Component 12

COMPONENT 12. PARENTAL INVOLVEMENT

Rationale:

As the child is in therapy only two-three times weekly, the parents must involve themselves in the treatment process to assure maximum progress. Parental communicative style and communicative feelings of guilt, fear and anger must be dealt with through the therapeutic process.

Research:

Conture (1990) - "All the good that is done in therapy can be offset, in a relatively short time, by parents who cannot, or will not, understand their role in their child's speech development. "

Gregory (1991) - feels strongly that parents need to understand the stuttering problem, its variability, factors associated with this variability, and how the child responds to fluency disruptions.

Gregory & Hill (1993) - success of the therapy depends to a great extent on the commitment of parents.

Kelly and Conture(1991) - stuttering results from complex interactions of constitutional and environmental factors. Intervention with children who stutter should include attention to these factors. Therefore, establishment of parent-child fluency groups may provide an opportunity for clinicians to assist parents in better understanding the disorder and ways they can help their child.

Perkins (1992) - implies that parents are part of the environment that maintains the child's disfluent speech; therefore, their direct involvement in working with the child is critical to effective treatment.

Ramig (1993) - "Involving parents in the intervention process is an important step toward facilitating the changes for improvement in the young child who stutters" (pg.226).

Botterill, Kelman & Rustin (1991) - stuttering arises out of a complex interplay between the child's environment and the skills and abilities the child brings to this environment. Intervention programs should incorporate a dimension of environmental change that will facilitate fluency development.

Van Riper (1973) - "parents feel a profound sense of guilt".

Wall and Meyers (1984) - "it's important to assure parents they did not cause the stuttering; also, there are many things they can do to enhance fluency".

Zebrowski and Schum (1993) - Discuss the counseling aspects involved when working with children who stutter and their families. Acknowledging the attitudes, beliefs, and feelings of the family unit is an important component to the intervention process.

Activities/Techniques:

1. Several parent-clinician conferences should be scheduled. During these conferences, parental fears, guilt and anger should be assessed and managed appropriately. Parents must be given the time and freedom to express their feelings.
2. Discuss normal disfluency and normal language development, focusing upon the following developmental areas necessary for the production of fluent speech:
   1. motor coordination and timing
   2. linguistic and cognitive knowledge
   3. emotional maturity
3. View the film "Stuttering and Your Child" (Speech Foundation of of America, 1977) with the parents, providing feedback and answers to any questions which may result.
4. Ask parents to assess how they are responding to their child's dysfluencies. Present Cooper's Parent Attitudes Toward Stuttering Checklist (Cooper, 1986) or Zwitman's Child Management Questionnaires and Checklist (Zwitman, 1978). These checklists are helpful to facilitate parental awareness and change.
5. Explain the importance of parental involvement. Be sure to provide concrete examples of how parents can become effectively involved in the therapeutic process.
6. View the film "Prevention of Stuttering - Part II" (Speech Foundation of America). When their child stutters, he/she can detect the listener's reaction through both their words and their non-verbal actions. If the child detects negative feelings, the result may be a negative attitude about himself/herself, their speech, or both. This may cause the child to stutter more severely and more frequently. Therefore, it is important for the parent to react the same for both fluent as well as dysfluent utterances from the child. An increase in attentiveness when the child stutters may reinforce the behavior.
7. The clinician can assist the parents in structuring a "talking time" (Botterill, Kelman, & Rustin, 1991) in which the parents make a commitment to spend three, four or five minutes: four, five or six times per week playing with their child. This should be done in a quiet room as to not allow for any interruptions. During this "talking time", the parents do not make any demands or comments on the child's speech. Listening to the content of the child's message is the primary emphasis. If parents are unable to complete this assignment (over a two week period), the clinician should discuss with them their role in the therapy process and factors which influence speech change.
8. Early in the intervention process, the parents should become familiar with the speech model used with their child. Often, the clinician will instruct the parents to slow their speaking rate. However, this task is not as easy as it appears. Parents also need to practice with the clinician as to ensure consistency between the therapy model and home model. This inclusion, even if brief or periodic, assists in increasing the parents understanding of how difficult changing speech patterns can be and will aide in the therapy program.
9. Establishing evening "Parent Support Group" meetings for parents of children who stutter is one way to reach out to parents who cannot attend in-school therapy sessions. Bennett (1990) discussed how one school district organized such meetings, with baby-sitters and translators, in order to train parents on issues around the disorder of stuttering, environmental factors which influence one's speech, and treatment considerations. This atmosphere also provides parents with an opportunity to share their feelings and attitudes with other parents in an accepting, warm environment.
10. Provide the parents with information they can take home. Booklets and pamphlets are invaluable sources of information. The following are suggested reading for parents and teachers:
    1. "If Your Child Stutters: Speech Foundation of America A Guide for Parents" P.O. Box 11749 Memphis, TN 38111 (800) 992-9392
    2. "A Brochure for Parents John Ahlbach of Children Who Stutter" National Stuttering Project 1269 Seventh Avenue San Francisco, CA 94122 (415) 566-5324
    3. "The Stutterer in the Ellin S. Rind, M.S. Classroom" Stuttering Resource Foundation 123 Oxford Road New Rochelle, NY 10801 (914) 632-3925
    4. "To the Parents of the Peter R. Ramig, Ph.D Nonfluent Child" Dept. of Communication Disorders and Speech Science University of Colorado Campus Box 409 Boulder, CO 80309 (303) 492-3049
    5. "To the Teacher of the Peter R. Ramig, Ph.D - as above Nonfluent Child"
    6. "Does Your Child Stutter?" Peter R. Ramig, Ph.D. - as above
    7. Stuttering and Your Stuttering Foundation of America Child: Questions and P.O. Box 11749 Answers Memphis, Tennessee 38111 (800) 992-9392