Case Studies

We would like to share some of the personal therapy experiences that have shaped our changing treatment philosophy. As specialists in the area of stuttering, it has not been uncommon for us to see children with resistant stuttering behaviors or children who have had previous speech therapy without success. Stories like these have led us to feel that in some cases direct therapy is the most appropriate course:

Andrew, a two-year, nine-month-old male, was initially enrolled in a very indirect therapy program that was done in the home. With no mention of talking whatsoever, we spent our time in fluency-enhancing play activities. Seven months of indirect therapy yielded little change. One morning Andy asked me, “Why it is so hard for me to talk?” Not quite sure how to respond to a two-year-old, I told him that his talking was not all grown up yet and lots of little children have trouble talking sometimes. Following this incident I shifted to a more direct therapy approach in which I taught Andrew to do “easy speech” during therapy and openly discussed his speech difficulties.

He began improving immediately. Within months, Andrew was dismissed from therapy.

Kimmy, a four-year-old female, had been receiving indirect therapy for four months. One day she came to therapy in a severe regression. In tears, she would preface every hard word with the starter “eyah.”
My first inclination was to put her on my lap and hold her while she cried. While I was struggling to decide how to respond to her tears, Kimmy told me she was” afraid to talk, afraid her words would get stuck” I knew I needed to respond to her fears and validate the pain she was feeling. I asked her why she was scared of getting stuck in her words. Even though she could not answer that question, it was the first time anyone had talked about her stuttering. I think it felt good to both of us. We then talked about the “new word” (eyah) she was using to help her talk She said it was like” chicken talk” because the next word was hard and she was afraid to say it. Today, Kimmy is twelve years old and, since the initiation of more direct therapy, has not stuttered since kindergarten.

Caitlyn, a four-year-old female who began therapy in the midst of her parents’ divorce, was exhibiting significant struggle and tension behavior as well as secondary behaviors. Of most concern was her head banging behavior during her most difficult moments of stuttering. After many sessions in which I attempted to eliminate this behavior through fluency-shaping principles, I saw no change. One day, shortly after Caitlyn banged her forehead on the table to interrupt a block, I modeled the same behavior. Caitlyn was shocked and ignored me. After I did this several times she asked me, “Why did you do that? Didn’t that hurt?” I responded, “I don’t know why I did it. But it sure didn’t help me get my word out!” Caitlyn never again banged her head to help her talk. Caitlyn has been out of therapy for over 25 years and remains fluent.