Treating Coexisting Stuttering, Language, and Phonology Disorders
Nancy E. Hall, Ph.D., Winter 1999-2000
Speech/language clinicians have reported the onset of stuttering during the course of treating a youngster's language or speech sound impairments. Clinicians who face this dilemma must make decisions about therapy with little information to guide their decision-making.
At the University of Maine, we are examining individual cases of children with communication impairments and stuttering to identify the important factors in treating these children, and to develop innovative ways of therapy. Presented here is one of our case studies identifying three phases of therapy and concluding with our thoughts on what aspects of this youngster's development were significant to the therapy and recovery processes.
At 3 years, 6 months, Max exhibited moderate expressive/receptive language delays, and mild phonological impairment. Stuttering was not a concern. He began therapy working on improving language skills and increasing his use of speech sounds.
Three months into this treatment phase, Max began stuttering, and intervention shifted to working on language while indirectly modeling easy speech, and discontinuing direct work on phonology. After four months, Max demonstrated progress on the language and phonology goals; however the stuttering continued to increase, with Max showing signs of avoidance.
At this point, we discontinued direct work on speech sounds and language, and began direct fluency therapy, with the following goals: (1) reproduction of slow and easy speech, (2) identification of stuttered speech in conversation, and (3) provision of parental support and resources.
After two months, Max demonstrated no stuttering behavior and his parents reported positive changes in their communicative interactions with Max. The final phase of treatment worked on phonology and language, while maintaining fluency. Adequate progress was made in language and phonology, and Max maintained his level of fluency in the classroom, individual sessions, and at home.
Several aspects of this course of intervention are significant. Max demonstrated linguistic impairments in conjunction with what appeared to be significant reluctance to take communicative risks. Possibly, the focus on specific language skills placed an overload on his system, resulting in stuttering. In terms of generalizing the observations of the present study, it is important to note the treatment's individualized nature. While the initial treatment involved phonology and language, its nature changed markedly following the onset of stuttering, and the second phase of treatment involved facilitating a supportive and fluency-enhancing communicative atmosphere. This required involvement on the part of Max's parents in the form of participating in the treatment sessions, altering their own patterns of speech, language, and communication, and allowing the therapy to take place in their home. In phase three, we took care to use Max's foundation of fluency skills, reinforce his success with speech, and ease back into addressing the remaining phonology and language concerns. The main considerations in addressing these concerns included being sensitive to Max's communication style, providing ample opportunity for success, and using the support of his classroom.
In conclusion, this case study illustrates that individual considerations will determine the ways in which sequential and/or concurrent treatment models are put into effect for any single child. These considerations may include the child's communicative and language learning styles, the involvement of family members, language acquisition factors, and service delivery methods. A final thought on the case presented here is that treatment of concomitant stuttering and language/articulation disorder can be successful, when careful review and planning occur.
If you are the parent of a child who is receiving speech and language therapy focusing on making sounds, words, or sentences accurately and your child begins to stutter, you may want to consider the following:
It is not unusual for a youngster to experience some stuttering while attempting to learn new words, sentences, or speech sounds; your slow and easy modeling of the target sounds, words, or sentences will provide positive opportunities for your child.
Try paying attention to your youngster's "communicative style", providing support and encouragement for his or her communication. Let your child know talking can be fun! You should find guidance and support from speech-language pathologists and helpful materials from the Stuttering Foundation of America.
Bernstein Ratner, N. (1995). Treating the child who stutters with concomitant language or phonological impairment. Language, Speech, Hearing Services in Schools, 26, 180-186.
Nippold, M. (1990). Concomitant speech and language disorders in stuttering children: A critique of the literature. Journal of Speech and Hearing Disorders, 55, 51-60.
Stuttering Foundation of America. (2000). If Your Child Stutters: A Guide for Parents. 5th Edition. Memphis, TN: Stuttering Foundation of America.
Interested in learning more? Please contact Nancy E. Hall, Dept. of Comm. Sci. and Dis., University of Maine, 5724 Dunn Hall, Orono, ME 04469, (207) 581-2404.