Co-occurring Stuttering and Phonological Difficulties in Children: A Model for Therapy☆

Abstract Speech-language pathologists have reported increased evidence of co-occurring stuttering andphonological disorders in their caseloads. Anecdotal reports also suggest that some cliniciansmay have uncertainties about specific diagnostic criteria as well as treatment plans for thesedual diagnosis children. Whilst there is some literature on clinical intervention for this populationof children, information is still sparse and clinical efficacy data is limited. Although futureresearch carrying out long-term treatment outcome studies is needed, some guidelines forclinicians who work with this population group are indicated at this time.A child's phonological difficulties may “mask” the perception of a fluency problem. For example,sometimes it is not until child's speech becomes more intelligible, that disfluencies make animpression on the listener. Additionally, parents of children with both disorders have beennoted to pay most attention to the speech/sound difficulties at first and not to the disfluencies.This may be due to a masking effect. Finally, these dual diagnosis children who exhibit a moresevere form of both stuttering and phonological difficulties may be experiencing a high level offrustration. This frustration may result from (1) an inability to produce forward flowing speechinherent in stuttering and (2) unintelligibility due to speech sound inaccuracy. It is impossible fora clinician to truly delineate which one of these disorders is creating more frustration. It is alsovery complex to understand the nature of speech motor control that may in fact underlie bothconditions. Nevertheless, all of these factors need to be considered by the clinician in theultimate design of the treatment program.In this seminar, a clinical intervention model is presented that offers guidelines for diagnosticand treatment plans for these dual diagnosis children. Assessment parameters are discussedin two parts: (1) assessment of disfluency, and (2) assessment of phonological abilities. Theimportance of determining suitable treatment approaches for children who exhibit co-existingdisorders is discussed. Intervention options for these dual-diagnosis children are offered.These include (1) sequential treatment, and (2) concurrent treatment, including both a discreteand blended approach. The notion of “contrasts” in both phonology and fluency therapy ispresented. Thirteen general principles for intervention with these children are provided. Theseprinciples include: (1) use of an indirect phonological process approach; (2) selected fluencyfacilitation techniques; (3) use of rate reduction; (4) reinforcing child's use of slow speech; (5)modelling appropriate turn taking and increasing pause time; (6) modelling correct articulatoryproductions and use of exaggerated postures; (7) avoiding explicit speech correction; (8)avoiding interruption; (9) focus on child's conversational content; (10) gradual increase oflinguistic/phonological complexity; (11) use of over-training strategies for transfer; (12) groupintervention; and (13) parent involvement. Seven principles for parent/caregiver involvementare provided. Finally, conclusions and suggestions for future research and treatment arepresented.