Journal Writing for Children Who Stutter

About the presenters: Judy Butler is a Speech/Language Pathologist with ASHA Specialty Recognition in Fluency Disorders. She attended the Workshop for Stuttering Specialists at Northwestern University sponsored by the Stuttering Foundation of America in 1992. She earned a Masters Degree in Communication Sciences from the University of Connecticut in 1981 and a Bachelor of Arts degree in Psycholinguistics at Brown University in 1975. Judy treated a variety of communication disorders in children at the Easter Seal Society of Allegheny County, Pittsburgh, PA from 1981-1991 before beginning a private practice. Since 1996, she has treated children who stutter exclusively. She lives in Franklin, MA.

Jackie Biagini is a parent of a child who stutters. She is also a Speech/Language Pathologist at the middle and high school levels in the Duxbury, MA public schools. Jackie is a graduate of Rutgers University with twenty years experience in public and private schools in Massachusetts, New Hampshire, and overseas. She lives in Marshfield, MA with her husband Steve and their children, Andrea and Nicholas.

Journal Writing for Children Who Stutter

by Judy Butler and Jackie Biagini
from Massachusetts, USA

INTRODUCTION

Children who stutter know more about their own speech than anyone else does. They know that talking is very difficult in some situations and easier in others. Some children have intense feelings associated with their speech. By encouraging children to talk about stuttering, we believe that you can help him improve communication skills. But how can you elicit this information? How can you get children to talk? And then, how can you organize these observations in a helpful way? In this paper, we propose that Journal Writing is one way to accomplish this goal.

Journal Writing for Children Who Stutter is a tool for discovering the child’s point of view about stuttering. We have found that journaling is an effective method of talking about the very personal way in which stuttering affects a child’s outlook on communication. Our journal format guides a child and adult listener into the process of talking about communication in a constructive and creative way. We are thrilled to make this available to others by presenting at this conference.

With Journal Writing, you will learn about the realities of living with a disorder of fluency. It is our hope that you will empathize with children who stutter. It is belief that you will develop a deeper sensitivity for their humanity, not just their disfluency. Journal Writing will help you to remember that stuttering is not just "bumpy speech." It is a disruption in the smooth communication between people. It interrupts interpersonal interactions. It changes lives.

Moving fluent speech out of the clinical setting into the real world, transference, is a crucial part of stuttering therapy. We hope that Journal Writing will help drive this process of transference, suggesting areas that need immediate attention.

Good fluency therapy respects the unique personal needs of each child. Conture (1997, p. 254) writes "Only if clinicians maneuver in response to the circumstances or the facts presented by a child, which may not be those that have been taught or that are expected, is it likely, in the long haul, that they will be able to assess and treat the child effectively." Journal Writing is a way to discover the qualities that define the child sitting with you as a unique individual. Conture advises in this same article that clinicians develop "an organized collection of motivated observations" about a child’s fluency-related issues" Conture, p. 242). Journal Writing provides such an opportunity.

HOW TO COMPLETE JOURNAL ENTRIES

Special training is not necessary to use Journal Writing. Parents, professionals, or other special persons in a child’s life are quite capable of offering guidance and support on this journey of self-observation. There isn’t any lesson planning involved. The student can open the journal and begin with minimal instruction. The directions for completing journal entries are brief and self-explanatory. The journal is organized into several levels. As a child progresses from one level to the next, the content of each journal entry is modified to redirect and expand his attention. We suggest that a child contribute an entry at least once a week.

Each entry form shares a common structure including date, the situation (people, place, time), speaker, speaker’s words, listener’s words and reactions, and child’s feelings. Suggestions for each space are provided in the left margin. Additional suggestions are listed in appendices. While these options are offered for a child to consider, be careful not to put words into his mouth. Wait. Give the child time to think and volunteer information.

To encourage communication, establish a relaxed atmosphere. Respond to a child’s ideas with non-judgmental comments and reactions, such as "Oh," or a nod of your head, or re-phrasing the statement (The child writes/says "I was really nervous when I answered the question." Your response, "That was a tense situation, an anxious moment, etc. ") Ask open-ended questions, such as "What else happened?" "What do you think about that?" "Tell me more about that." Ask questions to elicit specific details. The process of completing journal entry forms can become an experience that encourages speech and communication between the two.

You will find that as the child clarifies the situation for you, he will also make important related comments. Record these on the back of each journal entry. We recommend that you record what a child tells you with a matter of fact and accepting attitude. If you are taking notes, or assisting with the writing, allow the child to see what you write. A child’s vocabulary will be important when role-playing situations while working on transference. Place quotation marks around the child’s words. Quotation marks will emphasize the importance you place on what he has to say. You are looking for dialogue, emotion, and action. Remember that you are trying to learn as much as possible about a child as an individual. Then you can tailor your help to his very personal communication needs.

Because Journal Writing is organized into several levels, the Speech Language Pathologist working in a school setting may assign one or more levels to an academic term. If a child requires extra help completing journal entries, the SLP may elect to continue at one level or return and repeat a level for more than one term. The SLP will monitor and judge how far to pursue individual entries based on their content and significance. Of course, every child will vary in his willingness and ability to observe and describe speaking situations. We believe that every child can improve these skills with encouragement and practice.

Other users of Journal Writing may proceed in a more spontaneous way, taking varied amounts of time for each level as needed. Careful assessment of the issues raised, the emotions evoked, and positive and negative outcomes elicited by the entries will determine the amount of time and energy spent at each level. Very often, the child will lead the way under the guidance of a patient and understanding adult.

JOURNAL LEVELS

Level 1 introduces the journal entry form. The child and adult listener are directed to record communication situations in a specific way. This journal entry format is consistent across all the levels. If the adult completes entries with the child, we recommend being cognizant of turn–taking, response time latency, and interruptions (Kelly, 1993). We usually suggest that adults reduce their rate of speech, allow a few seconds pause time before responding to the child’s utterances, and avoid interruptions. Journal Writing, when used in this way, can lead to an organized, predictable, empathic, and accepting conversation that the child will find supportive of fluency. For more discussion about how types of discourse may influence fluency, see Weiss (1993).

Level 2 teaches the concept of pragmatics. Pragmatics includes the manner in which a person communicates verbally and non-verbally in different settings with different people. For example, children do not talk to a group of friends on the playground the same way as they talk to parents. Children are encouraged to watch others to observe the changes in their speech (vocabulary, intonation, volume, sentence length) as they talk to the doctor, baby, family pet, phone sales person, etc. "A hierarchy of pragmatic contexts could be delineated for an individual client that ranges from those contexts that have already been mastered, and so are typically produced with fluent speech, to those that present a challenge that makes disfluencies more likely" (Weiss, p. 223).

Level 3 focuses on fluency. We instruct the child: "You will use a rating scale to measure your speech. This is because your speech changes from day to day, time to time, place to place, and so on. Rating your speech does not mean it is good or bad. By rating your speech, you can learn more about when, why, and how fluency changes" (Biagini and Butler, 1999, p. 17). We avoid arguments about definitions of stuttering in this section. We realize that perception of disfluency is variable from person to person. Our intention is to discover how the child rates his own fluency, encourage the child to listen for fluency and share his observations. We recommend that adults do not challenge a child’s fluency rating. Judgements of fluency differ – and here is a place where perception is reality. For the purpose of this journal, both language fluency and speech fluency could be rated. (Linguistic fluency refers to the ease of sentence formulation, word finding, word pronunciation, and pragmatic skill. Speech fluency refers to "consistent ability to move the structures of the vocal tract easily, rapidly, smoothly, and with appropriate timing relative to other vocal tract activities." (Starkweather, 1997, p. 258)

Level 4 discusses emotional and physiological responses to communicative situations. For some children, the clinician or other adult might hypothesize that the stuttering is a reaction to frustration and fear rather than simply a motor-speech breakdown (Guitar, 1997 offers a theoretical perspective for this hypothesis on pp. 281-283). In an attempt to reduce conditioned emotional and physiological reactions to stuttering, Journal Writing helps a child to recognize, label, and talk about these reactions. Then the child can separate them from his true intentions. For example, the child can discover that his desire and ability to engage in an activity (speaking to an audience, oral reading in class) are not controlled by his body’s reactions (stomach butterflies, sweaty palms, rapid breathing). He can participate despite his physical panic while at the same time learning to tame the body’s fight-flight response.

Level 5 helps a child design hierarchies. A hierarchy is a way to accomplish a task one small step at a time. Hierarchies allow children to experience success, feel pride, gain hope, see progress, and have a strategy for getting something big accomplished. Speech hierarchies include variables such as the phonology, semantics, syntax and pragmatics of utterances. Such things as time pressures, type and number of listeners, speech rate, and social pressures are listed in this level. The purpose of Journal Writing is to define the steps of any one child’s hierarchy in terms of the persons, places, and situations most meaningful for the child.

Level 6 is about setting personal goals. Now that the child has a better understanding of how emotional and physiological reactions, pragmatics, and fluency influence communication. He is ready to set goals for personal improvement. It is at this level that the child will select a goal and then make a plan for its accomplishment. The plan will consist of hierarchical steps. It will allow for both success and failure. In Level 6, the journal blends all that the child has learned into a strategy for becoming his own fluency therapist. The goal of this level is to EMPOWER the child.

Level 7 is devoted to advocacy. The child who stutters can learn to be his own advocate. Of course, bold and responsible advocacy on the part of his parents and clinicians is often necessary. Nevertheless, adults cannot be with a child all hours of the day. So the child must learn to command respect and educate others about stuttering (Hansen, 1998).

CONCLUSION

Journal Writing for Children Who Stutter is a way to empower children to become their own speech therapists. It helps them to think about the ways in which they communicate in terms of pragmatics, fluency, and emotional/physiological responses. Then it organizes this information with instruction regarding hierarchies, personal plans, and self-advocacy. The teaching method is a consistent, easy-to-use, open-the-book-and-do-it journal writing process that can be accomplished with a sensitive lay person or Speech-Language Pathologist. You can read a version of Journal Writing for Children Who Stutter online, or can obtain a free copy of this journal by mailing $2.00 for postage and copying costs to:

Judy Butler
169 Pine Street
Franklin, MA 02038

Bibliography

• Biagini, J. & Butler, J. (1999) Journal Writing For Children Who Stutter, p. 17
• Conture, Edward G. (1997). Evaluating Childhood Stuttering. In R.F. Curlee & G. M. Siegel (Eds.) Nature and Treatment of Stuttering: New Directions (2^nd Ed.) (p. 254). Boston: Allyn & Bacon
• Guitar, B. (1997) Therapy for Children's Stuttering and Emotions. In R. F. Curlee & G.M. Siegel (Eds.) Nature and Treatment of Stuttering: New Directions ( 2nd Ed.)
• Hansen, M. (1998) What I Taught My Teachers About Stuttering. In J. Westbrook & J. Ahlbach (Eds.) Listen with Your Heart: Reflections on Growing Up with Stuttering (2^nd Ed) (pp. 43-48) Pacifica, CA: Friends: The Association of Young People Who Stutter.
• Kelly, Ellen M. (1993). Speech Rates and Turn-Taking Behaviors of Children Who Stutter and Their Parents. In R.F. Curlee (Ed.) Seminars in Speech and Language, Vol. 14, No. 3, 203-214
• Starkweather, C. W. (1997) Therapy for Younger Children. In R.F. Curlee & G. M. Siegel (Eds.) Nature and Treatment of Stuttering: New Directions (2nd Ed.)
• Weiss, Amy L. (1993) the Pragmatic Context of Children's Disfluency. In R.F. Curlee (Ed.) Seminars in Speech and Language, Vol. 14, No. 3, 215-225