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!

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