Educating the Educators About Stuttering

The following was part of an ASHA presentation by Crystal Cooper, Kristin Chmela, Ellen Bennett, and Victoria Williams, Creative School Programs for Children Who Stutter: Successful Strategies, presented at the ASHA Convention, November 21, 1998, San Antonio, Texas. The information below was Victoria Williams M.S.CCC/SLP's contribution to the session, and was designed to be used as an inservice in a public school setting to educate staff members about stuttering. The outline and some of the overheads and handouts from William's presentation are provided below with her permission. Speech-Language Pathologists working in a school setting are invited to adapt the workshop outline to their needs.

EDUCATING THE EDUCATORS ABOUT STUTTERING

Introduction

Discussion of Politically correct jokes
Famous People who StutterI. History of Stuttering

A. Stuttering has been recorded as a problem since people have kept a record of their lives. For example. The Old Testament describes how Moses spoke through his brother Aaron because he was "thick of tongue." We assume Moses stuttered. (Eugene B. Cooper, 1979).

B. There is evidence that the "curse" stuttering appeared in Chinese, Egyptian, and Mesopotamian cultures more than 40 centuries ago. (Peters and Guitar, 1991)

C. Stuttering affects both sexes and people of all ages, from toddlers to the elderly. Stuttering is found in all parts of the world, in all cultures, and races; it is indiscriminate of occupation, intelligence, and income. (Peters and Guitar, 1991)

II. Definition of Terms

A. Fluent Speech: That which is promptly initiated, continuously forward flowing, easy, and a coordinated activity that involves respiration, articulation, and phonation. (Martin Adams)

B. Disfluency: Refers to speech behavior and involves atypical, typical, normal, and abnormal behaviors. Children go through disfluency to achieve fluency. (Hugo Gregory)

C. Dysfluency: This involves the quantity and types of disfluent speech behaviors. Three components of the speech of a person who stutters includes the following:

1. The actual disfluent speech

2. The speaker's reactions to his disfluent speech

3. The listener's reactions to the speaker's disfluent speech. (Wendell Johnson)

D. Stuttering: Stuttering is characterized by core behaviors of abnormally high frequency and/or duration of stoppages in the forward flow of speech.

These stoppages usually take the form of

(a). repetitions of sound, syllables, or one-syllable words,

(b). prolongations of sounds, or

(c). "blocks" of airflow and/or voicing in speech.

Secondary behaviors such as gross motor movements, eye-blinks, or verbal concomitants as a result of avoiding or escaping the core behaviors occur. Feelings and attitudes can also be an important component of stuttering.

Stuttering is viewed as a disorder of neuromotor control of speech influenced by interactive processes of language production, and intensified by complex learning processes. (Peters and Guitar, 1991)

III. Development of Fluency

Handout A (Hugo Gregory) - (permission to put online not received, JAK)

Handout B (Peters and Guitar, 1991) - (permission to put online yet received, JAK)

IV. Normal Nonfluency vs. Stuttering

V. Indications from the Research Literature

A. Stuttering tends to run in families. Males run a higher risk than females to stutter; gender factor appears to be related to family history (Kidd, 1984, Ambrose, Yairi, and Cox, 1993).

B. Genetic factors confirmed by research on concordance of stuttering in identical and fraternal twins (Howie, 1981).

C. Emergence of tremor-like motor activity in children who stutter may coincide with neural maturation and development of stuttering (Kelly, Smith, Goffman, 1995).

D. Syntactic complexity has been shown to increase stuttering in young children (Ratner&Sih, 1987) but have diminished effect on stuttering of adolescents (Silverman & Ratner, 1997).

E. Poorer performance in the right ear of people who stutter when doing dichotic listening tests (Curry & Gregory, 1969; Hall & Jerger, 1978; Green & Guitar, 1987).

F. People who stutter appear to have a more dominant right hemisphere than the left hemisphere of the brain (Guitar, CSHA 1997). Cognitive stress increases the number if dysfluencies in people who stutter( Miller & Watson, 1992; Blood, Blood, Bennett, Simpson, Susman, 1997).

G. See Handout C - (permission to put online not received, JAK)

H. See Handout D - Factors Which Disrupt Fluency - (permission to put online not received, JAK)

VI. Teacher Influences

A. Teachers with a greater knowledge of stuttering demonstrated more desirable attitudes toward stuttering. This finding reinforces the theory that there is a significant relationship between knowledge of stuttering and attitudes toward stuttering (Crowe & Cooper, 1977).

B. Teachers can recognize the stuttering problem through their education about stuttering and refer the student to a qualified speech-language pathologist (Stuttering Resource Foundation, 1988).

C. Tips for the teacher

Youngsters who stutter are children who have trouble speaking. As a group they manifest no significant psychological or social differences from their normally fluent peers.
The youngster who stutters will frequently be as comfortable as the people around him/her.
Don't pretend that disfluencies don't exist. Point out your own "bumpy" speech. Don't use the word stuttering unless the youngster who stutters uses that word to describe his/her own speech.
Stay away from saying: "Think before you speak" "take a deep breath" "stop and start over" "just relax"
Have patience, keep your eye contact, and let the child complete what he/she is saying; stay away from filling in the words or supplying the answers.
Model slow speech. A slower rate can have a positive influence on the entire class.
Be aware of speaking techniques that the youngster is using to increase fluency and/or to be in charge of his/her stuttering:
Be involved with the youngster's fluency program so you can assist with the carry-over in the classroom.
Stuttering moves in cycles. During a tense cycle, choral speaking and reading are techniques to use to encourage fluency.
Have a predictable/organized class. This helps the student not to worry about what will be next, etc. Lack of organization encourages tension.

(Many of these suggestions are from: The Stutterer in the Classroom: A Guide For The Teacher; Stuttering Resource Foundation, 1988)

(The following suggestions were provided by a high school client of the presenter, who wanted his teachers to know the following information. They were presented by the client on a video. Such an exercise may be adapted for your presentation as well.)

Suggestions for Teachers: A Student's Perspective

Awareness of types of stuttering is important
1. Block at diaphragm: no sound is heard.
2. Block at the throat: sound is heard, but vowels are not enunciated.
3. Block at the lips: all consonant sounds get trapped and can't be shaped correctly.
Rate of speech should be slower. The pace of the classroom is determined by the teacher. When the teacher has a slower pace by students tend to speak using a slower pace. This will allow the class to speak more fluently!
Organization of the classroom schedule is important. If the teacher is disorganized, the youngster who stutters perceives it and this can weaken the student's trust in the teacher; decreasing a smooth running class as well as decreasing fluency.
Attendance is important for the maintenance of the classroom rhythm. A substitute can break the flow. It is essential for the substitute to be aware of students who stutter in your class.
Take time to know the student. Create a bond. Find common interests that could be used in teaching as well as in conversation. This helps to encourage fluency.
Stuttering is a speaking problem. . . not a problem with intelligence.

RESOURCES

Ambrose, N.G.,Yairi, E., Cox, N. (1993). Genetic aspects of early childhood stuttering. Journal of Speech and Hearing Research, 36, 701-707.

Bernstein-Ratner, N. & Sih, C. (1987). Effects of gradual increases in sentence length on childrens disfluency. Journal of Speech and Hearing Disorders, 52, 278-287.

Blood,G.W., Blood, I.M., Bennett, S., Simpson, K.C. Susman, E.J. Subjective anxiety measurements and contical responses in adults who stutter. Journal of Speech and Hearing Research, 317, August, 1997.

Carlisle,Jock A. TANGLED TONGUE: Living With A Stutter (1985), Reading, MA: Addison - Wesley.

Cooper, Eugene B. (1979). Understanding Stuttering. Information for Parents. The National Easter Seal Society.

Crowe, T., Cooper E. (1977). Parental attitude toward and knowledge of stuttering. Journal of Communication Disorders;10, 4, 343- 357.

Dietrich, S., Gottwald, SR., Tardelli, MN., Guitar, B. (1997). Diagnosis and Treatment of Children Who Stutter: Practical Strategies. Stuttering Foundation of America New England Workshop.

Gregory, H. & Hill, D. (1980). Stuttering Therapy for children. Seminars in Speech, Language, and Hearing,1, 351 -364.

Guitar, B (1997). Workshop on Stuttering. Connecticut Speech-Language and Hearing Association.

Howie, P. (1 981). Concordance for stuttering in monozygotic and dizygotic twin pairs. Journal of Speech and Hearing Research, 24, 317-321.

Kelly, E.M., Smith,A., Goffman,L. Orafacial muscle activity of children who stutter: a preliminary study. Journal of Speech and Hearing Research,38,1025-1036,1995.

Kidd,K. (1984). Stuttering as a genetic disorder. In Curlee & W.Perkins (eds.). Nature and treatment of stuttering (pp.149-1 69). San Diego: College-Hill.

Peters,T.J. and Guitar B. (1991). Stuttering: an integrated approach to its nature and treatment. Baltimore,MD: Williams & Wilkins.

Silverman,S.W., & Bernstein Ratner,N. (1997). Syntactic complexity, fluency, and accuracy of sentence imitations in adolescents. Journal of Speech, Language, and Hearing Research,40, 95-106.