by Ellin Rind, President Patricia Rind, Vice President STUTTERING RESOURCE FOUNDATION „a non-profit corporation„ Published by Stuttering Resource Foundation 123 Oxford Road New Rochelle, NY 10804
This guide has been written for teachers who have a child in class whose speech seems less fluent than that of his/her peers. Disruptions, such as hesitations and repetitions, in the forward flow of ongoing speech behavior are defined as disfluencies. Since three million Americans are considered to stutter, and since many more experience periods of unusual disfluency in childhood, it is likely that many elementary school teachers will encounter this situation.
It is important to remember that speech is a very complex task. Children vary in their spoken language development just as they do in their ability to learn to read, write and do math. It is now widely accepted that some children simply are not "ready" to read by first grade, while others learn to read before they enter school. So, too, some children speak easily and "perfectly" during their preschool years, while others are still developing slowly and normally during the early elementary school grades.
The difference between reading and speaking, however, is that speech is necessary for everyday social communication. The child who experiences disfluency frequently finds himself/herself at a serious disadvantage at home and at play. Younger siblings all have difficulty "getting a word in edgewise." Those who cannot even get a word out may find themselves lost in the shuffle of busy lives. What a child encounters in school can, thus, be of great importance in his/her speech development.
Teachers face a multiplicity of problems. They cannot be "experts" in every area of child development. What follows, then, is merely a guide to assist the teacher in recognizing a problem and in knowing how to treat the child who seems to stutter.
It cannot be stressed too strongly that any child suspected of having a speech problem should be referred to a speech-language pathologist. There are specialists in stuttering who will assist with evaluation and will recommend, if necessary, an appropriate course of action.
A child who stutters can be helped . . but, you have to know how.
Patricia and Ellin Rind
Stuttering Resource Foundation October, 1988
The difference between a child who is experiencing normal difficulties with speech production and one who is truly stuttering can be very subtle and difficult to distinguish. That is why it is important that a speech-language pathologist make the diagnosis.
However, there are certain signs of beginning stuttering of which the teacher should be aware. And, of course, if a child is manifesting signs of distress during speaking situations, or is being teased for the way he/she speaks, that is the only sign you need.
The following "warning signs" may appear occasionally in anyone's speech. However, if they occur frequently, consistently and over a period of time, the child should be referred for help.
Repetitions of the first letter or syllable of words
Many young children repeat the first sound or syllable of some words. In an older (beyond 7 years) child, any multiple repetitions of first sounds or syllables should be considered significant.
Stretching out sounds
Prolonging a sound such as mmmmother or moth . . .er
Noticeable physical tension in the face, neck or upper torso, and a sense that the child is struggling to push the words
Difficulty starting or sustaining sufficient airflow for speech
Unusual speech/language characteristics
Stutterers resort very early to a number of avoidance patterns. An unusual number of pauses, interjections of many extraneous sounds, substitutions of one word for another, repeated use of odd or unnecessary phrases are all frequent "tricks" used by stutterers in an attempt to talk or to begin talking fluently.
Many adult stutterers pride themselves on their extensive vocabularies„developed through years of substituting new words for the ones they cannot say. "Starter" sounds and phrases are another device used by stutterers. For instance, a stutterer who expects to experience difficulty saying, "Hello!" might begin saying, "Oh, hello!" until that stops working. Some try nonverbal behaviors such as fist pounding or clenching, stamping and head jerking to help themselves start speaking.
Involuntary quivering of the lips or other facial structures during attempts at speaking
Fear or avoidance of speaking situations
Some children express or demonstrate obvious fear of approaching words or of all situations that require speaking. These children obviously need help regardless of how severe or mild the problem appears to be.
Although research into the causes of stuttering continues, no definitive answers have yet been found. What is known is that the causes, like speech itself, are complex. They almost certainly involve a combination of developmental and environmental factors, or as stated by Edward G. Conture of Syracuse University:
Stuttering most likely results from a complex interaction between the stutterer's environment and the abilities the stutterer brings to that environment. (Stuttering, Prentice Hall, 1982.)
What is important to remember is that all evidence and research point to the fact that children-who stutter are, as a group, no less intellectually, academically and emotionally well-functioning than their peers. They are not, by definition, nervous, anxious, unhappy, unintelligent, or anything other than children who have trouble speaking. As a group, they manifest no significant psychological or social differences from their normally fluent peers, although their own and others' reactions to their disfluency may eventually create such problems.
Stutterers span all areas of the world. They represent all personality types, classes, ethnic groups, talents, skills and levels of intellect. Moses, Winston Churchill, Isaac Newton, Tommy John, Carly Simon, Thomas Kean, James Earl Jones, and Michael Spinks are only a few examples of famous stutterers.
Boys are four times as likely as girls to stutter. Almost all stutterers experience periods of relative or total fluency. Most speak fluently in unison, when they whisper and when they sing. Many speak easily through a puppet or when alone with a baby or a pet.
There is no easy prescription for treating any child, as every teacher knows. The stutterer, like all other children, is an individual with his/her own personality, needs, skills and problems.
Some children are quite comfortable with their disfluent speech, while others, who may seem objectively to have a lesser problem, are extremely aware of it and self-conscious at an early age. Some children who stutter love to speak, while many others report that they never volunteer correct answers and live in dread of being called on especially unexpectedly.
Use your judgment
The way you, as a teacher, react must be a result of your assessment of the child's own level of comfort. If he/she speaks frequently and comfortably in formal and informal situations, has many friends, and seems both accepting and accepted, your only task (and it may be a difficult one) is to keep things that way.
If, as more frequently happens (especially as children get older), the child seems uncomfortable, is unwilling or reluctant to speak or read aloud, withdraws from verbal contact, or seems to be suffering socially, then he/she needs your help.
Teachers are role models
As you probably realize, your behavior will significantly influence the reactions of the children in your class. If you are accepting, focus on what the child says rather than how he/she says it, and treat the young stutterer with respect, his/her classmates are likely to follow suit. Furthermore, the child who is disfluent will frequently be as comfortable or as uncomfortable as the people around him/her. And any child who is comfortable and at ease is much less likely to be teased or ostracized.
It is important, then, that you behave in a way that is comfortable and natural for you. If you know that you are a person who simply cannot be comfortable around a child who stutters (or one with any other disability, for that matter), it might be wise to request that such children not be placed in your class.
Stuttering is a problem in communication. It is a difficulty with verbal interaction. School can be stressful, at times, for any child. For one who is afraid to read aloud, to speak, to give an answer, to act in a play, or even to talk at recess, it can produce particular anxiety. If you, as a teacher, can prevent or change these feelings, if you can make the disfluent child and his/her peers understand that this is nothing to be ashamed of, you will be going a long way toward saving a person from a great deal of pain.
Focus on content
Adult stutterers will tell you that one of the greatest hurdles they face is overcoming a sense of shame or embarrassment. Many of them would rather not speak than allow someone to hear that they stutter. Those feelings develop because of the reactions of listeners: not only those who tease and laugh, but those who act impatient, fill in words, avert their eyes or turn their heads. Any reaction other than really listening to what is being said and responding to that, is a reaction that tells the speaker that his/her stuttering is what is important. Once that lesson is learned, the stutterer will do almost anything to avoid that pain.
1. Don't pretend that disfluencies do not exist. One of the most painful aspects of stuttering is the isolation that those who live with it come to feel. It is part of the child. He/She knows it and knows that you know it. A three-year-old we knew used to say, "I have troubles!" when disfluencies occurred and then go blithely on with what she was saying. She was perfectly at ease, but she was also aware that speaking sometimes gave her trouble. If everyone studiously avoids the topic, it becomes something "shameful" that must be hidden at all costs. In addition to the psychological damage this inflicts, it is also a cause of many of the strange behaviors that frequently accompany stuttering such as grimaces, hand pounding, head jerking and eye blinking. Each of these begins as an attempt to speak fluently. Do acknowledge the difficulties without labeling them. It's fine to say, "Johnny gets stuck sometimes" or "Jane has a hard time talking." It's nice to say something like, "Boy! that was really tough, wasn't it?" and even share a grin. Anything that simply accepts the problem like any other problem, can only help everyone relax. Try not to use the words "stuttering" or "stammering" unless the child uses those words to refer to his/her disfluency. These words do not objectively describe what the child is doing and they contain a number of negative connotations that may only add to the child's feeling of being different. 2. Don't tell the child to "think before you speak," to "take a deep breath," to "stop and start over," to "just relax." If these suggestions really worked, nobody would stutter. Saying them conveys the message that the child has it in his/ her own power to speak fluently any time he/she chooses. He/she doesn't. It also calls attention to how the child is speaking rather than to the content of what is being said. Do try to model slow speech. A sense of being under time pressure places a great deal of stress on the disfluent speaker. It is important to convey a sense of ease. The teacher can model his/her behavior by speaking more slowly and evenly, by eliminating situations where there is rapid give and take with frequent interruptions, and by not rewarding students who are quick to call out answers rather than raising their hands. Games that rely on giving the quickest response are agony for those who stutter. 3. Don't fill in words or supply answers. Having a listener fill in or supply words is something stutterers hate. The child may allow you to do this, and even seem relieved by it, but it is not good for him/her, and it conveys the sense that you don't have the patience to wait and that the child needs your help to talk. Do occasionally rephrase what he/she has said. This will focus attention (both yours and the students') on what he/she has to say, and will emphasize that this is what is important. Of course, if this is done only with the disfluent child, it will seem unnatural. 4. Don't avert your eyes, turn your head away, or look pained, pitying or impatient. The way you look is at least as important as what you say or do. All of us react to body language and facial expressions; children are particularly sensitive to nonverbal communication. Do remain calm and maintain normal eye-contact. Try to look interested in what he/she is saying. 5. Don't be unusually attentive during disfluent times. If you pay more attention when a child is disfluent than you do when he/she is fluent or than you do to others, it reinforces those disfluencies. Do try to act as you do when he/she is fluent and as you do with other children. 6. Don't discuss the child's speech in his/her presence. If parents, children or other teachers want to discuss the child's speech, do it when he/she is not around. Do talk openly with the child about stuttering if he/she expresses interest in doing so, but not in a way that gives it enormous significance. Again, treat it as what it is: something the child is doing some of the time when he/she speaks that is part of the child.
It is impossible to anticipate every question that may arise concerning the disfluent child in a classroom. Each child is an individual and each teacher has an individual style and way of handling things. However, there are some questions that seem to arise regularly, and we have tried to answer them as best we can. 1. Can I do anything to help a child through difficult periods? If a child is going through a period of greater disfluency, it is possible to provide him/her with successful speaking experiences. Fluency is encouraged by choral speaking and reading, reciting of rhymes in unison, singing, and the use of puppets. Such class activities will give the disfluent child a chance to experience success and may help get him/her through a difficult time. When a child is having a bad day, try to minimize the number of times he/she is called upon to speak or read. Conversely, make every attempt to maximize speaking opportunities on fluent days. 2. What about reading aloud? It is almost impossible to avoid oral reading in the lower grades. It helps to start reading the selection in unison with the child. However, do this with everyone occasionally, or the disfluent child will be singled out. It also helps if the teacher calls on children in some kind of predictable order. If you feel you must "jump around," you obviously cannot always skip one child. However, don't be surprised if the disfluent child often seems to have to leave the room during the exercise. 3. What about calling on the child to answer questions? It would be best to call on the child when he/she volunteers. Most children find it stressful to be "surprised" by a request to respond. For the disfluent child, to sit and wonder if and when it will be his/her turn may be particularly difficult. Equally hard on the disfluent child is the classroom where everybody simply shouts out answers. He/she will almost certainly never win that "race," and the frustration of knowing the answers and never getting a chance to show it can be devastating. 4. Should the child be asked to give oral reports? This should really be left up to the child. Talk with him/her privately about it. Explain that you know that he/she has some difficulty speaking at times and that you would like it to be his/ her decision as to whether or not he/she presents a report orally. (In this case,-"singling out" presents less of a problem, since the class is not likely to notice.) Some disfluent children who would be reluctant to give a report otherwise, might welcome the opportunity to present one describing some aspect of stuttering or speech development. 5. Should the child participate in class plays? Once again, this must depend upon the individual concerned. Some disfluent children love to participate in these activities, and they should not be prevented from doing so. However, it would be wise to try to ascertain beforehand whether the child will enjoy the activity even if disfluencies occur during the performance. The teacher should be able to determine how realistic the child is by comparable classroom experiences. There are also children (and adults) who will push themselves to participate in situations despite anticipation of "failure" and subsequent pain. If you observe such behavior in a disfluent child, it would be wise to try to determine what is causing it and to discuss it with his/her family as well as with the speech pathologist. Class plays, of course, present ample opportunity for participation in a non-verbal role such as director, set or costume designer. 6. What about tape recorders? It would generally be a good idea not to record the disfluent child, or at least not to play back such a recording in a group situation. All of us have experienced the surprise and discomfort of hearing or seeing ourselves on tape. Voices sound "wrong," we hear pronunciations we do not expect, and we find it hard to believe we sound or look that way. The fact that the disfluent child knows that he/she has difficulty speaking does not mean that there is a perception of how that sounds to others. Hearing a recording of his/her disfluencies can make even a child who has heretofore been completely comfortable, self-conscious and even unwilling to speak publicly. 7. What should be done if questions arise about a child's speech? Again, a great deal depends upon you and upon the particular child. If the child, himself/herself, raises the question, you can help by being empathetic, comfortable and willing to listen. You might tell him/her that everyone has trouble speaking sometimes. A chance to share If others raise questions in front of the child, you could try to give him/her an opportunity to answer them. (Not, of course, if they are malicious or jeering.) An older child might welcome this chance to explain how he/she feels and what happens. It is possible that a child who is working with a speech pathologist would want to share what happens there. If a disfluent child were willing to present a report on the subject, it would give him/her, as well as the class, an opportunity to learn more. 8. What about the family? One would expect that the family of a child with any problem would approach the teacher. And, in many cases that will occur. However, there are any number of reasons why the parents of a disfluent child may wait for you to take the initiative. Some misconceptions Frequently, parents have been told to ignore the disfluencies and they will simply go away. And, indeed, for many very young children this is true. Others hope that the child is not experiencing any problem at school even if he/she is at home. They assume that the teacher will notify them if it is necessary. As with many problems, there may be guilt, especially since so many people are under the false impression that stuttering is caused by mistreatment or trauma. Be open It is important that the teacher speak openly and comfortably with the family about this, as he/she would about anything concerning a child in the class. If there is a speech pathologist in the school, a joint conference might be a good idea. If there is not, the teacher should discuss the situation, reassure the parents, and inform them that only a specialist in stuttering is qualified to evaluate the child's speech and recommend a course of action Talking can help The teacher might also try to ascertain whether undue pressure is being placed on the child at home, and whether his/her parents seem to be exacerbating the problem. Often, just the fact that someone is speaking about it and is giving them advice will alleviate a great number of negative feelings. REFERRAL In any case, remember that the child should be referred to a specialist in stuttering, and that his/her family should be assured that there is help. They should be warned to avoid anyone promising a quick cure or a short term expensive treatment. The child needs to see a speech pathologist for diagnosis and evaluation. If they contact us: The Stuttering Resource Foundation 123 Oxford Road New Rochelle, New York 10804 1-800-232-4773 or 914-632-3925 we will be glad to send them further information, and we will try to refer them to someone nearby who specializes in working with disfluent children. A Classroom Discussion Pat Rind, co-founder and vice president of the Stuttering Resource Foundation, has stuttered since she began to speak. Here, she shares with you some practical suggestions and ideas that have developed as a result of her own life experiences. When a young child asks me why I talk "that way" or why I "shiver" when I talk (my lips often quiver), I tell him/her that talking is hard for me. I say, "Do you know how some people can't see„or can't see well„and some people can't hear? Well," I say, "l can't talk well." With a young child, the conversation usually ends there. With somewhat older children, though, more of a dialogue can be established. What is a handicap? I would begin with a class discussion on what handicaps are and develop an understandable definition with the class. The definition I like to use is that a handicap is something that prevents those afflicted from doing something that the vast majority of people can do without thought, for example, seeing, hearing, walking and talking. Different kinds of handicaps Then a list of handicaps can be written on the board. The inclusion of emotional handicaps, such as schizophrenia, or developmental ones like Down's Syndrome, would depend on the sophistication of the class. Certainly, mention of dyslexia seems warranted and relevant. Who becomes handicapped? Serious thinking should be stimulated with questions such as, Does one have to be born with a handicap or is it something that can happen later? Can anyone become handicapped? Does it matter who you are, where you're from or who your parents are? Sharing feelings Ask the class how they would feel if they were handicapped. Would anyone be embarrassed or ashamed if he/she were blind? Are there any handicaps on the list that would be embarrassing or shameful? If so, why? Should they be? Why do some people laugh at those who are handicapped? Summing up It is important to bring out that we have no control over how we see, hear and talk. If possible, talk about the senseless fact that eyeglasses are not only acceptable, but fashionable these days, whereas people often find it embarrassing to wear hearing aids. It should also be emphasized that everybody has difficulty in doing certain things that other people do well. The handicapped person, though, is in such an overwhelming minority that he/she is viewed as "abnormal." If there is a disabled child in the class, discuss with him/her beforehand the advisability of using that particular problem as an example. There is no question that it would help to have stuttering, for example, viewed as a handicap if the child in question finds it acceptable. We hope that this guide has been of value, and that it has answered some of your questions. If we can be of any further service to you or your colleagues, please do not hesitate to let us know. The Stuttering Resource Foundation is a not-for-profit corporation dedicated to sharing support and information about fluency disorders. Voluntary, tax-exempt contributions make projects, such as this guide and an "800" phone number, possible. If you would like to help, send a contribution to The Stuttering Resource Foundation, 123 Oxford Road, New Rochelle, New York 10804. Special thanks to: Oliver Bloodstein, Ph.D. Edward G. Conture,Ph.D. James F. Fauvell, M.A. James W. Hillis, Ph.D. Peter Keisler, Esq. Peter R. Ramig, Ph.D. Nan Bernstein Ratner, Ed.D.