Wednesday, December 18, 2013

Oh, You Are Such A Good Talker!

Throughout our journey we were occasionally encouraged to praise Eli for his fluent speech.  We never did that… it just didn’t feel like the right thing to do.  Why not?  This suggestion pops up in almost every list of recommendations for parents, from The Stuttering Home Page and the Stuttering Foundation of America to text books and instruction manuals.  The Parent’s Guide on the Stuttering Home Page suggests you

“Praise your child when s/he speaks well; but this should not be taken as praise for not stuttering; praise what s/he says, not how s/he says it. (1)

How do you praise a child when he speaks well without praising how he says it?  If you say “you sure know a lot about Pokemon©!” you are praising them for what they said, not how they said it.  If you say, “I like how you used your easy speech when you talked about Pokemon©,” you are praising them for how they said it, not what they said.   

I asked Eli how he might have felt if I had intermittingly praised his fluent and natural speech when he was younger (he’s 17 now).  He frowned and then responded: 

“Praise the small things.  Praise things that matter.   If you get lots of praise you will focus too much on looking good in other peoples’ minds. Don’t praise something that is commonly expected.  Most people talk without thinking about it. If I get praised for fluent speech, that tells me that if I don’t get praised, I must be doing something wrong.  I will think harder about my speech in order to get more praise.”

“Praise things that matter.” If you praise a child for fluent speech, they will get the idea that fluent speech is what “matters” to their listener.  Is this really the message we want to risk sending?  Doesn’t that come with an inherent risk of adding more anxiety to communicating?  Isn’t it pretty well-accepted that increased anxiety contributes to increased tension and stuttering behavior? 

I had a brief moment of hope when I read the Stuttering Foundations “Tips for Talking With Your Child.”  They say:

Praise strengths unrelated to talking as well, such as athletic skills, being organized, independent, or careful.”  (2)

Oh how I wish they had said “instead of” instead of “as well.”  So close, but yet so far away.    (Check the addendum at the end of this post for more examples.) 

I seriously cannot fathom any scenario where it would be appropriate and safe to praise a child for fluent talking.  It’s just not worth the risk. 

Keep them talking and keep talking fun!


Doreen (Dori) Lenz Holte


Addendum:  Additional examples of suggestions in professional publications to praise fluency. 

“The child’s disfluency should serve as an additional reminder to the parents to compliment the child’s fluency.”  Page 345, Stuttering Intervention: A Collaborative Journey to Fluency Freedom, Shapiro, David

“Children may be especially fluent when they are talking to parents at bedtime, providing parents with the opportunity to comment on this “smooth speech” and to let the child know that they can imagine how good it feels to talk easily.” Page 306, Stuttering: an Integrated Approach to Its Nature and Treatment, Guitar, Barry

“Praise your child’s talking; for example, “You are a good talker,” “I like the way you said that,” or, “It’s fun talking with you.” (Actually, I don’t object to that last one – it is referring to the content, not how it is being said.) Page 73, Fun with Fluency: Direct Therapy with the Young Child, Walton, Patty and Wallace, Mary

Thursday, December 12, 2013

"Let Me Be the Bad Guy"

Hope you all had a great Thanksgiving!  On a personal note, I must start by acknowledging the passing of another lovely “Pall Mall Puffing Potty Mouth Role Model” in my life.  My stepmom of 47 years (referenced in my previous blog) died unexpectedly on November 25th.  She was legendary for showing her love through her amazing cooking, card-playing, sewing, and acceptance of all who walked through her door.  Grandma Fern leaves a hole in our hearts and will be missed by all sixty-six (not kidding) members of her immediate family and so many others.  

On to the subject at hand.  Throughout Eli’s five years of traditional speech therapy we saw several different speech therapists.  Each therapist’s plan hinged on the speech tools included in the stuttering modification approach.  Each therapist encouraged me to do “special time” for 15 to 30 minutes a day, with Eli practicing speech tools while playing games or telling me stories.  I remember being told by one speech therapist to not remind Eli to use his speech tools outside of that 15 minutes of “special time” – she said “let me be the bad guy.”
On one hand, I felt the only way he was going to ever be able to use these tools would be to practice for hours each day until they became wired into his brain.  On the other hand, it seemed the more “special time” we did, the quieter he got.  Our time together quickly became tense and awkward and something neither one of us looked forward to.  I blamed myself – I just didn’t have that magical “whatever” to facilitate this practice in a way that felt fun and comfortable or in a way that would enable him to use these tools naturally in his world. 
I have come to believe that underlying the time and place limitations when it comes to practicing  tools is a lurking awareness of the inherent risks of suggesting a child speak in a prescribed manner.  We know it can do damage, but darn it, it’s evidence-based best practice!!  So we forge ahead. 
I have written quite a bit about the overwhelming lack of evidence supporting any treatment for children who stutter.  Just the other day I heard a comment on public radio that struck a chord, “we’ll have to wait until science catches up with anecdotal evidence.”  Experts continually marginalize the vast amount of anecdotal evidence from parents, teens, and adults who stutter around the uselessness and drawbacks of speech tools with children.  Instead they embrace “promising” strategies built on tiny numbers, inappropriate goals, and limited follow-up while children who stutter are growing more silent and disengaged each day. 
What advice can a clinician give a parent that will magically eradicate the risks out of telling a child to change how they talk?  Why is it deemed more penalizing for a parent or teacher to suggest speech corrections than for a speech therapist in a clinic setting?  Why are correction and modification instructions from mom during special time any different from at the dinner table or in the sandbox.  Mom is mom is mom.  There’s no magic hat that can eliminate mom from the messaging.  Nor does the training speech therapists receive cloak them with magic powers that make it “safe” only when implemented by them or someone under their tutelage. 
We need to do as much as we can to help kids stop thinking so hard about their speech.  Would we ever put 15-minute limitations on activities that increase self-confidence and keep talking fun for a kid?  How about cooking with Grandma, knowing you’re free to say anything you want (because you wouldn’t believe the things she says!)  Or “just playing the game” as Eli so often demanded when I would try and turn the game into “special time.”  Or helping them to pursue a passion such as snowboarding, sewing, art, or a big one in my house over the years -- Pokemon.  Get your 9-year old trading Pokemon cards with his buddies and the talking will flow and flow and flow…
Speech therapists have a golden opportunity to provide guidance and support to parents, teachers and other significant people in these kids’ lives to minimize anxiety and keep these kids talking.  And if these kids are really lucky, they’ll have a PPPM grandma to throw into the mix.   Rest in peace Grandma Fern.
Please feel free to share this essay with others who are affected by stuttering.  Also, I would love to hear of creative ways you have helped a child who stutters to increase verbal output and to keep talking fun! 


Dori Lenz Holte

Wednesday, November 20, 2013

Pall Mall Puffing Potty Mouthed Role Models

The other day I got to thinking about what a golden opportunity speech therapists have to develop the oh-so-important one-on-one relationship with a child.  Research-based evidence claims this can be the one most important factor for a kid who is struggling – one adult who will listen to them without passing judgment.  I started researching peer-reviewed journals to find quotes and numbers to prove my point, but all day long, Lorraine kept popping into my mind.  Pall-Mall puffing, potty-mouth Lorraine.  So here goes…

When I was a teenager, we had one small bathroom in our farmhouse and had to literally walk through our parents’ bedroom to use it.  Combining that with an ancient septic system and limited water supply, the old outhouse back by the grove of trees was often called into service, especially when extended family came to visit.  I remember Lorraine, my stepmother’s step-niece (I did say “extended”) absolutely hating that trip.  She was about 12 years older than me so in my 15-year old eyes, she was oh so adult.  We often ended up sharing a bed and Lorraine would sock me in the arm in the middle of the night to wake me up and accompany her to the outhouse.  I was honored.  

Lorraine would light up a Pall Mall for the trip and we’d tip-toe down the steps, giggling our fool heads off.  Once out the back door, we’d grab each other’s hands and bolt through the cold wet grass,  Lorraine swearing a blue streak.  My job would be to hold (and puff on) Lorraine’s Pall Mall and keep a look-out for men with axes.  The corn fields of southern Minnesota were full of them - seriously.  Lorraine and I bonded over those trips to the old outhouse.  And once back in the safety of my bed, too wound up to sleep, we would talk.  Well, I would talk, Lorraine would listen.  I could say anything to Lorraine, she would never never pass judgment.  She listened to all my troubles, all my hopes and dreams, she made me feel worthy, heard, and special.   
Now no one in the world would have positioned the Pall Mall smoking, potty-mouthed Lorraine as being a role model for a struggling teenager.  But she was.  She made a difference.  I will never forget her.  

To all the hard-working compassionate speech therapists out there – be the Lorraine in your clients’ life (Pall Malls and potty mouth optional).  You have that golden opportunity – one-on-one uninterrupted time to just listen – no assessment, no judgment.  Just listen. 

Keep Them Talking….


Dori Lenz Holte

Tuesday, November 19, 2013

Kyle Thompson - Powerful Photography Inspired by Anxiety

These amazing photographs came across my Facebook page yesterday.   Viralnova, the site that publicized these photos on the web, says this about the photographer:  
"A couple of years ago, Kyle Thompson became interested in photography. Unfortunately, his anxiety prevented him from talking to people, so he opted to experiment with self-portraits.
He would spend hours, even days, walking alone through forests and exploring abandoned houses. He’s been to over 50 of them. After taking hundreds of photos, he posted some of his best to Reddit. From there, his life changed forever."
These images are powerful, especially for anyone dealing with anxiety-induced silence. I thank Kyle for his amazing talent and images and I am displaying his work here with his permission.   


Wednesday, November 13, 2013

Do They or Don’t They Need Fixing?

Several years ago, while at a conference for families with children who stutter, a speaker/speech therapist called out to the crowd, “Our kids don’t need fixing!”  The crowd, myself included, clapped and cheered in agreement. 

Later that day therapists gathered to share their latest strategies for getting kids to use speech tools.  Parents gathered, often in tears filled with fears, lamenting the fact that their kids didn’t use their speech tools or practice them enough.   So if something doesn’t need fixing, why all the tears and tools?  I have a feeling that I wasn’t the only parent in the audience who applauded and at the same time was thinking “but seriously, help me find a way to fix it!”

Of course I would never want Eli to think he needs fixing or to think there’s something wrong with him, but let’s face it – that ship has sailed.  Consider all the trips to speech therapy, stickers for not stuttering, and using a significant chunk of our family vacation time and resources to go  conferences on stuttering – and then try to convince him that we really don’t believe there’s a problem that needs fixing?   It’s tough enough to hang on to some level of credibility as our children push towards the teen years, let’s not add fuel to their fire. 

What is it we are trying to say when we say “they don’t need fixing!?”  Certainly that we will accept, support, and love them no matter what.   But I think it’s confusing to both parents and children when we insist that they don’t need fixing at the same time we are putting great amounts of energy into finding resources to address the issue. 

Maybe “fixing” isn’t the best word for what it is we want to accomplish, but for simplicity’s sake, let’s stick with it.  I sometimes hear “tools” also referred to as strategies and techniques, so for the sake of this posting, let’s define “tools” and “techniques” as any prescribed way of speaking, and “strategies” as a more inclusive approach that is devoid of prescribing a speaking manner, i.e. tools and techniques.   

So let’s replace our tools aimed at fixing with strategies that minimize anxiety and maximize a sense of self, self-confidence, and engagement.  What does that look like?  Have you ever seen a child completely immersed in an activity?  Just the other day Eli participated in a high-energy volunteer activity with his church group.   He told me later that he was having so much fun he didn’t stutter at all because he “forgot to think about his speech.”  Those were his exact words. 

What strategies can we use to nurture that state of mind in our overly-anxious, often perfectionistic children?   Wouldn’t it be lovely if a speech therapist partnered with us to explore the possibilities as they relate to our child?  It would sure be a ton more fun than sitting down and practicing speech tools and techniques!  We need strategies aimed at helping them forget to worry about their speech, not tools that are likely to increase the focus and anxiety around speaking.  It’s crazy to deny the desire to make it go away – to fix it.  Let’s just make sure we are using the right too….er, strategies!  First do no harm…


Dori Lenz Holte

Friday, November 8, 2013

Family-Based Therapy - What Does That Really Look Like?

Another question that came up in response to my ISAD conference submission (The Right Time to Break Out the Stickers – see previous post) was around my opinion of family involvement in the therapy process.  Following are the questions and my answers.

Q: In class we are learning about how important it is to employ a “family based treatment” where not only does the SLP work with the child who stutters, but also educates the family and is interested in the family’s opinions and concerns about their child.  Did any of the speech therapists that worked with Eli also work with you and your husband to teach you what you could do at home to help Eli, or just talked to you about your questions or feelings about how Eli was progressing? Stacey

A: I’m not a speech therapist, but in my opinion, “employing a family-based treatment” is only helpful depending on exactly what you are asking the family to do. We felt that we were employed when the therapist helped us to understand the speech tools and ways we could practice at home. I begged for this involvement as I could not imagine he would ever be able to use these naturally without lots and lots of practice. Same with educating the family…depends on what you’re educating them to do…how to make fewer speech errors, or keeping them talking and engaged in the world around them. Too often the family involvement is hinged on practicing speech tools and working to transfer these into their real world. There is so much a family can do to encourage talking, to keep talking fun, to enhance communication, and to build on what the child does well and with a passion. And this can be done without risk of silence and withdrawal.

Q: Did the speech-language pathologists who treated your son ever take an approach to therapy that included the entire family system?  Do you feel this would have been beneficial?   Laura

A: One speech therapist included Eli’s brothers, dad, and myself in some of the sessions. She also had Eli bring a friend once. Was it beneficial — not really.  Is it a good idea? Depends on the focus of the therapy. Is it necessary? Absolutely. How’s that for confusing?

As a parent, I think therapy should focus on keeping the child talking, addressing the emotional aspects, and minimizing anxiety around communication. If this is the focus, then parental/family involvement is pretty crucial. If the focus is on eliminating disfluencies, then family (and teachers and grandma) can turn into the speech cops. Surrounding a child with speech cops runs the risk of increased anxiety, silence, and withdrawal.

Additional thought:  Insurance companies insist that speech therapists can only bill for time spent directly with the child or at least having the child present.  It is my understanding that they cannot bill for time spent alone with the parent.  This puts extensive communication with a parent on the back burner.  And yet, in my opinion, extensive time with parents is critical to the process.  A speech therapist can help parents create an environment where their child enjoys talking, communication is relatively stress-free and anxiety is kept at a minimum.  

So "family-based therapy” can look very different from therapist to therapist.  Again, I think it's critical to the process, but it can also be damaging, depending on what the family is being instructed to do.  I will definitely do more research around how this approach is presented academic systems.... feel free to enlighten me!

Dori Lenz Holte

Monday, November 4, 2013

I Kept Him Fed and Watered...

Good Monday morning.  Had a nicely quiet weekend and up early today with that pesky time change.  Maybe it will become the new normal?  I doubt it...  I will continue to share questions and responses that occurred in response to "The Right Time to Break Out the Stickers" (see previous post) during the October ISAD Conference. 
Another question that came up was around how, if, and when I communicated with Eli's speech therapists.  Franky, I wasn't a very good advocate because I knew nothing - absolutely zippo - about stuttering or therapy for children who stutter.   I figured I made the appointment, drove him there, did "special time" at home and kept him fed and watered...wasn't that advocacy enough?  So here goes...

Q: I was wondering if you were outspoken about Eli’s therapy from the beginning or if it took several years for you to become comfortable enough to question treatments and research? When speaking to future SLPs, do you have any advice on what we can do as professionals to empower parents to advocate for their children? Martha

A: I, too, was one of those parents who didn’t feel equipped to question the professionals, at least not for many years. I agree that parents should be advocates, at the same time, the helpfulness of this advocacy depends greatly on what exactly is being advocated! If a therapist suggests that your child can use speech tools to help “manage” their speech, and you encourage this at home and at school, you are being an advocate. But is this such a good idea?

There are SLPs out there who are having parents read my book, “Voice Unearthed” prior to therapy. The book helps to educated and empower parents as they are the crucial decision-makers on this journey. It gives them a voice…kind of ironic!

Q: Did you ever encounter any situations throughout therapy where you felt the need to interject in the therapy process with the SLP and Eli? and if so how did you handle that situation?  McKayla

A: In short, some therapists allowed me to observe therapy (where, of course, it looked like Eli could successfully use his speech tools), most suggested exercises and games to do during our “special time” at home where he was to practice his speech tools. I didn’t question this because I knew nothing, absolutely zippo, about speech therapy for children who stuttered. I tried hard to support and nurture the therapist’s recommendations. Eli’s struggle went from mild, to moderate, to severe. All we were told was to keep practicing. I had nothing to offer for the SLP to go against until I did six years of research, reflection, writing, and working with Dr. Halvorson. That’s why I wrote the book, so other parents and speech therapists could be educated, self-empowered, and aware of the risks. 

Q: From a parents perspective, do you think that it is hard for parents to consult with their SLP’s regarding effectiveness of the rewards?   Allie T.

A: It depends so much on the SLP. Like in any field, some are more welcoming and receptive to parental insights, some not so much. And some parental insights are constructive, some not so much… no easy answer there! 

Next blog:   Bring the Whole Fam Damily - Or Not. 

Keep them talking!

Dori Lenz Holte

Friday, November 1, 2013

International Fluency Association Recognizes "Voice Unearthed"

I am honored to be recognized by the International Fluency Association* (IFA) with the Unsung Hero award.  Thank you Mike Retzinger for the nomination and David Shapiro and Joe Donaher for their consideration. Go to  and click on IFA Newsletter 2013 to view the nomination.  

The IFA's stated purpose is to "increase communication amongst the membership of the IFA to forge dialogue regarding topics on which we agree and on which we might hold quite diverse perspectives."  

I love that.

Dori Lenz Holte

*  The International Fluency Association is a not-for-profit, international, interdisciplinary organization devoted to the understanding and management of fluency disorders, and to the improvement in the quality of life for persons with fluency disorders.

Monday, October 28, 2013

Giving Out Stickers Like There's No Tomorrow...

After reading my ISAD submission, The Right Time to Break Out the Stickers, (see previous blog posting) many graduate students in speech therapy acknowledged that it might not be such a good idea to give rewards to a child for successfully using speech tools, but they asked about rewards for “paying attention, doing something correct, positive speech behaviors, doing their best job, confidence, good talking, etc… As one student put it “speech therapists give out stickers like there’s no tomorrow!”  Everyone, just step back and take a deep breath. .. and enough already! 
I did asked myself … if I felt speech therapists were trained to provide treatment focused on keeping them talking rather than reducing speech errors, would I be so bothered by the inclusion of stickers (or applause, or praise, or candy)?   My conclusion?  Yes I would. 
So at the risk of getting a bit sidetracked, I will focus again on rewards.  I was inspired by the writings of Australian psychologist and author, Robin Grille*.  Grille’s primary audience is parents, but he helps us all to understand the shortcomings of the ever-so-popular practice of giving out rewards to children.  I will be using excerpts from his article, Rewards and Praise: The Poisoned Carrot that I feel are most relevant to speech therapists and parents of children who stutter.  (You can view the full article at 
Grille states that
  “Rewards and praise condition children to seek approval; they end up doing things to impress, instead of doing things for themselves. This can hold back the development of self-motivation and makes them dependent on outside opinion. When children get used to getting goodies for ‘performing,’ they become pleasers, over-reliant on positive strokes. Rewards and praise can create a kind of addictive behavior: children can get addicted to recognition, and thus lose touch with the simple joy of doing what they love.”  
  One of the worst things we can do is to praise a child's potential. Acclamations like "I just know you can do it", "You're getting better!", "I know you've got it in you!", "You'll get there!" sound supportive on the surface. Underneath the praise is the silent implication: "you're not good enough yet".
The last impression you want a child who stutters to walk away with is “you’re not good enough.”  I do believe there can be a healthy balance between doing everything for themselves and doing things to impress.  The extreme ends of either of these motivators lead to obvious problems, depending on the circumstances.  But let’s face it…we want kids who are comfortable enough in their own skins to express their feelings, not kids who are overly-motivated to impress others.  We want kids who are self-motivated, with their sense of self and well-being not reliant on external praise and rewards.  Grille goes on to say:
  When children are bribed with rewards for "good" behavior, they soon learn how to manipulate us by acting the part that is expected of them. They become superficially compliant, doing whatever it takes to flatter or impress us, and honesty suffers. After all, who wants to be honest or real with a person who is evaluating them?
Children are under constant evaluation and being judged all day in school.  Therapists are trained to do the same.  This does not inspire honesty or being in touch with your true feelings. 
Eli hated practicing his speech tools at home, or doing anything that focused on his speech struggles.  No matter what game I adapted to the process, which book I pulled out, or how hard I clapped my hands and assured him it was going to be fun, he still hated it.  Oh, and he did express his true feelings -- “This is sta sta sta stupid!, why does the fa fa fa fa fa fa focus of eeeeeeeeeeeeverything have to be on my speech?”  I didn’t listen.  I forged on, assuming that even though it felt stupid to him, at some point he would find it useful.  I did nothing to acknowledge or appreciate his honesty.  Grille is so right when he states:
  Rewarding children's compliance is the flip-side of punishing their disobedience. It is seduction in the place of tyranny
Until now I have never considered rewards to be equivalent to tyranny.  But I think Grille is right on the money.  It’s too easy for kids to lose touch with what they are really thinking and feeling when they are being seduced with stickers and praise.  Eli never told a speech therapist that he thought speech tools were too hard or stupid.  He did exactly what they told him to do.  He was compliant and well-mannered and got lots of stickers for “paying attention, doing something correct, positive speech behaviors, doing his best job, confidence, good talking, etc…”  We all rewarded him over and over again –  I was always so proud .
So instead of “giving out stickers like there’s no tomorrow,” let’s focus instead on creating a space where these kids can safely build their courage and capacity for honesty and self-expression.  It’s time to set our egos aside.  We need to keep them talking!    
Dori Lenz Holte

*Printed with permission.  Robin Grille is the author of Parenting for a Peaceful World and Heart-to-Heart Parenting.

Wednesday, October 23, 2013

The Right Time to Break out the Stickers

The Right Time to Break Out the Stickers
By Doreen (Dori) Lenz Holte
When our son Eli was around 12, I asked him if he remembered being told that it was okay to stutter.  It had been three years since we stopped traditional speech therapy and I was curious as to how he would respond.  He thought for a moment and replied “Once I stopped stuttering they would give me stickers or let me play with the toys in the room.  They’d tell me it was okay, then they’d tell me not to do it… I stopped talking as much because they said it was wrong.”

When Eli was between five and nine years of age he saw a number of speech therapists for treatment for his stuttering.  These therapists had varying degrees of experience with children who stuttered – ranging from none to having an ASHA Board Recognized Fluency Specialist certification.  Each therapist enlisted fluency shaping and stuttering modification speech tools, the approach considered to be “evidence-based best practice” by ASHA and leading universities.  Each therapist enthusiastically rewarded Eli with an array of colorful stickers when he used his speech tools.  At the same time I witnessed each of them kindly and continually assuring Eli that it really was okay to stutter.   They never told him it was wrong…I am certain of that.  

At home during special time (time set aside each day to practice using speech tools)  I would clap for and praise Eli when he successfully used his Tigger talk and turtle talk to deliver non-stuttered speech.  I would also assure him that it really was okay to stutter.  I also never told him it was wrong to stutter, but that was unfortunately the message he came away with.

We were confused and confounded when, even with all the positive reinforcement, Eli did not transfer the use of speech tools outside the clinic setting or our special time at home.  After four years of therapy we resigned ourselves to believing that at least we had given him a tool box full of speech tools...he would hopefully use them when he was ready.  (This is a common lament I've heard from both parents and speech therapists throughout the years.  “If he would just use his tools.  He can use them in therapy, so why not in other places?  He just needs more practice...”)

When Eli was nine, we stopped traditional speech therapy.  He had gone from mild to moderate to severe and was now twisting his chin to his shoulder and growling in order to talk...if we were lucky.  Most of the time he just didn't talk.  We noticed the silence when he was sitting around the table at Easter with aunts, uncles and cousins.  We noticed the silence at 4H meetings and during home school co-op days with friends.  Even at home with us he became increasingly withdrawn.  We felt like we were literally watching our Eli fade away.   We would vacillate between gently reminding him to use his speech tools and ignoring the behavior. We felt increasingly fearful and lost when it came to Eli’s struggles with speaking.  It seemed that the silence and disconnection was proving to be a far greater handicap than the stuttering itself.      

In retrospect, there is no doubt that the silence was a result of the shame Eli felt when he stuttered.  He also felt that shame when he didn’t meet up to the expectations implied in the ongoing praises and reward of stickers for non-stuttered speech.  Dr. BrenĂ© Brown has researched the subject of shame extensively and states that “nothing silences us more effectively than shame.”  Brown, Ph.D.,  licensed social worker, and renowned author and speaker goes on to say:

            shame unravels our connection to others...In fact, I often refer to shame as the fear of
            disconnection - the fear of being perceived as flawed and unworthy of acceptance or belonging. 
            Shame keeps us from telling our own stories and prevents us from listening to others tell their
            stories.  We silence our voices and keep our secrets   out of the fear of disconnection. ¹

The role that shame plays in stuttering behavior is no surprise to parents or speech therapists.  It is the absolute last feeling we want them to experience around talking but are our efforts backfiring? Was it really developmentally appropriate to expect a child of this age to manage the complex and conflicting messages of “It’s okay to stutter but here’s a reward if you don’t.”?  Research into the cognitive traits shared by children, ages 6-10, helps to shed some light on our discomfort.  In general, child development experts ² agree that this age group: 

§  Has a strong desire to perform well and do things right.
§  Finds criticism or failure difficult to handle.
§  Views things as black and white, right or wrong, wonderful or terrible, with very little middle ground.
§  Naturally seeks praise and wants to conform. 

Using speech tools requires a level of energy and concentration that is hard to fathom even for adults.  When you consider the development traits of children you begin to understand how shame can result from the unrealistic expectations and conflicting messages.  In addition, many experts (and parents) report that children who stutter are often more sensitive than others their age.   Mary Elizabeth Oyler,  a speech-language pathologist who also stutters has done extensive research around the issue of children who stuttering and sensitivity.  She found that: 

            children who stutter were significantly more sensitive and vulnerable than nonstuttering    children.  In addition, 84% of the children who stutter fell in the highly sensitive range as          compared to 36% of the children who do not stutter.  4

When we step away from a focus on eliminating the moment of stuttering behavior and look at the whole child, we truly begin to understand why a child might choose silence over risking continued failure in front of those they most want to impress and please.    

In 2011, I  published Voice Unearthed: Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter.   During my six years of research and reflection for this book I discovered a plethora of  disagreement, confusion, and uncertainty around treatment for children who stutter.   Extensive research around shame and stuttering has been done by Dr. Bill Murphy, speech-language pathologist and a clinical faculty member at Purdue.  Murphy warns:   

            The emotions of shame are self-perpetuating, regenerated repeatedly by the child, even if the        external stimulus (a parent inappropriately reminding a child to “use your techniques,” or a classmate laughing) is no longer present... the self acquires the identity of failure, at least in relationship to speaking skills. ³

Professional organizations and academia have an ethical obligation to abide by treatment approaches that are deemed to be best practice stemming from evidence-based research.  The problem in this particular area is that the vast majority of research has been done on adults.  The research done with children is extremely limited and often labeled as “emerging” or “promising.”   The goals of the research are to make fewer speech errors.  The goal for a child is to avoid feeling shame and the most realistic way to accomplish this is to stop talking. 

I am encouraged when I increasingly hear about a greater focus on desensitization and creating positive feelings around communicating.  But the use of stuttering modification and fluency shaping speech tools remain as a significant component of therapy for children as conveyed in ASHA’s  Specialty Board on Fluency Disorders Manual.5  The Stuttering Foundation of America even acknowledges that “many children and teens who stutter do not have the maturity or skill to monitor their speech in all situations. Therefore, it may be unrealistic to expect your child to use her tools in other environments at all times.”  What happens when you throw in a few stickers as a reward for using those tools?  What message does a child really walk away with?   Eli says “I stopped talking as much because they said it was wrong.”

From the time Eli was nine to this day, Dr. Jerry Halvorson, retired Communicative Disorders professor at the University of Wisconsin, River Falls has helped us provide support focused on keeping Eli talking and engaged in the world around him.  Within three months of changing our focus from reducing speech errors to keeping Eli talking we saw significantly less twisting, gurgling, and far more talking.  It was a long process that is far from over.  But today Eli is 17 years old, a full-time college student, a part-time employee, and a supportive and positive role model to his group of friends.   He still stutters, sometimes severely.  But he puts himself out there each and every day.  He can be wickedly funny… I figured it was a good sign when his co-workers affectionately nick-named him “Snarky.”  Now there is a good reason to break out the stickers.        

1.        Brown, Brene (2007) I Thought It Was Just Me (but it isn’t): Telling the Truth About
           Perfectionism, Inadequacy, and Power Penguin/Gotham
2.        The National Network for Childcare, Great, Human Development and Family
           Studies at Iowa State University
3.                  Murphy, B. (1999). The School-Age Child Who Stutters: Dealing Effectively with Guilt and
            Shame, VHS Publication NO. 86, Memphis, TN, Stuttering Foundation of America
4.                  Oyler, M. E. (1996b). Vulnerability in stuttering children. (No. 9602431). Ann Arbor, MI: UMI  
            Dissertation Services.

Biography:  Doreen (Dori) Lenz Holte is a professional writer and author of Voice Unearthed:  Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter.  She is also the proud mom to Abe, Adam, and Eli.