Patty Walton and Chelsea Blanchard have combined their extensive clinical experiences to develop a step-by-step approach that combines indirect and direct therapies and integrates fluency shaping with stuttering modification.
Our treatment philosophy has evolved over many years, from what once was relatively indirect to what is now a well-defined, direct approach. As specialists in the area of stuttering, it has not been uncommon for us to see children with resistive stuttering behaviors or children who have had previous speech therapy without success.
The Fun with Fluency treatment paradigm incorporates the following: consistent clinician modeling of speech strategies, positive reinforcement of targeted speech behaviors, a therapy structure based upon producing increasingly longer and more complex utterances, procedures to maximize success in and out of the therapy room, activities designed to improve the child’s self-esteem and self-confidence, and family participation whenever possible. All of our therapies contain these components, but the relative emphasis varies from child to child. The strategies are organized on a continuum ranging from a single focus on building fluency skills to a single focus on modification of stuttering.
Modeling Therapy Strategies
Clinician modeling is provided throughout the therapy process. Providing a continuous speech model of targeted behaviors facilitates the learning process.
We reinforce all productions initially, regardless of the child’s accuracy in producing the targeted speech strategy. This heavy reinforcement encourages further participation and increases the child’s self-confidence early in therapy.
It is not unusual for children who stutter to feel different from their peers, even at a young age. The experience of not being able to speak easily or not being able to say what they want to say can have serious, even devastating, effects upon the child’s development of healthy self-esteem. Children who stutter are often targets of teasing and ridicule, especially from other children. The sense of self developed in childhood often follows people into adulthood; therefore, it is critical that children who stutter have every opportunity for positive experiences, especially with respect to their speech.
Following a Hierarchical Therapy Structure
All therapy strategies are taught within a hierarchical framework in which the length and complexity of utterances are systematically increased. The rationale for this approach is that children’s disfluencies increase with the length and complexity of their utterances.
Maximizing Success in the Therapy Room
Every activity chosen is geared towards having the child experience as much success as possible in the therapy room. In addition, great care is taken to actively engage the child in the activities by choosing games or toys that are of high interest to the child.
For more specific information please read “Fun with Fluency”.
The profession of speech-language pathology has been at the forefront in researching, diagnosing, and treating stuttering in children and adults for more than 75 years. In the past decade new knowledge and advanced technology has created the opportunity to understand and treat stuttering more comprehensively than ever before.
Out of this process, a new group of highly trained and skilled professionals has emerged: Board Recognized Specialists in Fluency Disorders. These specialists hold the basic clinical certification (CCC-SlP) awarded by the American Speech-language-Hearing Association (ASHA) and, in addition, have received advanced education and clinical training in fluency disorders. After passing a comprehensive examination they are awarded a Certificate of Specialty Recognition by the Specialty Board for Fluency Disorders.
Fluency specialists work in many settings, including schools systems, universities, hospitals, clinics and private practice. They provide direct clinical services to people who stutter as well as consulting services to other speech-language pathologists (SLPs).
Speech-language pathologists work with a vast array of communication disorders. As in other professions, such as medicine or law, it is extremely difficult to be an expert in every area of practice. Many generalpractice SlPs are proficient in the diagnosis and treatment of stuttering, but at some point you or your current speech-language pathologist may feel that seeking the expertise of a specialist is in your (or your child’s) best interest. Your SlP may consult with a fluency specialist or refer you to a specialist for evaluation or therapy.
The fluency specialist will begin with a formal interview so that a complete history of you or your child’s stuttering as well as any past or current treatments can be obtained. This will generally be followed by a formal evaluation/ assessment and analysis of the speech dys fluency and its impact on your life. Following the evaluation the clinician will go over the results and make recommendations for treatment. You can expect that the interview and evaluation process will take from 1-3 hours.
Fluency specialists use a variety of therapy methods and usually tailor their approach to the needs of the individual. Therapy is a partnership in which both the clinician and the person who stutters (or the child and parent) should participate actively in setting goals and working to achieve them.