Background:
This conversation initially began on the SIG4 (ASHA’s Special Interest Group #4 – Fluency and Fluency Disorders) community page. There was an initial question from an SLP about syllable-timed speech, and when we saw Reuben’s response, we knew it would need to be published on our website so SLPs could learn from it and SHARE it with others. He gave us permission to adapt the response for a blog format. We appreciate Reuben’s time and effort in sharing his wonderful insights!
Reuben's response:
My name is Reuben Schuff, and I am an engineer at Space X. I presently serve as the Consumer Representative for the American Board of Fluency and Fluency Disorders, as well as volunteer for several non-profits in the stuttering community. Please allow me to share from both personal experience and from the stories of others who stutter regarding your question on syllable timed speech. I believe there are a number of specific behaviors that we could be discussing. These range from the Modifying Phonation Intervals (MPI) approach to more simple techniques such as a metronome or finger tapping approach [insert any “go for fluency” programs/techniques here]. I would advise great caution in all of these areas, specifically in situations where people who stutter are encouraged to use a non-motor or language system trick to avoid the moment of stuttering. Listening to the experiences of those who stutter - whether directly or through research - informs us that encouraging such rhythmic technique often leads to the following damaging and negative long-term consequences:
- Increase shame of stuttering and self-identity,
- Increase hiding of stuttering,
- Decreased willingness to engage in meaningful communication in life situations, and
- (Most concerning) Development of additional secondary, physical maladaptive behaviors that lead to increased struggle and significant interference with communication.
Personally, I think that it is important for SLPs to ask themselves the following questions:
- "Is the therapy I am providing moving towards the thoughts, feelings, attitudes, and behaviors of a healthy person who is an effective, efficient, and joyful communicator?" or
- "Is the type of therapy I am providing my student/client creating undue cognitive load that ultimately leads to fluency that is unsustainable?”
From my experience, I would argue that the former therapeutic alliance is preferred. Learning to communicate in an easier way is not a matter of "giving it an honest effort." Stuttering is more complex than the sounds and syllables listeners can hear. I believe that it is most important for SLPs to have a philosophy that values the communication freedom and quality of life of the client as highly valued outcomes. I have experienced points along my journey with stuttering when clinicians pursued a focus on my motor system, and times where they even encourage me to “try not to stutter.” Upon reflection, these therapies were ultimately harmful to my ability and willingness to communicate if I thought I was going to stutter. I have also experienced points on the journey with my stuttering where clinicians empowered me with the ability to exercise choice with my motor system, without the expectation of fluency. This has been the most beneficial aspect of therapy for me. Understanding a person's experience with stuttering is crucial in providing neurodiversity-affirming therapy for children and adults who stutter. Thank you for the opportunity to share my experience as someone who stutters. It is the voices of the stuttering community that can provide the insight SLPs need to align with their students to find the joy in communication!
