How effective are treatments for stuttering?
ASHA produced a treatment efficacy summary on stuttering [PDF] that describes evidence about how well treatment works. This summary is useful not only to individuals who stutter and their caregivers but also to insurance companies considering payment for much needed services for stuttering.
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What do SLPs do when working with individuals who stutter?
SLPs work to help people who stutter lessen the impact or severity of disfluency when it occurs. The goal is not so much to eliminate disruptions in fluency—which many people find difficult to do—but to minimize their impact upon communication when they do occur. People may be taught to identify how they react to or cope with breaks in speech fluency. They learn other reactions that will lead to fluent speech and effective communication. For instance, a person who often produces long, physically tense disfluencies would learn to modify these disfluencies so that they become fleeting, relatively effortless breaks in speech. As people become better at managing fluency in therapy, they practice the newly learned skills in real-life situations.
People usually find that these behavioral strategies are relatively easy to implement during therapy activities. In contrast, people may find that day-to-day fluency management—at least in the early stages of treatment—is hard work! Use of the various fluency management techniques requires mental effort. It is one thing to manage or monitor speech rate in a quiet, controlled setting like a therapy room, but quite another in a noisy, fast-paced office or classroom. For this reason, SLPs often work with family members, teachers, and others on what to expect from therapy. Generally, it is not reasonable to expect that a person who stutters will be able to monitor or control his speech fluency at all times of the day in all situations.
Traditionally, there has been some reluctance to treat stuttering during the preschool years. This reluctance has stemmed from at least two sources: the observation that many children "outgrow" stuttering, and the belief that therapy heightens a child's awareness of fluency difficulty which in turn increases the child's risk for persistent stuttering. Current thinking is somewhat different from these traditional views, however. It is now generally agreed that early intervention for stuttering is desirable. That said, an SLP still may recommend a "wait and see" approach for children who have been stuttering for only a few months and who otherwise appear to be unconcerned and at low risk for persistent stuttering. If treatment is recommended for preschoolers, the approaches taken usually are somewhat different from those used with older children and adults. For example, parents may be trained to provide youngsters with feedback about their speech fluency, praising the fluent speech ("That was very smooth!"), and occasionally highlighting instances of disfluent speech ("That sounded a little bumpy"). Parents and/or SLPs may model smooth speech. SLPs teach parents when, where, and how to implement these treatments. Recent research suggests that intervention programs like these are quite effective at reducing, if not eliminating, the symptoms of stuttering with preschoolers.
In addition to the approaches described above, a variety of assistive devices have been developed to help those who stutter speak more smoothly. Most of these assistive devices alter the way in which an individual hears his or her voice while speaking. The devices often are small, so that they fit in or behind a speaker's ear. Laboratory research suggests that some individuals who stutter speak more fluently when they hear their voice played back to them at a slight delay or at a higher or lower pitch, or when "white noise" is played into their ear as they speak. How effective these devices are in real-life settings continues to be studied. Early findings suggest that some people find some auditory feedback devices very helpful, while others do not. Research is ongoing to identify:
- why some people benefit from the devices more than others
- whether the devices can be made to be more effective
- how much improvement one might expect in fluency when a device is used either alone or with speech therapy
- whether the benefits last over time
More information on the role of the SLPis available:
In addition to treatment provided by SLPs, some people who stutter have found help dealing with their stuttering through stuttering self-help and support groups. In general, stuttering support groups are not therapy groups. Instead, they are groups of individuals who are facing similar problems. These individuals work together to help themselves cope with the everyday difficulties of stuttering.
Many such groups exist around the world. In the United States stuttering support groups have a long-standing and strong tradition of helping people overcome the burden of stuttering. Support groups often have local chapters that consist of anywhere from a few to a few dozen members who meet regularly (e.g., weekly or monthly) to discuss issues related to their stuttering. Some groups also have e-mail lists and chat rooms, newsletters and books, and annual conferences that bring together hundreds of people who stutter and their families.
Many support group members report that their experiences in the support group improve their ability to use techniques learned in therapy. Others report that the support group meets needs that their formal speech therapy did not meet. Thus, many people benefit from participating in treatment provided by an SLP and a stuttering support group. Indeed, most support groups have developed strong partnerships with the speech-language pathology community to promote and expand treatment options for people who stutter.
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Research articles on stuttering
Select from the terms below to view search results for journal article abstracts:
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See also:
Stuttering
Stuttering: Causes and Number
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