This blog is intended as a resource for parents and teachers of the students I serve. Take a look around!
Stuttering therapy is something that many SLPs have a hard time with. Only 1% of the population stutters, so it is one of the less common disorders we treat. It is one of the disorders we cannot cure, which also makes it tricky to work on in therapy – how do you work on something that will never go away? It is highly variable, which means that what worked for one student may not work at all for the next. And the success of stuttering therapy depends as much on the motivation of the student as it does on the skill of the therapist.
I think that is why SLPs focus so much on teaching fluency strategies. We want to measure things, and we want to target specific skills. We see a motor pattern (blocks, prolongations, repetitions), and we think “I can fix that!” So, we spend hours and hours focusing on motor patterns, but in the end our students are burned out from the drill-n-kill approach, they still feel weird about their stuttering (which of course is still happening), and maybe they don’t even like the strategies we taught them. No wonder stuttering therapy is hard!
Part of the difficulty is the over-focus on speech strategies. They seem the most “concrete”, so they are the easiest to target, but they are only a part (and sometimes a small part) of the whole picture. Stuttering is multifactorial, which means that it is influenced by multiple factors.
The graphic above was developed by Dr. Charles Healey, who is a person who stutters and a professor at the University of Nebraska. He has identified 5 main factors which impact stuttering: Cognitive, Affective, Linguistic, Motor, and Social. He calls this the CALMS model of stuttering.
- Cognitive: what a person knows about stuttering
- Affective: how a person feels about their stuttering
- Linguistic: how language demands impact stuttering
- Motor: prolongations, blocks, repetitions
- Social: how stuttering impacts a person socially
As I said above, we SLPs tend to focus on the motor component of stuttering by teaching speech strategies to increase/establish fluent speech. Sometimes we have “stuttering facts” activities which teach kids about stuttering, and we’re pretty good at providing language therapy to address linguistic demands.
The two most challenging of the 5 factors to address are affective and social – how a person feels, and how stuttering impacts them socially. Talking about feelings is tricky, as anyone with a significant other already knows! On top of that, we need to address self-advocacy, how to manage social situations, stuttering acceptance, and feelings of anxiety, particularly for middle and high school age students. It sometimes feels like I should have a counseling degree on top of my CCC-SLP.
How do we target feelings and social impact in stuttering therapy?
Since emotions, stuttering desensitiztation and stuttering advocacy are so important, how can we target them in therapy? Using voluntary stuttering is one way. Using YouTube videos of people who stutter is another. I’ve done lots of activities over the past few years, used tons of topics and videos (many from current events), and had quality conversations with my students about accepting their stuttering. I finally decided to consolidate my ideas into one spot, to make sure that I can hit important topics and could always have ideas ready to spark important conversations.
Stuttering Chat Pack is a collection of 36 questions, topics and scenarios centered on the experience of stuttering. Students have the opportunity to think about their stuttering, figure out how to advocate for themselves in different situations, and explore how they feel about stuttering. The only way to normalize talking about stuttering is to talk about stuttering! I have used it several times in the past week, and am so glad to have all my ideas down in one place. Since it is a powerpoint presentation I don’t have to print it – I can bring up the topic for the day on my laptop without using any paper! I like to let my students pick a number (1-36) for the “question of the day”, but you could just as easily do it chronologically. Here is an example of one of the pages:
I use one page per week, as an icebreaker before we begin to work on strategies. I notice that my students have become much more confident talking about stuttering, and more comfortable about their own stuttering, since I started incorporating these kind of conversations. My ultimate goal for every student who stutters is for them to have easy communication, and to like the way they talk. Talking about stuttering helps!
You may *hear* about what we are doing *here* in room 10 this month – multiple meaning words! We did many of the activities I posted about before (CLICK HERE for the previous post) so you can check that out for more book ideas and YouTube videos.
Multiple-meaning words, otherwise known as homonyms or homophones, are words that sound the same but mean different things. Words like flour/flower, blue/blew, see/sea… Working on these words helps expand students’ vocabulary, but also increases the connections between different words within their vocabulary. Those connections contribute to overall language skills and vocabulary robustness. Working on multiple-meaning words helps students who are concrete and literal in their thinking to learn to be flexible. Words can mean more than one thing! How cool!
I found a great addition to the unit this month — a new book!
Amelia Bedelia’s First Day of School is an updated story about the same nutty character you knew as a child. I don’t often like “updates” to classic stories, but this is an exception. The original Amelia Bedelia books were great, but many of the jokes are pretty dated (“dress the chicken”, anyone?) and went right over my students’ heads. The update keeps the same nutty style, and the same misunderstanding of multiple meaning words and idioms for the humor, but uses up-to-date words and content that kids today can relate to. The class LOVED the page where Amelia Bedelia glued herself to her chair, as well as the part where she “wiggled her fingers in Clay” (instead of clay).
There are a whole series of updated “Amelia Bedelia’s First _____________” books, which I look forward to checking out. They would be a great way to follow up at home with more multiple meaning words and idioms!
I’ve created a brochure to share with parents and teachers when a child is first diagnosed with a speech sound disorder, similar to my brochure about fluency disorders. Many parents have questions, and it can be hard to remember all of the things we talk about at an evaluation or IEP meeting. I designed a brochure to summarize current research on what we know about speech sound disorders, and why speech therapy is important.
Here is the text from the brochure:
What is a speech sound disorder?
Speech sound disorder (SSD) is an umbrella term referring to any combination of difficulties with perception, motor production, and/or the phonological representation of speech sounds and speech segments (including phonotactic rules that govern syllable shape, structure, and stress, as well as prosody) that impact speech intelligibility. (ASHA)
What causes SSD?
Speech sound disorders may be motor based (dysarthria, apraxia), structural (cleft palate, short frenum), caused by syndromes (eg: Down Syndrome) or by a hearing impairment, or may have an unknown cause. They tend to run in families, but also appear in families with no history of SSD.
SSDs are NOT caused by learning another language, bad habits, “baby talk”, or parenting style.
Is there a cure?
Speech therapy is used to treat SSDs. Most children who receive speech therapy for SSDs will master their goals and eventually be able to speak with clear sounds. Speech therapy can help reduce frustration, and increase your child’s ability to be understood.
A Speech Language Pathologist (SLP) is trained to provide speech therapy for speech sound disorders.
What can I do at home?
There are many things parents and caregivers can do to help children develop clear speech sounds.
- Practice at home: if your child receives speech therapy, ask your SLP for home practice pages to review at home in between sessions. Short, daily practice is best! Aim for 2-3 minutes per day.
- Model clear speech: Children learn by listening. Show how to use clear sounds by example!
- Read books: Reading together helps all areas of speech and language development. Choose high interest books on topics that will interest your child. Point out words that have your child’s sounds in them (eg: Find all the L words, or all the S words). Talk about the story, ask questions, and encourage your child to ask questions or retell the story to you.
- Play with letters: Use sidewalk chalk to draw letters on the ground. Make playdough letters, or have fun with letter magnets on the fridge. Draw letters in the steam on the bathroom mirror. Talk about the sounds each letter makes.
Does my child need speech therapy?
Children develop at different rates, but there is a range for normal development. If your child is significantly below these guidelines (see below), please talk to an SLP about speech therapy.
If your child is frustrated by not being understood, that is also a sign that she/he may need speech therapy. You can talk to your doctor for a referral to a hospital-based or community SLP, or contact your local school district for a free communication evaluation.
- 2 years old: 50% intelligible
Many speech sound errors
- 3 years old: 75% intelligible
P,B,M,N,H,Y are consistent
D,T,K,G,F,S,Y are emerging
- 4 years old: 90% intelligible
B,D,T,F,K,G,Y are consistent
- 5 years old: 90-100% intelligible
May not have TH, R or S/L-blends
- 6 years old:
S/L-blends and R start to develop
- 7 years old:
TH begins to develop
R sound and S/L-blends may still be emerging.
What should I expect from speech therapy?
Speech therapy is the treatment for SSDs. An SLP will do some testing with your child to determine exactly where they are in their speech sound development, and then set some goals to work on in therapy.
If you receive speech therapy through public schools, your child will have an Individual Education Program (IEP) developed for him/her, which will include their speech goals, and how much time each week they will work with the SLP.
Your health insurance may also cover speech therapy through hospitals or community providers. Contact your insurance provider for more details.
- Info on speech development
- Free speech therapy worksheets
- Free downloadable Speech Sound Screener
- Articulation apps for your iPad or iPhone
If you feel your child has a speech sound disorder, you can receive a communication evaluation and, if necessary, speech therapy through your public school.
Contact your local public school for more information about speech therapy for your child.
I know, I know. It’s been ages since I’ve posted. I can only say, that’s because I’ve been very busy doing therapy! Also, I’ve been busy updating the Fluency Homework for the Whole Year packet, which is up on TPT. I added 10 new stuttering missions, so there are now 4 per month (3 in December and June).
I have a lovely graduate student intern coming on board this month, so hopefully that will give me some breathing room to post more frequently.
I like focusing on comparing and contrasting in November. There is lots of seasonal material to use (fall vs winter, comparing Thanksgiving foods or holiday traditions). It is also far enough into the school year that students are getting more comfortable, and are more confident to take risks during speech.
Almost all of the students in room 10 know the basic concept words “same” and “different.” If they didn’t, we would start by working on those words. Stating how things are the same is often related to a student’s ability to categorize (identifying that two things are the same type of thing). Stating how things are different is related to ability to describe. Both of those skills are integrated into every major curriculum, including the Common Core State Standards. They are important skills to have!
For previous activities I’ve used to target compare/contrast skills, CLICK HERE.
A fun website to use at home that compares different things is the Diffen website: http://www.diffen.com/. You can type in any two things, and it brings up a chart to compare them! Very cool.
To get ready for thanksgiving, we did a whole class activity comparing/contrasting common thanksgiving foods. After talking about the ways each pair of foods was the same and different, each student chose their favorite and drew it on their plate. Yum!
I’ve been working this month on creating a brochure to share with parents and teachers when a child is first diagnosed with stuttering. Many parents have questions, and it can be hard to remember all of the things we talk about at an evaluation or IEP meeting. I designed a brochure to summarize current research on what we know about stuttering, and why speech therapy is important.
Here is the text from the brochure:
What is stuttering?
Stuttering is the disruption of fluent speech. People who stutter may “get stuck” on words, phrases or sounds. They may repeat these words or sounds multiple times. They may “block” and not be able to say anything at all. Stuttering is involuntary; the person who is stuttering does not have the ability to stop stuttering. It is not a choice, or something caused by bad habits.
What causes stuttering? Did I cause my child to stutter?
Stuttering is a multifactorial disorder, which means it is influenced by many different things. It has genetic causes, which we know because stuttering tends to run in families. Stuttering can be triggered by emotions, stress, or particular situations, but it is NOT caused by these things. Stuttering is not caused by parenting style, bad habits, or anything you or your child chose to do. It is neurological, and involuntary.
Is there a cure?
There is no cure for stuttering. Children who begin stuttering after age 4, or who continue stuttering beyond preschool, are classified as having a persistent stutter and will not grow out of stuttering. Speech therapy can help a child or adult speak more easily, but cannot cure the underlying condition. Persistent stuttering is permanent.
Does stuttering stay the same over a person’s lifetime?
Stuttering is unpredictable, and impacted by many factors. It can be triggered by strong emotions (feeling excited, nervous, or scared), by particular people, by specific words or sounds, by life changes (moving, new baby in the family) or even by growth spurts or puberty.
Stuttering severity is often cyclical, so stuttering might be mild for a time, then increase and be moderate or severe, then come back down to mild or even imperceptible. These cycles are normal, and can happen at any time during a person’s life.
Speech therapy can help get stuttering under control, and support a person who stutters as they manage their stuttering.
What can I do to help my child?
The biggest thing you can do to help your child who stutters is to remain supportive and listen to what they say rather than how they say it. Here are some tips:
- Listen attentively to what your child says.
Don’t interrupt or say words for your child.
- Avoid competition among family members when speaking.
Make sure everyone has lots of time to express their thoughts.
- Model a slow, relaxed speaking style
with short phrases and pauses in between thoughts. This helps reduce pressure on your child to speak quickly.
- Be honest.
It is okay to acknowledge that your child is struggling with his/her speech. Talking about stuttering openly can help reduce anxiety or other negative feelings about stuttering.
- Be positive!
Make sure your child knows that it is okay to stutter, and that you love hearing what she/he has to say.
What should I expect from speech therapy?
Speech therapy will not cure stuttering. A few people who stutter will be able to achieve 100% fluency using speech strategies, but most will still have occasional disfluencies in their speech.
The purpose of speech therapy for stuttering is to make talking easier, and to give the person who stutters control over their speech. Learning speech strategies helps a person who stutters control their fluency when it is important to them, and makes talking easier when they are expressing their ideas. Learning about stuttering is also important to help a person avoid feelings of guilt or frustration, and to reduce anxiety about stuttering.
Speech therapy can make stuttering less severe, and support a person who stutters in finding (or keeping!) their own voice.
- National Stuttering Association
- Stuttering Foundation
- American Speech Hearing Association
If you feel your child is stuttering, you can receive a free communication evaluation and, if your child qualfies, speech therapy through your public school.
Contact your local public school for more information about stuttering therapy for your child.
This made me cry, sitting in my office this morning. I hope each of my students who stutter find their way to this place.
“My voice is the only one like it. My stutter is not a speech impediment… My speech, composed by God.”
Credit to http://stutterrockstar.com/ for posting it.
We have worked on making inferences and predictions before in room 10, but it never hurts to review a good thing! Making a “smart guess” based on clues from what someone says, or from written text, is something that children are often asked to do in school. When interacting with fiction, students frequently are asked to predict what will happen next or how the story will end. For students who have language disabilities, these skills can be hard.
HERE is my previous post on making inferences. We used many of the same books and activities this month. However, I always try to add something NEW even when doing a unit I’ve done before.
We started with and old favorite of mine, “Guess Where You’re Going, Guess What You’ll Do“. This book is out of print, but you can find it used on BetterWorldBooks.com for about $4.
The book uses the formula of a scene full of clues (both in the words, and in the pictures), and asks the question “Where are you going? What will you do?” The next page has a scene showing where the children went, and what they did. The illustrations are full of fun details, and the students love looking closely for the clues. The book is aimed at younger children (pre-K through 1st grade), but I find that older students can enjoy it when they view it as a sleuthing game.
I checked out Teachers Pay Teachers (my go-to website for finding new materials!) and found THIS product by Mia McDaniel, which uses a text message format for students to make inferences and predictions about what is happening. It was a great addition to our fun unit!
It’s almost 12:00pm. My stomach is growling.
Where do you think I will go?
What do you think I will do?
Today I worked with a 5th grade student on phrasing. Phrasing is a fluency strategy where the speaker pauses at the end of each phrase. You can take an easy breath during the pause, or just take a brief moment to collect and think about what to say next. Phrasing is a very effective speech strategy for many of my students. However, it is also tricky to get them to slow down enough to use it, or to remember to take the time! (CLICK HERE to download a list of my most-used strategies, with descriptions and examples of each).
We practiced first while reading a grade level passage out loud. The passage was in a sheet protector, and we marked places to pause with a dry erase marker. Poetry is another great way to practice phrasing – it not only increases fluency, but also improves inflection and expressiveness.
The trickiest part of learning phrasing is always getting beyond doing it when you can see the marks on the page, and doing it during conversational speech. Today, I found a great activity to do just that!
Rory’s Story Cubes are a fantastic activity for many language tasks, but today we used them as a pacing guide for telling a story. Here is what we did:
- Roll the dice
- Tell a story using all the dice
- Pause after using each die
The dice gave a natural way to pace, and my student realized that she can use the “pause time” as thinking time to help her conversation be more fluent AND have more interesting things to say!
If you can’t find Rory’s Story Cubes in your local store they are available on Amazon, OR you can purchase the app!
I don’t do many app reviews, but I found one that I’ve been using in the intensive support classroom I serve that has been fabulous for helping my students stay on-track with their behavior.
Class Dojo is a FREE app and website for classroom teachers. You can get it for apple or android devices, or use it on the website. I use it to motivate students to make good choices during speech, and to help them begin to monitor their own behavior (for those impulsive kids we all have!).
Here is an introductory video for students, to show them how it works:
For teachers, here is a video on how to set up your class. It outlines the main features, and shows you how to set it up for your students/class.
I use it when I am working with a whole class to reward students for showing me positive behaviors, and to alert students when they are choosing poor behaviors. I set up my laptop so that students can see the screen, and give points as students show me positive or negative behavior.
Reasons I love this app:
- Behavior expectations are represented visually, which is important for my students
- Students like getting rewards
- Everything is customizable
- It reminds me to reward positive behavior!
- It makes it easy to redirect negative behavior without interrupting the flow of the session
- I can print reports of student behavior if I need to share with teachers or parents (though I have not needed to do this so far!)
- I can access the same data from any device – laptop, phone, or iPad.
So far I have not needed to use this app to address any large behavior issues, but even with light use I am seeing my students more motivated to participate during therapy, and less likely to engage in negative behaviors.