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20Q: Early Childhood Stuttering: Less-Direct and More-Direct Treatment

20Q: Early Childhood Stuttering: Less-Direct and More-Direct Treatment
J. Scott Yaruss, PhD, CCC-SLP, BCS-F, Nina Reardon-Reeves, MS, CCC-SLP, BCS-F
September 6, 2019

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From the Desk of Ann Kummer


The very first article in this 20Q series was entitled Early Childhood Stuttering: Background and Assessment by Drs. Scott Yaruss and Nina Reardon-Reeves. This article was filled with practical information for clinicians who occasionally or frequently see children with fluency disorders. As such, the article was immensely popular and highly rated! Out of close to 6,000 readers, it maintains a solid five-star rating from the reviews! Fortunately, these authors have agreed to do this follow-up article.

In this article, the authors address the key issues in the treatment of early childhood stuttering. In particular, they describe aspects of less-direct and more-direct treatment approaches. They also discuss ways that clinicians can draw upon various treatment approaches in order to develop individualized treatment that addresses each child’s and family’s needs.

Both of these authors are nationally recognized experts in the evaluation and treatment of stuttering and they have developed many educational and clinical resources for this condition.  A little more information about these authors is as follows.

J. Scott Yaruss, PhD, CCC-SLP, BCS-F, F-ASHA is a researcher and clinician who specializes in the evaluation and treatment of stuttering across the lifespan. He is a professor of Communicative Sciences and Disorders at Michigan State University. Scott has served on the Board of Directors for the National Stuttering Association (NSA) and on the Steering Committee of ASHA’s Special Interest Division for Fluency and Fluency Disorders. His research focuses on the development of stuttering in young children, as well as the evaluation of stuttering treatment outcomes. He has published more than 85 peer-reviewed papers and more than 120 other articles, chapters, and books about stuttering, including the Overall Assessment of the Speaker’s Experience of Stuttering (OASES). He frequently presents continuing education workshops designed to help speech-language pathologists improve their confidence and competence in helping individuals who stutter (www.Yaruss.com).

Nina Reeves, MS, CCC-SLP is Board Certified Specialist in fluency disorders (BCS-F) and staff fluency specialist for Frisco Independent School District near Dallas, TX. She also serves as a fluency specialist consultant to San Diego Unified Schools. Nina provides stuttering therapy services to children and adolescents who stutter in her private practice (www.StutteringTherapyServices.com). She has authored materials for the Stuttering Foundation (SFA) and the National Stuttering Association (NSA). Nina presents interactive professional development workshops on practical assessment and treatment strategies for early intervention and school-age stuttering therapy. Nina is a recipient of the ASHF Van Hattum Award for outstanding contributions in the schools.

After reading this article, you may be interested in other resources that have been developed by these authors, including: Early Childhood Stuttering Therapy: A Practical Guide (Yaruss & Reardon-Reeves, 2017) and School-Age Stuttering Therapy: A Practical Guide (Reardon-Reeves & Yaruss, 2013). Both are published by Stuttering Therapy Resources, Inc. (www.StutteringTherapyResources.com). 

Now…read on, learn, and enjoy!

Ann W. Kummer, PhD, CCC-SLP, FASHA, 2017 ASHA Honors
Contributing Editor 

Browse the complete collection of 20Q with Ann Kummer CEU articles at www.speechpathology.com/20Q

20Q:  Early Childhood Stuttering: Less-Direct and More-Direct Treatment

Learning Outcomes

After this course, readers will be able to: 

  • Define and differentiate less-direct therapy, more-direct therapy, and operant conditioning therapy as it applies to young children who stutter
  • Describe two less-direct aspects of therapy that can be used to help parents create a fluency-facilitating environment
  • Describe two ways in which parents can help their young children who stutter develop healthy, appropriate attitudes toward speaking and stuttering
  • Describe two more-direct aspects of therapy that can be used to help children improve their speech fluency and communication as a whole
YarussJ. Scott Yaruss
CoppensNina Reeves

Speech-language pathologists can provide effective, meaningful treatment for young children who stutter. Unfortunately, many clinicians are uncertain about what treatment approaches are most appropriate. In a prior 20-questions article (20Q: Early Childhood Stuttering - Background and Assessment), we discussed basic facts about early childhood stuttering and reviewed the process for determining which young children who stutter are likely to need treatment and which children are most likely to grow through stuttering without intervention. This article provides a follow-up, with specific details about intervention for children, ages 2 through 6, who are deemed to be in need of treatment for stuttering.

Responses are adapted with permission from Early Childhood Stuttering Therapy: A Practical Guide (Yaruss & Reardon-Reeves, 2017), published by Stuttering Therapy Resources, Inc. (www.StutteringTherapyResources.com). (Disclosure: The authors are co-owners of Stuttering Therapy Resources, Inc. and receive royalties and other benefits for the sale of this and other books about stuttering therapy.)

Of course, we cannot provide a full explanation of the many complexities of stuttering in a short article. We hope to provide readers with an overview of key topics to consider when approaching stuttering in this age group. Readers are encouraged to seek out additional information to help them develop their ability to help those who stutter. Numerous citations are included in the answers below—and in the comprehensive resource from which they are drawn—to help readers who are interested in learning more.

1. I’ve decided that I need to provide treatment for a young child who stutters. What options are available to me?

Although many different treatments have been described over the years for helping young children who stutter, all of them essentially involve three general approaches: less-direct treatment, more-direct treatment, and operant conditioning (De Sonneville-Koedoot, Stolk, Rietveld, & Franken, 2015; Millard, Edwards, & Cook, 2009; Millard, Nicholas, & Cook, 2008; O’Brian et al., 2013; Yaruss, Coleman, & Hammer, 2006; Yaruss & Reardon-Reeves, 2017).

  • Less-direct treatment focuses on helping parents and others create a communication environment that facilitates and supports the child’s development of more typically fluent speech. Common strategies include helping parents learn to reduce time pressures on the child by modulating their speaking rate and the overall pace of communication, diminish demands on the child’s speech that make it more difficult to maintain fluency, and model a more regulated approach to communication.

  • More-direct treatment focuses on helping children develop appropriate attitudes toward their communication abilities (including stuttering) and helping children make changes to their own speech production in order to facilitate fluency. These more-direct strategies are similar to those used for older children who stutter; they are just adjusted for the needs and abilities of preschoolers and young children.

  • Operant conditioning involves helping parents learn to provide verbal contingencies that reinforce fluent speech and correct stuttered speech. The goal is to encourage the child to do more of what he does when he is speaking fluently and less of what he does when he is speaking disfluently.

In our own work, we use a combination of less-direct and more-direct strategies, as appropriate for each individual child and family (Yaruss et al., 2006; Yaruss & Reardon-Reeves, 2017).

2. How do I know which approach is best for which child?

We don’t always know when we start therapy which approach is going to be best. We can increase our confidence that we are choosing the right treatment at the right time by focusing on the individual history and needs of each particular child and family. A multidimensional assessment can help us consider such factors as the child’s risk for persistent stuttering, the child’s overall speech and language abilities, the child’s cognitive level, the child’s reactivity and ability to regulate his reactions to stuttering, the parents’ ability and desire to be involved in therapy, and the parents’ level of concern. Our knowledge of these factors can provide a solid background for choosing appropriate therapy approaches for each child.

There is no “one size fits all” treatment program that is right for all children. Because there are several options for early childhood therapy, we must be prepared to make informed decisions for each child and family in our care. Our role in therapy planning is to create a broad-based approach to enhancing a child’s communication skills while supporting the child’s development of healthy, appropriate communication attitudes.

3. I heard that “XYZ” treatment has the “best” data. Doesn’t that mean that we should always use that approach?

As with treatment for any condition, individual practitioners tend to use the approach that resonates with their own beliefs and their own reading of the literature. You may find that some authors advocate fairly strongly for the approach that they prefer, perhaps by saying that their approach has the “best” evidence and should, therefore, be used exclusively or, at least, favored over other approaches.

It is true that some approaches are supported by a greater quantity of research evidence, or research evidence of a higher quality (e.g., a randomized control trial as opposed to a chart review). At present, however, there is no approach that has evidence of greater efficacy than other approaches. Moreover, all of the approaches with published data indicate generally similar success rates (De Sonneville-Koedoot et al., 2015; Millard et al., 2009; O’Brian et al., 2013; Yaruss et al., 2006). This means that there is no approach that is the best, in terms of the outcomes for the children and families who use them. There is much work to be done to differentiate the various approaches to treatment, though as you will see in the next question, researchers in the field are also recognizing notable similarities across approaches.

4. Are the different treatment approaches really that different?

Although much of the stuttering treatment literature has focused on differences between therapy approaches (Onslow & Millard, 2012; Onslow & Yaruss, 2007), there has been a growing recognition that there are some aspects of therapy that are actually quite similar, regardless of which approach you use!

For example, all of the common therapy approaches for early childhood stuttering seek to help children overcome stuttering, and all start with the assumption that this is possible, at least for many children who enter treatment. All of the approaches also involve helping families learn to manage stuttering at home and in other settings, though the ways in which parents are encouraged to do this varies. Perhaps most importantly, all of the approaches involve teaching parents what to do and how to respond when a child stutters—in general, this involves a calm, matter-of-fact response to the child’s stuttering. Thus, although there are some key ways in which the available treatment approaches do differ, we can also say that, in some ways, the various treatment approaches are more alike than different.

5. What if the child has already received some “other” type of treatment?

As we have noted, the field is learning more about the similarities between various treatment approaches. That said, there are still some notable differences that make some aspects of the different therapies less compatible with one another (Onslow & Millard, 2012; Onslow & Yaruss, 2007). For example, in our therapy, we emphasize the importance of helping children develop healthy, appropriate attitudes toward their communication difficulties. We provide more detail on this below, but in brief, the reason for this is to ensure that the child feels good about himself and his speaking abilities even if he continues to stutter.

Unfortunately, messages about acceptance of stuttering are at odds with messages that the child should try not to stutter, as is common in operant conditioning therapies. Such mixed messages can be confusing for parents and children alike. Therefore, it is important to understand what type of treatment a child has received in the past to ensure that parents are “on-board” with the specific goals and procedures being used in your own therapy. If the philosophy or approach is different, be sure to discuss this with the parents up-front to help the parents provide consistent and supportive messages to their child.

6. Okay, I’m ready to begin the therapy process. What are the overall goals for this age group?
When we adopt a broad-based view of early childhood stuttering treatment, we shift our focus away from working on fluency alone, and we work to help the family develop communication skills that support the development of typical fluency skills. Simultaneously, we help caregivers create an environment that supports the development of healthy communication attitudes.
In our view, the goals of therapy for young children who stutter include:

  • Helping parents create fluency facilitating environments
  • Helping children and parents develop healthy communication attitudes
  • Helping children use techniques—as needed—to increase their fluency and ease of communication

At first, these components of comprehensive therapy may seem daunting. Remember, though: each child has different needs, so not every child will need all aspects of intervention. We see therapy not as an inflexible set of procedures and rules that should be applied for all children but as a solid foundation of dynamic and flexible concepts that must be adjusted to meet the needs of each child and family. 

7. I’ve decided to start with some less-direct therapy. How do I do it?

Less-direct therapy is based upon the principle that children benefit from a communication environment that supports their ability to maintain fluent speech. We call this environment a “fluency-facilitating environment.” Importantly, communication pressures in a child’s environment do not cause stuttering. Still, they can increase stuttering in some situations. Therefore, in less-direct therapy, we work with parents and caregivers to modify certain aspects of the child’s communication environment to support enhanced speech fluency (De Sonneville-Koedoot et al., 2015; Millard et al., 2008; Yaruss et al., 2006).

For example, we may help parents decrease their overall pace of communication through changes in rate, pausing, and turn-taking during typical speaking situations. We may also help parents learn how to model acceptance and support for the child’s communication, no matter how it looks or sounds. In other words, we teach parents to show their child that what he or she says is valued and important, regardless of whether or not the child stutters. 

An important component of this process is for you to model these changes for parents and caregivers, so they will know when they are making the desired changes correctly. Armed with this information and support, parents will feel empowered to know that they are doing something useful to help their child communicate with ease and confidence in real-life settings. 

8. What if the parents aren’t able to be involved in treatment, or if I don’t have access to the parents?

When we start therapy, we are eager to work with the parents to reduce their fears about stuttering and to help them learn what they can do to help their child. Many times, parents are just as eager to become actively involved in the therapy process. This is not always the case, however. For a variety of reasons, some parents just aren’t able to be as involved in the therapy process as they (or we) might like.

In such cases, we try not to dwell on the situation, and we certainly try not to increase the parents’ feelings of worry or guilt over not being able to participate fully in therapy. Instead, we simply move on to the more-direct child-focused components of therapy. In fact, this is one of the key reasons that we developed this therapy the way we did: we work with parents using the less-direct components of therapy when we are able to and when they are appropriate for the child and family. If we are not able to do so, for whatever reason, then we work with the child using the more-direct components (Onslow & Yaruss, 2007).

9. What if the parents are really, really concerned? How do I help them calm down?

Understandably, some parents become very worried when their child stutters. Often, this worry is due, in part, to the fact that the parents don’t yet know much about stuttering. They see that the child is struggling to get words out, and they begin to panic. They want the stuttering to stop, and they want to know what to do to make that happen—immediately!

In the context of this high degree of concern, it can be tempting for clinicians to try to calm parents down by telling them that most young children who stutter actually recover so, statistically, their child is likely to “be okay.” Certainly, we will share such information with the parents as part of the comprehensive evaluation and treatment process, but before we do that, we want to ensure that our assessment of the child’s risk for persistence indicates that this is indeed the case. Because not all children will recover, we want to be careful to provide such reassurance only in those cases where it is likely to be true.

Instead of jumping directly to the recovery figures, therefore, we try to help the parents focus on the bigger picture: when their child is talking, it is not the fluency that is most important; it is what he is saying that matters. Along the way, we teach the parents about what stuttering is, and why it is happening. And, we help them recognize that, for the child, the most important thing is his desire to communicate and the content of what he is seeking to share.

This not only helps parents redirect their energy and attention back toward enjoying interacting with their child; it also provides them with a more balanced view of how to successfully cope with stuttering. We don’t want them to view the child as only being okay once he or she stops stuttering; we want them to know that the child is okay even while stuttering—and while we are working to improve the child improve speech fluency and overall communication abilities.

10. What if the child is very upset by his stuttering or stuttering very severely?

Just as parents may be concerned about stuttering, children, too, may be worried when they have trouble saying their words. This is not surprising—feeling stuck in your speech can be a frightening experience, especially when children don’t know what is going on or why these speech difficulties are happening!

When a child is concerned about stuttering, the most important thing that we can do is to let the child know that he or she is okay. It is okay to get stuck when talking; it is okay to stutter; and, it is okay to try to figure out what is going on and to wonder what to do about it. All of this is part of a comprehensive approach to treatment—and part of the reasons that we approach therapy the way we do. Thus, when a child is upset, we try not to panic: we simply address these reactions directly, as part of therapy. We also teach parents how to model accepting and supportive reactions to the child’s stuttering (Logan & Yaruss, 1999)—and, we talk directly with the child to let him or her know that it is okay to stutter.

11. How can I prevent the development of negative reactions to stuttering?

We have used the term “healthy communication attitudes” several times in this article and throughout our writings on childhood fluency disorders. This is not an accident. One of our most valuable roles in working with young children who stutter is helping parents and others create a supportive environment that allows children to communicate without judgment and without fear that their speech disfluencies will be viewed as a “mistake.” In our view, stuttering is not something the child is doing wrong, and it is not something that he or she needs to be corrected for. Stuttering is just something that some children do when they are learning to talk.

In addressing this goal, we help parents learn to talk about speech difficulties in non-judgmental and supportive ways, so their children can learn that stuttering is nothing to fear. Caregivers can demonstrate complete acceptance of all types of talking, and they can model appropriate reactions when the child stutters. When appropriate (and with our guidance), they can even directly talk about stuttering to let the child know that stuttering is okay.

We recognize that this may be different from what many clinicians have learned. Historically, researchers and clinicians in our field believed that we should never bring attention to a child’s stuttering for fear of making it “worse.” Today, we know that awareness of stuttering is actually quite common (Boey et al., 2009; Ezrati-Vinacour, Platzky, & Yairi, 2001; Langevin, Packman, & Onslow, 2010; Vanryckeghem, Brutten, & Hernandez, 2005). More importantly, we know that awareness of stuttering is not, in and of itself, a problem. Recognizing that a child is aware of stuttering gives clinicians an opportunity to talk about stuttering in supportive ways, and thereby minimize the likelihood that the child will develop negative reactions to stuttering.

12. Wait a minute. Is it really okay to talk to young children about stuttering?

In a word, YES! We know this realization may be difficult for those of us whose training suggested that talking about stuttering would make it worse. This is an old view (Johnson, 1949) that has affected the advancement of early childhood intervention for decades. Whereas we once thought that talking about stuttering would cause a child to become more self-conscious, we now know that talking about stuttering in a supportive way can actually help the child feel better! Thus, a fear of talking about stuttering is no longer a valid fear for clinicians. It is okay to talk to young children about stuttering.

When children struggle with communication, and when the people around them seem to be afraid or reluctant to discuss the issue, children can feel isolated and confused. Conversely, when we discuss stuttering in open and accepting ways, children learn that stuttering is not something to fear. Young children need to see models of calm acceptance of their speaking difficulties, so they, too, can learn how to respond to stuttering with acceptance.

13. What if less-direct therapy doesn’t seem to be enough?

It is always our hope that children will respond to the less-direct components of therapy by developing more consistent speech fluency and positive communication attitudes. We want our students to move toward dismissal, with our support for parents during the transition. Unfortunately, some children show increased stuttering or greater frustration when speaking, even when parents are making appropriate and supportive communication changes at home. The reasons for this are not always clear; it may simply be that some of these children are at a very high risk for continuing to stutter due to genetic or other factors beyond our control. These children need to be moved toward more-direct components of therapy.

When we provide more direct therapy, we continue to support the progress we have made in parent education and environmental modifications. We also begin to help young children learn how to produce easier speech by introducing fluency facilitating techniques. Because we now know that learning about and talking about and exploring stuttering are no longer “taboo” for young children, this type of therapy is no longer reserved for older children.

14. How long should I try less-direct therapy before getting more direct?

For some children, all they need in order to develop more fluent speech is an environment in which they experience reduced demands and reduced time pressures. For those children, the less-direct aspects of therapy will yield results fairly quickly: the child will demonstrate increased fluency, and you will be able to see a clear relationship between the reduced communication demands and easier speech. Other times, that relationship will not be immediately apparent, and you may need to help parents try the modifications for a bit of time to see if they help the child improve his or her speech fluency. Don’t wait too long, however.

How long is long enough? We tend to get impatient with the less-direct aspects of therapy if a child’s fluency has not improved after approximately 3 months of treatment. Thus, if it does not appear that the less-direct components of therapy are not sufficient for a particular child or family after just a few months of treatment, then don’t hesitate to move on to the more-direct components. There is no harm in getting more direct!

15. Should I hold off on direct treatment if the child is not aware of his stuttering?

Clinicians often express concern about “creating awareness” of a child’s stuttering by drawing attention to it. Again, this worry comes from our field’s age-old fear about talking about stuttering with young children. Because we know that it is okay to be open about stuttering, we don’t have to wait to move toward direct treatment if it is indicated. If the child is not aware of stuttering, we help him become aware—in an understanding and supportive way—just as we might do with a young child who is not aware of an articulation disorder.

16.  I’m ready for more-direct treatment. How do I do it?

The goal of more-direct therapy for early childhood stuttering is to help children learn to make changes in their speech that will enhance their fluency. Some of the most common changes that children might make include changes to the timing of their speech production or the tension in their speech muscles. Common timing changes include the use of increased pausing between groups of words and a slightly slowed overall pace of communication. Common tension changes include learning not to push as hard when they are feeling stuck. This helps them move through moments of stuttering more easily. Note that these goals and procedures are very similar to the ones that you might use with older children who stutter.

There are a few challenges that we need to overcome, however. First, while our students are still very young, most of the speech or stuttering modifications that we might use with older children are too advanced. Second, younger children probably will not be able to understand complex descriptions of how to modify speech. Whereas older children may be able to handle an array of different modification strategies, younger children need a simpler approach.

Therefore, the first step in the process is building a solid foundation for the child’s use of techniques. We cannot simply jump to introducing speech techniques without giving the child necessary background knowledge—at an age-appropriate-level—about speaking and about stuttering. At a very basic level, this may even include helping children learn about the difference between doing something more quickly (e.g., running very fast) and doing something more slowly (e.g., walking very slowly). Or, it may involve teaching the difference between using more muscle tension as opposed to using less muscle tension. Until children understand these concepts, they will not be able to independently differentiate “bumpy” vs. “smooth” speech, and they will certainly not be able to consistently use any type of speech or stuttering modification strategy.

After the child has this important background knowledge, we can begin to introduce changes to the child’s speech that are specifically designed to enhance fluency. Of course, a full explanation of more-direct therapy is beyond the scope of this brief overview. Chapter 6 in our Early Childhood Stuttering Therapy book provides a comprehensive explanation of this process.

17. You talked about building a foundation. Can you tell us a bit more about what that means?

As we move toward more-direct treatment, we begin by helping young children learn how language and speech are produced at a level they can understand. These discussions provide a foundation for the “whys” and “hows” of changing speech, so they can understand what stuttering is, what strategies are, and how strategies can help make speaking easier.

In building a foundation, we work with young children to explore key concepts such as:

  • Language formulation (how sounds go together into words and words into sentences)
  • Speech anatomy and physiology (how the “speech machine” works and feels—proprioceptively—to make talking happen)
  • “Tight” and “loose” muscles (how large muscles in our bodies and small muscles of speech production feel when they alternately tense and release)
  •  “Fast and slow” movements (how rate changes in activities such as walking, drawing, and talking affect our ability to do the what we want to do successfully)
  • The overall process of speaking (how we can have fun while talking and explore the many “ways our voices work”)

In our books and other materials, we write extensively about activities to help SLPs feel more comfortable while pursuing more-direct activities with young children. Through such activities, you can learn how to build young children’s foundational knowledge in fun and creative ways so they can begin to explore how speech works and how they can be in charge of their own communication. Young children can handle it!

Indeed, one of the biggest roadblocks we have seen clinicians experience when working with young children who stutter (or even school-age children, for that matter) is that they tend to jump too quickly into fluency strategies without first ensuring that the child has an appropriate foundation.

18. How does more-direct treatment for stuttering differ from therapy for other conditions?

The procedures used in more-direct therapy for young children who stutter really don’t differ from the procedures used in more-direct therapy for other conditions. In articulation therapy, for example, we help children learn how to change their speech sound production through a series of steps: we model the target sound for the child and make that model salient so the child will know to pay attention to it, we give the child opportunities to produce the target sound, we provide feedback on the child’s production, and we allow ample opportunities for practice in an enjoyable activity. The same is true for stuttering therapy: if we are helping a child learn to make a change in the pace of his interactions, for example, we model an easier interaction style, we give him the opportunity to practice it, we provide feedback, and we practice and practice and practice. The key difference between more-direct therapy for stuttering and more-direct therapy for other conditions is the specific changes we are seeking to make in the child’s speech. The overall process is not actually that different from what you are already familiar with.

19. How do I write goals for all this?

Many of our colleagues have shared with us their struggles with writing measurable goals for early childhood stuttering therapy. We hope to increase your confidence in writing these goals by affirming that you already have much of what you need to create individualized goals for this population. In short, writing goals for early childhood stuttering intervention is not unlike writing goals for the other communication issues with which we work. Each goal needs to contain (at least) the following standard components:

  • Skill: What is the child to be able to do?
  • Criterion: At what level must the child demonstrate the skill?
  • Context: In what setting?
  • Support: With how much support, and by whom?
  • Measurement: How often, how, and by whom will measurement occur?

We then adapt these components for the specific needs of young children who stutter. In the less-direct stages of therapy, for example, we might write goals that reflect the desire for increased speech fluency on the part of the child while a caregiver makes various changes to the communication environment. For example, “The child will demonstrate increased speech fluency compared to baseline as measured by a frequency count while the parent uses ‘easy talking’ during a free-play interaction.” When working on the child’s communication attitudes, a goal may simply reflect a discussion between the child and clinician about talking. For example, “The child will engage in 2 age-appropriate conversations with the clinician in the therapy room about what happens with the speech machine during the moment of stuttering.” Finally, for more-direct therapy, we can write goals that address the specific changes that a child will make in his speech during a particular activity. For example, “The child will demonstrate increased pausing following a clinician’s model during a structured conversational interaction in the therapy room as measured by the clinician’s observations.”

Of course, these are just examples, and they will need to be elaborated and adjusted to account for your district’s specific requirements. Still, when you synthesize these components with the overall goals of early childhood therapy (discussed in question #6), you will realize that you can write goals which encompass all of the necessary aspects of intervention for young students who stutter.

20. What do I do if the child keeps stuttering even after I’ve done therapy?

Sometimes, even the most strategic and appropriate early intervention does not yield the desired result: the development of typical fluency. Some students will continue to stutter during therapy. The longer a child stutters, the more likely it is that stuttering will persist in some fashion throughout the person’s life.

In such cases, we need to transition to longer-term intervention plans, and we must be prepared to adapt our treatment to address the ever-evolving needs of our students. Most importantly, we need to adapt our therapy goals to help the child communicate effectively, regardless of whether he or she continues to stutter.

Importantly, children who have experienced acceptance of their communication and who have been guided in the development healthy communication attitudes from the beginning of therapy will be better prepared to work on the broader goals of effective communication and acceptance of stuttering. Thus, we have planted the seeds for long-term success starting at the beginning of the process.

Along the way, we also seek to diminish parents’ anxiety about this transition by providing support as they come to terms with the likelihood that their child may continue stuttering. This helps them to become better equipped to move into the next phases of therapy, and, together, we can work to bolster their child’s acceptance of stuttering.

We will provide an overview of the evaluation and treatment processes in upcoming 20-Questions articles, so stay tuned for more!


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Onslow, M., & Yaruss, J. S. (2007). Differing Perspectives on What to Do With a Stuttering Preschooler and Why. American Journal of Speech-Language Pathology, 16(1), 65-68.

Reardon-Reeves, N. A., & Yaruss, J. S. (2013). School-age stuttering therapy: A practical guide. McKinney, TX: Stuttering Therapy Resources, Inc.

Vanryckeghem, M., Brutten, G. J., & Hernandez, L. M. (2005). A comparative investigation of the speech-associated attitude of preschool and kindergarten children who do and do not stutter. Journal of Fluency Disorders

Yaruss, J. S., Coleman, C., & Hammer, D. (2006). Treating Preschool Children Who Stutter: Description and Preliminary Evaluation of a Family-Focused Treatment Approach. Language Speech and Hearing Services in Schools, 37(2), 118. https://doi.org/10.1044/0161-1461(2006/014)

Yaruss, J. S., & Reardon-Reeves, N. A. (2017). Early childhood stuttering therapy: A practical guide. McKinney, TX: Stuttering Therapy Resources, Inc.

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j scott yaruss

J. Scott Yaruss, PhD, CCC-SLP, BCS-F

J. Scott Yaruss, PhD, CCC-SLP, BCS-F, F-ASHA is a researcher and clinician who specializes in the evaluation and treatment of stuttering across the lifespan. He recently joined the faculty of Michigan State University as Professor of Communicative Sciences and Disorders after 19 years at the University of Pittsburgh. Scott has served on the Board of Directors for the National Stuttering Association (NSA) and on the Steering Committee of the ASHA Special Interest Division for Fluency and Fluency Disorders. His research focuses on the development of stuttering in young children, as well as the evaluation of stuttering treatment outcomes. He has published 70 peer-reviewed papers and 115 other articles, chapters, and books about stuttering, including the Overall Assessment of the Speaker’s Experience of Stuttering (OASES). He frequently presents continuing education workshops designed to help speech-language pathologists improve their confidence and competence in helping individuals who stutter (www.Yaruss.com).

nina reardon reeves

Nina Reardon-Reeves, MS, CCC-SLP, BCS-F

Nina Reeves, M.S. CCC-SLP is Board Certified Specialist in fluency disorders (BRC-F) and staff fluency specialist for Frisco Independent School District near Dallas, TX. She also serves as a fluency specialist consultant to San Diego Unified Schools. Nina provides stuttering therapy services to children and adolescents who stutter in her private practice (www.StutteringTherapyServices.com). She has authored materials for the Stuttering Foundation (SFA) and the National Stuttering Association (NSA).  Nina presents interactive professional development workshops on practical assessment and treatment strategies for early intervention and school-age stuttering therapy. Nina is a recipient of the ASHA-F Van Hattum award for outstanding contributions in the schools, and serves a member of the Advisory Board of the NSA. 

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