I was recently asked about an 8th-grade student who didn’t want to come to therapy. She told the clinician that, “strategies don’t work,” and the clinician was wondering if was time for dismissal. The parents still wanted the child in therapy (of course), but the clinician was feeling frustrated.
I was also asked about a 7th-grade student who is resistant to therapy. He says that strategies do not work for him. The clinician reported that he was a “mild stutterer” and that the teachers said that he participates in class. Reportedly, the father said that the child is not the kind of kid to use "strategies," but he still wants him in therapy. Again, the clinician was frustrated and wanted to dismiss the child because of his “low motivation.”
Yet another situation: A child who doesn't use his strategies because he's "just fine" and doesn't see a need for them.
These are all very common situations for school-age children who stutter, so if you've found yourself in this position before, you're not alone!
I think of it this way: even if a child is experiencing negative consequences as a result of his stuttering, it still takes a lot of effort and attention to use fluency-enhancing speech strategies. Plenty of kids don't want to use strategies even though they might enhance fluency. The reasons are many: they take effort, they sound different from the child's usual speech, they sound different from other children, and, most importantly, they don't always work. It's sort of a tough sell because what we have to offer kids for enhancing their fluency isn't terribly compelling. This is not to say that strategies are unimportant; it's just that it's not surprising to me when a kid says he doesn't want to use the strategies —even if they do help him be more fluent
So, what do we do about it? Fortunately, there is quite a bit that we can do—we don’t need to jump right to dismissal due to our own uncertainties or frustration. The first thing is to make sure that we are focusing therapy on what is most important for the child—that is, the ways in which stuttering is affecting his life.
One way to do this is by using the Overall Assessment of the Speaker's Experience of Stuttering (OASES; Yaruss & Quesal, 2016). The OASES will help you identify the adverse impact that the child is experiencing. (This is necessary for qualifying a child for therapy in the schools anyway! The frequency of stuttering is not an appropriate qualification metric if we are supposed to consider the adverse impact when making treatment recommendations.)
Then, once we know about the ways in which stuttering is causing negative impact (including negative reactions to stuttering, difficulties in functional communication, or decreased quality of life), we can focus our goals and treatment specifically on diminishing those negative consequences.
Typically, kids find this approach to therapy to be more compelling for them because it addresses what is really bothering them. (Oddly, it's often not just the stuttering that bothers them—it's the things they have trouble doing because of the stuttering that bothers them.) This shift in the focus of therapy helps to increase motivation because it increases the real-world benefits of our intervention. Most notably, such work will likely involve reducing negative reactions to stuttering. That can diminish the negative impact and, importantly, enhance fluency and reduce the severity of stuttering. That is probably the direction that I would consider for therapy in the cases cited above.
There’s much more about how to do that—and about how to shift our focus in therapy so we are addressing what is meaningful for the child—in School-Age Stuttering Therapy: A Practical Guide.
