Banter Speech & Language

Sydney speech pathologists helping adults and children speak for themselves.

Stuttering

5 ways for teachers to help children who stutter – tips from people who stutter themselves

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Last week I attended a public forum co-hosted by the Australian Speak Easy Association and the Australian Stuttering Research Centre of the University of Sydney.  The focus was on how to help school-age children who stutter in the classroom.

The event was moderated by Associate Professor Ross Menzies, a clinical psychologist who has been doing some great research on studying the complex relationship between anxiety and stuttering.  It also featured talks from speech pathologists from the University of Sydney and the Stuttering Unit of the Bankstown Health Service.

But, for me, the highlight was hearing several adults who stutter recount some of their experiences at school.  Not everyone who stutters had difficulties at school – there were some examples of people who had wonderful teachers and peers supporting them at school.  But there were some harrowing stories, too, for example about:

  • being teased and bullied by other students;
  • feelings of dread while waiting for their turn to read aloud to the class or to answer a teacher’s questions;
  • worrying about whether teachers and the other children thought they were “slow” because of their stuttering;
  • deciding to “go mute”, call in sick, or otherwise avoiding situations like presentations requiring speech; and
  • leaving school as soon as possible to “escape”.

Teachers and others who work with children who stutter at school often ask what they can do to help.  And because we still don’t know exactly what causes stuttering, there is still no “professional” consensus.

So here are 5 tips from the real experts – people who stuttered at school and were brave enough to share their stories:

1. Don’t think a student is less intelligent because they stutter.  There is no link between intelligence and stuttering.

2. Give the student time to speak and maintain eye contact while they are talking to you.  No-one likes to be interrupted or have others finish their sentences or look away mid-sentence.

3. Although anxiety doesn’t cause stuttering, it can make it worse.  For some children who stutter, it can be really hard to read aloud in class, to answer questions when put on the spot, or to give a class presentation.  Have a private conversation with the child and ask him or her whether there is anything you can do to make it easier.  If a child is anxious about stuttering in front of the whole class, for example, you might:

  • allow the child to give their news or a presentation to a smaller group or just to you; or
  • ask the child to read aloud in unison with someone else.

4. Don’t give unsolicited advice to “take a deep breath” or to “calm down”.  This kind of advice – which is usually given with the best of intentions – can increase anxiety and make the stuttering worse.

5. Don’t pretend the stuttering isn’t there.  Make sure the student is getting appropriate help. Evidence-based treatments are available, but stuttering gets harder to treat with age, with early treatment strongly recommended for school-aged children.

A student might already be in treatment.  If so, ask the parents whether you can speak with the child’s speech pathologist for further advice specific to the child and to coordinate care.  If not, recommend to the parents that they get in touch with a speech pathologist as a matter of priority.

More resources for teachers

Since playing a person who stutters (or “stammers” as they say in the United Kingdom) in A Fish Called Wanda – and as the son of a man who stuttered and never talked about it – Michael Palin has been a fantastic public advocate for people who stutter for many years.  His centre has published some terrific resources about stuttering for teachers, including this video (which could be used in class to educate children about stuttering):

and this fact sheet, which contains a number of suggestions consistent with the tips above.

Also:

Related articles:

Image: http://tinyurl.com/qgkedp8

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).

My pre-schooler stutters and has problems with speech sounds: which one should I treat first?

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See our 2018 update about this topic.

We know that 30-40% of children who stutter also have a speech sound disorder (Gregg & Yairi, 2007).

We also know that both stuttering and speech sound disorders can lead to kids being perceived negatively by their peers at school – and even their teachers (e.g. Langevin et al, 2010; McCormack et al. 2009).

So, if your child stutters and has a speech sound disorder, which should you treat first?  Or should you treat them together?

We don’t know.  The research evidence to date is lousy; almost non-existent!

From a real world, clinical point of view, many factors may influence your decision, including the severity of each condition, your child’s age, and the effect each issue is having on your child’s intelligibility, participation and quality of life.

A major factor, sometimes overlooked, is the nature of the treatments involved.  For example:

  • we advocate the Lidcombe Program for many preschoolers who stutter.  The Lidcombe program is a direct parent-delivered treatment which focuses on rewarding the child for fluent speech (see here for more detail).
  • for speech sound disorders, we recommend a variety of different evidence-based treatments, from traditional articulation programs through to more complicated phonological treatments like Cycles, Minimal Pairs and Maximal Oppositions (we’ll explain more about these treatments in later articles).  Most of these approaches also work directly on speech by rewarding correct production, often by repeating the sounds several times in isolation, syllables, words and phrases.

Our concern with treating a pre-schooler’s stuttering and speech sounds together is that you may inadvertently confuse your child (or even yourself!) about which behaviours are being rewarded, and why.  For example:

  • in the Lidcombe Program, parents praise or otherwise encourage smooth or fluent, non-repetitive speech; and
  • in traditional articulation therapy, children are rewarded for saying the target sounds, syllables or words consistently and correctly.

So, if, one morning, you are praising Johnny for his fluent speech (with no repetitions) and then later on the same or the next day you are praising him for repeating a particular sound over and over, Johnny may – understandably – get confused.  This may result in the treatments interfering with each other – or even (if some anecdotal evidence is to be believed) making things worse.

This is why, everything else being equal, we usually recommend “serial service delivery”: working on one goal (stuttering or speech sounds) first, before moving onto the other goal.

Depending on the age of the client and family preferences, we would normally suggest starting with stuttering treatment – especially if the child is about to start school.  Our approach is consistent with the practice of a majority of Australian speech pathologists interviewed in a recent study (see citation below).  But, in truth, we really don’t know enough about this group of children at this stage and need better research evidence to help guide clinical recommendations to parents.

Key source: Unicomb, R. et al. (2013). Clinicians’ management of your children with co-occurring stuttering and speech sound disorder. International Journal of Speech-Language Pathology, 15(4): 441-452.

Related articles:

Image: http://tinyurl.com/kppfc7z

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).

Does anxiety cause stuttering?

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No.

So why do people who stutter often feel anxious? 

Here’s what some of the latest research tells us:

1. Speech is fundamental to both:

  • daily functioning, e.g. making an appointment on the phone, ordering dinner at a restaurant or participating in a work meeting; and
  • starting and maintaining relationships, e.g. meeting new people, asking someone out on a date, participating in team building exercises at work, simply chatting with friends at a BBQ, colleagues by the water cooler and acquaintances at networking or community events (Messenger et al., 2004);

2. (Somewhat obviously) many people who stutter face considerable difficulties when trying to speak (Packman et al. 2000);

3. Many people, on hearing someone stutter, react negatively to it.  It can be hard not to – even pre-schoolers have been observed reacting negatively to peers who stutter (Langevion et al, 2009). This negative feedback can continue for years and decades – across a person’s lifespan.  For example, people who stutter can experience:

  • listeners looking away, embarrassed, interrupting them, trying to finish their sentences for them, and straight out shunning;
  • bullying and teasing at school and in the workplace;
  • social isolation and rejection;
  • relationship problems;
  • educational and occupational underachievement, e.g.  some people who stutter take on low paying, lowly-skilled jobs well below their aptitude levels simply so they can avoid situations requiring them to speak; and
  • fear of public speaking and speaking in social situations (e.g. Menzies & Onslow, 2011).

Given all these negative experiences, sometimes over very long periods of time, it’s not surprising that some people who stutter feel anxious!

So how does anxiety affect stuttering?

We know that an anxiety can exacerbate stuttering severity. From a stuttering management perspective, we also now know that untreated social anxiety and other mental illnesses can increase the risk of relapse for people who’ve been successfully treated with an evidence-based speech restructuring treatment like the Camperdown Program (e.g. Iverach et al, 2009).

Is help for social anxiety available?

Yes.

Cognitive Behaviour Therapy (CBT) is one of the most effective psychological interventions available for treating social anxiety.  In 2008, a team at the University of Sydney published the results of a randomised controlled trial which showed that CBT for anxiety was associated with significant reductions in anxiety, even a year after treatment.  Interestingly, CBT did not of itself reduce stuttering severity (Menzies et al, 2008), another indicator that stuttering is not caused by anxiety.

For busy people – or people who don’t want to see a clinical psychologist face-to-face – an online program for the treatment of social anxiety among adults who stutter has been developed (Helgadottir et al., 2009).  The early results of this project has been promising and Associate Professor Ross Menzies and his team are currently conducting a randomised controlled trial on the program.

So watch this space.

If you would like more information about stuttering and anxiety, please contact us.

Related articles:

Principal source: Iverach et al. (2011). Anxiety and Stuttering: Continuing to Explore a Complex Relationship. American Journal of Speech-Language Pathology, 20, 221-232.

Image: http://tinyurl.com/mfybms7

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).

33 of our best free articles to get you up to speed on child speech, language, voice and reading delays, and stuttering

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We’ve published heaps of free information about child communication delays and problems.  But who can be bothered trawling through a website? So 1990s.

Here are direct, free links to 33 of our most popular information sheets and articles.  All in one convenient place.

If you find these useful, please “like” our Facebook page to get our free articles going forward. (We’re always keen to be “liked” – on Facebook, but also out in the real world!)

Free information:

1. Child Speech:

2. Child Language:

3. Child Voice:

4. Child Stuttering:

5. Literacy:

6. Child Assessments (generally):

7. Evidence-based treatments and therapy (generally):

About Banter and David

Thanks for reading.  Do drop us a line if you have any comments or questions, or want more information about any aspect of your child’s communication development.

Image: http://tinyurl.com/mnnfh8u

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).

Robot Talking: another evidence-based option to treat pre-schoolers who stutter

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In Australia, there is near consensus among speech pathologists that the Lidcombe Program is the most effective treatment for pre-schoolers who stutter – especially amongst those of us who were trained at Sydney University.  The Lidcombe Program is safe and, in clinical trials here and overseas – as well as in clinical practice out in the real world – it’s been proven to work for most children, time after time.

But what if it doesn’t?  Is there another evidence-based option for families to consider?

Yes: the Westmead Program, known colloquially as Robot Talking.

Syllable-timed speech techniques (STS) like the Westmead Program have been used (in different forms) for hundreds of years.  They involve speaking with very little difference in stress across syllables.  This is achieved by saying each syllable with equal stress to a rhythmic beat – almost like – you guessed it – a robot.  The Westmead Program is different from some of the older STS treatments in that it doesn’t require:

  • any props, e.g. metronomes, to set or maintain the beat;
  • the child to speak very slowly or in a monotone voice (children are instead encouraged to speak at a near-normal normal rate with pitch variation); or
  • the child to start with single sounds, syllables and words and work slowly up to conversation in several pre-programmed steps.

As with the Lidcombe Program, the Westmead Program has two stages and is administered by parents or other carers who measure average stuttering severity daily using the Lidcombe Program’s 1-10 scale.  In line with the clinical trials, children learn and then practice the technique 4-6 times a day, for 5-10 minutes each time, until stuttering is eliminated or almost eliminated.  This is followed by a period of maintenance where the treatment is slowly withdrawn under the supervision of a speech pathologist to minimise relapse risk.

Also like the Lidcombe program, we’re not sure why the Westmead Program works.  The latest theory is that syllable stress variations in natural speech are a stuttering “trigger” in those with a vulnerable speech motor system.  It is thought that, in children, STS may induce long-term improvements in stuttering severity before their neural pathways for speech are established (Trajkovski et al., 2009).  Incidentally, the effects of STS are usually temporary for adults who stutter.

The Westmead Program does not – yet – have the same level of evidence to support its effectiveness as the Lidcombe Program, but its research base is growing.  In 2011, a phase II study of a clinical trial of the Westmead Program was published (see key source citation below).  The trial was conducted with 17 Australian pre-school children aged between 3 and 4.5 years of age.  The key results were as follows:

  • Only 8 of 17 children completed the program – less than 50%.  Nine dropped out for various reasons, including satisfaction with early speech gains and problems completing the program because both parents worked full-time. The researchers commented that families tended to withdraw at the point when low-level stuttering severity had been attained, but not stabilised.
  • For the 8 children who completed stage 1, mean stuttering severity before treatment was 6% syllables stuttered.  After the treatment and at 12 months post-stage 2 entry, the mean stuttering severity had decreased to 0.2% syllables stuttered, a mean reduction of 96%.

These results, including the dramatic improvements in fluency, need to be interpreted with care because of the small sample size and the lack of randomisation and other controls.  Out in the real world, the Westmead Program can be very challenging for families, particularly for time-poor parents who are both working.  But it is an option, particularly for families that have been through several rounds of the Lidcombe Program without success, and for children who have been treated successfully but have relapsed.

Key source: Trajkovski, N., Andrews, C., Onslow, M., O’Brian, S., Packman, A., Menzies, R. (2011). A phase II trial of the Westmead Program: Syllable-timed speech treatment for pre-school children who stutter. International Journal of Speech-Language Pathology, 13(6): 500-509.

Related articles:

Image: tinyurl.com/muybcx6

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).

Banter Research Review 1: Stuttering Relapse – Video Self-Modelling vs Cognitive Behaviour Therapy

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As we’ve said before, speech restructuring techniques like the Camperdown Program are effective, evidence-based interventions for adults who stutter (O’Brian et al., 2003).  But around one-third of adults treated with speech restructuring relapse within 6-12 months (Onslow et al., 1996).

Video self-modelling (VSM) and Cognitive Behaviour Therapy (CBT) are relapse treatments for adults who stutter (Cream et al., 2009; Blood, 1995).  VSM involves people who stutter viewing video images of themselves free of stuttering.  CBT involves cognitive restructuring, behavioural experiments and attentional training, often from psychologists, to assist adults who stutter to eliminate or reduce their social anxiety.

But which is more effective in reducing stuttering?

In late 2013, we conducted a review of the research and concluded that, based on the best evidence:

  • VSM is more effective than CBT in reducing mean stuttering frequencies for adults who have been treated for stuttering with speech restructuring such as the Camperdown Program but have relapsed;
  • CBT has the potential to prevent relapse for adults who stutter and also have social anxiety disorder;
  • no study has yet compared the two treatments directly.  Given adults who stutter are a very diverse group of people, it is unlikely that either treatment will be more effective for all clients; and
  • more research is needed to explain the relationship(s) between stuttering severity, anxiety levels, therapy compliance rates and relapse risk before one treatment can be recommended over the other in all cases.

If you would like more detail or technical information on the research cited below, please contact us and we will send you our research review.

Image: https://archive.org/details/mundussubterrane00unse

Related articles:

Key References:

Amster, B.J., & Klein, E.R. (2008). Perfectionism in People Who Stutter: Preliminary Findings using a Modified Cognitive-Behavioral Treatment Approach. Behavioral and Cognitive Psychotherapy, 36, 35-40.

Blood, G.W. (1995). A behavioural cognitive therapy program for adults who stutter: computers and counselling. Journal of Communication Disorders, 28, 165-80.

Craig, A. (1998). Relapse following treatment for stuttering: a critical review and correlative data. Journal of Fluency Disorders, 23, 1-30.

Cream, A., O’Brian, S., Onslow, M., Packman, A., & Menzies, E. (2009). Self-modelling as a relapse intervention following speech-restructuring treatment for stuttering. International Journal of Language Communication Disorders, 44(5), 587-599.

Menzies, R.G., O’Brian, S., Onslow, M., Packman, A., St Clare, T., & Block, S. (2008). An Experimental Clinical Trial of a Cognitive Behaviour Therapy for Chronic Stuttering. Journal of Speech, Language,and Hearing Research, 51(6), 1451-1464.

O’Brian, S., Onslow, M., Cream, A., & Packman, A. (2003). The Camperdown Program: outcomes of a new prolonged-speech treatment model. Journal of Speech Language and Hearing Research, 46, 933-946.

Onslow, M., Costa, L., Andrews, C., Harrison, E., and Packman, A., (1996). Speech outcomes of a prolonged-speech treatment for stuttering. Journal of Speech and Hearing Research, 39, 734-749.

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).