# Speech-Language Pathology/Stuttering/School-Age Stuttering

Ask your child whether he or she likes school. In first and second grade, girls see school as where they socialize with their friends, via quiet verbal communication and cooperation. In contrast, boys see school as where they're told not to play with their friends, via physical interaction such as running around or showing off their physical abilities. This difference makes school more stressful for boys, with effects on their speech.

## Why Do More Boys Than Girls Stutter?

Among preschoolers, boys who stutter outnumber girls who stutter about two to one, or less.
But more girls recover fluent speech, and more boys don't. By fifth grade the ratio is about four boys who stutter to one girl who stutters. This ratio remains into adulthood.
Why boys are more likely to stutter, and less likely to recover, isn't certain. Boys generally have more diseases and disorders, for reasons having to do with the Y chromosome. Boys generally have more speech disorders because girls are better at speech and language, and especially at using speech and language for social purposes. Speech and language are more stressful for boys, so boys prefer to interact physically.
At five for girls and seven for boys, children's brains go through a massive adrenaline shift. After this shift, the child is able to socialize with other children in groups. Before this age, playing with more than one or two friends can be a stressful experience.
This was apparent to me at my nephew's sixth birthday party. One of his presents was a slinky. I showed his friends how to make the slinky walk down stairs. Three girls sat together at the top of the stairs and took turns. One girl could easily make the slinky walk down the stairs. This was harder for the second girl, but she could do it. The third girl couldn't do it at all. But they cooperated and encouraged each other. Two boys wanted to try it. But they couldn't get to top of the stairs without wrestling each other and falling back down the stairs. I wouldn't allow wrestling on the stairs, so they'd run around the living room chasing each other. Then they'd come back to play with the slinky, but start wrestling on the stairs again.--Thomas David Kehoe 02:10, 28 March 2006 (UTC)
At five, girls are ready to start school. Boys are wild animals until seven. School can be stressful for boys who aren't ready for school. The most stressful part of school for boys may be the communication demands. Girls are using communication to make friends. Girls' communication skills and social skills develop together. In contrast, boys may not be ready to socialize with 25 other children, in a building with hundreds of other children. Some children are in school and day care for twelve hours, without time to relax or to be alone&#151;that'd stress me out!
If your five- or six-year-old son stutters, and you don't think he's ready for school (e.g., he vomits or wets his pants at school), consider keeping him home another year, or look into a co-op school where a parent can attend school with him, or let him attend school but don't put him in daycare for another six hours each day.

## SLPs vs. Parents vs. Computers

A large study found that speech-language pathologists training parents to do speech therapy with their children was more effective than the speech-language pathologists doing therapy with the children. The study also found that computer-based stuttering therapy, with minimal involvement from speech-language pathologists, was the most effective treatment of all.
A study of 98 children, 9 to 14 years old, compared three types of stuttering therapy. The three types of therapy were:
* Intensive "smooth speech" fluency shaping trained relaxed, diaphragmatic breathing; a slow speaking rate with prolonged vowels; gentle onsets and offsets (loudness contour); soft articulation contacts; and pauses between phrases. The children did this therapy in a speech clinic for 35 hours over one week.
* Home-based "smooth speech." This was similar to the first group, but parents were included, and encouraged to continue therapy at home. Therapy was done in a speech clinic for six hours once a week for four weeks (24 hours total).
* Electromyographic biofeedback. The children used an EMG biofeedback computer system about six hours a day for one week (30 hours total). The EMG system monitored the child's speech-production muscle activity. The children were instructed to tense and then relax their speech-production muscles. The goal was to develop awareness and control of these muscles. The children then worked through a hierarchy from simple words to conversations, while keeping their speech-production muscles relaxed. After mastering this while watching the computer display, the children did the exercises with the computer monitoring but not displaying their muscle activity. The speech pathologists did relatively little with the children: "Constant clinician presence was not necessary as the computer provided feedback as to whether the child was performing the skills correctly."
A fourth (control) group didn't receive any stuttering therapy.
At the end of each therapy program, all three therapies reduced stuttering below 1% on average. The control group had no improvement in fluency.
One year after the therapy program, the percentage of children with disfluency rates under 2% were:
* 48% of the children from the clinician-based program.
* 63% of the children from the parent-based program.
* 71% of the children from the computer-based program.
The results for children with disfluency rates under 1% were even more striking:
* 10% of the children from the clinician-based program.
* 37% of the children from the "parent-based" program.
* 44% of the children from the computer-based program.
I.e., the computers were most effective, the parents next most effective, and the speech-language pathologists were least effective in the long term. At the 1% disfluency level, the computers and the parents were about four times more effective than the speech-language pathologists.
Four years later, all three groups had average stuttering reductions between 76% and 79%. This may have been due to the more dysfluent children receiving additional speech therapy.

## Motivation for Speech Therapy

The father of a ten-year-old stutterer wanted to do everything to help his son. On the advice of his son's speech-language pathologist, the father bought a top-of-the-line electronic stuttering therapy device. The speech-language pathologist trained the father to use the device. The father worked with his son thirty minutes every evening.
After two months, the father returned the device for a refund. The son was 100% fluent when practicing with the device. The kid had no interest in using slow, relaxed speech the rest of the day. Stuttering didn't stop the boy from playing baseball or doing other things boys do. In the world of seven- to twelve-year-old boys, talking isn't an important activity.
But your seven- to twelve-year-old son's good self-esteem can be a double-edged sword. It's hard to get school-age boys motivated to do speech therapy. This makes it more important that parents do speech therapy with their child in every conversation. Ask your child's speech-language pathologist what your child should be doing (e.g., slow speech with stretched vowels). Have your child use therapy skills on every sentence he says to you. Be your child's therapy helper.

## Advice for Parents, by Magdalene Lima, SLP

I am a speech-language pathologist in private practice and formerly a public school therapist for nine years. My suggestions to parents of children with speech problems are:
* Do some research in these areas. Check out the communication disorders websites.
* Go to your school speech-language pathologist with what you know and ask her what she thinks. The best approach is to treat her as the professional she is in a non-critical way with the attitude that you just want to understand all the treatments available for your son. Offer to help get information to her if she doesn't have it. Let her know you understand the position she is in and that you are on her team. This will get you much further in getting the appropriate services for your child than fighting your school.
* If your insurance covers it or you have the funds, find a good private pediatric speech and languageclinic in your area and AT LEAST have an evaluation done. Just that information alone could really help the school SLP. If you can afford private therapy, get it. The main difference in service is that your child will receive individual therapy with a clinician that has the time and resources needed to provide the highest quality therapy.
As a former school speech-language pathologist, my skills and knowledge didn't suddenly change when I switched over to private practice. The setting changed, and that makes a huge difference. I now serve 30 clients rather than 75, I see them all individually, and I am paid more than in the schools. In the hours I don't see clients, I am busy researching, giving parent support, writing regular and detailed reports, and planning innovative therapy rather than going to bus duty, lunch duty, hall duty, faculty meetings that don't really apply to me and filling out massive amounts of government-required paperwork.

### Is The Problem Ability or Setting?

Now to those of you who think the worst of the public school speech-language pathologist: I'd like you to stand in her shoes for a minute. In the last three years of my public school experience my caseload became unmanageable. I had 75 students, including a severely and profoundly handicapped class, four autistic students and all other students in speech from grades K-5 at that school. I begged, cried and pleaded for help from my supervisors. I KNEW I could not provide the quality of service each and every one of these students and their families deserved. However, the answer was always: get creative, we don't have money in the budget. Please understand, in my situation, it was not a lack of caring, lack of skill or ability&#151;there was absolutely nothing I could do. I became angry and frustrated at our administration. Why didn't they provide the training, time, personnel and support we needed to provide services to these students?

### Speech Pathology: A Growing and Diverse Field

The disorders in our field and the therapies that have now been developed have become extremely specialized. In the schools I was expected by parents to be an expert in the following fields: stuttering, swallowing disorders, voice disorders, articulation disorders including tongue thrust, cleft palate, phonological process disorders as well as motor speech disorders, autism and PDD, traumatic brain injury, ADHD, language and learning disabilities, hearing impairments and social and pragmatic communication disorders. Excuse me, do you realize that just as physicians receive a basic foundation in medicine, so do speech-language pathologists receive a basic foundation in all of the above disorders. You graduate from college and through your experience and personal growth and research, you become an expert in a few areas. It would be virtually impossible for one person to have the time and energy it would take to become an expert in all those areas!
This is why our field is moving towards specialty certifications. What will public schools do then? I guess they will have to hire the specialists that their individual students require.

### Many and Varied Problems in the Schools

More and more our district began hiring speech assistants (speech practitioners who are not required to meet the standards of education, clinical practicum and experience needed to be fully certified and licensed) to handle huge caseloads with minimal supervision from licensed speech-language pathologists. There is a shortage of qualified speech language pathologists willing to go into public school therapy when there are much more lucrative and attractive positions available in other settings. As I talked with administrators, I soon became aware of the pressure being applied to them from the state, parents and other agencies to meet all these educational requirements. For every parent who complains there is not enough money to provide quality special education services in the school, there is another parent complaining that their gifted and talented child is not being given the education THEY deserve because of all the money being poured into special education programs. Or what about the parents of children in sports programs, they have THEIR list of complaints. Everyone thinks that their cause is totally justified because they are arguing for their children, and nothing can convince anyone that their child doesn't deserve the best.
I left the public school system to go into private practice and now my problem is solved&#151;I love my work and I'm giving quality services to clients with fantastic results! However, what's your solution? My final and personal resolution to this whole issue, is that in many cases&#151;not all, but many&#151;I truly feel that schools are doing the very best they can with the resources available to them to provide the services that our children need. However, sometimes, parents are right, it's not enough. So what are we going to do? Is every parent in America with a complaint going to file suit against the local school district? If this happens, our schools will begin focusing on preventing lawsuits rather than on how best to serve and educate our children.

### Work With Your Administration/Educators

Sometimes all it takes is going to an administrator, such as the Director of Special Education, and pleading your case. Also give your specific suggestions at your child's IEP meeting. You'd better have some research and documentation to back up the necessity of your suggestions. The attitude and manner in which you present yourself is of utmost importance, if they perceive you are willing to make compromises and work with them they will be more willing to stick their neck out for you. Suggest specific things such as the district paying for an outside assessment, or hiring a consultant temporarily who can lend their expertise to your child's case. Get over any intimidation you feel in asserting yourself with these people, they are just people with children and jobs and stresses just like you. What they say to you is never written in stone.

### Conclusion

I'm not saying you shouldn't fight extreme injustice or abuse. I'm saying it's a huge system with a lot of variables involved. The fight is societal and governmental&#151;usually not your local educational facility. Become involved politically in your state with your speech and hearing association&#151;they always have a branch that is lobbying for legislation to improve speech services in the schools. Meanwhile, you have a child that has needs for quality services in the area of speech pathology, do the best you can to get that service, whether it be private therapy through insurance or private pay, or school therapy, don't stop looking until you find what you need.
YOU take responsibility to research, learn things for yourself and communicate with those who affect your child's education.

## References

* ^ Yairi, E, & Ambrose, N. (2005). Early childhood stuttering. Austin, TX: Pro-Ed, Inc. Kloth, S., Janssen, P., Kraaimaat, F. & Brutten, G. (1995). "Speech-motor and linguistic skills of young stutterers prior to onset." Journal of Fluency Disorders, 20, 157-170.
* ^ Yairi, 2005; "On the Gender Factor in Stuttering," Stuttering Foundation of America newsletter, Fall 2005, page 5.
* ^ Craig, et al., 2002; Craig, A. Tran, Y., Craig, M., & Peters, K. (2002). "Epidemiology of stuttering in the communication across the entire life span." Journal of Speech, Language, and Hearing Research, 45, 1097-1105.
* ^ Craig, A., et al. "A Controlled Clinical Trial for Stuttering in Persons Aged 9 to 14 Years" Journal of Speech and Hearing Research, 39:4, 808-826, August 1996.
* ^ Hancock, et al. "Two- to Six-Year Controlled-Trial Stuttering Outcomes for Children and Adolescents," Journal of Speech and Hearing Research, 41:1242-1252, December 1998.