Question
I have a patient (age 6) who exhibits very mild dysfluencies, though it appears as if it could develop into something more severe if intervention is not provided. Most therapeutic protocols do not seem to work with a mild stutterer. How would I start a
Answer
One of your primary goals is to help this child maintain high self-esteem, by dealing with teasing, encouraging eye contact that indicates "I'm okay," and helping the child understand stuttering as not being his fault nor related to his IQ. Secondly, this child should learn to enjoy communicating, and to avoid going into a fear/tension zone or secondary behaviors. This enjoyment of communicating can be learned by 'playing' with the voice without words, and then with words and sentences, which can be appropriate for many children who begin to develop communication anxieties due to various problems. If you would like, I can offer some examples of just how to use certain words or sentences to enjoy pitch changes, emotion, and impact on correct words to send messages "in the moment." This is an enjoyable way to learn to avoid metalinguistics (thinking about thinking about talking), when one begins to struggle with the stutter and thereby stops listening to oneself and is no longer "in the moment."
You need not explain the 'why' of what you do, unless you find it necessary for the patient to know this. Aim for naturalness! Avoid the whole breathing issue, unless unusual breathing patterns are noted in a particular stutterer. I tell my clients that we breathe to stay alive, and if we did not breathe we would not be alive and could not talk! Both children and adults "get it" when I put it this way. Furthermore, quick inhalations via the mouth cause a natural reflex (like a startle response) of the vocal cords closing and the epiglottis folding over to protect the lungs. This means it is vital to breathe in via the nose and out through the mouth while speaking. A recent study showed that a strong, prolonged "ah" sound, done three to four times per day, affects the speech activity of the brain and has been demonstrated to decrease stuttering! The main problem I have found with this simple exercise is COMPLIANCE! Please feel free to contact me personally.
Janet Skotko, M.Ed., has been a Speech/Language Pathologist for approximately 30 years and was distinguished by being one of the first named to be among the Board Recognized Fluency Specialists. She maintains a private practice in Tampa, Florida but sees clients world-wide. For further information, please visit: www.thevoiceinstitute.com
