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| Therese Espegard |
Our
series about working with preschoolers who stutter continues today with speech
and language therapist Therese Espegard. In this ongoing
series we will be talking to healthcare professionals, speech and language
therapists and parents about managing preschool children who stutter. Therese
Espegard is a SLT working in her own private practice in Drammen. She has
been working with preschool children who stutters for six years, lately in her
private clinic, Drammenslogopeden. Here she shares some of her thoughts about
treating preschool children who stutters:
What
is a common question you get asked about stuttering by parents and/or
kindergarten teachers?
In my experience, many parents
have heard myths about stuttering. They are often worried stuttering is caused
by something they did. A typical example is questions about whether the
stuttering can be caused by them tickling their child. Many parents meet at the
clinic expecting the stuttering to disappear. This also reflects on the
questions that I am asked. I often start the collaboration with the parents by
presenting them with information about stuttering, research and prognosis.
Does
your service have a waitlist for services? If so, does your service have a
protocol for determining who receives access to intervention?
I do have a waitlist, but I
normally prioritize children who stutter. That means I often have the
possibility to start early in those cases, proving parents with information,
assessing the child, and when its appropriate, start treatment at an early
stage.
What
factors do you consider when deciding when to start treatment with a preschool
child who stutters?
I normally consider how long the
child has been stuttering for, whether there is a genetic factor, whether the
child is aware its own stuttering and if the child has started to show negative
reactions or secondary behavior towards its stuttering.
What
is the earliest age you provide stuttering treatment for preschool children?
I consider this differently from
case to case, but I have worked with several kids from they are about three
years of age, and I have positive experiences with early intervention.
How
do you decide which treatment to use with preschool children who stutter?
Again, I consider this from case
to case. It depends on how long the child has stuttered, stuttering severity,
and awareness. Sometimes I change approach after a while. It is normally a
continuous consideration. I do this in close collaboration with the
parents.
What
stuttering managing approaches do you use the most with preschool children and
why?
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| Working on Lidcombe with a fun game of explaining. |
I work both directly and
indirectly. I try to stay in close contact with parents and preschool teachers.
I have positive experiences from using the Lidcombe program. Although in my
experience, not all parents want to start doing Lidcombe because of the time
consume.
Other management approaches I use
with children and parents consists of desensitization, giving the child good
strategies and experiences with coping. Research show that many children who
stutter, can have negative thoughts about their own speech from a very young
age. That means getting help early is important. My hope is early intervention
will prevent the child from getting into a vicious circle of avoidance and
problematic relationship with communication situations, etc.
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The green and red piece works as positive reinforcement
together with the verbal contingencies. Published with permission from parents. |
I also work closely with the
parents as to how they react to the child's stuttering, mention the stuttering
and so on. I find that many parents are afraid to talk about stuttering with
their child, making the stuttering the pink elephant in the room. In my experience,
children are often relieved when they can talk about it and neutralize
stuttering.
I do not always use the word stuttering with the children. Sometimes
I will rather use hand puppets and role-play, explaining how words can jump or
get stuck. In my experience, children respond well to this. I also work with
desensitization by using voluntary easy stuttering and by letting effortless disfluencies
into my own speech.
I also introduce fluency shaping
techniques and contrasting using concretes like a turtle and a hare, a rock and
a piece of cotton. With the older children I draw on elements from CBT. I find
using CBT “roadmaps” to be a useful tool when talking about anxiety and
stuttering with the older kids.
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This turtle
exemplifies slow rate, and the preschool child
Therese was working with here
wanted the kitten to symbolize smooth stalking. |
On
a scale from 1 to 10, 1 being not confident at all and 10 being extremely
confident, how confident do you feel about working with preschool children who
stutter and their families?
I’d say I feel about a 5 or a 6.
I feel confident, but there is a lot still to learn and I wish to still develope
as a clinician. This is a field
continuously in change, and I think there will be a lot of interesting research
coming on the field, that will be of great importance for me as a
clinician. As far as possible, I try to
sign up for all courses on stuttering I can find, so I make sure I stay
professionally updated.
Do
you have any formal training working with preschool children who stutter? If
so, what type of training have you received?
In addition to my formal training
as a SLP I have Lidcombe training. I also do my best to attend courses,
networks and seminars to keep up to date. Lately, courses I have attended have
covered topics from indirect treatment to fluency shaping and CBT. This fall I
look forward to learning more about stuttering management doing a MiniKIDS
training. It is also my wish and a personal goal to attend the European Clinical Specialization
in Fluency
Disorders one-year program at some point.
Describe one thing you find
rewarding and one thing you find challenging about working with preschool
children who stutter?
I find meeting children and the people around them rewarding,
as well as the possibility to make a difference and to make the child more
confident and less anxious in communication situations.
Some of the biggest challenges might be when a parent
stutters and have a hard time coping with their own stuttering. In
that case I spend a lot of my time talking to that parent. I believe that parents with a negative view on their
on stuttering might reflect that in how they cope with their child’s
stuttering.
In
your country, are there national guidelines for treating stuttering in
preschool children? If so, what are the key recommendations for working with
preschool children who stutter?
I follow the ethical rules made
by the Norwegian association for Speech and Language therapists. Beyond that there is, to my knowledge, no
special recommendations for using a special method in treating preschool
children who stutter. I consider treatment approaches according to the needs
and challenges the child has. Further, I inform parents about the methods that
exist and finding the right treatment approach to pursue together with them. I assess
the effect of the treatment on a continuous basis. Working with preschool
children who stutter, I think it’s important to clarify expectations and not
promise anything for results etc.
In
your opinion what’s the most important outcome of intervention when working
with preschool children who stutter?
Not everyone will be fluent, so
the goal is often less fear of their own speech, more coping with the
communication situation, reducing the frequency of stuttering, and limiting
negative strategies and negative feelings related to their own speech.
Thank you, Therese!
