In the previous blog post, ‘We need to talk about therapy for children who stammer’ (March, 2019) we argued against traditional, medical model practices which perceive stammering as un-natural or disordered, and focus on eradicating or diminishing stammering. We argued for a new, consistent approach to support children who stammer in their early years; one in which understanding and accepting stammering as human variation and difference by society is the crucial factor.
In this article, we want to explore a new approach to working in early years stammering therapy which has been informed by the social model of disability.
There is a general misunderstanding about stammering in current society which leads to prejudice and discrimination towards people of all ages who stammer. As a result of this, people close to the child, parents for example, can have stigmatised and misinformed thoughts about stammering. For instance, they may think that they have caused the stammering; that they are being judged for what they do or don’t do to eradicate or reduce the stammering; or they simply want the stammering to stop.
Parents can also have powerful feelings and emotions around stammering. For example, anxiety about what to do, what other people think, or feel sad that their child appears frustrated by their stammer. These feelings can influence a parent’s response (behaviour) towards their child’s stammering that can be helpful or unhelpful in the longer term.
The social model encourages us to explore where negative beliefs and attitudes originated from in therapy and then to tackle them proactively. Indeed, at the centre of a social model approach to therapy with children who stammer is: myth busting education; encouragement of a new way of understanding stammering; empathy; empowerment to support children to stammer without struggle and parental confidence to advocate for their child’s needs and rights.
| Type of response | Examples of unhelpful responses |
| Ignoring it
for fear that drawing attention to stammering and any responses to it will cause more stammering (not true) |
· Not talking about stammering or about the child’s responses to their stammering (e.g. the child’s frustration)
· Not looking at the child when they are stammering
Children who stammer need to be communicated with in the same way as any other child and comforted when they are in distress. |
| ‘Playing down’ the child’s words, behaviour or feelings
because they cause discomfort for the adult or they don’t want their child to experience discomfort |
Adults may say:
· ‘It’s okay’ (when the child is not feeling okay) · ‘Don’t be silly’ (when the child is not being silly) · ‘No, you don’t…[feel sad]’ (when the child is feeling this way)
In order to develop emotional intelligence, children’s feelings need to be understood and communicated back to them in a way that demonstrates care. This helps build resilience, confidence and self-esteem as well as strengthening the relationship with the child. |
| Compensating
in the belief that they are helping the child or because they don’t want people to hear the stammering due to stigma/shame |
· Speak for the child
· Interrupt the child · Finish the child’s sentence · Allow the child to speak over other people
The child has a voice; they can communicate. They also need to learn the rules of effective communication (e.g. listening and turn-taking) |
| Trying to reduce the stammering
Because they want the child to speak without stammering; they don’t know what to do; they think children who stammer need more time to think (not true) |
Adults may say:
· ‘Slow down’ or ‘Take your time’ · ‘Take a deep breath’ or ‘Calm down’ · ‘Say it again’ or ‘Say it properly’ · ‘Think before you speak’
These give the child the message that they are speaking incorrectly, which may cause them to develop negative thoughts and feelings about their speech. This can lead to avoidance of talking and/or lowered self-esteem. |
A different approach
In Bradford District Care Foundation Trust over the last six years, early years ‘therapy’ for children who stammer has changed beyond recognition. The first point of entry to the service for younger children referred for stammering pre-6 years is a parent information and advice group. In this group, parents of children who stammer meet together and stammering is discussed in an open, accepting space. This socialises stammering, rather than keeping the conversation one-to-one.
Initial emphasis is on education about neurodiversity and evidence-based facts about stammering, such as what stammering is and isn’t; the cause of stammering; how many children stammer and how many stop stammering. Parents will naturally bring up myths and misconceptions about stammering when the cause of stammering is discussed. Presumptions, such as nervousness, drinking fizzy drinks and ice cream or traumatic childhood experiences causing stammering, are dispelled.
We invite parents to reflect on the language they use when talking about their child’s stammer. For example, we challenge parents when they describe stammering as ‘bad’, ‘terrible’ or ‘abnormal’; and model the importance of stammering being ‘understood’ not ‘stigmatised’*(we use ‘different’ below); ‘accepted’ not ‘oppressed’; ‘allowed’ not ‘controlled’.
Parents are encouraged to see stammering as a different way of talking; not a ‘less fluent’ way. Thus, they learn that stammering is their child’s natural way of talking. Unless the child has other speech and language needs, there is no direct ‘speech work’ for individual children. In fact, we mostly never meet the children at all.
Once parents learn the primary neurological cause of stammering and understand why they and their children think, feel and behave the way they do due to societal norms and stigma, they often begin to become curious and question their old behaviours in light of the renewed (non-fluency orientated) hopes for their child.
Their oppressive ‘fix it’ goals are challenged and changed though discussion. This discussion is not only with a stammering therapist, but also, and often more importantly, with other parents. New outcomes are facilitated for their children based on confidence and comfort communicating. We encourage parents to help their children stammer without shame or embarrassment. Examples of helpful responses to stammering are shown below in table 2:
| Type of response | Examples of helpful responses |
| Allowing the child to stammer
by accepting that stammering is currently the child’s natural way of talking. |
· Make natural eye contact
· Focus on what the child is saying · Respond to what they say
This shows you value what your child has to say and that you accept them for who they are. This is valuable for building resilience, your relationship with your child, confidence and self-esteem. |
| Allowing the child timeto speak for themselves and to problem solve or to self-advocate (ask for what they need)
|
· Actively listen
· Wait for the child to have their turn – be patient · Use reassuring non-verbal communication (e.g. nodding your head or a relaxed facial expression)
When children stammer they need more time; stammered words take longer to say. When you give children time you will be amazed at what they can do! |
This approach may feel incredibly ‘uncomfortable’ for parents in the first instance. Deeply engrained, previously unquestioned cultural and historical beliefs and attitudes are confronted.
When informed about stammering parents always notice that most, but not all, children stop stammering naturally. The fear from parents that their child will be in the small percentage of children who will continue to stammer into adulthood radiates strongly. However, after just one group session parents begin to re-construe their understanding of stammering; the concept that their own child may retain this unique way of talking loses most of its terror.
We inform parents how a child’s well-being can be negatively affected by unhelpful responses to stammering over time (see italics in second column of ‘Table 1’). Our aim is preventing children who stammer from developing negative attitudes, feelings and behaviours about their speaking and about how they construe themselves as communicators and people. Parents begin to understand that ‘allowing’ stammering and reducing negative responses will be beneficial for the child.
Being spoken to honestly and candidly can be a comfort for parents. Many parents are also tremendously relieved to find out the stammer is not their fault and that curing and reducing stammering does not have to be the main motivation and burden for them.
However, parents also learn that the social model is not a passive model. Neither is acceptance of stammering a passive activity. Energy is directed actively towards building resilience in children, to embracing the diversity of stammering as a different way of talking and an important part of their child’s identity. The social model becomes a means of empowerment for both the child as they mature and the parent as an advocator for their child’s needs and rights as a communicator.
Environmental changes are often encouraged similar to an ‘indirect therapy’ approach (like demands and capacities), but the difference here is the change is being driven by embracing stammering as a difference to be respected and adjusted for, rather than a drive to facilitate fluency and reduce stammering.
Showing their children that they understand their thoughts, feelings and behaviours linked to stammering is difficult for parents in a society that silently screams, ‘don’t talk about that thing!’ (Bailey, 2016). Parents need to be aware that their own negative feelings often prevent them from being congruent about what they observe in their children. This is important in order for them to actively learn to empathise. See table 3 below:
| Type of response | Examples of empathic responses |
| Show your child that you understand their thoughts, feelings and behaviour (empathise):
Your child is experiencing distress if they show it so WING it… I’m wondering… I’m imagining… I’m noticing… I’m guessing… or comment on what you hear and see.
|
· Non-verbally:
– a pat, squeeze or a hug – a facial expression that shows you know how the child feels (e.g. a sad face)
· Verbally by commenting on what you observe: – ‘I can see that you are frustrated/upset’ – ‘I’m noticing that you are sad’ – ‘I’m guessing it can be annoying when your word gets stuck like that.’ – ‘Mummy imagines that you are confused as to why that word took longer to say…?’
Children’s feelings and experiences need to be understood; they want to know that you care. Empathy also helps build resilience, confidence and self-esteem in your child and your relationship with your child. |
The responses outlined above in tables 2 and 3 support a child’s comfort, confidence and resilience while they stammer. Doing this means parents will have given their children a solid foundation to make decisions about their own speech in the future (e.g. whether they want to learn to speak more fluently or to embrace the diversity of their stammer as a different way of talking and an important part of their identity).
An approach to therapy informed by the social model also offers consistency throughout childhood and adolescence. There is no sudden changing of the goalposts once the ‘window of opportunity’ has passed. As a child matures, they will have learnt the emotional and factual language needed to educate others about stammering. They will also have developed the ability to advocate for their needs through the modelling of their parents. Their internal language, the way they think and feel about themselves as a speaker and as a person is robust. Moreover, even if the child naturally stops stammering, then a social model approach has encouraged them to have open and accepting attitudes to diversity and difference throughout their adult lives.
The worry parents first bring to ‘therapy’ is often relieved when they understand that they are building in their child ways to problem solve and to assert their rights in the future should they need to. Pressure is removed from them to ‘fix the unfixable’ and channelled into a more empowering route of educating others and advocating for their child. In terms of society, they are helping to change the world for other people who stammer too. Educating parents about acceptance, listening, empathy, problem solving, and assertiveness is also beneficial to all areas of child development not just stammering.
Ultimately, negative attitudes towards stammering can be changed, and supporting children to be happy with themselves regardless of the way they speak, we would argue, is a more ethical therapeutic response to stammering.
Kathryn Bond and Patrick Campbell
References
- Bailey, K. (2016), Scary Canary: Stammering, Struggle, Challenge and Beauty. Stammering Pride and Prejudice Conference, City Lit, London. Available from:https://www.youtube.com/watch?v=y47SeRJq1Xc&list=PL86eMTndRi7R1WSDLBVKswtCGom3HFPiP 0:48/6:29
- The tables (1, 2 and 3) are courtesy of Bradford District Care NHS Foundation Trust and copyright remains with them. They were slightly amended for use in this article.