(8) More-Direct Therapy for Early Childhood Stuttering; When, Why, and How

Abstract:
Early childhood stuttering therapy has traditionally focused on less-direct methods, such as modifying the environment in the attempt to support the child's development of easier speech. These approaches continue to play an important role in the overall therapy process; however, it is also necessary for clinicians to know how to apply more-direct methods when needed in order to further support young children who stutter in developing healthy communication attitudes and effective communication skills. This presentation will review less-direct and more-direct approaches for early childhood stuttering and highlight how more-direct therapy can be incorporated into a comprehensive, individualized approach for young children who stutter, ages 2 to 5.
 
Summary of Presentation:
Speech-Language Pathologists often express confusion about the best way to help young children who stutter. Traditionally, therapy has relied on so-called “less direct” approaches to therapy, which mainly involve helping caregivers learn to make changes in the child’s communication environment in order to increase ease of speaking. More-direct work, such as helping children specifically learn how to change their speech to increase fluency or addressing negative communication attitudes, has generally been postponed until the child is older. One reason for this is that many clinicians have feared “drawing attention” to the young child’s stuttered speech for fear of creating negative attitudes or causing the child to become concerned about stuttering and thereby experience increased stuttering severity.
Although less-direct approaches have long been favored, there is reason to question the effectiveness of purely indirect therapy, as there have been no studies that have established that environmental modifications by themselves are sufficient for helping children overcome the burden of stuttering. Instead, it appears that many young children who stutter can benefit from more-direct therapy techniques similar to those used in therapy for other conditions. 
Moreover, there is ample evidence indicating that fears about drawing attention to stuttering are overblown. Decades of research have shown that talking to children about stuttering does not necessarily or automatically result in negative emotional or cognitive reactions to stuttering. To the contrary, talking about stuttering with young children appears to be one of the key “common factors” that cuts across all modern approaches to stuttering therapy.
The purpose of this presentation is to review the distinctions between less-direct and more-direct therapies for early childhood stuttering and to specifically describe ways of incorporating more-direct strategies into therapy for children who stutter, ages 2 to 5. The goal is for clinicians to feel more comfortable providing comprehensive, individualized treatment for children who stutter to increase the likelihood that children will be able to speak more easily and communicate effectively, regardless of whether they continue to stutter.