Speech Pathologists Can Help Children Who Are Teased Because They Stutter

About the presenter: Bill Murphy, a person who stutters, is a speech, language pathologist at Purdue University. He has worked for over 25 years with children and adults who stutter. Bill is a member of the National Stuttering Association, Friends, and is on the Steering Committee of ASHA's Special Interest Division of Fluency and Fluency Disorders. He has given numerous state and national presentations regarding the treatment of stuttering. Bill believes that successful stuttering therapy incorporates both the modification of speech behavior as well as emotional and attitudinal changes.

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Speech Pathologists Can Help Children Who Are Teased Because They Stutter

by Bill Murphy
from Indiana, USA

Children who stutter are often subjected to teasing from peers. Teasing may lower a child’s self-esteem, trigger weight changes as well as emotional and physical illnesses, and affect school performance (Lew, 2000). Teasing can also exacerbate stuttering behavior and reduce therapy progress.

Lew (2000) has described excellent procedures for parents to help their children who stutter deal with teasing or bullying. Speech language pathologists (SLP’s) should be at the forefront in helping children effectively handle teasing but are often hesitant to do so. This reluctance for SLPs to teach assertiveness training may come from either a lack of understanding of their role in therapy or uncertainty on how to perform such tasks. The purpose of this paper is to share with SLP’s and other interested parties therapy procedures for helping children who stutter effectively handle teasing or bullying behavior. Children often experience a cluster of negative emotions about stuttering including shame, guilt, and anxiety (Murphy, 1999). The goal of the SLP is to empower children to not only effectively handle teasing but also remediate stuttering behaviors in general. Therapy procedures should normalize or "deawfulize" stuttering. These procedures have been described in detail (Murphy, 1998). They not only help children change negative emotions and speech motor behavior, but make therapy fun. SLP’s who want to help children who stutter deal with teasing can also implement techniques that make therapy enjoyable. During the past twenty years, I have developed a two-staged approach for effectively handling teasing or bulling behavior. As a form of shorthand, I have named the steps Let’s Make A Movie and Let’s Go to Class.

Let us begin to examine the therapy techniques by first listening to the child. This can be accomplished in individual or group therapy. Typically, I hear, "Tommy’s teasing me cause I stutter" or "Susan asked me why I talk funny". Children’s reactions range from mild indignation, to tears, to anger. First, I believe it is important to identify and authenticate the children’s feelings. Brief remarks are helpful, like "Being teased about your stuttering makes you feel (fill in the blank). You must be pretty upset. Teasing doesn’t feel good." Therapy can proceed by helping children process why teasing happens. I begin the discussion by asking for the children’s input and then insert my own ideas. Typical points to be made include: Children can tease or bully when they are unhappy, scared, or have low self-esteem. Bullys often see teasing as a way of being popular or as an attempt to look tough or in charge. As an SLP, I stress to my clients that teasers are also uneducated about stuttering. Many children don’t know what stuttering is and see it as something to be called attention to, to be made fun of. This concept, that teasers are uneducated, will form the bases for the second stage of therapy, the classroom visit.

Next, I begin to help my clients’ problem solve how to effectively respond to the teaser. I start with a large piece of butcher paper and multicolored pens or crayons. The clinician dialogue goes something like this: ‘Hey, Billy, let us think of all the things you could do or say to Johnny when he teases you". I encourage the child to be as creative as possible and I never censor responses. Children’s responses range from "I want to run away and cry" to "I want to slug him in the mouth". These are recorded on the paper in different colors either in sentence form or by drawing pictures of the proposed event. Helpful, socially acceptable responses to teasing include ignoring the teaser and walking away, telling the teacher, or using humor. One SLP I know gives her business card to the client. When they are teased through imitation, "Hey y-y-y-you t-t-t-talk funny", the clients are instructed to give the card to the teaser and say, "You better go see the speech teacher, you need help" or "I’m going to tell Mrs. Chemla (SLP) to bring you to therapy". Other children respond by saying, "Oh, you better watch out or you will catch it too". Sometimes children choose the direct approach, "Don’t make fun of me, I stutter, so what". Further teasing remarks are responded to by "So what." Bill Cosby in his book, The Meanest Thing to Say (1997) tells kids to respond to teasing by saying "so" over and over. In What’s Bullying children being teased are reminded they are not the problem, the bully is. Children are told they have a right to feel safe and secure. If they are different, be proud of it because we are all different. Children are also encouraged to spend time with friends because bullys seldom pick on people if they are in a group. Teasing Hints for Children give children lots of information on who bullys are and why they bully and ways to respond to teasing. They advise children to wear a special ring and rub it whenever hurt by teasing. This "power" ring can remind them of all the things they can think or do in response to teasing. SLP’s can also help children explore the internet for tips on how to deal with teasing. This is an empowering task. The current site (Kuster) where this discussion is taking place is excellent. Another site, Band Aids and Blackboards: Focus Group on Teasing interviews children on how they handle teasing.

The problem solving continues by hanging the paper, covered by proposed responses, on the wall. Now the SLP must help the clients sort out socially appropriate responses from ones that would not serve the children well. Most important, is to have the clients choose responses they feel comfortable performing. This is not always easy; children may have difficulty visualizing new behaviors so I introduce the Let’s Make a Movie step. As we discuss teasing response options I excitedly remark, "Hey, I just realized we thought of lots of neat things to do to a bully. They’re so cool we should make a movie". Children are intrigued about the prospect of movie making and easily agree to do so. Equipment requirements are simple. A camcorder and a tripod or someone to hold the camera are all one needs. Movie scripts are kept simple. The SLP or another client plays the part of the bully. The child playing the "teasee" gets to choose what the bully will say e.g., "Hey stutter baby" and how they want to respond, choosing one of the options from the prepared list. Each video vignette is played out and recorded. To make for more fun and reduce client’s negative emotions, I encourage the selection of some socially inappropriate or ineffective responses such as hitting the bully or running away crying while wildly waving ones arms. Of course the majority of options recorded are socially appropriate so the child can experience these actions before attempting them in real life.

To further "deawfulize" the effects of teasing and to empower the clients, we proceed by having a movie premiere. Clients are encouraged to create invitations for parents, siblings, grandparents, teachers and friends to view the premiere. The event is scheduled and when guests arrive, they are served popcorn and sodas. The SLP and clients have prepared an introduction informing guests how teasing makes people feel and how they problem solved ways to respond to bullys. In my experience the "movie making" and "premiere" is always a hit with clients and their guests. Children have the opportunity to be desensitized and empowered through problem solving, choosing appropriate reactions, and emoting via movie making. Parents and other guests experience some of the same desensitization; often sharing their experiences with childhood teasing and empathizing with the clients. Again this is a way for families to normalize, "deawfulize" the common negative emotions associated with stuttering. Role-playing using the clients’ choice of socially acceptable responses will continue in therapy. The SLP should periodically check to see if clients are still teased, if they can use their option responses, and the outcome.

As I have noted, the final stage in helping children deal with teasing is called, Let’s Go To Class. It has been my experience that except for the occasional true bully, most teasing or remarks about stuttering come from children who don’t understand what the disorder is and how unsolicited comments can be hurtful. This information needs to be imparted to children who stutters. They need to know that ignorance plays a large part in other’s comments and that they have the power to educate and reduce teasing.

To set the stage for a classroom visit, I remind clients that most people who tease about stuttering do so through ignorance and lack of education. Past therapy has stressed to clients that they are the expert about stuttering and also good teachers (Murphy, 1998). Further problem solving emphasizes that each client is smart and has lots of good power to be used to teach others to be more accepting of stuttering. Since most children like to bring visitors to class, I stress we will be doing the teaching together; we are partners, both experts on stuttering. We discuss how it may be a little scary to talk to the class but being scared is all right. It reminds us that we are doing hard and important work. We further problem solve how other children might feel about the visit. Along with accepting the clients’ reactions, I emphasize that the class will probably perceive him/her as brave and maybe even "cool" being able to bring the speech teacher to class.

Ultimately a classroom visit to help a child discuss his stuttering with his classmates should be done only if the child is in agreement. For some children this is an easy task. They want their classmates to know about stuttering. For others who have been teased about stuttering or who already have negative emotions strongly attached to the disorder, desensitization work must come first. Strategies to reduce or eliminate anxiety, shame, and guilt must be implemented both in and outside the therapy room (Murphy, 1998).

Teachers and parents must understand the rationale for this experience. Even if a child has not been teased about stuttering by classmates, important skills, such as the benefit of purposeful self-disclosure, are acquired by the child in this exercise. During a conference with the teacher the general mood of the classroom is ascertained to determine whether the teacher expects interference from any particular child.

The client should be included in the planning. Does the child want to inform the class regarding specific issues? How much does the child want to actually say versus what the SLP should tell? If the child is still at a point where speech management skills are not consistent, the SLP may want to limit the child’s verbal participation to speaking parts that are short and well rehearsed.

What and how issues are discussed will vary according to each child’s needs and age level. Kindergarten children can understand concepts of bumpy or sticky speech and that it feels bad to be teased. They can learn that the speech teacher will teach how to have smoother speech, but that sometimes bumpy speech will still happen. Third and fourth graders can understand more complex explanations about stuttering, speech therapy techniques, their inconsistent success, and the ramifications of teasing. Following is a sample outline of a class visit that would be appropriate for third and fourth graders. This is only a guide and each SLP must adapt it to their own style and the developmental level of the class.

1. Introduction
   The SLP can introduce herself as the speech teacher and briefly explain her job.
2. Classroom participation
   To normalize the concept of receiving speech therapy in the classroom, ask the children how many of them have been to speech before and what they worked on. Many times a child will mention that your client is currently in speech. Acknowledge that this is true and that you will soon be discussing it.
3. Other speech problems and rationale for coming to the class
   Briefly indicate there are many types of speech difficulties, e.g. how to pronounce speech sounds, hoarse voice, etc., but today you and the client are going to focus on a problem called stuttering. Let the class know that you and the client want to teach them some interesting things about stuttering, and to educate them, because we all know how important it is to be educated people. If the SLP also stutters, this is a good time to give this information.
4. Define stuttering and it’s causation.
   Give a brief definition, age appropriate for the class. When speaking to this age level, I like to ask the kids if they know what stuttering is and summarize the discussion with something like, "stuttering is a speech problem where some people’s speech system doesn’t work very well all the time. It doesn’t seem to be as coordinated as it should. It gets tripped up or stuck on sounds. We are not sure what cause this but we think maybe some people are just born this way."
5. Famous people who stutter
   I like to ask the class if they know that many famous and successful people have stuttered and then briefly tell them about some of these people. As visual aids, one can use some of the posters depicting famous people produced by the Stuttering Foundation of America or the National Stuttering Association.
6. It’s no one’s fault.
   It is very important to stress that no one is responsible for stuttering. People don’t stutter because they are dumb or sick. Moms and Dads did not cause it and it’s not a disease that you can catch.
7. Different ways to stutter.
   Most clients, no matter what degree of speech management skill, can be verbally involved with the class in this task. The clinician and client can demonstrate different forms of stuttering behavior (repetitions, blocks). Ask for volunteers to imitate the various patterns. It can be fun, if done in a friendly manner, the client can grade attempts by classmates, e.g. A, A-, etc. The SLP should indicate this type of imitation is for learning purposes only and should not be done at other times. A class discussion should follow in which the children are asked how they would feel and act if they had to talk this way all of the time.
8. Tools that facilitate smoother speech.
   Using the linguistic level at which the child is most comfortable, the SLP and client together demonstrate the speech management techniques the child is trying to incorporate, e.g. pullouts, stretched speech, etc. It may also be helpful to ask a few of the other children in the class if they can do some of the fluency enhancing techniques, such as prolonged speech. Here the class may also begin to appreciate the level of difficulty involved in such management techniques.
9. We can’t have 100% success. Change is hard.
   It is important that both the teacher and the class recognize that speech management in conversation is difficult and the client will continue to have some hard stuttering. Change will come, but it takes time and practice. Influences that make changes difficult can be discussed. Items may vary for each child but usually include the following: being tired, competing messages (many people trying to compete at once) and fear of being teased or ridiculed.
10. Why people make fun of others and how this affects us.
    Here the SLP asks the class to share what they have been teased about. Most elementary aged children are willing to disclose this information and doing so actually creates a stronger bond among the children. I always emphasis that anyone who is willing to share something they have been teased about is very brave. It is also helpful to ask the children how teasing makes them feel and behave. Parallels can then be drawn to teasing someone about stuttering.
11. How the client wants his classmates to respond to stuttering.
    The SLP and client can talk to the class about how they can react to stuttering in a helpful manner. I have found that many elementary children actually welcome their classmate filling in words on which they are stuttering. Of course others want the listener to be patient and wait until they are able to say the word.

My experience with classroom visits has been quite successful. The children are excited about the visit and ask many questions about stuttering. Classmates readily volunteer to share their experiences with teasing and the resulting negative feelings. Follow-ups with the client, parents and teacher almost always suggest a stopping or significant decrease in teasing. Teachers and clients report that any continued teasing from other students outside the classroom is met with protective, supportive remarks from children in the client’s class, e.g. "Hey, you can’t tease Billy about his stuttering", or "it’s not nice to tease".

In summary, chronic stuttering in childhood may be met by teasing behavior from a variety of sources. Teasing cannot only exacerbate stuttering behavior but it can lower self-esteem and elicit a variety of emotional and physical problems. Parents’ can certainly be partners in helping but SLPs should be the leader in using therapy procedures to lessen the pain of being teased for stuttering. Helping clients to understand the nature of teasing, how it effects them and how to respond goes a long way in healing the negative emotions and aiding clients in beginning the recovery process.

REFERENCES

Cosby, B., (1997). The meanest thing to say. New York, NY: Scholastic, Inc.

Kuster, J. The stuttering home page, Minnesota State University, Mankato. http://www.mnsu.edu/comdis/kuster/stutter.html

Lew, Gail W., (2000). When a child is being teased. What parents can do. Advance for Speech-Language Pathologist and Audiologists, 10, 11-12.

Murphy, W.P. (1998). The school-age child who stutters: Dealing effectively with shame and guilt. Videotape No. 86. Memphis, TN: Speech Foundation of America.

Murphy, W. P., (1999). A preliminary look at shame, guilt, and stuttering. In N. Bernstein-Ratner and C. Healy (Eds.) Stuttering Research and Practice: Bridging the Gap. (pp. 131-143). Mahwah, NJ: Lawrence Erlbaum Associates.

Teasing. Teasing Hints for Children. http://funrsc.fairfield.edu/~jfleitas/teasetips.html

What’s bullying. http://www.nobully.org.nz/advicek.htm">http://www.nobully.org.nz/advicek.htm

Who ya gonna call?: The teasebusters. BandAids and Blackboards, Focus Group on Teasing. http://funrsc.fairfield.edu/~jflitas/teasing?.html