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. Brené 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.
§
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
Schools.org, 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.
sbfd-manual&catid=79&Itemid=502
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.
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