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Yet another example of professionally accepted evidence-less prejudice & practice

So I glanced through this article… Stuttering this, yada yada yada; stuttering that bla bla bla… (Seen it all before, nothing overtly good or bad so it’s not worth posting about…)

Until the section on how to respond to incipient-stage pediatric stuttering.  (i.e., when stuttering *just* emerges in young children)  And all of a sudden–a whole slew of bad ideas that are supported only by pseudoscience.  So let’s go through some those in question:

* “Do not draw attention to your child’s stuttering. Let him know he communicates well. Be empathetic.

Ok–so where does this come from?  What’s the motivation for the statement.  It all stems from Wendell Johnson’s Diagnosogenic Theory.  Drawing attention to stuttering will make little Billy even more nervous. (Because we all know that Billy’s stuttering because he’s a nervous kid, right?)  So if everyone can just stick their head in the sand, everything’s going to be ok.  If Mommy and Daddy deny their right to nervousness and conceal 100% of it form Little Billy, then he’ll stop being nervous and everything will be ok.  Uber-Fail on every account.  The (pseudo)science behind this little nugget of bad advice is make-believe.  Therefore, why do we continue to cling to a practice based on bad ideas?  I honestly have no idea why–either the field of SLP is just as prejudice as everyone else, or they’re really bad scientists who are getting confused by the 80% spontaneous recovery rate.  (They could do everything or do nothing and still hit the same result.  Even a tribe of SLPs jumping around with sticks would result in an approximate 80% recovery rate, so how’s this advice different from voodoo or a witch doctor?)

* “Encourage your child to talk, particularly about things in which she is interested. Try to avoid specific questions that have to be answered. Always listen attentively.

This one makes me giggle a little.  What kind of parent would discourage a 3 year old from talking altogether, if stuttering emerges?  Maybe one exists–who knows.  Next, the idea of ‘avoiding specific questions’ is a little perplexing to me.  I’m guessing that the (pseudo)science behind this is to reduce linguistic complexity, thereby attempting to reducing the frequency of overt stuttering moments.  Any convincing evidence to support this practice?  No.  Any common sense to support this practice?  Not really.  Little Billy’s started stuttering, so let’s deny it and not ask him any questions.  Yeah–there’s the road toward recovery.  (Well, at approximately 80% of the time, anyway.)

* “Do not interrupt your child when she is speaking. Do not ask her to repeat something you may not understand. Do not have her practice certain sounds or words, or repeat the words she stuttered.

Should parents get into the habit of interrupting their children? No, so I guess that’s not bad.  Parents should also continue to feed and bathe their children who stutter too.  The rest of the gem essentially says that direct treatment is bad.  That direct treatment will draw attention to stuttering, thereby inflaming the real problem–which must be speech-related anxiety.  Which is ultimately a personal character flaw–Little Billy just can’t take the pressure of communication.

* “Do not try to make the child speak more slowly.

Again–no real evidence here.  Theory being that direct treatment of the stuttered speech is bad.  Why is it bad?  Because it will make Little Billy even more nervous, and therefore solidify his persona as being a nervous person (and therefore stutter).  Even non-SLPs realize that it’s pretty hard to change a behavior by ignoring it.

I’ve stopped *smacking my forehead* when I read this kind of tripe, but I continue to *sigh* and shake my head in professional disgust.

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  1. April 5th, 2009 at 08:12 | #1

    This may be an offshoot of the self-esteem movement, actually. The self-esteem garbage everyone gets spoon-fed from infancy nowadays states that no one is different from anyone else, thereby avoiding all that “good-better-best” stuff.

    I would actually have read the first part backward than you did: that they don’t want Billy to think stuttering is bad and therefore they wouldn’t call attention to it at all. Especially if Billy has no control over a problem, calling attention to it might create emotions such as frustration, and we don’t want our children to experience frustration on any level.

    I’m sure you’ve seen enough parenting magazines in general that you realize the formula for writing about kids:
    1) come up with a problem some parents face
    2) tell an illustrative story about it
    3) give six bullet points
    4) quote some expert somewhere, usually the first person who returned your phone call

    Pieces like this one get sold not because the editors know what they’re writing about, but because they fill the News Hole. (Actually, maybe I should write one, and I can quote you if you’d return my phone call. Hah!)

    But back to the bullet points: the advice he gives is practically identical to the garbage I got when I was asking for help with my son’s enraged meltdowns (ignore the behavior, don’t react, don’t punish him, don’t try to correct,give him his space) and that’s because it’s the prevailing trend in parenting right now to let kids parent themselves. And as you said, it works 80% of the time.

    [Reply]

    Greg @ Stuttering.me Reply:

    Ha! Amazing how the same point is arrived, but from two totally different experiences & settings. I’ve updated the post to link to Johnson’s Diagnosogenic Pseudoscientific Theory. This is the foundation of the treatment “suggestions” posted above.

    The thing of it is, your perspective is pretty much spot on, just without all the SLP mumbo-jumbo that still clings to the field like an annoyingly bad date or a cockroach. It’s all cut from the same cloth… (Or knit from the same yarn?)

    [Reply]

  2. April 5th, 2009 at 12:29 | #2

    Hah! Bad cloth only makes bad clothing. Bad knitting can get ripped out and re-knit with no problem. I think you’re dealing with bad cloth here.

    I’ve been thinking, and I really should write something like this for some parenting magazines and quote you. That way, at least something would be done right. 🙂

    [Reply]

  3. Cricket
    April 5th, 2009 at 13:48 | #3

    I disagree. Much of the advice you pulled out has merit. My experience in childhood speech therapy is with the Hannon program we did with my speech-delayed son, then sound-correction, in the form of games.

    The goal is to make communication happen. You find teachable moments rather than put the kid on the spot, or ruin the flow of a conversation for therapy.

    Drawing too much attention to the stuttering may get in the way of what he’s trying to say. When a kid wants a cookie, he doesn’t want a lecture about his stuttering or mispronunciation. He wants a cookie.

    If we gave him a lecture, he’d learn that asking with words isn’t effective. Instead, we did a mini-lesson. For speech delay or mispronunciation, we echoed what he actually said, then modeled what he tried to say, then modeled the same concept one level more complex. “Caca? Cookie. Want cookie.” Later, “Wan caca? Want cookie. I want a cookie.” And gave him the cookie! (Or at least a clear answer that shows he communicated effectively, and the our answer had nothing to do with his speech, like, “No, it’s too close to dinner.” Also, if the answer was no, it wasn’t a teachable moment, so we skipped the lesson.)

    Okay, maybe this point they went too far in “make communication effective”. We didn’t ignore the problem, just didn’t let the problem and lesson get in the way of the main point — he wants a cookie!

    Putting any child on the spot with a specific question, can cause him to shut down, especially one that’s already uncomfortable. “What’s your bear’s name?” is less effective than, “I wonder what your bear’s name is.” Or, even better, get a bear yourself and play with him!

    It’s also rude. Would you ask an adult “What colour is that?” just to hear them talk? No, you’d talk about it _with_ them. The point has nothing to do with linguistic complexity, but more to do with having natural conversations with the kid.

    Listen attentively. Yes, that’s important. If you don’t listen, why would the kid even bother speaking?

    And, yes, frustrated parents are tempted to get the frustrating conversation over with as quickly as possible.

    Repeating something you didn’t understand, once or twice, is fine, but it can be overdone. Wouldn’t it be re-enforcing the wrong neural pathways? I was always told to stop practicing when I started making mistakes.

    We helped him find options so he could communicate. If we couldn’t recognize the word, we played detective, and he gave us clues, or used another word, point to it, whatever. Only after the communication happened did we do the mini-lesson.

    This isn’t saying a kid should learn to always hide his stutter, but to give him extra tools so he can communicate when and if a serious block happens, or he’s in a situation where hiding his stutter is appropriate (like around Great Aunt Hilda who will lecture for hours about how he should slow down).

    You’ve told us time and again that we shouldn’t tell stuttering adults to speak more slowly. Why should the advice be different for a kid (unless slowing down helps them but not adults)?

    The first problem with the bits you’ve quoted isn’t the advice they give, but the pattern the add up to, of totally ignoring it.

    The second problem is that they don’t say what to do during the teachable moments — when everyone’s calm, and the child isn’t so frustrated he’s shutting down. We did “imitate, interpret, add.” What’s the equivalent for stuttering? Should we do the same thing for all types of blocks? Are all blocks the same? Is there any benefit to slowing down? Long or short sessions? One tool or treatment per game, or many at once? Is it different for different ages? If so, because of attitude (game vs get it done), or physiology?

    However, most of the sound-bytes seem to me to be good advice, if taken as part of a more comprehensive therapy, where the goal for the child to continue to use his words to communicate rather than hide his stutter or go silent.

    And, yes, Jane, you should write for parenting magazines! You do great research, get our attention, and write well. I’m thoroughly sick of reading the same useless articles on a three-year cycle.

    [Reply]

  4. hthrb
    April 6th, 2009 at 20:17 | #4

    an oddly familiar approach.. i still say my family rules, they just hold antiquated beliefs about some things.. like stuttering.

    btw.. this approach also doesn’t work on 35 year olds

    [Reply]

  5. tal
    April 10th, 2009 at 16:08 | #5

    Greg, it sounds like you are mischaracterizing this approach to me.

    You talk as if the approach is aimed at reducing general nervousness, because the alleged theory is that general nervousness causes stuttering.

    The idea is actually not to make the kid self conscious about his speech specifically, because it will cause him to engage in avoidance behaviors if he gets disapproving feedback when he stutters.

    It seems like a reasonable theory to me that avoidance behaviors will start to pull the child toward being a chronic stutterer rather than just a kid with normal disfluency that he grows out of.

    Maybe there is no evidence of it, but I disagree that there is no common sense behind it.

    [Reply]

    Greg @ Stuttering.me Reply:

    Thanks for demonstrating my point. You’re creating false premise. There are ways to directly manage a behavior while not assigning it overtly negative attributes.

    If we wanted to reduce avoidances in kids, then logic suggests that we’d use volitional stuttering, etc.

    Bluntly stated, the point is this: Common Sense is the enemy. Common Sense is routinely wrong. Common Sense kills people, such as George Washington (the 1st president of the US). Common sense, which is usually devoid of data, misleads people and paradigms toward stupidity.

    [Reply]

    tal Reply:

    I was presenting the approach as one way to keep the kid from avoiding, not the only way. Volitional stuttering is another way.

    I’m not saying common sense should override science, but you were explicitly saying it goes against common sense after describing the theory in an way that seemed uncharitable.

    [Reply]

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