Blog by Voon Pang
Dec. 28, 2015
I have been fortunate to have many teachers in my career as a specialist speech language pathologist. None of the formal learning can surpass the everyday interactions I have with the families I work with. I hope you enjoy reading Olly and Kate’s account of preschool stuttering therapy, keeping in mind that the events which unfolded were unique to them and that speech language pathologists need to tailor therapy to suit the individual’s needs. This blog post is dedicated to Olly (who is 5 years old going onto 10) and Kate (Olly’s mum), for teaching me that two treatment approaches, the Lidcombe Programme and the Demands and Capacities treatment approach, are both effective and that there is never a “one-size-fits-all.” Names have been changed to protect the identity of individuals in this story.
Thank you Kate and Olly for agreeing to share your story about stuttering. Can you talk about when you first noticed Olly’s stutter and what prompted you to contact our clinic.
When he first started stuttering the absolute first thought was concern, and whether it was something permanent or whether it was just a phase he was going through and of course I had all of the thoughts about my dad and how his stuttering started. A little bit of confusion, like why, why did he have a stutter and what to do about it. Do we wait out for a while and see what happens? Was it just his brain thinking too fast for his mouth? Or do we seek help. Lots of different thoughts, I guess now it’s so far away, so long ago that you forget the intensity of the concern but certainly there was a feeling of concern.
That was quite early on as Olly is now 5. His stutter was quite variable…
Absolutely. I guess I also forgot to say that of course Sam also had a stutter that began at about the same age yet Sam’s only lasted about 6-8 weeks and then it went away and so with Olly it started and it stopped and it started and it stopped and I was never sure if it was going to stay.
And then you were observing and monitoring for quite a while before you sought help and tell me when that turning point came for you because that was quite a big step wasn’t it?
It was a big step, but I think at first the stuttering was quite mild and it would come and go and come and go and then it became a little bit more intense. More occurrences on a regular basis but what made me really think “Ok we have to seek help and find out what to do” was when it moved from short blocks and instances of stuttering to having his whole neck go quite stiff with his muscles poking out and pausing with the block with what seemed like a long time, and then there was one particular occurrence which I still remember quite clearly with my mother-in -law over and instead of him speaking he began to sing in a very high pitched voice and sing out his response. That was when I thought “Ok we need to see somebody because it’s not going away and it’s becoming more difficult for him” and at the end of that episode he went quite quiet and he knew that something was amiss and that he was struggling.
So he was about 3 and a half at the time, and he had been stuttering for about 11 months. We met in March of 2014…
Wow, he was so little, yes 2014.
And we started with the Lidcombe Programme which is something that is well documented to be proven to be effective for young children. Can you remember the first few sessions of Lidcombe and the idea of ‘smooth’ and ‘bumpy’ talking and how that felt for you?
Yes, I can. I remember the first feeling of just a sense of relief that I wasn’t seemingly alone with him and that we had help. At the time, whilst you gave me some documentation and a video (the Stuttering Foundation 7 tips video) to see and it was interesting to learn about the Lidcombe process, I didn’t really mind what we were starting with. The fact that we were starting at the time which process didn’t bother me. It was more just the fact that we were starting something. But the Lidcombe process made sense and it seemed user-friendly if you like. Also, a process that related well with our family at that stage, with other small children and quite a relaxed approach which I liked.
And then that helped to some degree didn’t it? You took on board and really made it your own style. It was interesting because we got to the point around 8 sessions where it got to a point where it didn’t work as well as we were hoping and what was going through your mind then?
I was concerned. I remember being concerned because when looking at the graph with the crosses (severity rating chart) and thinking “Oh we started off with progress and we then seemed to pause and then take a down-turn and, of course in a lot of the literature from memory I think I spotted 12 weeks and I remember focusing on that 12. Comparing that progress to our own I did feel concerned. I began thinking “uh oh Olly’s not going to get better”.
And then there was a time in that process to change tact and try a Demands and Capacities approach or perhaps learning about easy speech as well as change what we did when we were interacting with Olly. How did it go for you because it was a complete change?
It was a complete change, but I guess it flowed. In a way, we were still using the dedicated time each day and still I was focusing on giving feedback and praise and paying more attention to our lifestyle and the busyness of life and trying to slow that down, so in a sense it flowed on, but then the different approach gave me positive reinforcement to try something else and that there wasn’t only one way to figure this. Because if there was only that one way, then we were stuck in a rut.
And that would have been quite difficult to get out of that rut…
Yes for him and for me.
And what was Olly’s response to some of the smooth talking praise?
He liked it. But what we liked most was the special time. There were definitely times of frustration for him and there were also times where Sam would join in my role and Olly didn’t like that at all because it was having a sibling only a year and a half older say what was correct and say what wasn’t. And he didn’t like that. So we had to figure out how to take on board all of the instruction when there are other people. If you’ve got one child, and it’s only you and that child you can do it. But when there’s everybody else’s input and life it has to be adapted a little bit. And with the Lidcombe process, we couldn’t really adapt it that well. So by changing tactic it suited our family more and it became achievable. And it also suited Olly’s personality…
Tell me a bit more about his personality and how that changed over time because he initially responded well to praise and then it changed.
Olly’s personality is quite ‘go go go’ and you can almost see his mind churning. He’s listening and he’s taking it in, but he’s already thinking of what he’ll be doing next and what will be done in 10 minutes time. So whilst the praise almost made him stop and pause and I think reflect in his own way on why he was praised and what for and he liked it, he then quickly he rushed off to do something else. But at least it made him stop and pause for just a second before moving on.
That makes sense because it coincided with the progress we made initially and then what we added to Lidcombe and what we did with changing approaches was that we started teaching him to resist time pressure or not rushing as much and also having easier speech.
Yes and I had to really consciously change my approach to life from getting shoes on to getting out the door, to having breakfast on the table. I had to really slow down which was hard as Olly’s baby sister got bigger and to make sure we all had enough time in life and it wasn’t a big rush. And even now I have to really think about that and this process has made me aware of the impact that it can have, the rush-rush-rush lifestyle.
It’s been more than 12 months since we’ve last heard any stuttering, if you reflect back and you had to give advice to someone, what advice would you give to the readers and what advice would you give to speech and language pathologists?
To readers, I would say if in any doubt, seek professional help sooner rather than later. If you search on the internet, it may say “if it’s been only going on for 6 weeks don’t worry about it it will pass”, yet if it’s been going on for 6 months seek help. And I think parental intuition-you know if something is right. And if every day you think “hm do I seek help or do I not, do I seek help or do I not?” Then just seek help because they can only say go away for a month or two and come back later. For me that’s number one because I know I tried a few different avenues before coming here. Not knowing where was the right place to go took time. But I’m glad I persisted at that time. And then I guess for speech therapists, what I found the best was the flexibility in approach and not giving up on us and persisting with somebody so young and at times difficult to handle and just changing different tactics because without that if we had stuck with one we don’t know where we’d be now and yeah when you hear with Lidcombe, for example, that 12 weeks is the average and we’re getting to the 20 week mark… we’ve seen progress but not a massive change then it was great to have the different input and the change and flexibility.
That’s really helpful for readers and speech therapist to take those bits of advice on board.
The whole process been great and the other thing of course is thank you to you, Voon, for accepting our personal situation like having to have another child in the room, if not one then two the entire time, because for us it’s just impossible to get the other child looked after at session times. It’s the reality, it’s like this in your office and it’s like this at home as well. That’s wonderful, because it makes our time not stressful.
You’ve made it really work as well. We’ve made it work as a team so thank you.
Thank you so much.