Croatia Stuttering Symposium, day two

The topic of the second day of the symposium was treatment of youth who stutter. This is a broad age group and clinicians treating this age group will meet many different challenges.  As on the first day we were given clinical insight through videos showing both speech pathology methods (Rosalee Shenker) and clinical psychology methods (Ross Menzies).

Associate professor at The University of Texas at Austin, Courtney Byrd, gave a historic backdrop in her lecture, focusing on some of the theories and ideas from Van Riper. Some of her key points was that stuttering modification reduces fear and avoidance, and that voluntary stuttering facilitates positive affective, behavioral and cognitive change. She emphasized that for voluntary stuttering to be effective in desensitization it needs to closely resemble the persons authentic stuttering, something Menzies later agreed on in the plenary discussions. Although there is little research done on the effects of voluntary stuttering, there is an abundance of evidence showing that being exposed to what you fear the most is desensitizing.  

Courtney Byrd highlighted the importance of non-apologetic self-disclosure, and that teaching kids who stutter to do this can be empowering. She talked about the risk of bullying and the negative effects this can have, and that educating the child about stuttering and developing their ability to handle bullying and stigmatization is an essential part of treatment. Lastly, she talked about communication, and that good communication can be achieved regardless of stuttering and is not defined by fluency alone.

Rosalee Shenker, Executive Director at Montreal Fluency centre, talked about the many challenges there is in treating youth who stutter. Negative feedback and social anxiety increases, past experiences with failed or incomplete treatment, difficulties with generalization to out-of-clinic settings and the resistance to changing speech in fear of sounding even more unnatural then they already do. She emphasized the importance of creating a positive therapeutic relationship, and that treatment must adapt to the child´s needs. We have to measure change, and treatment should reduce or eliminate stuttering in a reasonable time frame. Rosalee Shenker commented on the fact that youth are often said to be unmotivated for therapy. She was clear on the fact that effective treatment will motivate, and if treatment isn´t working we need to adapt and change, and that it is our responsibility to motivate our clients.

Ross G. Menzies talked about increased risks of anxiety and mental health issues for this age group, and that it is a critical age for positive change and successful treatment. If we do not handle these issues at this age, they will increase and become more severe in adulthood. The consequences of anxiety are enormous for education and social life. According to Menzies adolescents often deny or minimise their anxiety problems, and it can be challenging to get them to open up. Menzies states that cognitive-behaviour therapy (CBT) is the most supported treatment for reducing anxiety in young people. Youth who stutter experience bullying at high rates, which increases the risk of anxiety, and this must be dealt with in CBT.

Menzies explains that anxiety, fear and anger comes from our consciousness. And that consciousness, our inner voice, is our biggest enemy, but is camouflaged as a friend. In therapy he uses the metaphor of the wolf in sheep’s clothing. The goal of modern CBT is to change the relationship you have to your own consciousness, and get clients to realise that they should not trust their inner voice because a friend would never talk to them that way. The more proof you get that the “wolf” is wrong, the easier it is to ignore him. An exception to a feared situation will in most cases just give a feeling of relief, and will not make you any less anxious of the same situation the next time. Therefore, the idea of the untrusting wolf must be reinforced by explicitly saying again and again that the wolf was yet again mistaken.

This is a guest post written by Ragnhild Rekve Heitmann (UiB) and Ane Guldberg (Statped Vest).  Starting from the left side on the picture below you can see Åse, Ane, Ragnhild and Linn enjoying a typical evening in Cavtat with good food and lovely scenery.