Functional Fluency: Going Beyond Fluency Shaping Part 2

Functional Fluency: Going Beyond Fluency Shaping Strategies Part 2

Last week we explored the foundations of how to approach Adolescents Who Stutter (AWS) and how to write goals that go beyond just targeting increasing fluency %. If you missed Part 1, please go here and check out that blog first.

This week, let’s delve into the nitty gritty and look at some ideas for conducting therapy sessions with AWS. Remember, for AWS, there is no one “therapy plan” that will work for all students. Some of these ideas are inappropriate for certain students - trust your clinical judgement to know when it’s appropriate to introduce these different session ideas.

Ideas for Sessions with AWS

• Personal Goal Setting: This is my go-to activity for my initial session with an AWS. I like to complete goal-setting activities with all my students, but I think discussing goal-setting is especially important for AWS. Frequently they come in with the goal of “chasing the Fluency Fairy” and their personal goal is to achieve 100% fluency. It’s important to discuss what a realistic goal looks like. I use this graphic to illustrate the relative amount of time and effort we should be spending on working towards the 3 aspects of fluency therapy.

As you can see, increasing fluency is the smallest part of the triangle - it’s not the main focus of our therapy. Improving communication overall and developing autonomy take up the larger pieces, symbolizing the idea that goals for therapy should be centered more on these broad ideas. With this idea in mind, have the student brainstorm achievable, personal goals such as increased self-confidence, improved communication with parents, increased willingness to ask questions in class, increased knowledge of stuttering, etc. I ask my students to identify their personal goal/s each week when the session first starts in order to focus our work (and sometimes the triangle makes repeat appearances!).

• Anatomy and Physiology of the Speech Mechanism: By the time AWS reach high school, they’ve likely spent somewhere around 10 years dealing with stuttering. They may have come up with their own theories on what happens when they stutter. They may not have even given it a second thought! But I always make sure that within the first few sessions we discuss how the speech mechanism actually functions. I use diagrams of the speech mechanism found on google and we label the different anatomical pieces. We talk about where they feel tension when they stutter - their lungs? Their vocal folds? Their tongue? This discussion often reveals information that the AWS would have been unable to put into words, such as what they feel anatomically in a stuttered moment. This instruction also helps our AWS to feel more knowledgeable and in control; stuttering doesn't have to be an un-explainable event that "just happens." Stuttering Therapy Resources has a nice hand-out here.

• Hierarchy of Dysfluencies: I’ve found it interesting that, in my experience, some AWS have made it all the way to high school without ever considering when, where, and with whom they stutter more or less. Some AWS, of course, can tell easily tell you exactly when they have their worst stuttered moments and have spent a great deal of time thinking about the subject. But I’ve also encountered students who seem to have taken the approach that they are powerless in deciding when they stutter, so closely monitoring when they stutter has never been a priority.

This is a picture of a typical hierarchy I create with students. As you can see, he was able to identify that he’s most dysfluent when he really wants to say something. But when talking to his baby brother or animals, he’s more fluent. When talking to adults, such as his aunt, mom, and a teacher, his fluency varies more. This activity really helps give AWS ownership of their stutter: they can monitor and make determinations about difficult situations, people, and places. Once they feel in control of difficult situations, they can then be more prepared to use their fluency strategies effectively.

• Personal Strengths and Weaknesses: I’ve found that AWS often wind up with pretty low self-esteem. One of my AWS is so embarrassed by her highly noticeable secondaries that she texts people she’s standing next to in order to avoid talking. One 17-year-old AWS is convinced that he won’t be able to find a summer job because no one will hire a stutterer. It’s frustrating for me, as a clinician, to see the inherent value and worth in these students when they can’t recognize it themselves!

So, for at least one session, we sit down and write a list of both strengths and weaknesses in all aspects of life (school, home, extracurriculars, etc). I like to focus on the strengths first and build up the students as much as possible. However, I believe there’s real value in identifying weaknesses (besides stuttering) that may actually have a greater impact on their life. For example, all my AWS write stuttering as their biggest weakness. But after some discussion, we might come to realize that their poor grade in math is what will actually keep them from getting into the college they want - not their stuttering! Or perhaps constantly fighting with siblings might be what’s actually causing poor family relations - not their stuttering! We then brainstorm ideas of what they can do to target these weakness (e.g. attend tutoring, be more patient with siblings, etc.) to support the belief that AWS can take control over their own lives.

The students typically reach the realization that, yeah, stuttering does suck to deal with. However, there are many areas of life that can be improved upon. Stuttering is not the only facet of their personality or existence. It’s dangerous for AWS to get caught up in the idea that being fluent would fix everything, because then their stuttering becomes an out-of-control monster to defeat rather than just another part of their life that they can control. Discourage the relentless pursuit of the Fluency Fairy!

You can find the worksheet I use to complete this activity here at my TPT store: https://www.teacherspayteachers.com/Product/Strengths-and-Weaknesses-Fluency-Activity-2548904

• Exploration of Fluency on Social Media: Let’s face it: we live in a world dominated social media. And like all teenagers, our AWS exist in the epicentre of the social media world. Teenagers today use social media to broadcast all aspects of their lives, and for our AWS, social media can be a where they feel safe. After all, AWS can type a message or snap a picture and maintain the illusion of 100% fluency (remember my student who would rather text than talk?)! But unlike the real world, they have access to an entire network of resources about stuttering and connections to PWS at their fingertips! Below, I’ve outlined a list of online resources I like to expose to my students. I like to introduce a new social media outlet or website to my students at the end of each session in order to give them something to check out over the week. I typically introduce them to the facebook group NSA TwST first, as I think connecting with other teens who stutter is the one of most beneficial things we can do for our AWS.

Recommended Materials:

• Do You Stutter: A Guide for Teens - This is a great, fairly short but comprehensive guide for teens. I have several copies that I loan out to my students. I’ve found that some of my students do better when they feel like they have some ownership of their treatment and this is a great way to do it.

*Also available in Spanish!

• The School-Aged Child Who Stutters: Working Effectively with Attitudes and Emotions - Although it says it’s for the “school-aged child,” many of the activities and techniques outlined in this book can be adapted and used with teenagers. There are plentiful examples of student work and assessment tools you can copy and use with your students. For only $15, it’s a must-have in my mind.

On-line Resources:

• Stuttering Therapy Resources - I love this website's "resources" tab - it's chock full of therapy ideas, handouts, and videos! This site is run by one of the favorite fluency experts, Nina Reeves, and I highly recommend spending some time familiarizing yourself with the wonderful information kept here.
• NSA TwsT Facebook Group - A closed group on facebook (moderated by adults, of course) that’s open to teens who stutter. It’s a very supportive community and a great place for AWS to “get their feet wet” by reading what other teens post!
• www.reddit.com/r/stutter - A forum-type website where PWS ask questions, post treatment ideas, and celebrate achievements. It is monitored to remove abusive content, but users may use profanity, so be careful who you recommend this to.
• Stutteringhelp.org - The Stuttering Foundation’s Official Website, replete with information, videos, handouts, and resources.
• Westutter.org - The National Stuttering Association is your go-to website to find opportunities for meet-ups, meetings, and other in-person activities. I took 2 of my students to a local NSA meeting and they reported that meeting adults who stutter really changed their outlook about their future prospects. They even spoke up at the meeting and told the group about themselves - something they swore up and down they wouldn’t do before the meeting!
• Friendswhostutter.org - Although I have yet to attend a Friends event, this group is really active in promoting opportunities for children and teens who stutter to meet up and worth checking out if there is a group or event in your area!
• Stuttertalk.com - A great podcast that highlights stories from PWS, SLPs, parents of CWS, researchers, and more. There are lots of podcasts of successful young adults who stutter talking about their lives - highly encouraging for our AWS!

At my school, I inherited several other “pre-packaged, ready to use” fluency therapy tools (you know the type). I really don’t like them for use with the adolescent population - they often have childish illustrations, focus solely on fluency strategies, and the students can tell that it's "off the shelf," impersonal therapy. Most of my students have talked about strategies with a goal of increased fluency for years. Now, as teenagers, they deserve answers about why they stutter, why it can be so hard, and more information about the larger community of PWS that exists in the world. I hope these posts have refreshed your outlook therapy ideas for AWS! Let me know your thoughts in the comments below. Next week, we’ll dive into the topic of new ideas on assessment of AWS.

As always, it doesn't have to be fancy, just keep it fun and functional!

• Jillian, the No-Frills SLP