
- Building resilience throughout the family to survive painful interactions, get beyond those instances, and thrive.
I recently learned of efforts by a group of dedicated professionals to develop a post-graduate platform of training and experience for speech therapists who are passionate about treating stuttering but, for practical reasons, choose to not invest in the onerous ASHA certification process.
As exciting as that sounds, here’s the problem. Our systems, both insurance and IEP – school-based systems (in the U.S.), do not support this framework. Insurance pays only for time spent with the child. Goals for both insurance and IEPs are still primarily focused on lowering the percent syllables stuttered. The only families who can access this hybrid of support are those who can afford to pay for private therapy – and my guess is that they are few and far between.
More on my ideal world:
- Therapists are free to practice using teletherapy with clients from across the country without having to jump through expensive bureaucratic hoops.
- Therapists have access to a practical training route that prepares them to work with the entire family in a wholistic way.
- Families have increased options – not limited by geography – for choosing support that will first do no harm.
The iron-clad grip insurance companies and special education departments have on measures and outcomes of therapy, especially for children who stutter, supports harmful and irrelevant therapy options. Stuttering is simply not like other speech challenges where the focus is on fixing the speech motor system. This focus, especially in children, can do irreparably damage that lasts a lifetime and creates a level of disability that goes far beyond the overt behavior of speech tension.
Putting a child who is stuttering in a room once a week with a speech therapist, with minimal guidance for parents, is frankly absurd. Eighty percent of children will see the behavior subside by the time they are seven years of age, therapy or no therapy. Twenty percent will persist and we don’t fully understand which kids will be in that subset. Spending early childhood therapy focused on the goal of fluency feeds a foundation of shame, fear, and too often silence for those children who do persist.
There’s momentum for change. Let’s make it happen. Keep them talking and keep talking fun!
Best,
Dori