Preschoolers who stutter: What and how? - Part 2: A talk with Norwegian SLT, Therese Espegard

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?

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.

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.

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!