Our guest chat hosts tonight, March 26, 2001, are Vivian Sheehan, MA, CCC/SLP,
Dale F. Williams, Ph.D., CCC/SLP, and Peter Dugan, M.Ed, CCC/SLP.
These three SLPs will chat about stuttering therapy. They will also be conducting a
STUTTERING THERAPY INSTITUTE on May 3, 2001 at the Academy of Private Practice in Speech
Pathology and Audiology (APPSPA) Spring Conference in Delray Beach, Florida. 

Vivian Sheehan, MA, CCC/SLP, is an ASHA Fellow, specializing in stuttering.
She is the Director of the Sheehan Stuttering Center, a Private Practice in Santa Monica,

Dale F. Williams, Ph.D., CCC/SLP, is an Associate Professor at Florida Atlantic
University and Director of the Fluency Clinic there.  He holds Specialty Recognition
by ASHA Special Interest Division 4: Fluency and Fluency Disorders.

Peter Dugan, M.Ed, CCC/SLP, is a speech/language pathologist with the Broward County
Schools.  He is also an Adjunct Supervisor at Florida Atlantic University Communication
Disorders Clinic.

Resources for Stuttering porvided by the guest hosts can be found at the bottom of this page.

<Robin> Welcome 8871!!! Do you or 29,  have any questions about stuttering therapy
    for our panel of guest hosts?
<Adrienne> hi  8871, we're talking about stuttering... any questions for our experts?
<Brian> do you know of any research on the brain that is connected to stuttering?
Anonymous4742 has joined the chat room.
<Dale> Brian, there's a lot of neuro research. Was there something in particular you
    were interested in?
<Brian> I just want to know more on that subject... I believe that my stutter is more
    neurological than anything else
<Peter Dugan> Why do you think that Brian ?
<Vivian Sheehan> Brian-- Did you have a brain injury that you know about?
<Brian> I find that when I even talk to myself... I stutter
<Brian> but when i juggle 2 tennis balls with my right hand in front of others, I won't
    stutter at all
<Dale> Oh, so research on cause? Nothing definite--many diff's w/in the brain, but the
    res. is on adults...
<Dale> ...so the diff's may be a result of stuttering rather than a cause.
<Anonymous8871> It seems so confusing when data to support genetic, neurologic,
    environment etc. causes
<Brian> No, no brain injury... but my dad stuttered up until he was 13
<Peter Dugan> You would probably be more relaxed if you weren't worried about
<Vivian Sheehan> Brian -- This is just a distraction device.  That is why you temporarily
    do not stutter but the fear of the next word and time is still there.
<Karen> What is a good relaxer?
<Dale> Brian--I was referring to developmental stuttering.
<Karen> To stay calm?
<Karen> breathing in and out?
<Karen> deeply?
<Beverly> If stuttering is involuntary, why does relaxation help? 
<Karen> before speaking?
<Vivian Sheehan> Relaxation does not work when you are under pressure.
<Peter Dugan> Fear definitely can negatively effect stuttering and make you feel much
    more neverous
<Karen> Does coffee make it worse?
<Vivian Sheehan> Coffee does not affect stuttering.
<Brian> developmental stuttering?  I've not heard of that
<Dale> Beverly--relax. makes it easier to use controls.  But Vivian's right--sometimes
    you'll be under pressure.
<Peter Dugan> But if you aren't worried about stuttering you are going to naturally be
    more relaxed
<Karen> hard to do
<Dale> Brian--that's run-of-the-mill stuttering--develops gradually in childhood.
<Adrienne> Peter, sound logical enough- but then how do you not be worried if you
<Peter Dugan> Practice and time, not in one day
<Peter Dugan> Change your attitude and perspective about it
<Brian> I see... I do remember my stutter gradually developing
<Dale> Brian--that's typical. The question of whether it's due to a neuro dysfunction (or
    at least how much of it is) is still being debated.
<Brian> Do you know of any studies currently going on?
<Beverly> If it's thought that persistent stuttering is genetic, how can treatment help?
<Dale> Brian--there are PET studies going on in Cal.  De Nil is doing neuro research
    in Canada.  There's more too.
<Dale> Check the Stuttering Home Page for a list of ref's.
<Adrienne> good question Beverly
<Peter Dugan> Beverly, treatment can help quite a lot, stuttering changes over time and
    there are many ways to treat it
<Beverly> I get the counseling aspect
<Brian> ok... thanks.  That's definitely worth looking into
<Beverly> but what can an SLP do?
<Dale> Beverly, the onset of stuttering may well be genetic.  But most of the behaviors you
    see are learned.
<Beverly> So would that fall more into behavior modification
<Beverly> or speech therapy?
<Vivian Sheehan> Whatever the cause, there is treatment to overcome the choices in
    behavior that you have fallen into and have become habits, leading to attitudes and
    values that hurt you
<Dale> Also, remember that the idea is not to make it go away.
<Peter Dugan> Teach the client ways to control the moments of stuttering and counter
    condition the learned aspects of stuttering
<Dale> Unless you're dealing with a preschooler.
<Beverly> And if you are dealing with a preschooler?
<Dale> Teach him a way of talking that's stutter free.
<Vivian Sheehan> The parents need help to handle the child well.
<Vivian Sheehan> Then the child will be comfortable.
<Peter Dugan> and modify the speaking environment to make it more fluency friendly
<Robin> Glad all of you could come tonight...any questions for our guest host panel?
<Robin> Erika, have you had any clinical experience with stuttering clients?
<Erika> not directly...only observation
<Beverly> Do you advocate for the use of diaphragmatic breathing?
<Erika> I observed a cluttering client that was interesting
<Erika> I reallly liked that
<Beverly> easy onset?
<Beverly> Is it trial and error
<Beverly> or how do you determine what will assist in empowering the client
<Dale> Bev--for some breathing is not the problem, so that's client-specific.
<Adrienne> how is cluttering different from stuttering?
<Dale> Re easy onset, only as a means of teaching an easier stutter.
<Erika> cluttering I believe is not being able to control the rate of speech
<Erika> they end up talking so quickly and run out of breath
<Dale> Erika is right--it's also characterized by lang. formulation problems...
<Dale> ...and charactistics such as poor reading, bad handwriting, artic errors, & more.
<Adrienne> ok, thanks
<Vivian Sheehan> Cluttering sounds like stuttering, but is ususally more involved with
    learning to read and write.
<Brian> I do have another question... what is the must successful intervention
<RB> Do you advocate a mix b/w fluency enhancing and stuttering mod?
<Peter Dugan> Prefer stuttering modification because it treats all aspects of stuttering
<Beverly> what is the difference?
<Dale> RB, fluency shaping with desensitization, counter-cond. etc. is much better than w/o
<Dale> ...but even then it will help in only limited situations.
<Anonymous825> I just joined but I do have some questions.  I work with elementary
    aged stutterers and ask them to speak at a slower rate because they do speak very fast
    partially due to their primary language....comment?
<Peter Dugan> There is so much more to stuttering than just disfluencies and
    stuttering modification seems to address more aspects
<Brian> how does stuttering modification address more aspects?
<Dale> Brian--there is no universal efficacy scale for therapy, so I don't know...
<Dale> ...about what's most successful.
<Beverly> What's the difference between stutt mod and fluency enhancing?
<Peter Dugan> It deals with fears: word, situation, etc., attitudes and gives client ways to
    control stuttering
<RB>  Do negative feelings affect people differently or are they pretty universal?
<Vivian Sheehan> 825 -- For the stutter who speaks rapidly, try to get him not to rush.
    That is what he is doing to stop his stuttering.  
<Vivian Sheehan> 825 -- There is a difference b/t slowing his speech down and not
<Dale> Bev--F-S is to learn to talk without stuttering; stuttering modification is to control the stuttering.
<Peter Dugan> Vivian raises a good point... so much of what stuttering is, is the
    stutterer trying not to stutter
<Beverly> Thanks!
<Erika> that's an interesting way to put it
<Dale> RB, re. negative feelings, do you mean people who stutter?
<RB> Yes, the fears/negative feelings experienced by people who stutter
<Peter Dugan> To me in my mind, fluency shaping feeds into the trying not to stutter
<Vivian Sheehan> Good point, Peter.  I agree.
<Peter Dugan> Thanks
<Adrienne> I thought shaping was trying to stutter a different way?
<Dale> RB, like everything about stuttering, this varies greatly across people.
<Erika> seems like my instructor advocated stuttering modification also
<Erika> she is a person who stutters also
<Peter Dugan> People will only use it when they feel they can do it successfully without
    stuttering, so what do you do the rest of the time ?
<Robin> 825, did you get the answer(s) to your question?
<Dale> RB again: the ones without fears, etc. we don't see, as they have no use for therapy
    or support groups
<Erika> the ones without fears though, do they have a good attitude about their stutter,
    or are they denying the fact there is a problem?
<Anonymous825> I understood that it is acceptalbe to ask them to slow their speech.
    Other slps I work with tell me that is not to be done anymore. 
<Peter Dugan> right, calls negative attention to their speech
<Robin> Peter, you work in the schools...do you have any more suggestions for 825?
<Dale> Erika, I was referring to the first group, but, yes, there are others in denial.
<Peter Dugan> You do not want to ask them to slow down
<Dale> 825, clients have to be taught HOW to slow their speech.
<Peter Dugan> Better way to therapy is to begin the process of changing the way the
    client stutters
<Vivian Sheehan> Modeling easy speech without rushing is a good way to give an
    example for them to practice.
<Robin> Peter, what recommendations could you make to 825 when
    working with elementary school aged kids?
<Peter Dugan> Use alot of open stuttering, have the students learn about what
    stuttering is, learn a better way to stutter, changes the pattern of hiding stuttering, start
<Vivian Sheehan> Very good answer, Peter.
<Peter Dugan> Begin to decrease avoidance behaviors and any stuggle behaviors
    during the moments of stuttering
<Peter Dugan> Begins to show students not to avoid situations and also try to provide
    therapy in as many different places in the school enviromnt as possible, get the
    teacher involved in therapy process
<adriana> I work here in Mx as SLP
<adriana> sorry...... i do not understand :)
<adriana> ok I got it
<Robin> Adriana, you are from Mexico?
<adriana> yes Robin
<adriana> I work here in a private hospital
<Dale> Adriana, stuttering is prolonged and repeated sounds & syllables, with
    accompanying avoidance and escape behaviors.
<adriana> actually I do the tests here
<Erika> what is the earliest that one should be concerned that a child may be a
<Erika> I guess I am asking about EI for stuttering
<Adrienne> sometimes regular development can be mistaken for stuttering right?
<Erika> yeah, thats what we learned anyway
<Dale> Erika, that's a source of much controversy. If a parent suspects something,
    he/she should schedule an eval...
<Dale> ...parents know when they hear something abnormal
<Anonymous825> parents, teachers, and others expect the student to stutter less thus
<Dale> I have found parents to actually be good judges of normal vs abnormal
<Brian> has anyone seen a 3 and a half year old boy who struggles when he talks?
<Peter Dugan> definitely, some children are at risk that young
<Dale> Brian--I've treated 3 y/os before.
<Erika> we've had kids in our clinic that young
<Erika> we do a fluency clinic here
<keely> I am currently treating a 3 1/2 year old who stutters
<Dale> Erika--where?
<adriana> stuttering is like a boy talks like this ??  he-he-hel-l-lo-o-o ?? how--a-a-a-re
    y-y-you.-...... am i right ?
<Robin> Erika is from Oklahoma
<Erika> hehe
<Dale> Adrianna--sounds like you're talking about the same thing.
<Brian> I'm not sure... one of my managers at work has a son that young who stutters
    and he asked me about it
<Brian> I haven't heard him talk yet
<adriana> Ok...... i just needed to know...... because as I am from Mexico, so i have to know
    what you mean.... that's all:) Thanks Dale
<Brian> some SLP's here don't believe that children that young shows struggle
<keely> The 3 year old I am seeing definitly stutters and has occasional blocks
<Brian> I haven't heard him talk yet
<Vivian Sheehan> Keely -- when the child is blocking he is trying to stop himself from
    stuttering and that is a bad thing for him to do.
<keely> Vivian-what should I do when he has blocks?
<Andrea> goodnight all... thanks for the information!
<Anonymous825> what is your impression of the Monterey Fluency Program?
<Dale> 825, the Monterrey Program is fluency-shaping, which is a little different than
    what I prefer to try with stuttering clients.
<Peter Dugan> Haven't heard of it ?
<Anonymous825> which of the programs for fluency would you advocate in public
<Peter Dugan> There isn't a specific program I have seen which I would recommend
    for the schools
<Vivian Sheehan> Keely -- You cannot change the immediate block, but begin to help
    him feel more comfortable and accept the fact he is stuttering but doesn't have to stop
<Dale> 825, pick & choose from the commercially produced program.  Don't follow any
    one to the letter...
<keely> Dale, what do you usually do with your stuttering clients?
<adriana> yes, Dale,..... what you do ?
<adriana> i have no clue
<Vivian Sheehan> Keely --Keep good eye contact and get him to look at you, especially
    when he stutters.
<Dale> ...it's very important to individualize therapy for such an individualized disorder.
<keely> Vivian-he has awareness of trouble speaking, but has no awareness of the
    actual "bumpy" stuttering
<keely> I model smooth and bumpy speech and he has no idea....
<Dale> I incorporate the stuttering modification phases of ID (education), desensitization, modifying
    the stuttering, all the while working on transfer.
<Vivian Sheehan> Keely --Just do not try to make him fluent.  Get him to talk a lot and
    his parents listen to what he has to say rather than how he says it.
<Dale> Very nicely said, Vivien.
<Vivian Sheehan> Thanks.
<Adrienne> like drawing attention to it may be more harmful?
<Dale> Adrienne, they shouldn't harp on the kid, but if he wants to talk about it, the parents
    should do so.
<Anonymous825> how about teaching him to prolong a beginning consonant when he
    begins to block
<keely> He is a VERY sensitive kid, shy too...probably doesn't help the situation
<Adrienne> i see
<Anonymous825> what techniques should be taught then when he comes to speech?
<keely> 825--don't know what SHOULD be done, but we are currently doing a
    combination of direct/indirect techniques...
<keely> such as slowing speech rate, recasting stuttered statements, etc..
<keely> plus giving examples of bumpy vs. smooth speech.
<Anonymous825> explain recasting stuttered statements
<Dale> 825, this is where it gets tricky--whether a technique is effective or an
    avoidance depends largely on what's going on inside the speaker's head.
<keely> recasting--say the sentence he has just stuttered back to him in a smooth,
    slow manner
<Anonymous825> thanks so much
<keely> no prob
<Adrienne> do these strategies reduce stuttering occurance or just provide strategies
    to use when stuttering
<keely> Adrienne-they're meant to reduce stuttering occurances, it's not foolproof by
    any means though
<adriana> guys do you think stuttering is just emotional ? or involves other problems?
<Erika> I think it's neurologically based
<Dale> Adriana--just emotional? No.  Involves other problems? Not sure what you
<adriana> i think that too, ericka, but most of the patients i see, they have emotional
    problems too
<adriana> yes, emotional like, family problems, or school problems, so they stutter because
    they are just nervous
<Peter Dugan> Adriana - there is alot more to it than that
Brian> being nervous only enhances the stutter that is already there
<Vivian Sheehan> Adriana-- we do not know the cause of stuttering.  Only those factors
    which make it worse or make it better. 
<Dale> No, Adriana. It's important to know that it's not a psychological problem.
<adriana> OK dale
<Brian> thank you, Dale... that is a very good point
<Anonymous825> would you suggest to use whatever works?  if a student improves
    in all environments isnt that acceptable
<Dale> 825, the change has to be long term...
<Dale> ...meaning the clients have to have tools to help themselves when the SLP is no
    longer around.
<Robin> Our hosts have been chatting for two hours and may be getting tired!  Are
    there any more questions you would like to ask?
<Adrienne> Thank you all for your help!  Very interesting chat tonight
<adriana> thanks and good bye
<Vivian Sheehan> I am going to sign-off.  See at the institute.
<Peter Dugan> Vivian looking forward to May 3rd
<Vivian Sheehan> Robin, thanks for guiding us this evening.
<Peter Dugan> Thanks Robin
<Robin> Thanks to YOU, Peter, Dale and Vivian!!!!!!
<Dale> Thank you everyone.  I enjoyed your thoughts & questions.
<Robin> thank you to all of our students  too!
<Brian> this has been interesting.  I hope to talk to you again

Internet Resources:

The National Stuttering Assoc.                http://www.nsastutter.org

The Stuttering Foundation of America           http://www.stuttersfa.org

The Stuttering Home Page                     http://www.mankato.msus.edu/depts/comdis/kuster/stutter.html

The British Stammering Association           http://www.stammering.org

International Stuttering Awareness Day On-Line Conferences 1998-2000

Suggested readings from our handout:

Conture, E.G. (2001). Stuttering: Its nature, diagnosis, and treatment. Boston: Allyn & Bacon.

Dietrich, S. (2000). Tension control therapy: An integrated approach to treatment. Paper presented at the International Fluency Association World Congress.

Keys & Ruder (1992). A review of commercialized fluency treatment programs. ECHO, 14, 14-17, 21-24.

Kuster, J. et al. (2000). A Picture Is Worth One Thousand Words. Paper presented at the International Stuttering Awareness Day Online Conference. At: http://www.mankato.msus.edu/dept/comdis/ISAD3/isadcon3.

Quesal, R. (1998). What is "successful" stuttering therapy? Paper presented at the International Stuttering Awareness Day Online Conference. At: http://www.mankato.msus.edu/dept/comdis/isad/isadcon.html

Ramig & Bennett (1995). Working with 7- to 12-year-old children...Language, Speech, and Hearing in Schools, 26,138.

Sheehan, J. (1997). Message to a stutterer. Stuttering Home Page. At: http://www.mankato.msus.edu/dept/comdis/kuster/Infostuttering/sheehanmessage.html

Shields, L. (2000). Using the Internet with Children Who Stutter. Paper presented at the International Stuttering Awareness Day Online Conference. At: http://www.mankato.msus.edu/dept/comdis/ISAD3/isadcon3.

Sugarman, M. & Yaruss, J.S. (2000). Use of Helpful Counseling Techniques for Fluency Therapy. Paper presented at the International Stuttering Awareness Day Online Conference. At: http://www.mankato.msus.edu/dept/comdis/ISAD3/isadcon3.html

Van Riper, C. (1973). The Treatment of Stuttering. Englewood Cliffs, NJ: Prentice-Hall.

Yaruss, J.S. (1998). Describing the consequences?JSLHR, 41, 249.