The field of stuttering has changed a lot over the past couple of decades. The problem is that many of the previous “truths” are still thought of as truths, like the idea that we should not bring attention to stuttering in young children because it might exacerbate the problem. “Not true,” says Dr. Scott Yaruss, Professor of Communication Sciences and Disorders at Michigan State University and President of Stuttering Therapy Resources. In his presentation Everything Has Changed: New Views About Stuttering Therapy, Dr. Yaruss walked us through 16 persistent myths about stuttering. We want to help spread the word so that these practices are not continued. As Dr. Yaruss points out, many of these practices are downright harmful to those who stutter.
Changing Truths in Stuttering?
I want to start with a very important question that Dr. Yaruss asked.
“How is it possible that something we once believed about stuttering is no longer something we believe?”
This is science. We base our clinical decisions on scientific data. In scientific fields, we are always operating on the best information we have at the time. Remember The King’s Speech, where the King’s speech therapist had him rolling on the ground to cure his stutter? That seems ridiculous now, doesn’t it? Science has progressed, and now we know that it would be unethical to take such an approach. Well, the same is true for the myths that Dr. Yaruss shares. Science has progressed and we must too.
Evidence-Based Practice for Working with People Who Stutter
The work that we do as speech-language pathologists is driven by different bodies of evidence. We learn from scientific research that is published in peer-reviewed journals. We learn from the work we do with and the experiences we have with clients and their families. We learn from the advocacy efforts of people who stutter. It is the blend blend of all of these sources of evidence that drives the work that we do and that tells us that some of the things we thought we knew about stuttering isn’t actually true. It wasn’t ever true. And, unfortunately, some of the old ideas have lingered.
Where to Find Amazing Evidence-Based Resources for Working with People Who Stutter
The work that Dr. Yaruss and his business partner, Nina Reeves, have done in the area of stuttering is so important to our field. They highlight that previous beliefs and approaches to working with people who stutter have been driven from an ableist perspective and they stress the importance of not pathologizing stuttering. They have produced incredible resources for those working with people who stutter that can be found at Stuttering Therapy Resources. Many of those resources will be highlighted throughout this blog post.
Dr. Yaruss shared 4 myths in each of 4 areas. He shared myths about the fundamentals of stuttering, myths about assessment of stuttering, myths about stuttering in early childhood, and myths about school-age stuttering. If you want to see his full talk and earn ASHA CEUs, you can find it here.
Myths about the Fundamentals and Causes of Stuttering
Myth #1: The environment causes stuttering
The environment does not create stuttering, as people once believed, but it can exacerbate it. The diagnosogenic theory of stuttering proposed the idea that the environment causes stuttering. This view was proposed in the 50s and sadly, still lingers today. The truth is that stuttering has its origins in genetic and neurologic differences. It’s not a single gene but it is a pattern of genes. It comes from within the persons genetic code rather than from the environment. You cannot take a person who does not stutter and turn them into someone who stutters. We know that. You can give someone anxiety that results in disfluent speech but you cannot turn them into a person who stutters. How many times have you heard people say, “Don’t bring attention to it because it will cause them to stutter.” This is simply not true. Parents do not cause stuttering. These ideas are based on an old theory and it is wrong. It is not only okay to talk to children about stuttering but Dr. Yaruss argues that it is necessary.
Myth #2: People who stutter talk too fast, try too hard, put too much pressure on themselves,…
This is simply not true and we know this because, even when you change that thing, they still stutter. This view suggests that the person who stutters is doing something wrong, and that’s not true. Encouraging slower speech does not make stuttering go away. Encouraging people to relax and not try too hard does not make stuttering go away. Encouraging people not to put pressure on themselves does not make stuttering go away. That’s because stuttering is due to a neurologic difference.
It is normal for people who stutter to stutter. Further, people who stutter exhibit normal variability in their speech. In some settings and situations they stutter more than in others, and the variation is normal. Stuttering is verbal diversity. Verbal diversity is a term coined by Nina Reeves of Stuttering Therapy Resources.
Instead of encouraging people who stutter to be more fluent, we can create an environment that is more accepting of people who stutter.
Myth #3: Everyone can be fluent if they try hard enough
There is no percentage of fluency that we should be trying to work toward. The belief that if you are disfluent more than 3% of the time you are a person who stutters and if you are difluent less than 3% of the time you are not a person who stutters is not accurate. There is no set point between stuttering and not stuttering. That idea came from a study Wendall Johnson published in 1955. In his study he had two groups of kids—a group that stuttered and a group that did not stutter. He observed that their data points crossed around three percent. It was from that study, that people inferred that 3% is the cut-point at which people are considered to stutter or not. The truth is, there is no cut-point. There is too much variability in stuttering to set a cut-point. That’s an arbitrary number that has been used since the 50s to the detriment of people who stutter. It artificially pushes those who stutter to strive for fluency less than 3% of the time, which may not be possible for them. It’s an arbitrary point and the research goes not support the theory that there is a cut-point that determines stuttering/non stuttering.
“We can let arbitrary cut-points go. We can do everything we need to do as speech-language pathologists without ever calculating another frequency count.” J. Scott Yaruss
This is also why we don’t set goals about how fluent a person who stutters should be.
Myth #4: People can overcome stuttering
This is a very harmful measure for people who cannot achieve that. Stuttering varies not only within people but also between people. Perhaps someone who had some disfluencies became more fluent. And it is possible that one person can achieve a high degree of observable fluency but not everyone can. Instead of focusing on achieving a certain fluency level, let’s celebrate the verbal diversity that people exhibit in their speech fluency.
Nina Reeves wrote a beautiful blog post entitled What is Verbal Diversity? We encourage you to check it out and share it widely.
Myths about Stuttering Assessment
Myth #5: It’s important to measure observable behaviors
The amount of stuttering a person exhibits during an evaluation tells you nothing. Why? Because stuttering varies. You can’t make decisions based on the amount of stuttering a person exhibits during an evaluation.
Myth #6 You need a frequency count to qualify a child for therapy
There is no frequency count that tells you whether or not a person stutters. On a constantly varying behavior, frequency counts tell you nothing. Stuttering is more than just a disruption in speech.
Dr. Yaruss wrote two blog posts about the SSI and why frequency counts are not what is needed to identify stuttering.
Myth #7 If you don’t see the stuttering, you cannot qualify the child for therapy.
People who stutter feel stuck, out of control, or unable to move forward when they are speaking. When they feel this way, they do things to get unstuck. These are the observable behaviors that we see. They are observable reactions to being stuck, like prolongations, facial grimacing, etc. Some children may appear to push the words out by hitting their head or shaping their lips in a certain way. The feelings, actions, and thoughts that people who stutter have in response to their stuttering are what determine whether there is an adverse impact resulting from stuttering.
We need to look at how stuttering affects the individual. People who stutter may experience an adverse impact to their stuttering, such as an inability to succeed in academic activities, and difficulty participating in academic activities, socializing with others, and engaging in curricular and extracurricular activities.
Myth #8 The child seems okay so they don’t need therapy.
How does one measure “seems okay”? Without some systematic measurement of the adverse impact of stuttering, there will be a lot of variability in whether a child “seems okay” or not.
The Overall Assessment of the Speaker’s Experience of Stuttering (OASES) was designed to measure the adverse impact, which is what we need to address for IDEA. It explores:
- Affective Behavioral and Cognitive Reactions
- Functional Communication
- Quality of Life – Participation in Various Environments
Myths about Stuttering in Early Childhood—Ages 2-1/2 to 5
Myth #9 When children are first starting to stutter, we should wait and see what will happen
The wait and see approach is based in the diagnosogenic theory that overreacting to normal disfluencies causes stuttering, which isn’t true. Now, there is research that indicates that most children in this age group who start stuttering stop stuttering. In fact, about 75% of them do. But that doesn’t mean that we should take a “wait and see” approach.
The research shows that who stops is not determined by whether attention was brought to their stuttering or not. Research indicates that there are neurological differences between the children who:
- Stutter and stop
- Stutter and continue to stutter
- Never stutter at all
Dr. Soo-Eun Chang of the University of Michigan has done research that shows that there are neurological differences at the point of stuttering onset in children in these three different groups. There are differences in brain activity, brain development, brain structure, and brain function. Therefore, we are not going to cause problems by getting involved. There’s no need for us to wait and see.
This can be tough for parents who want speech-language pathologists to jump in an “fix” the stuttering. There are some great resources on Early Childhood Stuttering at Stuttering Therapy Resources, including:
Early Childhood Stuttering: Information and Support for Parents
Early Childhood Stuttering Therapy: A Practical Guide
What Treatment Approach Should I Use with a Particular Young Child Who Stutters?
Myth #10 Young children are not aware that they stutter
Children may not have the words to effectively describe how they feel about their speech but it certainly isn’t the case that they are unaware. Research indicates that children are aware of their speech. They blink their eyes, tap their head, shape their mouth, and more. All of these observable behaviors demonstrate awareness of stuttering.
If we can teach children that stuttering is okay, we can reduce the negative reactions to stuttering.
Myth #11 We should not talk about stuttering with preschoolers
There is decades of research that demonstrates that talking to children about their speech does not make their speech worse. Talking to children and their parents about stuttering can help children to speak more easily and can help to prevent negative reactions.
Myth #12 We should not work directly with young children who stutter
Believe it or not, there are clinics out there that have blanket policies that they do not work directly with children who stutter until a certain age. This is an absolute no-no. It is too many years to allow a child who stutters to develop negative reactions. Early intervention is best, hands down! The research shows that talking to children about their stuttering can help to reduce or even prevent their negative reaction to their stuttering.
Myths about School-age Stuttering Therapy
Myth #13 Kids just need to practice more.
Dr. Yaruss calls this idea insidious. Perhaps there is someone out there who practiced something ten thousand times and it made them able to speak more smoothly. This could be true but just because it is true for one person does not mean it is true for everyone. No amount of practice can turn a person who stutters into a person who does not stutter. Their brains are different and they will continue to stutter. Some people achieve increased fluency but not all.
It comes down to this: We should not be preaching that if you practice enough you’ll achieve fluency. This is an ableist approach that is detrimental to children who stutter.
Myth #14 Once students have been taught all of the techniques, there’s nothing else to do.
There is so much we can do beyond teaching a child to use strategies. We can address feelings and thoughts about stuttering, teach students how to advocate in their environment, and ensure that they know how to address different experiences in different environments. There’s a blog post at Stuttering Therapy Resources called What do I do if the child won’t use strategies?
Myth #15 If the current view is that it’s okay to stutter, there’s no role for a speech-language pathologist
We’ve tackled this one but will reiterate here that our role is to help people who stutter minimize the adverse impact that stuttering has on them.
Myth #16 Our role as a speech-language pathologist is just to tell kids that it’s okay to stutter.
Yes, we tell people who stutter that it’s okay over and over until they believe it and their parents believe it but we also have so many other roles. We can help them to understand and manage their feelings and thoughts, navigate their experiences with stuttering, and teach them strategies for living in a world where their difference is not well understood.
You’ll find loads of ideas in this newly published book Getting Started with School-Age Therapy published by Stuttering Therapy Resources.
Hear the Full Story and Earn CEUs!
Everything Has Changed: New Views About Stuttering Therapy
A very big thank you to Dr. J. Scott Yaruss and Nina Reeves for the amazing work they do in the field of stuttering and for the incredible resources that they provide to support individuals who stutter and speech-language pathologists and others who work with individuals who stutter.
