Treatment for Child who Exhibits Severe Blocking

Question

Answer

First of all, I wouldn't let the rural setting be an issue. I work in the middle of the cornfields, and with the Internet geographical limitations are much less relevant than they were as recently as a decade ago. Second, I wouldn't let the report of a child being a ''severe blocker'' color my perceptions before I met him or her. I've had many situations in my career where someone has described stuttering behavior to me, and when I met the child I wondered if it was the same child that had been described. It's much better to meet the child with an open mind and draw your own conclusions about the nature of the child's stuttering and the most appropriate treatments.

What I will provide is just one perspective on working with this child. There are other views on stuttering treatment. I'm not suggesting that this is the only way to approach treatment for a kindergartener who is a ''blocker'' but it is the approach that I would take, assuming that the report of blocking was accurate.

Assuming, however, that the child is in fact a ''blocker'' let's take a minute to consider what that means. The child, when speaking, experiences an inability to move ahead in speech. These ''blocks'' could occur at a number of places in the vocal tract: the larynx, the lips, the tongue/alveolar ridge, and the tongue/velum are probably the most common. You should be able to get a sense of where the child is blocking by noting the sounds on which s/he has trouble. Vowels, for example, would suggest blocking at the level of the larynx. The child should be able to help you to identify where s/he is experiencing the blocks, as well. Conture (2001) uses the excellent ''garden hose'' analogy as a means to help children understand the notion of blocking at different places in the vocal tract. You could also use terminology like ''sticky speech'' to help the child to understand and express to you what s/he is experiencing.

Once you (and the child) can identify the place(s) where the blocking occurs, the next step is to change the nature of the blocks into something that moves ahead. Easy onsets of phonation are often effective in reducing laryngeal blocks, and light articulatory contacts can be effective in reducing tensing in other areas of the vocal tract. The goal, of course, is to get the child to do something different - to change the blocks into something less effortful and more forward-moving, and then to shape that into speech that is as fluent as possible.

It's important to point out that it will probably be fairly easy get a child to do these modifications in the therapy setting, particularly if therapy is provided one-on-one. The challenge will be to get the child to generalize these behaviors to other settings. Fortunately, the school provides a good environment for generalization, and you can involve others, such as teachers, in the generalization process.

It's important, too, to remember that success is not only measured in terms of fluency, but in terms of the child's ability to take part in school activities regardless of the level of fluency. I always say that fluency is the de facto goal of any treatment, but remember that along that road, successes may include reduced struggle and effort in speaking, and an increased willingness on the part of the child to take part in school activities. These types of goals are very much in line with IDEA and can be written into a child's IEP (Yaruss & Quesal, 2001).

Two entire issues of Seminars in Speech & Language were devoted to the challenges of providing good therapy in the school setting, and the authors of the articles in those journals provide a variety of ideas for implementing effective treatment. I'd recommend those to anyone working in the schools with children who stutter

For individual's who work with children who stutter only infrequently, I often recommend a well-structured commercial program such as Cooper and Cooper's Personalized Fluency Control Therapy (2003). As long as you understand the rationale behind what you are doing and carry it out effectively, these programs can be very helpful.

There also are a number of good sources of information about stuttering on the Internet, including Judith Kuster's Stuttering Home Page, and particularly the links on therapy at that site: https://www.mankato.msus.edu/dept/comdis/kuster/therapy.html. Another good site is the Stuttering Center of Western Pennsylvania. The Stuttering Foundation of America and National Stuttering Association both have good sites, as well, and both provide low-cost resource materials to SLPs working with children (and adults) who stutter.

In the final analysis, working with children who stutter is not necessarily that different from working with other children. The primary difference is that you don't see them as often on your caseload, and therefore SLPs tend to be less confident in their ability to help these children.

References

Conture, E.G. (2001). Stuttering: its nature, diagnosis, and treatment. Needham Heights, MA: Allyn & Bacon.

Cooper, E.G., and Cooper, C.S. (2003). Cooper Personalized Fluency Control Therapy for Children (3rd Edition). Austin, TX: Pro-Ed.

Yaruss, J. S. (Ed.) (2002). Facing the Challenge of Treating Stuttering in the Schools, Part II- One Size Does Not Fit All. Seminars in Speech & Language, 23(3).

Yaruss, J. S. (Ed.) (2003). Facing the Challenge of Treating Stuttering in the Schools. Part I: Selecting Goals Strategies for Success. Seminars in Speech & Language, 24(1).

Yaruss, J.S., and Quesal, R.W. (2001). The many faces of stuttering: identifying appropriate treatment goals. ASHA Leader, 6, (21) 4-5; 14. (Also available online: https://professional.asha.org/news/011120_4.cfm)

Biographical Sketch

Robert W. Quesal, Ph.D., CCC-SLP, earned his Bachelor's and Master's degrees at Indiana University and his Ph.D. at the University of Iowa. He is a professor at Western Illinois University where he has been employed since 1991 and has served as program director since 1994. He is a board-recognized specialist in fluency disorders. He is currently the associate coordinator for the American Speech-Language-Hearing Association's Special Interest Division 4 (Fluency and Fluency Disorders). His current research is primarily devoted to the measurement of stuttering treatment outcomes in the affective and cognitive domains.