Monday, May 31, 2010

Why would I send a child to treatment?

Why would I send a child to early childhood intervention?

1) to check that the child doesn't have any other issues.

2) to avoid that the child tells me 20 years later: Why didn't you do something when I was young?

3) because the worst case scenario is nothing happens.

4) to hope that a therapist can reduce severity of symptoms.

5) to give the child tool to deal with stuttering events.


But Is it effective? Here are my conclusions:


Stuttering has a neurobiological basis that appear at a time many speech and language related areas are developing, because there is a mismatch in neurological demands and capacity. This mismatch can be permanent or temporary in that some areas have developed earlier than others. Those kids with a temporary mismatch recover. Those with a permanent mismatch might either compensate well (neurologically or behaviourally) to have recovered for all practical purposes, or not and develop adult stuttering.

So in my view there are three different types:

A) permanent (due to strong deficiency and/or strong reaction) and stuttering

B) permanent (due to moderate deficiency), compensated and occasional mild stuttering under stress but stuttering after specific neurological incident

C) temporary and no stuttering

B and C are those 80% that recover.

7 comments:

Anonymous said...

don't you have to consider the COST and $$$ of treatment? Are you just wasting your money and give it to SLPs....

Is spending $$$ on treatment worth it, or just invest the money for the child?

Einstein said the rule of compounding is amazing.

Let's see $5000 for a Speecheasy or $500,000 for the child when he grows up....

StutterTalk said...

Tom,

You ask, “Why would I send a child to early childhood intervention?” You left an important reason off the list – “To help parents face stuttering as productively as we can.”

Parents receive so much unsolicited information, advice and guilt about stuttering. The tough part about preschool stuttering is that the child begins speaking without stuttering. And then, around 2-4 years of age, the stuttering sets in. This really scares parents and families. Parents think, “What did I do wrong?” “How did I cause this?” Mothers and fathers are often blamed either explicitly or implicitly. All of this fear, desperation and frustration make it difficult for parents to objectively and productively face the situation.

My experience as a speech-language pathologist is that preschool speech therapy is similar to how an airline trains parents to deal with an emergency. Parents are told to put the air mask on themselves and make sure they are breathing before putting the air mask on their child (after all, parents are no good to their child if they pass out). Just as with adults who stutter, I want parents leaving my office feeling as if they can problem solve situations and become their own therapist.

One thing I find interesting is that the Demands and Capacities folks and the Lidcombe folks seem to agree that preschool therapy for children who stutter is based on parent counseling. Some speech-language pathologists even recommend billing speech therapy for preschoolers as parent counseling and not as speech therapy.

Peter

Anonymous said...

"Some speech-language pathologists even recommend billing speech therapy for preschoolers as parent counseling and not as speech therapy."

So psychologists who knows about stuttering should be the ones treating preschool stuttering?

SLPs are not professional psychologists.

Anonymous said...

Doesn't StutterTalk know that ASHA does an exquisite job of requiring professional preparation in treating stuttering, as well as most definitely preparing ASHA licensed SLP's and BRS-FD SLP's, and SFA certified SLP's for counseling parents of CWS about stuttering and its treatment?

Ah, yeah, sure...

StutterTalk should know anybody can treat stuttering and counsel parents of CWS. Just get ASHA CCC's, go to an SFA, NSA or FRIENDS event, and you're all set to go! For evidence of this method of success, just look at all the fine therapy for CWS in the public schools of the USA. Positive outcomes are the norm, beyond a shadow of doubt.

Lidcombe is great...Just stop your bumpy speech and talk with out mistakes, will you kid? And if that don't work, well, we'll just give you Bouncy therapy...

Just a little reminder - Remove head from arse...

ig88sir said...
This comment has been removed by the author.
ig88sir said...

Well some children, like myself, only show mild secondary symptoms with no overt stuttering until puperty so it's better to be safe than sorry! Too bad most doctors know little about identifying this type of dormant stuttering. I was a shy child around adults but talked fluently around my friends and at school. It wasn't until I went to jr high school that I developed a full blown overt persistant stutter. Now I am part of the club! Including Sergent Peppers!

Pam said...

It sounds like "anonymous" favors an interdisciplinary approach, which makes a lot of sense.
It's too bad that there is not more of a push to have more disciplines involved.
Personally, I did not seem to much benefit from traditional fluency shaping therapy. It was limited in scope (I think), inconsistent, and did not really address core issues I had as an adult who stutters.
I did greatly benefit from attending self-help and feeling accepted by other stutterers.
And I benefited from seeing a counselor for other issues. This person did not "treat" my stuttering, as he is not qualified to do that, and did not profess to, but we certainly talked about my stuttering during the course of tackling other things. In fact, we talked about it a lot, in context to other things in my life and how they paralleled.
I think a combination of disciplines coming together to treat the whole person - child, teen, or adult - has so much potential.
But as "anonymous" alludes to, perhaps that is too scary.