Helping Children Develop Healthy Attitudes Toward Stuttering

1. Helping Children Develop Healthy AttitudesToward Stuttering J. Scott Yaruss, Ph.D. Stuttering Centerof Western Pennsylvania University of Pittsburgh

2. Wait a minute!!! What do you mean by,“Healthy AttitudesToward Stuttering” ?!?

3. Attitude Matters • Stuttering can have a profound impact on children’s ability to succeed in life • But…it doesn’t have to be this way! • As NSP parents, you know that the most successful adult speakers are those who have been able to accept their stuttering • Like stuttering, the process of developing healthy attitudes can begin in early childhood

4. It is not stutteringthat holds people back... It is how people reactto their stuttering

5. How should we expectchildren to reactto stuttering?

6. Feelings about Stuttering • It is normal for children to have emotions and feelings about their stuttering • It is also normal for you to have emotions about feelings about your child’s stuttering • Children don’t always understand their feelings…you can help!

7. The Traditional Role of Parents • In speech therapy, parents typically receive lots of advice about how to help children speak more fluently • “Slow down your own speech” • “Pause before speaking” • “Shorten and simply your sentences” • “Don’t interrupt the child” • “Don’t tell the child to ‘slow down’”

8. Helping children speakmore fluently is good... …but it’s not enough!!!

9. So…what elsecan parents do?

10. Parents Can Also Help Children... • Understand what they are doing when they stutter and how to change it • Learn how to react to stuttering and how to deal with other people’s reactions • Interpret what it means to have a speech disorder and (for older children) accept it • Feel acceptance regardless of their speech

11. Parents Can…WHAT?!? • Many parents have their own issues and concerns about stuttering, making it difficult to react supportively • Plus, parents are consistently told not to react to their children’s stuttering… • “Do nothing at any time, by word or deed or posture or facial expression, that would serve to call attention to interruptions in (your child's) speech. • (Johnson, 1962)

12. The Parent’s Dilemma • Watching children stutter is hard! • It is nearly impossible to watch our children struggle with any difficulty without trying to do something--anything--to help them • So...the advice to “just ignore it” is in direct conflict with our parental instincts • The advice is wrong...our instincts are right!

13. Is It Really Okayto Talk about Stuttering? • In a word…YES! • “There are no published reports of a relationship between discussing...stuttering and sustained increases in the frequency or severity of stuttering” • --Zebrowski & Schum (1993) • Children who stutter do not respond adversely when parents provide feedback about their speech fluency. • --Lincoln & Onslow (1997)

14. Keeping Talking in Perspective • Talking is just another motor skillyoung children need to develop • It is perfectly normal for young childrento make mistakes when learning to talk • Children make mistakes when learning every other motor behavior and we accept it without concern • For older children who stutter, we need to recognize that stuttering is normal for them

15. Why Talk about Stuttering? I felt isolated and frustrated…like stuttering was something to be ashamed of This problem is so awful that my parents can'tbear to talk... about it. Some quotesfrom adultswho stutter --Rustin & Cook (1995)

16. Why Talk about Stuttering? • Break the “Conspiracy of Silence”(Starkweather & Givens-Ackerman, 1997) • Help children understand stuttering • Help children feel more comfortable about their speaking abilities • Help children learn how to react to stuttering • Help to normalize stuttering

17. Okay, So…What Should We Say? (It depends…)

18. Child Factors DeterminingWhen and How to Talkto Young Children about Stuttering Child’s awareness of stuttering Child’s concern about stuttering

19. Children’s Awareness of Stuttering • Most young children are probably aware of their stuttering at some level • Most of the time they are able to speak fine, but sometimes it just doesn’t “work right” • The same is true for nearly every other motor behavior they are learning how to do • Awareness is not necessarily a problem, but we probably don’t want to increase it if we don’t have to

20. Some Signs of Awareness • Mild word substitution • Mild tension or struggle • Mild frustration during or after stuttering • Trying different ways to speak fluently • Questions such as “why can’t I talk?” asked in a matter-of-fact manner

21. Guidelines for Talking with Children Who Are Aware • Don’t over-react…it’s normal for childrento be curious about their developing skills • Children learn how concerned to be from you • Respond to questions in a matter-of-fact way • “Everybody has trouble talking sometimes…it’s just part of learning.” • “Sometimes we have trouble talking, just like sometimes we have trouble walking.”

22. Children’s Concern about Stuttering • As children’s continue to stutter, they may become concerned about their speech • Increased tension and struggle • Avoidance of words or speaking situations • Nonspeech behaviors (e.g., hitting mouth) • Embarrassment in talking about speech • More questions about their speech • Fear about speaking

23. Goals for Talking withChildren Who Are Concerned • Help children express their beliefs, feelings, and concerns about their speech • Help children develop constructive ways of thinking and talking about stuttering • Decrease the chance children will develop shame, embarrassment, or guilt about speech • Help children accept themselves, their speaking abilities, and their stuttering

24. A Word about Acceptance • Accepting stuttering does NOT mean you are giving up on improving their fluency • To help older children who stutter, we need to look at the big picture -- this involves more than just their speech fluency • Acceptance of stuttering reduces the chance children will develop the negative reactions that make stuttering more severe

25. Think about it this way… If your child were to continue stuttering… How would you like him to respond?

26. Stuttering can bevery stubborn... …not every child will be able to overcome it If we continue to emphasize only fluency, we may end up contributing to the development of guilt and shame that affect many adults who stutter

27. General Guidelinesfor Achieving these Goals • Model… …appropriate responses to stuttering • Listen… …to children’s concerns about talking • Talk… …with children about their stuttering

28. Modeling a Calm Response to Stuttering • Modeling a calm response to stuttering will help the child learn to do the same • To do this successfully, you need to be aware of your own reactions to stuttering • Affective: How do you feel about stuttering? • Behavioral: What do you do when he stutters? • Cognitive: What do you think about stuttering?

29. Modeling DifferentWays to Stutter • For children with significant tension, it may be helpful to model easy, relaxed disfluencies • Shows the child a different way of stutteringthat has less impact on his communication • Helps desensitize the child (and parent)to the occurrence of disfluencies in speech • This is more advanced…check with a stuttering specialist to see if this is right for your child • Real desensitization work is best done by the clinician

30. Modeling EffectiveResponses to Adversity • Children may develop distorted perceptions about their stuttering and speaking abilities • Over-estimation of stuttering (“I always stutter”) • Over-estimation of other people’s reactions (“Nobody likes the way I talk”) • Loss of perspective (“I can’t do anything right”) • Parents must challenge these perspectives to help children develop healthier reactions

31. Explanatory style Examples “Sometimes learning takes a little while.” “That word was kind of bumpy” (or tense) “You sure have a lot of good things to talk about.” Temporary Specific Permanent Pervasive Modeling EffectiveResponses To Adversity (Peterson, Buchanan, & Seligman, 1995)

32. Listening to Children • Content versus manner: Listen to what children say rather than how they say it • Affirm any emotions children express • You do not need to solve their problems or try to make them feel better…just let them know that you hear them and are with them • This paves the way for an open dialogue about stuttering and other topics

33. Talking about Stuttering • Respond to children’s questions • Label speech-related behaviors and feelings • Reassure and encourage concerned children • Reframe the child’s experiences • Promotediscussion by giving the child the opportunity to talk about his feelings

34. Responding to Questions • If the child is aware enough to ask about his speech, it’s important to respond • “Why do I stutter?” / “Why am I made this way?” • “Will I always stutter?” / “Will it ever go away?” • Think about what to say before he asks • Present stuttering in a matter-of-fact way that: • conveys your acceptance of the child • helps to normalize stuttering (either as a normal part of learning, or as normal for your child)

35. Examples of Other Responses

36. Summary • Children don’t know how to react to stuttering • Left to their own devices, there is a good chance they will over-react or react negatively • Parents can play a critical role in shaping children’s responses so they will develop healthy attitudes • Healthy attitudes help minimize thenegative consequences of stuttering • Parents must also exhibit healthyreactions to stuttering

37. Some Tough Questions • How do you feel about stuttering? • Can you accept your child’s stuttering? • Can the other parent or other family members accept your child’s stuttering? • What if the stuttering doesn’t go away? • Could you stutter on purpose in public to see what it feels like for your child?

38. Questions for Discussion • How does your child feel about stuttering? • What situations have you faced with your child’s reactions to stuttering? • What roadblocks do you see to using these suggestions in your life? • What other suggestions do you have for helping children develop healthy attitudes?

39. Questions? Comments?Please contact me! • J. Scott Yaruss, Ph.D., CCC-SLP Assistant Professor, University of PittsburghCo-Director, Stuttering Center of Western PA • Address: 4033 Forbes Tower Pittsburgh, PA 15260 • Phone: (412) 647-1367Fax: (412) 647-1370Email: jsyaruss@csd.upmc.edu