Stuttering therapy

Stuttering therapy is any of the various treatment methods that attempt to reduce stuttering to some degree in an individual. Stuttering can be a challenge to treat because there is a lack of evidence-based consensus about therapy. Some believe that there is no cure for the condition, and experts have argued that the preferred treatment outcome is one that involves satisfaction on the part of the stutterer, with both his communicative performance and the therapy process. While there is disagreement about acceptable treatment outcomes from stuttering therapy,] a wide range of methods have been developed to treat stuttering, and these have been successful to varying degrees.
Goals
In general, stuttering therapy aims to reduce stuttering to some degree in an individual, although there is disagreement about acceptable treatment outcomes from stuttering therapy. Some believe the only acceptable therapy outcome is a significant reduction in or total elimination of stuttering, others believe that speech which contains some stuttering, as long as the stuttering has become less tense and effortful, is just as acceptable, and yet others believe that the most important therapy outcome is the increased confidence a person has in his or her ability to talk, whether or not stuttering continues to be present. Additionally, the many different methods available for treating stuttering, and a history of promoting unsuccessful treatments, have left both stutterers and clinicians confused and frustrated about what can be accomplished with stuttering treatment.
In 1997, experts argued that in the case of a stutterer seeking professional treatment from a clinician, the "preferred treatment outcome" is that the stutterer will demonstrate feelings, behaviors, and thinking that lead to improved communicative performance and satisfaction with the therapy process. They argued that the criteria for a treatment to be viewed as successful includes the stutterer being satisfied with her therapy program and its outcome, feeling that she has an increased ability to communicate effectively, feeling more comfortable as a speaker, and believing that she is better able to reach her social, educational and vocational goals.
Robert W. Quesal, an associate professor who teaches courses in fluency disorders, anatomy, and speech and hearing science, defined successful stuttering therapy as one that leads to a change in speech fluency, a reduction in the impact of stuttering on an individual's life, and an increased acceptance of stuttering on the part of the stutterer; and J. Scott Yaruss, Ph.D., an assistant professor of Communication Science and Disorders at the University of Pittsburgh, suggests three instruments for clinicians to use to document changes in the stuttering of their clients: the reaction of the stutterer to the fact that she stutters, how much stuttering interferes with the stutterer's ability to perform daily tasks, and the impact that stuttering has on the client's ability to pursue their life goals.
Approaches
There are many different approaches to stuttering therapy. While some believe that there is no cure for the condition, stuttering can be reduced and even eliminated with appropriate timely intervention, and various therapy methods have reduced stuttering in individuals to some degree. In any case, for all persons who stutter, the successfulness of speech therapy depends on the combination of education, training, and individualized treatment provided.
For a child that stutters, the focus of treatment to prevent the worsening of the condition, and families play an important role in the process. Successful elimination of mild stuttering is likely when treatment is initiated before four years of age. For those who have more advanced forms of stuttering and secondary behaviors, therapy is generally a variation or combination of two approaches: a fluency-shaping technique that replaces stuttering with controlled fluency, and stuttering modification therapy, which focuses on reducing the severity of stuttering.
Therapy for children
Treatment of mild stuttering in children younger than six years of age focuses on the prevention or elimination of stuttering behaviors. Families play an important role in the management of stuttering in children: therapy is usually characterized by parental involvement and direct treatment, and providing an environment that encourages slow speech, affording the child time to talk, and modeling slowed and relaxed speech can help reduce stuttering.
For example, the Lidcombe Program, which has become prominent in recent years and is effective in preschoolers who stutter, involves a parent or some significant person in the child's life being trained and delivering treatment in the child's everyday environment. In the program, family members are to provide an environment that encourages a child to speak slowly, and one in which the child receives praise for fluent speech in the child’s daily speaking and, occasionally, correction of stuttering. Some of the most effective preschool intervention programs call for direct acknowledgment of stuttering in the form of contingencies such as “that was bumpy” or “that was smooth.”
Several organizations organize summer programs for children, including summer camps, to help treat stuttering. These programs offer a range of services from providing a fun outdoor experience in a nurturing and supportive environment that is free from ridicule, to providing "intensive work on communication skills". Ellen M. Bennett, an assistant professor who has practicing speech therapy for at least 18 years, encourages "public school therapists to advocate for the establishment of summer programs" for children who stutter.
Fluency shaping
Fluency shaping therapy focuses on changing all the speech of the person who stutters, and not just the portions of speech in which he or she stutters. This type of therapy involves teaching the stutterer to use a speaking style that requires careful and prominent self-monitoring; examples of such therapy include one in which the stutterer slows his speech down and smoothes out all his words, and one in which the physical mechanisms used in the speech production are retrained. Fluency shaping therapies do not address attitudes, feelings, and self-concept issues under the assumption that eliminating the stuttering will eliminate these issues. Proponents of this type of therapy believe that the outcome of any therapy depends directly on its focus:"if clinician and client focus on changing stuttering, they'll get stuttering; if they focus on changing fluency, they'll get fluency". This type of approach can reduce stuttering, although in children its effectiveness decreases if stuttering persists after eight years of age; Woody Starkweather, as at 1998 a Professor of Communication Sciences, asserted that in his experience this type of therapy improves speech only when used with other techniques.
Certain devices, known as fluency-shaping mechanisms, use this approach in an attempt to reduce stuttering. For example, delayed auditory feedback devices encourages the slowing down of speech by replaying the stutterer's words. The stutterer is then forced to slow her rate of speech to prevent distortions in the speech that is heard through the device. The effectiveness of such devices varies with stuttering severity.[3]
Stuttering modification
Stuttering modification therapy, also known as traditional stuttering therapy, was developed by Charles Van Riper between 1936 and 1958. It focuses on reducing the severity of stuttering by changing only the portions of speech in which a person stutters, to make them smoother, shorter, less tense and hard, and less penalizing. This approach attempts to reduce the severity and fear of stuttering, and strives to teach stutterers to stutter with control, and not to make the stutterer fluent. Therapy using this approach tends to recognize the fear and avoidance of stuttering, and consequently spend a great deal of time helping stutterers through those emotions, This approach generally does not eliminate stuttering events, but it helps minimize the impact and occurrence of stuttering. Since its creation, many clinicians have improvised on Charles Van Riper's basic stages and strategies. The stages of Van Riper's therapy can be summarized up in the acronym MIDVAS:
1. Motivation
The person who stutters needs to assess his motivation for seeking therapy, and the speech-language pathologist (SLP) needs to help the person build and maintain the motivation necessary for successfully changing speech behaviors and attitudes.
2. Identification
In this stage the client and clinician identify all of the behaviors, feelings, and attitudes that go along with the person's stuttering.
3. Desensitization
Van Riper designed this stage to help drain away the negative emotions, the fears, and the anxieties associated with the act of stuttering. The most common strategy used in this phase is called voluntary stuttering, in which the person stutters on purpose.
4. Variation
The individual is now able to change how he stutters and his reactions to the stuttering; he learns how to stutter differently in this phase. For example, if the person usually prolongs the initial "s" in "sister", the SLP may have him repeat the sound or stutter on a different sound in the word.
5. Approximation
The individual now learns specific strategies to smooth out and minimize the moments of stuttering. The three most common strategies for altering the stuttering are cancellation, in which the person stutters all the way through a word, stops immediately, and then repeats the word stuttering a different way; pull-out, in which the person gains control over a moment of stuttering while it is happening and smooths it out; and preparatory set, in which the person prepares for a moment of stuttering before it happens, starts it gently and glides through it smoothly.
6. Stabilization
In the stabilization phase, the individual becomes his own clinician by using the new stuttering controls in more and more situations of daily life. The individual also continues to stutter voluntarily and to seek out communication situations which s/he previously avoided.
Integrative approaches
Integrative approaches combine fluency shaping and stuttering modification techniques; there is a wide variety of such approaches.
Contemporary devices
Contemporary devices used to reduce stuttering alters the frequency of the speaker’s voice to mimic the “choral effect”, a phenomenon in which person's stutter decreases or ceases completely when she is speaking with a group of others, or slows the rate of speech through delayed auditory feedback (above). Studies on the long-term outcome of these devices have not been published.
Diaphragmatic breathing


The Freeing Voices, Changing Lives award given by the American Institute for Stuttering to people who stutter who have achieved great professional success.
Several treatment initiatives advocate diaphragmatic breathing (or costal breathing) as a means by which stuttering can be controlled.
Self-therapy and support groups
Self-therapy
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Some stutterers are only able to seek self-therapy because adequate clinical treatment is not available to them, and some experts in the field believe that stuttering therapy is largely a do-it-yourself project anyway.
As a form of self-therapy, Malcolm Fraser, founder of the Stuttering Foundation of America and life member of the American Speech-Language-Hearing Association recommends the following guidelines for stutterers needing immediate relief, even temporarily, in his book Self-Therapy for the Stutterer:
1. Make a habit of always talking slowly and deliberately whether you stutter or not.
2. When you start to talk, do it easily, gently and smoothly without forcing and prolonging the first sounds of words you fear.
3. Stutter openly and do not try to hide the fact that you are a stutterer.
4. Identify and eliminate any unusual gestures, facial contortions, or body movements which you may possibly exhibit when stuttering or trying to avoid difficulty.
5. Do your best to stop all avoidance, postponement or substitution habits.
6. Maintain eye contact with the person to whom you talk.
7. Analyze and identify what your speech muscles are doing improperly when you stutter.
8. Take advantage of block correction procedures designed to modify or eliminate your abnormal speech muscle stuttering behavior.
9. Always keep moving forward as you speak (keep moving your voice from one word or sound to the next, without repeating or back-tracking).
10. Try to talk with inflection and melody in a firm voice.
11. Pay attention to the fluent speech you have.

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