DAVS

Identity Problems with Stuttering Children and Their Parents
dansk udgave by Dorte Hansen, speech therapist

Presentation at the 2nd Worldcongress on Fluency, San Fransisco, august 1997

For the past fifteen years, I have been working both with pre-school children and school children who stutter. This has given me a lot of experience, enabling me to make comparisons with what has been described elsewhere. There are many things which over the years have given me food for thought concerning child and teenage stutterers. Some of my opinions I have had to revise, others I have had confirmed.
One thing I have come to regard as central and basic in working with these stutterers, is the need for them to see themselves as normally functioning children, who together with their many other and various characteristics and abilities happen to have the speech peculiarity known as stuttering. I have also found it important to impress upon them the following:

As a speech therapist, one finds oneself in the paradoxical situation of having to deal with the stutter - that which is a peculiar, but unfortunately often also a negative thing for the person concerned - something they would prefer to be rid of.
At the same time, one has to tell them that they are completely normal children, and that their stutter doesn't need to make any real difference to them in their lives and the choices they make.

I have thought about these problems for many years, wondering how best one can apply a therapy which is positively charged, and which brings out the positive sides and the positive potential in the children. How one can make them see that they must not focus on the stutter as something special - even though it is. How one can deal with the stutter without seeming to be singling it out as something negative. In other words -

How can one get the stutter worked into the stutterers personality development in such a way that it interferes as litle as possible?

How can one at the same time change the hard stutter into a lighter stutter, making speech easier for the stutterer?

How can one turn struggle and avoidance around to become active and positive participation?

The most important point in answering these three questions, it seems to me, is getting the children to grow up with a clearly defined and strong stuttering identity.

It's a shame for a stutterer who isn't allowed to develop one, but who instead is forced to go around among friends, family and strangers, constantly trying to make out that he or she isn't a stutterer.

It's a lucky stutterer, on the other hand, who has the courage to admit to himself and others that he stutters - who dares use his stutter as the speech peculiarity it is, and who thus doesn't allow the stutter to decide things for him. This is a stutterer who has gained a stuttering identity! It seems obvious to me that this must be the primary aim of speech therapy with any child stutterer, and that the child's life will be much easier if the stutter is not allowed to become the determining factor.

It is also clear to me, that the child's status among its peers and its degree of self-esteem and self-confidence are issues which have to be faced up to in teaching child stutterers.
The trouble is, that these things can be hard to get to grips with. The therapist often has very little to go on. One also has to look at the child's social environment to various extents, as stuttering isn't just a speech affliction, but also a social affliction. In the most serious cases, it can become an affliction needing psychiatric help - where the stutterer does not develop a strong stuttering identity, but instead has to struggle all the time to try to hide the stutter.
 

Example One
The other day I was rung up by the mother of one of my twelve-year-old stutterers. She told me that her son had come home from school and told her that his class was going to put on a play -to be performed in front of the whole school. He was keen to act one of the parts in the play, but was worried that he might not be able to manage it on account of his stutter. The alternative was to be a 'lighting technician'.

"What shall I advise him?" asked the mother. "What if he acts one of the parts and stutters in front of the whole school? Will he be teased? Would he be able to cope with that?" We talked a bit about the boy wanting to act a part. He wasn't afraid of stuttering in front of the whole school. He saw his stutter neither as something negative nor forbidden, but sometimes troublesome. We talked about how his classmates would react. Would they be supportive when he stuttered in the play, or would they tease him. Would his teacher back him up or demand a fluent delivery.
"Oh, they'll back him up!" said the mother. "No-one at the school sees his stutter in a negative light. He's popular, because he's a natural initiator, and is always friendly and cheerful."
The mother had decided by the end of the conversation to support her son in his wish to act a part in the play. She had realised by then that she was the one who was afraid of the stutter. But it was her son who was going to be doing the stuttering. She was only going to be a member of the audience.

This example illustrates the way in which a stuttering child's potential is increased if it is allowed to grow up with a strong stuttering identity.
It also indirectly illustrates the harm which might have been done, if the mother had decided that the stutter precluded her son's acting a part, and advised him to take a manual rôle in the play instead of a verbal one. Or, if his classmates and teacher had decided he wasn't suitable for an acting part because of his stutter.

The boy would experience having taken part on an equal footing with his classmates. He would have weighed up his acting ability rather than his stutter. Of course, it's quite all right to take the stutter into account too, as long as it doesn't become a primary consideration. This is how self-esteem and self-confidence can grow. The stutter has not become something negative. Nor has it been the determining factor in the making of his choice. It wasn't the stutter which decided matters, but his urge and his ability to act. This is a boy who will grow up with a strong personality development and a good stuttering identity.
What is a good stuttering identity?
A stutterer has a good stuttering identity :

when he has enough self-confidence and self-esteem to acknownoledge his stutter,

when he has the courage to use his stutter to express his thoughts and feelings to others - and, last but not least,

when he can avoid letting the stutter influence his decisions.

And what is successful therapy ?
The therapy is successful if the stutterer can:
be taught to have enough confidence in himself to grow up with a strong personality
development, and
be made to understand that the stutter is a peculiarity, not necessarily negative,
although sometimes difficult and trying. It is a peculiarity he may some times feel sad
about and be teased for and wish he could get rid of. And he may indeed get rid of it
sooner or later, but that isn't part of our work with him!

We must teach him that struggle and avoidance will always be waiting for a chance to
sneak in on him.
We must teach him to distinguish between a hard and a light stutter.
We must teach him to have the courage to enter the stuttering moment without panic, and to continue with what he is saying.
We must toughen him against impatient listeners.
We must teach him how to explain himself to people who start advising him how to
combat stuttering.
We must help him to come to terms with his stutter and see himself as a normal person
with the same potential as others.

This is how I see the speech therapist's wide-ranging work with child stutterers. A lot of people have asked me if all this is really part of our job, and if we shouldn't just teach the children to use a light stutter. Well, one could try doing that, but I'm afraid that many of the children would then never dare to use it outside the therapy room.

Working with families.

When we have parents and their stuttering child in for the first exploratory examination, it's interesting to observe whether the child tries to fight the stutter and to conceal it. And also to find out if there is stuttering in the family. But it's far from certain that we will be given honest answers. Through conversation with the parents though, we will almost always be able to discover if one or both of them has a stutter. It is then interesting to see if the child's manner of stuttering and trying to conceal the stutter is the same.
If this is the case, we then have to make the parents understand the consequences of covert stuttering in relation to what we are trying to achieve. Otherwise, it will create conflict for the child if it is allowed to stutter in the therapy group while at the same time being praised at home for not stuttering (i.e. for concealing its stutter). The parents are the most important adults in the child's world; they are the child's rôle models, and it is their norms which the child will tend to adopt as its own.
We have often found that the child 'inherits' not only a stuttering parent's attitude towards stuttering, but also the way in which the parent stutters and the way of trying to conceal it.
We can say that:

It is not the parents' fault that the child stutters.

The parents have a big responsibility for how the child's stutter develops.

The parents have a big responsibility for how the child develops in life with its stutter.

Our norms are likely to be rejected out of hand in some cases, and we have to consider whether it is advisable to give non-avoidance therapy to a child whose parents are unwilling to go in for our norms. In my opinion, it is far more important to work on the parents attitudes to stuttering before we begin to work on the child itself.

Example Two
Peter was four and a half - the younger of two children. His parents brought him in for examination. At that time, he was very much a covert stutterer, and his speech attempts were accompanied by twitches and other avoidance signs. The mother was very talkative however - also on behalf of both husband and son. But they seemed to have no objection. The mother was convinced there was something wrong with the boy, and had taken him to a child psychiatrist.

"There must be something you people can do!" she said.
"It's dreadful the state he's in. Sometimes his whole body arches like a bow when he tries to say something. Once he even fell off the sofa in an attempt to get something out. It was as if he was having an attack of cramp!"
The mother was crying. The father said nothing - a covert stutterer perhaps? The boy sat still and listened. They were offered places in an observation group.
"Oh yes, thank you. My husband's got 'parent's leave' (this is a scheme we have in Denmark whereby parents can have leave from work to be with their children for a time), so he'd be happy to come. I'm afraid I can't get time off for it though."

So father and son - both as silent as the grave - took part in an observation group, four times one and a half hours weekly. After that, Peter was placed in a stutterers group with three other boys. The father came with him every time, sat dutifully and listened, but never spoke. The son could not be induced to stutter. He joined in the play, but withdrew when invited to join in a conversation. He simply refused to stutter voluntarily. He tried to make out that he didn't stutter any more. He even 'helped' the speech therapist by saying words for her when she stuttered.

At Peter' kindergarten, they had noticed that he had some odd 'nervous' movements, and that he used a lot of 'filling' words such as er and uhm. But he didn't stutter. And the parents didn't talk about it either. When they came to pick him up at the kindergarten, the mother might say:
"How's it gone today?" And the staff would usually reply:
"Very well. He hasn't stuttered at all."
"Oh, that's a relief!" the mother would say.
Peter picked up this message very clearly, and continued to fight against his stutter. He will never get a stuttering identity. If his mother had wanted to help her son develop his feelings of self-worth and self-confidence and grow up with a strong personality, she should have said instead:
"Hasn't he dared stutter at all today? Oh dear, that's a pity. What's been the matter?"

Peter was taken out of the stutterers group, as it wasn't helping him. He has now been at grade school for over a year.
No-one at the school was informed that Peter is a covert stutterer. He is a quiet boy, a child who exists on the periphery of his peer group. He lives with his 'fluent identity'. But in a parallel class to his, there is another boy who stutters; one who is developing a strong stuttering identity - a boy who attends one of our other stutterers groups. This is how we know a bit about how Peter is getting on. Peter has 'inherited' his father's covert stutterer identity. He uses the same avoidance methods as his father, and has no chance of achieving a stuttering identity. He just has to go on struggling.

I can also see now, that if we manage to break down the parents' pattern early enough, and bring about a change in their attitude to stuttering, the child will have a far better chance of getting rid of its stutter - in spite of the biological factors involved.

CONCLUSION

The conclusion is then, that if we are to treat the small stutterers, we need to be very active in guiding parents and institutions as part of our treatment of small stutterers. We need to put forward our strategy very clearly and incisively -making it easier for them to understand that the children must be allowed to talk with their stutter, and that the adults must back the child up with its stuttering. Because if the children continue to stutter for the rest of their lives, we shall then have helped give them a strong stuttering identity. If, however, they stop stuttering, they will have had a good life as stutterers up till then - they will have gained a feeling of self-worth and self-confidence, and these are good things to have whether one stutters or not.

Summary:

We have for many years been aware of the need to pay extra attention to children with a parent or parents who stutter. I have felt sure that this was on account of biological hereditary factors. But today we are no longer so sure. Because I see now that it is also the way in which the stutter develops which is inherited. This would seem to point more in the direction of environmental influence. I can also see now, that if we manage to break down the parents' pattern early enough, and bring about a change in their attitude to stuttering, the child will have a far better chance of getting rid of its stutter - in spite of the biological factors involved.
 

DORTE HANSEN
Edelhofvej 11
8462 Harlev
Denmark
Phone (+45) 86 94 20 07 


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