Treatment practices for stuttering have varied widely over the years. Some professionals advocated ignoring the stuttering behavior, in the hopes that it would disappear; others centered on dealing with perceived psychological problems, while still others advocated relearning the basic components of speech production. While there is no universally accepted treatment program for stuttering, the majority of clinicians would support the following statements:
- Early intervention is important and effective. When a physician identifies stuttering in a young child, or is unsure if a disfluent speech pattern is indicative of stuttering or normal nonfluency, referral to a speech-language pathologist for an evaluation is appropriate and vital. The earlier that stuttering behavior can be identified and effective treatment strategy put into place, the less likely that the child will acquire the negative emotional reactions to stuttering and experience the ensuing complications and exacerbation.
- While the high recovery rate seen in children may tempt one to advise parents to wait and see if the child outgrows the problem, there is no assurance that the child will outgrow it. For the 20% to 40% of children for whom stuttering continues into grade school and adolescent years, the lost time during the early stages of the development may significantly complicate the treatment picture.
For young children, treatment by a speech-language pathologist often includes identification of risk factors, education of the parents, management of possible environmental influences, and adjustment of speech production patterns. These strategies typically have a positive effect on stuttering and can help return the child to a normal fluency pattern.
- For older children and adolescents, treatment strategies may also incorporate much more direct work on speech production and speech management techniques, such as slowing speech rate and simplifying linguistic and speech production patterns. Some professionals may also teach self-monitoring and self-management strategies, as well as acceptance and non-avoidance of stuttering and speaking situations. Similar treatment strategies are used with adults. Treatment strategies for adults may also include pharmaceutical management of some aspects, and the use of assistive electronic feedback devices.
- From time to time, radically different treatment strategies may appear in the literature or in the media. As with treatment of anything, such strategies should be considered in light of empirical support. Speech-language professionals can often provide suggestions and guidance relative to new treatment approaches.
Who should treat stuttering? Speech-language pathologists (SLPs), licensed and certified by the American Speech-Language-Hearing Association (ASHA). Not all SLPs are comfortable with stuttering, so there has been a move toward specialization. Stuttering specialists are speech-language pathologists who have been recognized by the American Board of Fluency and Fluency Disorders (ABFFD) as having achieved advanced training and clinical skill for working with people who stutter and their families. A list of Board-Certified Specialists in Fluency Disorders (BCS-F) can be found at www.stutteringspecialists.org.
The physician can often play a significant role in the treatment process. This may include monitoring the effect that pharmacological agents used may have on the patient’s stuttering, and sometimes in various management approaches (e.g., pharmaceutical management strategies in older individuals). Physicians also serve as an important counseling resource for parents, and as a referral source for other treatment and management personnel.
Note: Original material provided by Larry Molt, PhD, CCC-SLP (Auburn University).