Do you feel like your child might have a stuttering problem? How can you tell the difference between normal developmental disfluencies and a real fluency disorder? The Stuttering Foundation has TONS of resources you can check out to learn the difference. Take a look at this article, and then observe your child's speech to get an idea of what might be going on. If you are still unsure, consult a speech therapist and get your child evaluated.
Here are some tips on helping your child's stuttering difficulties in his/her natural home environment. Since speech therapy services are usually given between 2-3 times a week, it is crucial that you are working on these strategies at home as well. Carrying over strategies is essential for helping your child generalize to their natural environment and, ultimately, progress.
1. SLOW, EASY, SMOOTH SPEECH
What is slow, easy, smooth speech? Exactly what it sounds like! Teach your child to speak at a slower rate, with easy onsets (no hard stops or contacts), and smoothly (eliminate as many "bumps" as possible). It is very important that your child understands the difference between slow, easy, smooth speech, and fast, hard, bumpy speech. If they understand how to identify and even "model" the differences, they will be much more aware of their speech and how to use the correct model. Start by modeling the different types of speech and having your child identify the correct type of speech you're using. Then, you can quiz your child by having them model each type as well, using different vocabulary words. Once they have mastered this, you can practice using slow, easy, smooth speech during fun games, functional activities, and even designate 20 minutes a day of ONLY using slow, easy, smooth speech.
2. REDUCING SECONDARY BEHAVIORS
Secondary behaviors are the behaviors your child uses to avoid bumpy speech, or stuttering. It is often caused by tension in the body or anxiety during stuttering. Some examples include blinking, hand movements/gestures, irregular breathing patterns, etc. To help alleviate this, you must make your child aware of which secondary behaviors they are using. The first step is ALWAYS awareness. Have your child engage in a speaking activity (i.e. games, answering questions, imitating words, reading passages or sentences). Then, ask your child to relax his/her body as much as possible and try not to move while speaking. Following each sentence or word, ask if they felt any part of their body moving. You can print a blank picture of a shape of a body, and have your child mark the part that moved. Then, have them repeat the activity while eliminating this movement. Over time, this will allow your child to become more aware of their secondary behaviors and will help him/her to decrease tension and anxiety.
3. DEALING WITH EMOTIONS: SELF-RATING SPEECH
At the beginning and end of each speech therapy session, I like to ask the child how they are feeling: happy, sad, mad, or normal. I post an emoticon in every corner of the room and ask them to run to the corner that identifies how they are feeling. You can print any simple emotions chart and ask your child to point to how they are feeling before you practice slow, easy, smooth speech. Get your child comfortable with letting you know how they feel. Emotions are one of the most important components of stuttering. You can also have your child rate how they thought they did on a simple 3-point scale to increase awareness and feel in tune with their progress.
-Use increased pause time and reduced time pressure. Wait a few seconds while turn taking in conversations with your child to allow them to finish their idea. Never interrupt them.
-Use strategic words to reduce pressure during communication. Ask less questions. Use words such as "maybe", "I bet", "I wonder", "It sounds like".
-Rephrasing while modeling slow, easy, smooth speech. For example, if your child says "I want to have a cookie" with bumpy speech, you can respond with "Oh, you want to have a cookie!" while modeling slow, easy, smooth speech.
Now you have some of the simple tools to help your child carryover the skills they've learned in speech therapy to the home setting! Remember, maintaining these skills and practicing as much as possible will help your child's progress significantly. Happy practicing!
Do you suspect that your child may have a speech and/or language delay? Has your child's teacher or pediatrician expressed concerns that your child is not meeting his or her speech/language developmental milestones? Here are some steps to take for finding the right help:
1. Do your own research
Become familiar with what the expectations are for a child's speech and language developmental milestones. If you simply go on the internet and Google "developmental milestones" or "speech and language milestones", there are many websites, charts, and handouts you can find that map out the chronological age that your child should be meeting each milestone. Be sure to gain knowledge about your child's development from credible resources. This will give you a good idea of whether or not you think it's time to seek speech therapy.
2. Find a speech therapist and schedule an evaluation
Find a local speech therapist (try to find one that a friend recommends or a doctor refers you to) that is in network with your insurance, unless you are willing to pay private pay. Some therapist accept clients even if they are out of network- ask your therapist if they accept out of network clients and if they are able to provide you with a Superbill for insurance reimbursement. Find out how much your insurance covers for the initial evaluation. Do your research when choosing a speech therapist and ensure that whoever you choose is qualified (the speech therapist should be licensed in your state and have a M.S. in Speech-Language Pathology). He/she may also have CCC's, which means the therapist is certified by ASHA (the American Speech-Language and Hearing Association). Pricing for therapists differs depending on the specific skills of the therapist, level and extent of experience, and geographic area. Keep in mind there are many different settings in which your child may receive services, such as in a clinic, at school, or right in your home. Call the clinic or therapist when you are ready to schedule your appointment. Typically, you will be asked for some general background information about your concerns over the phone.
3. Fill out intake form
Prior to your evaluation, you will likely be asked to fill out an intake form either online, or in person right before your appointment. This intake form will include questions about your child's speech and language development, pertinent medical history, progress in school, social development, and your primary concerns. Be as detailed as possible in your explanations and expressing your concerns. The more detailed you are, the more it will help your speech therapist select the appropriate tools for assessing your child's speech and language. It is important to specify whether your child's problems are with speech (incorrect pronunciation of sounds, such as "sop" for "stop"), or with language (difficulty following directions and identifying objects/things, limited language output). You may also be asked to fill out and sign contracts/paperwork for your speech therapist to keep on file. This will outline the services that will be provided, methods of payment (i.e. insurance, private pay), and what's expected of the therapist as well as the parents and child.
On the day of your evaluation, make sure your child is well rested. You may bring snacks and toys that your child likes--this will encourage more talking, and will give the clinician a better evaluation of where your child's speech/language is in development at this time. If your child is sick, it is better to cancel and reschedule for another day. Let the clinician know if something is going on with your child that is out of the ordinary on that day (it's important for the clinician to get a clear snapshot of what your child's speech/language is like on a typical day). Bring something to entertain yourself or keep yourself occupied! An evaluation can take anywhere from 1-1.5 hours. You may be asked to leave the room, if the child is distracted (some children do better when they have their parent in the room to interact with, and some become more distracted--this all varies from case to case). Remember: formal assessments are very strict with the amount of "clues" the clinician is allowed to give, so during the formal assessment portion of the evaluation, try not to interject (this may impact the results, and we want the most accurate results).
5. After the evaluation
The evaluation may take from a couple days to a week to go over, score, and generate a report and plan of care-- do not expect the results right away. However, usually the clinician discusses his/her general impressions right after the evaluation so the parent/client has an idea of how they did on the test (especially since part of the evaluation is informal observations). You may set up a time to meet in person or over the phone to discuss results as well--make this appointment ahead of time. The therapist may suggest referrals to other disciplines, such as behavior therapy, occupational therapy, or physical therapy. If speech and/or language therapy is recommended, the clinician will write up a plan of care that includes the type of services that will be provided as well as a list of the goals for your child. This will also include the duration and frequency (how long the plan of care will last for before we consider discharge from therapy or re-evaluation, and how many times a week and how many minutes your child will be seen). Once this is approved by the doctor and/or insurance company, you can schedule your first session!
I hope this outline of the steps necessary to initiate speech therapy answers some of your burning questions or concerns! This step by step process may vary from client to client, so ask your doctor or referred speech therapist if you have further questions about this process as well as the pricing that will go along with it.