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Most treatment programs for people who stutter are "behavioral," in that they are designed to teach the speaker specific skills or behaviors that lead to improved oral communication. For instance, many speech-language pathologists teach speakers who stutter to control and/or monitor the rate at which they speak. In addition, speakers may learn to initiate words in a slightly slower and less physically tense manner, and/or regulate or monitor aspects of breathing. With rate management programs, speakers often begin by practicing smooth, fluent speech at rates that are distinctly slower than typical speech, using short phrases and sentences. Over time, speakers learn to produce smooth speech movements at progressively faster rates, in progressively longer sentences, and in progressively more challenging situations until speech sounds both fluent and natural. "Follow-up" or "maintenance" sessions are often necessary after completion of formal intervention to prevent relapse. Treatment approaches such as these have been shown to be effective in improving the communication skills of both children and adults who stutter.
In addition to the strategies described above, speech-language pathologists may also work to help people who stutter lessen the impact or severity of disfluency when it occurs. The goal here is not so much to eliminate disruptions in fluency - which many speakers find difficult to do - but to minimize their impact upon communication when they do occur. Speakers may be taught to identify the ways in which they currently react to or cope with breaks in speech fluency, and then learn alternate responses that are more compatible with fluent speech and effective communication. For instance, a speaker who routinely produces long, physically tense disfluencies would learn to modify these disfluencies so they become fleeting, relatively effortless breaks in speech. As speakers become increasingly competent at managing speech fluency in therapy settings, they gradually practice the newly learned skills in real-life situations.
Speakers usually find that these behavioral strategies are relatively easy to implement during therapy activities. In contrast, speakers 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, and quite another in a noisy, fast-paced office or classroom. For this reason, speech-language pathologists often work with family members, teachers, and other significant individuals 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. (To get an idea of the challenge involved in rate management, try spending the next four hours walking at a pace that is about 10% slower than usual. Keep this up during every step you take, in all situations, throughout every activity you do. It's not easy!)
Traditionally, there has been some reluctance to treat stuttering during the preschool years. This reluctance 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. That is, it is generally agreed that early intervention for stuttering is desirable. That said, a speech-language pathologist 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 speech-language pathologists may model alternative ways to produce disfluent words, as well. Speech-language pathologists instruct parents on matters such as 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 miniaturized, 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. The effectiveness of these devices in real life settings continues to be studied. Preliminary findings suggest that some speakers 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, to determine whether the devices can be made to be more effective, and to clarify how much improvement one might expect in speech fluency when the devices are used either alone or in conjunction with speech-language therapy.
To find an ASHA-certified speech-language pathologist, visit http://www.asha.org/findpro/
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