The first thing that must be accomplished in therapy is for the client to understand stuttering and identify that he himself is stuttering.  The client’s awareness of his stuttering at the onset of therapy will determine what this step looks like.  Some children may have no awareness of their stuttering at all.  Other children may think that their stuttering is significantly worse than it really is.  You need to meet the child where he is and help bring him to an objective, accurate view of his own stuttering.

If the child has no awareness at all, begin by having him identify dysfluencies in your speech first.  Talk about the different kinds of dysfluencies using the list below.  Demonstrate these for the client and have him practice them so he knows what they feel like as well.

Click Here to Download the “Types of Dysfluencies Page”

As the client is able to identify these dysfluencies in your speech, encourage him to do so in his own speech.  He may need to listen to recordings of him speaking to identify it clearly at first.  

If a child is overly sensitive to his stuttering and believes that the problem is far worse than it really is, you may, again, need to do some work with recordings.  Help him hear that the dysfluencies are not so often or so debilitating as he thinks.  Help him interview those closest to him about how much his stuttering impacts how well they understand him.

Help your client come up with a list of the different types of stutters that he uses in addition to the triggers he has.  These would be situations or events that cause him to stutter more.  This level is all about bringing a very basic awareness of the stuttering that the child is exhibiting.  

Now we need to look at the negative emotions that stuttering may bring up in a child.  You can ask the child what types of emotions he has directly, but he may not be able to give you great answers to this question just yet.  Some children shy away from talking about their stuttering and others are so oblivious to it that they don’t even realize what types of emotions they experience. 

Here is a great packet of questions that will help you gently guide the client through some self-discovery about what negative beliefs and emotions are dwelling below the surface:

Click Here to Download the “Discovering Emotions with Stuttering” Packet

Now we need some strategies to address those negative beliefs and emotions that you identified earlier.  Some of them, you will be able to address with some simple education.  For example, if a child has misconceptions about the cause of his stuttering (like, if he thinks it’s because he’s dumb), then you can do some great education about the causes of stuttering.  

Other negative beliefs and emotions will be harder to overcome.  Here are some research-proven strategies for tackling some of these:

Desensitization: 

• Identify the types of stuttering that the student uses
• Have the child practice those stutters in the speech therapy room (pseudo-stutter)
• Gradually increase the anxiety level of the speaking situations:
  • Bring new people into the room/activity
  • Move your conversations to more stressful rooms in the building
  • Have the child pseudo-stutter when talking to others around the school (go for a walk)
  • …when talking to friends at school
  • …when answering a question in class
  • …when giving a presentation at school

Click Here to Download the Desensitization Prompt Worksheet

Cognitive Restructuring:  change the way they think about themselves and their speaking situations; they learn to identify the thoughts underlying their negative attitudes and emotional reactions and examine the link between their thoughts, attitudes, and emotional reactions and their speech.

• At first, acknowledge all feelings as legitimate and OK
• Then, identify to yourself any misconceptions or negative reactions that are impacting the child’s ability to speak fluently
• Address each negative thought/reaction by helping the child restructure or get better perspective on the issue
• Examples:
  • If the child thinks he stutters because he’s dumb, explore the research on the causes of stuttering
  • If the child thinks that his friends hate talking to him because of his stutter, help him interview his friends about his stuttering
  • If the child thinks that he will never be able to hold a job because of his stutter, help him interview adults with stutters who have awesome jobs

Self-Disclosure: communicating to others information that reveals one’s identity as a person who stutters. Can involve revealing that identity directly, talking about stuttering or treatment of stuttering, explaining or interpreting symptoms of stuttering, providing advice on how to respond to someone who stutters, or, in the case of school-age children, advertising through a classroom presentation with the guidance of the SLP or classroom teacher

• Help the child prepare several different ways to self-disclose his stuttering to others. Create a notebook or resource he can refer back to when needed.
  • Presentation that he could give to his class (if he wanted to)
  • Information sheet/handout that he can give to new teachers with a few talking points that he can bring up with them
  • A short explanation that he can memorize and tell to new peers to talk about his stuttering
  • Responses to common questions that he gets about his stuttering
  • Links that he can save on his phone to show peers great information on stuttering or examples of famous people who stutter
  • If the child likes to joke about his stuttering, help him prepare some good-natured jokes about stuttering to help ease the tension.  Keep in mind that many children will not feel comfortable with this so this would ONLY be for children who are already drawn to approach this situation in this way.

Connect with Support and Counseling: 

• Connect students who stutter with other students who stutter
• Allow them to ask each other about common problems they face
• Pose prompts to the group that will open discussions about the difficulties associated with stuttering
• Bring in counselors or other professionals to talk to the group about big issues, like bullying (or whatever the students are interested in)