Question
I have three middle school students who are severe stutterers, whose greatest challenges appear at the laryngeal level. Two of them cannot get enough airflow during blocks to permit phonation and have difficulty finding a way to relax the constriction. Th
Answer
Treatment for school-age children who stutter typically involves "management" of the disorder, rather than elimination of stuttering. As such, goals of treatment should include reducing the number of disfluencies, reducing physical tension, increasing the child's knowledge of stuttering, increasing communication skills, and reducing any negative reactions to stuttering on the part of the child.
Your question involves reduction of physical tension during stuttering. Treatment for this area typically involves stuttering modification techniques. This typically begins with having the child identify the place of tension during a block. It is best to start with having the child identify this when the clinician does a purposeful block and then have the child move toward identification of place of tension in his own blocks. Once the child is able to do this, we typically move toward the use of cancellations, pull-outs, and easing out. For a full description of these techniques, you can visit a link on the Stuttering Center of Western PA (www.stutteringcenter.org) at https://www.stutteringcenter.org/PDF/PSHA Handout.pdf.
In addition to speech modification techniques, it is important to understand why blocks happen. In most cases, the presence of physical tension is a response on the part of the child to try not to stutter. Physical tension and other secondary behaviors typically arise from negative reactions to stuttering. Along with targeting the speech modification strategies, I would also heavily target attitudes, emotions, and knowledge of stuttering with all of these children. It seems like they may need some desensitization work. They, as well as others around them, may also need help accepting their stuttering. Because stuttering does not typically "go away" at the middle school level, these children and their families, peers, teachers, etc. will need to understand that stuttering is something they will likely be dealing with for a long time, and that an expectation for perfectly fluent speech is not a realistic goal.
Craig E. Coleman is a Clinical Coordinator at Children's Hospital of Pittsburgh and Co-Director of the Stuttering Center of Western Pennsylvania. He received his Bachelor's and Master's degrees at the University of Pittsburgh. Craig is a member of the National Insurance Advocacy Initiative and Chair of the National Stuttering Association's Insurance Advocacy Committee. In addition, Craig is an elected member of the ASHA Legislative Council.
