What is the treatment for stuttering?
Do you stutter? Or, is it your child, who’s showing symptoms of stammering? 
Stuttering [__GHOST_URL__/what-is-stuttering/] can make it extremely difficult
for anyone to express what they are feeling. Which is why getting help from a 
speech-language pathologist (SLP)
[https://www.asha.org/public/Who-Are-Speech-Language-Pathologists/] is extremely
necessary for those who stutter. Treatments for stuttering are most effective
when they are started in the earliest.

Treatments for stuttering vary depending on the severity and the age of the
person who stutters.

Treatment for a pre-school aged (2 to 3.5 years of age) child who stutters
Let us begin with the potential treatment for a child who stutters. The team
typically consists of the child, the child’s parents and other family members,
even their teacher and the SLP. The child’s treatment plan depends on the
following –

 * How much the child stutters
 * The child’s language and speech skills
 * The child’s reaction to their own stuttering
 * The impact of stuttering on the child’s everyday life
 * Others’ reaction to your child’s stuttering
   [__GHOST_URL__/stuttering-in-children-understanding-shame/]

The treatment approach includes either one or both of these strategies –

Integrated strategies
An integrated strategy involves the clinicians counselling the parents to reduce
their level of anxiety and fear about their child’s speech impediment. The
initial focus is always alleviating the concern of the parents and other family
members. It is also about understanding the concerns of individual family
members and guiding them towards making changes in family-child communications.

Direct strategies
During direct treatment, the SLP interacts with the child to understand their
fluency problems and facilitate improvement. Speech modification, stuttering
modification, and reduction of secondary behaviour
[https://ghost.stamurai.com/what-is-stuttering/] are parts of direct treatment for children
[https://ghost.stamurai.com/five-stuttering-exercises-to-help-your-child/].

Indirect strategies
Family members are the key players in indirect treatment approaches. The SLP
focuses on counselling the family members regarding necessary changes in the
child’s environment that can support fluency. It may include the reduction in
the rate of communication, and rephrasing sentences to facilitate fluency.

Treatment of stuttering in older preschool-aged children (3.5 to 6 years)
Children of this age may have begun stuttering very recently or may have been
stuttering for several months. Thus their parents are well aware that it is not
a transient speech issue. It is common for children of this age group to feel
negative about their stutter.

Typical core behaviour of this age-group includes partial repetition of words,
rapid and irregular rhythm of speaking, and some prolongations. The SLP may
notice excessive tension during the repetition and prolongations. Secondary
behaviour also become noticeable by the time the child is of older preschool
age. Such secondary behaviour may include rapid blinking, eye twitching,
twitching of the lips, head nodding and sudden increase in pitch.

However, strong fear is still absent from most candidates of this age group.

Charles Van Riper advocates the Lidcombe Program for older preschool-aged
children. The SLP teaches the guardians of the child to reinforce his/her fluent
speech. Only then the SLP teachers the parent how to respond to stutters. The
parent of the child who stutters is supposed to use varied and
situation-appropriate verbal contingencies after distinct fluent speech.
However, the parent must only use gentle comments on the child’s stutter. The
parent can also ask the child to repeat the stuttered word ever so gently.

The Lidcombe program involves several clinic visits with the child. During the
first visit, the SLP determines the severity score of the child’s stuttering.
All subsequent clinic visits involve multiple goals –

 * Assessment of the child’s current stuttering
 * Discussion of the child’s and parents’ progress
 * Introduction of new techniques, when the SLP deems it appropriate

Although the fluency goal of every individual who stutters tends to be
different, preschool-aged children who have only stuttered for months may reach
desired fluency or regain spontaneous fluency within a year or two of the
conclusion of the treatment.

Older preschool-aged children may not have any recollection of their stutter.
They may not require speech monitoring later in life as well.

Treatment for school-age (6 to 14 years of age) children who stutter
By the time a child reaches 6 years, their stuttering core and secondary
behaviours [__GHOST_URL__/what-is-stuttering/] are well developed. Therefore,
they require more-than-one goal-based approaches depending on their unique
necessities. Children of this age exhibit complexities in disfluent behaviour
since fear, anxiety, embarrassment and avoidance
[https://ghost.stamurai.com/stuttering-in-children-understanding-shame/] become part of their
habit.

The approaches for school-aged children and adolescents who stutter are
different from those used for preschool-aged children.

Strategies to reduce the impairment of body function
Most SLPs use a combination of speech modification and stuttering modification
to improve the fluency of a school-age child, who stutters.

Speech modification strategies may include –

 * Control of rate
 * Continuous phonation
 * Prolongation of syllables
 * Loose articulatory contact
 * Easy onset

Stuttering modification strategies typically reduce the speaker’s physical
tension. According to techniques introduced by Van Riper
[https://www.youtube.com/watch?v=oKV1ecN_QEM] in 1973, stuttering modification
helps the individual learn about speech mechanism during disfluencies and also
during a fluent speech.

Increasing their awareness about the speech mechanism and teaching them
self-monitoring skills can help reduce the frequency of stammering
[https://ghost.stamurai.com/stuttering-misconceptions/]. It can help children modify the
moments of stammering and make them less tense.

Reduction in avoidance of words
Children often cope with stuttering by avoiding certain words or introducing
interjections (“uh”, “um”). Speech therapy for stuttering can help children
increase the spontaneity of their conversations by improving their fluency. SLPs
work towards reducing avoidance behaviour [__GHOST_URL__/what-is-stuttering/] in
children and early teenagers so they can say exactly what they want to say and
the way they want to say it!

Reducing negative reactions
Desensitization, self-disclosure, cognitive restructuring and support are the
three main approaches that aid in reducing the negative reactions an individual
may associate with their stuttering.

 * Desensitization – the SLPs help individuals face their fear of stuttering in
   carefully structured environments. It prepares them for real-life situations.
 * Self-disclosure – it is popular as “Advertising” in the stuttering community
   and therapy sessions. It involves conversing about stuttering, how it affects
   the individual and offer advice on responding to an individual who stutters.
   For school-aged children, it is often achieved via a classroom presentation.
 * Cognitive restructuring – it is also referred to as counselling, where SLPs
   or therapists can help individuals, who stutter see themselves in a new
   light. They can learn to identify their negative emotions and attitudes, and
   their influence on their speech.
 * Support – it can be in the form of group activities, daily exercises within
   the family or structured venues for practising activities the individual has
   learned from the sessions with the SLPs.

Encouraging approach behaviours in individuals who stutter
SLPs don’t restrict treatment inside the therapy room. It is important for the
child to find the courage and confidence to display their acquired speech
strategies and participate in discussions outside the treatment room. Often
phone conversations and video conferencing techniques are used by SLPs to
encourage a child’s generalization activities.

Treatment of stuttering for teens and adults who stutter
The treatment for teens and adults
[https://ghost.stamurai.com/stuttering-treatment-for-adults/] who stutter can be long-term
and intensive because their core and secondary behaviours
[https://ghost.stamurai.com/what-is-stuttering/] are more difficult to alter as compared to
children. Teenagers and adults can opt for treatment on an individual or group
basis.

Currently, the individual may opt for treatment that offers the following forms
of therapy –

 * Block modification – The goal of this treatment is not to achieve complete
   fluency, but to help the individual stutter with more ease.
 * Avoidance reduction – The aim is to enable the individuals to accept their
   stuttering and give them the confidence to speak in situations that they
   would rather avoid.
 * Fluency modification – Slowed speech and prolonged speech are popular
   treatment techniques SLPs use for adult and teenage clients. The aim is to
   replace stuttered speech with a prolonged or slowed speech in the clinic set
   up and then extend the techniques outside the treatment room.
 * Psychological approaches – Personal construct therapy (PCT)
   [https://en.wikipedia.org/wiki/Personal_construct_theory] and cognitive
   behavioural therapy (CBT)
   [https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/]are two of
   the most sought after ways that help the client reflect upon the influence of
   stuttering on their life. It is especially necessary for teenagers and
   adults, who may have already faced considerable ridicule, differential
   treatment and bullying at high school or work due to their speech
   disfluencies.

Treatment for stuttering at any age share a few common goals which include the
improvement of fluency, increasing their understanding of stammering and share
their experiences with fellow individuals of similar age who stutter as well.

Stuttering Treatment

“Oh, you should just speak slowly,” “maybe it’s the anxiety getting to you”-
children who stutter have heard these suggestions ad nauseam.

Do they help reduce their stutter? No. Does it make them become more conscious
of their speech disfluency? Yes!

The truth is anxiety, fear, or shyness do not cause stammering
[https://ghost.stamurai.com/what-is-stuttering/]. Children who stutter or
stammer may do so more frequently when they have to talk in front of their
classmates, new people or unfamiliar situations. However emotions do not
precipitate stuttering [__GHOST_URL__/stuttering-misconceptions/].

Modern sciences have found multiple mutations on several chromosomes that
correspond to stuttering. These mutations can be heritable, although the male
population is more susceptible to stuttering than the female population. 60% of
the people who stutter have a family history of stuttering.

So, is there anything you can do to help a child
[https://stamurai.com/blog/parents-guide-to-help-child-who-stutters/] who
stutters? Well, of course. You can, for instance, help your child practice
stuttering exercises at home.

[https://stamurai.app/z4HKmlNXigb]Before we start discussing the top stuttering
exercises to help your child, let's understand the basics.

Why Is Stuttering Common Among Preschool-aged Children?
In the case of preschool-aged children who stutter (CWS), speech therapy,
regular speech exercises and practice can reduce and may even eliminate
stuttering [__GHOST_URL__/how-to-stop-stuttering/]. Stuttering is
common in children between the ages of 2.5 years and 3 years, when they are
acquiring their language skills at an incredible speed. Such stuttering is known
as developmental stuttering
[https://ghost.stamurai.com/causes-of-stuttering-in-adults/], and it is common
in children; it disappears on its own within a few months.

Many speech therapists recommend waiting and observing a child’s speech if s/he
has been stuttering for significantly less than 6 months. If they have been
stuttering for more than 6 to 12 months, parents of CWS should seek the help of
a speech-language pathologist or speech therapist.

Who Is At A High Risk Of Stuttering?
Stuttering or stammering is quite common. According to experts, many children
experience stuttering when learning a new language or expanding their vocabulary
at a rapid pace. Children outgrow their stammering on their own in many cases,
but it might become a lifelong condition for some. High risk factors include –

 * A family history of stuttering.
 * Incidence of stuttering for more than 12 months.
 * The child is male [__GHOST_URL__/is-stuttering-gender-specific/]
   . Girls recover faster. A girl who has been stuttering for more than 12
   months is at a higher risk of persistent stuttering.
 * A child who begins stuttering later (onset after 3.5 years of age) has higher
   chance of persistent stuttering.

Children on the autism spectrum
[https://ghost.stamurai.com/stuttering-and-autism-spectrum-disorder-diagnosis-and-treatment-in-children/] 
have a high risk of developing stuttering at an early age. Other disorders and
conditions that co-occur with stuttering
[https://www.researchgate.net/publication/10572760_Co-occurring_disorders_in_children_who_stutter] 
include ADHD, Tourette’s Syndrome (TS), hearing impairments, central auditory
processing disorder, and cerebral palsy.

How Will You Know If Your Child Is Stuttering?
Developmental stuttering has a few signs that are hard to miss. These symptoms
of stuttering include –

 * Difficulty in starting a word, sentence, or phrase
 * Repetition of a syllable, an entire word, or a particular sound
 * Breaking of words or undue pausing, and missing syllables
 * Prolongation of parts of words or entire words
 * Adding sounds like “um” or “uh” at the beginning of the next word

Along with these signs, you can also notice the following –

 * Twitching or trembling of the lips and/or jaw
 * Tightening of facial muscles
 * Clenching fists
 * Rapid and abrupt blinking
 * Jerking of the head

If a child experiences physical duress while trying to get the words out, it may
signify a serious stammering
[https://ghost.stamurai.com/understanding-degrees-of-stuttering-severity/] 
problem. You may also notice their voice changing pitch and rising with each
repetition.

These are the signs that you need to take proactive measures
[https://ghost.stamurai.com/stuttering-in-children-understanding-shame/] to help
ease your child’s stuttering instead of waiting for it to ride itself out.

What Should You Do If You Notice Your Child Stuttering?
You should seek the help of a speech-language therapist. It might sound
intimidating, but speech therapy for children can consist of quite a few simple
stammering exercises at home moderated by their parents.

In many cases, the SLP takes an indirect approach and talks to the parents and
other members of the family.. The stuttering treatment for kids aims at reducing
the family’s concern and altering their family-child interactions.

[https://stamurai.app/z4HKmlNXigb]What Are Some Exercises Parents Can Do With
Children To Reduce Stuttering?
At Stamurai [https://stamurai.com/], we are always here, to help you understand
speech therapy for stuttering and its implications. Here are some of the most
common activities your SLP might ask you to do with your child –

1. Adopting a Slower Rate Of Speech With Pauses
A slower rate of speech has two purposes –

 1. It serves as a model for your child. S/he can learn what a more fluent and
    smoother way of speaking sounds like.
 2. It makes your child feel less rushed. They realize they can take more time
    to respond and be more fluent
    [https://www.tandfonline.com/doi/abs/10.3109/02699206.2014.1003970?src=recsys&journalCode=iclp20]
    .

Here’s how we sound most of the time while holding a conversation with a fellow
fluent adult – “hey, howryoutoday?”

While talking to your child, you might want to talk like this “Heey, How aare
yoou today?”

You can also add more pauses to your speech to make it slower, but sound more
natural. So, instead of your usual rushed speech, try to…taallk…more like…this.
The…slight pauses…throughout your speech…will make you…sound more…relaxed…and
calm.

You can also try to stretch the first word of every sentence “aaaaas you play or
converse with your child.” Adding the extra stretch to the first word will show
your child how to ease into a word and embrace fluency naturally in
conversations.

2. Introducing Syllable-Timed Speech
Syllable-timed speech (STS) technique can reduce your child’s stuttering by
almost 96% in around 12 months. However, it only works if you practice it with
your child every day!

Here’s how you can include syllable-timed speech in your daily conversations
with your child –

Speak. like. this. Each. per. iod. rep. re. sents. a. break. in. the. syll. a.
bles. of. the. words. in. a. sent. ence.

Children under the age of 6-years can reduce their stuttering by 96% if they
practice syllable timed speech for 10 minutes, 4-6 times per day for 12 months.

It might be difficult for you to syllable-time your speech in daily
conversations. You can master it easily before you try it with your child by
tapping your leg for each syllable.

You can learn more about STS from this video 

If you feel weird speaking with syllable-timed speech at first, it’s completely
understandable. Keep your voice normal and speak at a normal speed. Simply think
of it as adding “finite limits around each syllable” during your daily
conversations.

3. Trying Reduced Demands
A child who stutters, finds it difficult to start a conversation spontaneously.
All we need you to do is dial down the demands around speaking.

Research on child psychology shows that asking too many questions can make your
child feel stressed or anxious, which can worsen his or her stuttering. So let
them share their emotions, knowledge and experiences spontaneously.

Allow your child to take the lead on what they want to discuss, play or watch.
Do not finish their sentences or guess what they’re trying to say. Give them the
time to finish their own sentences
[https://www.huffpost.com/entry/stuttering-advice_b_6740732].

Instead of asking them questions, make close-ended comments. For example,
instead of asking “hey, what are you playing there?” you can say, “I see you are
playing Minecraft.”

Learning comes naturally to children and there’s little reason to believe that
not asking enough questions will set his or her learning process back.

4 Adopting New Verbal Responses
Verbal responses are like giving your child feedback on their speech. Since
children’s brains have high plasticity (ability to learn new things), they can
learn to speak fluently even when you don’t teach your child complex speech
therapy techniques.

Here are the five verbal responses you can use while talking to your child –

When they are fluent –

Make sure to praise them. Say “that was great buddy”, “hey, no bumps” and “I’m
loving your smooth speech man.”

You can ask them to evaluate their own speech like “do you think that was better
than before”, “was that smooth.”

Acknowledge their smooth speech by saying “That was really smooth,” and “smooth
again.”

When they are having a bad day or stuttering, you can –

Acknowledge their stutter by saying something like, “that got stuck there a
little” or “that was a difficult word.”

You can ask for self-correction. “Can you say that again for me?”

However, not every child reacts positively to comments on their stutter or
self-correction. If your child reacts negatively, simply drop it.

Stick to positive verbal responses only. Make sure you give them at least 5
positive responses for every 1 comment on their bumpy speech.

5 Increasing Listening Time
Children who stutter have trouble expressing themselves. Having a family member
lend a listening ear can make a significant difference in the child's attitude
towards his or her own speech. Be sure to dedicate some "listening time" each
day for your child.

It can be after play school when they have a lot to share about their
experiences, or right before the child heads out for their playtime. Quality
listening time lets your child know that you “are there” for him or her although
you should intentionally make sure not to make suggestions or give instructions,
especially on their speech during this time!

Attentive playtime with the child can show significant improvement in a child’s
speech. For example, mirroring a child’s expression during the playtime with
vocal cues, like sounds of disappointment when the child’s face shows the same
emotions can build confidence in the child, in the long run.

You should let your child lead you during the interactive playtime which should
also be unstructured, spontaneous, and enjoyable for your child.

[https://stamurai.app/z4HKmlNXigb]Wrapping It Up

When your child is showing symptoms of stuttering which includes repetitions,
prolongations, and blocks, you should immediately consult a reputed speech
therapist [https://stamurai.com/blog/online-speech-therapy-for-stuttering/]. A
professional will take into account your child’s predisposition towards
stuttering, the severity
[https://ghost.stamurai.com/understanding-degrees-of-stuttering-severity/]and
suggest stuttering treatment(s) accordingly.

These stuttering exercises are commonly suggested by speech therapists.
Practicing them at home can help your child attain more fluency and confidence
while sharing their thoughts.

Best  Stuttering Exercises to Help Your Child

A significant number of adults have persistent stuttering characterized by
repetitions, blocks and prolongations. Stuttering treatment for adults primarily
consists of fluency enhancement and stuttering modification techniques alongside
counseling sessions.

Although stuttering treatment for adults usually takes more time, it is also
effective, since the treatment methods are direct. An adult client can take
responsibility and track their progress during the course of the therapy.

Stuttering treatment is an intensive process. Advanced stuttering not only
requires the attention of a good speech-language pathologist (SLP) but also a
cognitive behavioural therapist (CBT) or psychological counsellor.

Symptoms of Stuttering
Repeated words, syllables or sounds along with the disruption of the normal rate
of speech characterize stuttering. Repetitions, prolongations and blocks
comprise the three core behaviors of stuttering.

The stress from stuttering may contribute to secondary behaviors like -

 * Physical symptoms [https://www.asha.org/public/speech/disorders/stuttering/] 
   like twitching of the lips, blinking of the eyes and tension in the face or
   upper body
 * Frustration or aversion towards face-to-face communication
 * Pausing before beginning to speak
 * Rearrangement  or replacement of words in a sentence
 * Pausing abruptly or hesitating before starting a dialogue
 * Difficulty starting a sentence or uttering particular sounds

Secondary behaviours of stuttering in adults are much more complex. Adults have
acquired and perfected them through years of practice. Avoidance and escape are
difficult to detect in adults who have been stuttering for more than a decade or
two.

Most children who stutter are either unaware of their speech disfluencies, or do
not feel frustrated by their stutter. Kids, especially preschoolers
[https://ghost.stamurai.com/stuttering-in-preschool-kids/], hardly show any secondary
behavior of stuttering.

In some cases, adults may even successfully suppress their stammering by using
synonyms or reconstructing an entire sentence. While these are common among
adults who stutter, these aren’t always intentional behaviors.

The negative emotions and attitudes are stronger in adults who stutter than in
children. Negative reactions from listeners contribute to the increasing
negativity among adults who stutter.

Negative attitudes may manifest in the form of withdrawal from social
situations, damage of self-esteem and/or reduced self-confidence.

How Does an Expert Diagnose Stuttering?
The differential diagnosis of stuttering should only be made by professionals.
Only a doctor, speech-language pathologist (SLP) or speech therapist can
diagnose stuttering and its type.

Since stuttering may have different causes, it is important to consult a
healthcare professional for the correct diagnosis.

An SLP may perform several assessments including speech rate analysis,
stuttering severity tests and language skill tests before arriving at a
conclusion. The diagnosis will depend upon multiple factors including the age of
the individual, their family history and the severity of stuttering
[https://ghost.stamurai.com/understanding-degrees-of-stuttering-severity/].

The SLP will also determine how the disorder affects the person’s mental health,
social skills and their overall ability to function.

Stuttering is a childhood-onset fluency disorder. According to DSM V
[https://www.apa.org/monitor/2014/07-08/stuttering-dsm], it has a couple of
diagnostic criteria.

 1. Disturbances in the flow of speech and interruptions that are unsuitable for
    the person’s age and/or linguistic skills. These should persist over time
    and should have one or more of the following traits -

 * Repetitions of sounds and syllables
 * Prolongations of vowels and consonants
 * Pauses within a word
 * Silent blocking and/or audible blocking
 * Excess physical tension while pronouncing words
 * Whole (monosyllabic) word repetitions
 * Substitutions of feared words (circumlocutions)

 1. Anxiety about speaking and limitations in social participation, effective
    communication, academic or occupational performances.
 2. Typically, the onset is early, in the developmental years (by 6 years of
    age).
 3. The disfluency is not due to sensory or speech-motor deficit, or
    neurological causes (like brain injury or stroke).

The SLP has to rule out sensory deficits, normal speech disfluencies, side
effects of medication, adult-onset disfluency disorders and Tourette’s Syndrome
during differential diagnosis.

What are The Available Stuttering Treatments for Adults?

Today, you can find several stuttering therapy techniques that may suit your
needs. There are several ways to speech fluency. You may choose to visit a
clinician or receive speech exercise updates on your mobile phone.

Either way, you should know about all the various stuttering treatments that you
may consider before choosing one or more.

Stuttering Treatment for Adults - The Options
1. Speech Therapy
Speech therapists or clinicians can help you learn how to pace your words,
cancel a block and pull out of it. A professional may help teach you how to
manage situations that trigger stuttering.

You can learn fluency shaping
[https://ghost.stamurai.com/stuttering-fluency-shaping-techniques/] and stuttering
modification techniques, which you can apply to daily conversations.

Speech therapy is undoubtedly the best course of treatment for stuttering in
adults. Whether you are receiving it from a SLP in-person, or via a cutting edge
anti-stuttering app [__GHOST_URL__/stamurai-app-to-stop-stuttering/], speech
therapy is undoubtedly the best long-term treatment for stuttering.

2. Psychological Counseling and CBT
Coupling traditional speech therapy with CBT can increase the efficacy of the
stuttering treatment. CBT for adults who stutter may address -

 * Educating and informing the person about stuttering
 * Giving them a new perspective to their problems
 * Helping them adopt a positive attitude
 * Assisting and supporting the adults find their own solutions
 * Challenging and resolving the unhelpful and negative thoughts
 * Teaching relaxation techniques to combat anxiety and stress
 * Improving their communication skills

Combining CBT or counseling with speech therapy offers a holistic approach for
the treatment of stuttering in adults.

CBT may help counter the negative feelings and attitudes that adults typically
garner from years of rejection or refusal. In fact, it is the only way to
address the secondary behaviors.

3. Support Groups
When the world seems bleak, nothing helps more than reaching out to people who
may be going through something similar.

Support groups are instrumental in helping people who stutter. These groups
provide a safe-zone for sharing life experiences, fears, expectations, dreams
and treatment progress for everyone who stutters.

You can find a stuttering support group
[https://ghost.stamurai.com/benefits-of-talking-to-other-people-who-stutter/] in your
locality, or find one online. Participating in group meetings, or simply
observing others journey through stuttering can imbibe confidence and hope.

Sharing with like-minded individuals can reduce stress, anxiety and fear. It may
even open new avenues for therapy, and self-treatment.

Support groups offer the opportunity to connect and communicate with real people
without the fear of being judged or bullied.

4. Electronic Devices
For years, researchers have been working on electronic devices like DAF
[https://ghost.stamurai.com/daf-stuttering-guide/] (delayed auditory feedback) and FAF
(frequency altered feedback) to assist those who stutter. Modern-day speech
therapy apps also include such tools.

Many of such devices assist the speakers in slowing their speech down. There are
others that provide a “choral effect”, so the speaker hears their own voice as
if they are speaking in unison with others.

They work best when the user receives guidance from a clinician while using
them. SLPs may change the frequency of the feedback depending on the progress of
the speaker.

These devices are indeed effective for adults who stutter. However, they come
with their own sets of limitations since the user has to wear
headphones/earphones for DAF or FAF to work.

Stuttering Treatment for Adults - What You Must Know
The therapist must understand that the adult with advanced stuttering may not
fear the situations and words only, but also the stuttering itself.

Here are a few facts about the treatment of advanced stuttering every adolescent
and adult must remember –

It Can Be A Lengthy Process
The treatment of adolescents and adults who stutter can take a long time since
it needs to focus on many aspects such as -

 * The emotions of the individual
 * Integral beliefs associated with stuttering
 * The secondary behaviours

While preschool children may take only a couple of months or a year to show
marked improvement in fluency, adults must remember that patience and
persistence are going to be their only friends in the long journey towards
fluency.

Thus, it is of utmost importance for adults to work with their SPLs to set
realistic goals before they begin working on his/her speech. An integrated
approach that includes exploring their nature and severity of stuttering,
learning controlled fluency and increasing approach behaviour.

An adult has to unlearn a significant amount of coping behaviour they have
learned over the years they have been stuttering. It requires hard work on the
part of the therapist, counsellor and their client.

There Is No One-size-fits-all Treatment
Each client comes with different levels of stuttering severity, emotional
turmoil and stuttering related beliefs. Therefore, it is impossible to stretch
one particular stuttering treatment to every adult.

The treatments vary according to their experience related to stuttering, their
upbringing, traumas related to stuttering, and even their perception of the
listener when they stutter. Of all treatment processes, controlled fluency is
most important. The performance of the patient during controlled stuttering
sessions will dictate the future of their treatment.

Integrated treatment should always include an increase in approach behaviour and
reduction in avoidance over the years. SLPs have associated low levels of
avoidance and increase in approach behaviour with an improvement in the fluency
of speech.

An integrated approach pays attention to the negative emotions, attitudes, and
avoidances of the client. The use of controlled fluency or superfluency can
positively influence the attitude and emotions via recurring experiences of
fluency.

Neurologically speaking, it can kindle speech regulation and emotional
regulation by stimulating the left hemisphere. At the same time, it can dampen
avoidance behaviour in the same person. The skills acquired after integrated
therapy can include slowed speech rate, easy phonation onset, proprioception,
pausing, and light articulatory contact.

Treatment May Not Remove Speech-processing Deficits Completely
Adults who stutter may continue to possess some speech-processing deficits even
after the completion of successful treatment. Brain imaging studies show that
adults with stuttering may continue to display lower-than-average left-brain
activity, despite receiving complete speech therapy sessions by an expert.

Dealing with residual stuttering is a long-term commitment and it can be a
continuing task for the client and his/her therapist. A study
[https://pubs.asha.org/doi/10.1044/1092-4388%282008/07-0019%29] conducted
recently where a majority of the 216 participants chose fluency over freedom
from stuttering as their therapy goal.

Keeping Yourself Motivated
You need to keep a measure of your progress and the result of the regular
therapy. Make a note of the percentage of syllables stuttered to capture the
snapshot of progress before and after speech therapy. Your therapist should be
able to help you learn how to measure stuttering severity using easy-to-track
methods.

Don’t forget that speech therapy is a long journey for adolescents and adults.
Therefore, it is important to stick to your exercises
[https://ghost.stamurai.com/stuttering-exercises-for-adults/] and attend the appointments
with your therapist for continuing improvement of your speech fluency.

Adults who stutter can seek out
[https://ghost.stamurai.com/benefits-of-talking-to-other-people-who-stutter/] online forums
or communities near their location to share their feelings and emotions about
stuttering. Finding a safe space to share life experiences that may have
occurred due to stuttering can help one find confidence.

It will help you set realistic goals for your speech, as well as to measure the
progress once you begin attending the therapy sessions with your SLP.

Understanding the Main Causes of Stuttering
Developmental stuttering [__GHOST_URL__/causes-of-stuttering-in-adults] begins
early and typically coincides with the period of rapid linguistic development of
a child. Stuttering is a heterogeneous childhood disfluency disorder. Therefore,
one or many of the following factors can cause stuttering
[https://ghost.stamurai.com/what-is-stuttering/] -

1. Genetics
Stuttering tends to cluster in families. A child who has a close blood-relative
who stutters, may continue to stutter as an adult. Genes influence a person’s
predisposition towards stuttering.

2. Neurology
Genetics also influence the neural network and activities of a person. People
who stutter have distinct differences in the right and left hemisphere
activities in their brains. Their right hemispheres are more active than the
left, which might explain their speech disfluency to a certain extent.

3. Cellular Factors
Recent studies have shown
[https://ghost.stamurai.com/cellular-causes-of-stuttering-in-adults-and-children/] that mouse
models with a deficiency of astrocytes (star-shaped cells) in their corpus
callosum show stuttering-like vocalizations. Scientists led by Dr Dreyna
postulate that people who stutter may have a lower density of astrocytes in
their corpus callosum as compared to those who don't stutter.

4. Childhood Stress
It is important to remember that children who have family members who stutter
have a higher risk of developing stuttering from sudden childhood stress.
Several children go through highly stressful situations but do not show lasting
effects on speech.

5. Environmental Changes
Similarly, children genetically predisposed to stuttering have a higher chance
of developing speech disfluency as a result of these changes. Environmental
changes may include moving to a new and unknown neighborhood, losing friends,
separation of parents or getting a new sibling.

You can find out more about the causes of stuttering right here
[https://ghost.stamurai.com/is-stuttering-biological-or-psychological/].

Types of Stuttering
Genetic predisposition, emotional trauma, physical trauma, and several
neurodegenerative diseases may contribute to stuttering. Currently, experts have
described four different types of stuttering
[https://ghost.stamurai.com/the-unexpected-development-of-stuttering-in-adulthood/] based on
the probable causes.

1. Developmental
Developmental stuttering is the most common type. It begins in early childhood
as toddlers begin to acquire new speech and language skills.

2. Neurogenic
Sudden changes in the neurological pathways or activities associated with the
brain centres for speech process and development may lead to neurogenic
stuttering [__GHOST_URL__/neurogenic-stuttering-vs-psychogenic-stuttering/].
There is no particular age-barrier for this type of stuttering. Neurogenic
stuttering may be a result of stroke, brain trauma, neurodegenerative diseases
and/or brain tumor(s).

3. Psychogenic
Diagnosing psychogenic stuttering is challenging. It may result from severe
emotional trauma and distress. Post-traumatic stress disorder (PTSD), severe
anxiety, and/or chronic depression may manifest in the form of stuttering along
with other symptoms in adolescents and adults.

4. Drug-induced
Drug-induced stuttering is typically seen in adults. It may result from a sudden
change in medication or its dosage. A new medicine or even the use of a
recreational drug may induce stuttering in adults with no prior history of
speech disfluencies. Typically, reverting to the older dosage or replacing the
new medicine with another one stops drug-induced stuttering.

What are the Available Medicines for Stuttering Treatment?
Currently, there is no FDA-approved medicine for stuttering
[https://ghost.stamurai.com/stuttering-medicine/]. There are a few psychoactive compounds
that induce fluency in patients/clients.

Drugs like haloperidol, risperidone, olanzapine, ziprasidone and clonidine can
contribute to reduced stuttering and increased fluency in adults who stutter.

New-age medication that may inhibit the vesicular monoamine transporter 2
(VMAT2) may help reduce stuttering. New research shows that drugs that decrease
dopamine synthesis may help in inducing fluency.

What Kind of Research Is Being Conducted on Stuttering?
In the last few years research on stuttering has progressed significantly.

In 2021, Dr Maguire led the study
[https://neurosciencenews.com/astrocytes-stuttering-17761/]of risperidone action
on increasing the activity of the astrocytes in the striatum. Risperidone can
reduce stuttering by boosting the metabolism or activity of the striatum.

In 2019, Dr Drayna and his team genetically modified mice with a Gnptab
mutation. These genetically engineered mice had a reduced density of astrocytes
in the corpus callosum. These mice made abnormally long pauses in vocalizations
which the team considered similar to those in people with the same mutation.

NIDCD researchers have identified
[https://www.stutteringhelp.org/genetic-and-neurological-factors-stuttering] 
four genes and their mutants that are directly linked to stuttering. Dr Drayna
has contributed significantly to the current knowledge on the role of genetics
in stuttering. Genetic factors play an important role in at least 50% of the
cases.

Currently, research [https://www.nidcd.nih.gov/health/stuttering]is also ongoing
to determine which children will outgrow stuttering and who are at risk for
persistent stuttering.

Scientists are now using fMRI, MRI and PET scans to determine the differences in
the brain structure and function of people who stutter.

A combination of genetic engineering, drug studies and imaging techniques may
soon be used in the future to help and treat people who stutter.

Stuttering in Adults: Treatment, Diagnosis, Symptoms & Causes

Everyone who is trying to come to terms with their stuttering
[https://ghost.stamurai.com/stuttering/] share a common dream – one day they will wake up and
speak with complete fluency.

Sadly, that remains a dream for most, especially those who do not have access to
speech therapy and counselling. Most individuals talk without any repetitions,
blocks and prolongations. However, even the most fluent speaker experiences some
dysfluency during their lifetime.

However, a person who stutters severely does so on at least 50% of the words
they speak. They tend to stutter more when they are under duress, but stress,
fear and anxiety do not precipitate stuttering [__GHOST_URL__/stuttering/] in
children or adults!

So, when someone asks “how to stop stuttering?” there are quite a few factors a
speech therapist needs to assess before giving them the right answer. The truth
is, the treatment or cure for stuttering not only changes with each age group,
but also with every individual depending on their personality, emotions and
avoidance behaviours.

What is developmental stuttering?
Developmental stuttering [__GHOST_URL__/stuttering/] typically begins in
children when they are developing their language skills at lightning speed. It
is typically between the ages of 2 and 3.5 years. It is a common form of
stuttering which depends on multiple factors including genetics, heredity and
environment. There are other forms of acquired stuttering that demand different
courses of treatment.

Here, we will talk about how to stop developmental stuttering and its treatment
in children, adolescents and adults.

Is there a treatment or cure for stuttering?
The treatment of stuttering [__GHOST_URL__/treatment-for-stuttering/] depends
upon the age of the patient, the symptoms exhibited by them and their overall
general health. The severity of stuttering dictates the course of treatment and
its success. It is too early to conclude that stuttering cannot be cured.
Sometimes, the treatments work well enough so that the person is able to speak
fluently most of the times with the help of breathing and speaking exercises.

Currently, there are applications like Stamurai [https://stamurai.com/] that
help individuals with stuttering [__GHOST_URL__/stuttering/] to practice their
speech while away from the SLP’s clinic. It is indeed true that not all types of
stuttering have a cure, but it is also possible to overcome the fear or
anticipation associated with stuttering, which in turn, reduces the frequency of
dysfluencies.

The treatment of stuttering [__GHOST_URL__/treatment-for-stuttering/] is often
complicated by –

 * Lower self-esteem of the individual [__GHOST_URL__/stuttering-depression/]
 * Poor performance in school/at work [__GHOST_URL__/reining-in-the-bullies/]
 * Poor social and personal relationships
 * Limited participation and introverted nature

The SLP can directly work with the client to improve their speech fluency and
decrease the impact it has on their work and social life. Adults often require
psychological counselling in addition to speech therapy to encounter the 
emotional problems [__GHOST_URL__/channel-your-emotions-to-reduce-your-stutter/] 
that result from stuttering.

What is the treatment for a child who stutters?
A child exhibits signs of developmental stuttering [__GHOST_URL__/stuttering/] 
may show improvement or complete recovery within a couple of months without any
intervention. According to works of Yairi and Ambrose in 1999, more than 74%
recover without therapy, and as per data from Mansson (2000), 71% recover within
2 years without treatment. Follow ups after 4-5 years show that 85% of these
children continue to speak fluently.

However, if stuttering in children
[https://ghost.stamurai.com/five-stuttering-exercises-to-help-your-child/] continues for
years, well into the child’s elementary school age, then it demands the
attention of a speech language therapist.

Indirect therapy is mainly useful for a child. It is especially useful for
children under the age of 6 or 7. Preschool-aged children can benefit from the
indirect approach which ropes in the parents, guardians, and teachers of the
child. Indirect therapy targets to make changes in the home and school
environment. The ulterior idea is to change the way the adults communicate with
their children at home or school.

Indirect approaches depend on –

 * Speaking calmly and slowly to the child in question
 * Taking out “listening time” for the family
 * Not interrupting the child or completing their sentences
 * Spending time on family activities including word association games, puzzles,
   playing, walking together or simply chatting about each of your days.

Indirect therapy aims to make the family environment as relaxing as possible for
the child to remove as many external stimuli for stuttering as possible.

Direct therapy demands the involvement of the speech-language pathologist (SLP)
working with the child directly. It can be one-one sessions of therapy in small
groups. Sharing, talking to other children who stutter and learning new
techniques to reduce tension while speaking are all integral parts of the direct
approach.

Is there a cure for children who stutter?
Stuttering in children
[https://ghost.stamurai.com/stuttering-in-children-understanding-shame/] often goes away on
its own. In other words, it cures itself within a couple of months of starting.

Good and timely therapy of stuttering in pre-school or kindergarten-aged
children can bring about near-perfect fluency with only mild traces of
repetitions, blocks or prolongations that become prominent only when they feel
fatigued, stressed or sick.

What is the treatment and cure for adolescents who stutter?
Adolescents who stutter have significantly higher social anxiety than their
non-stuttering peers. Therefore, tweens and teens who stutter not only require
intensive speech therapy, but also psychological counselling to reduce their
social anxiety and increase their confidence in social scenarios.

According to the researcher, speech pathologist and author Barry Guitar, how to
stop stuttering in adolescents has various phases –

 * Exploring their stuttering
 * Learning superfluency or as Guitar referred to it – controlled fluency
 * Encouraging and increasing approach behaviours
 * Maintaining their progress with daily practice, speech assessment and therapy
   sessions

Apps like Stamurai [https://stamurai.com/] that include speech therapy exercises
that the person can perform when at home, or in between classes. The practice of
speech exercises, correct breathing techniques and controlled fluency is
critical outside the therapist’s office is extremely important to maintain
fluency.

Tweens and teens typically have complex negative emotions
[https://ghost.stamurai.com/channel-your-emotions-to-reduce-your-stutter/] associated with
their stuttering. These require just as much attention as their stuttering
during therapy. The goals include removal of avoidance or escape behaviour.
These are integral parts of behaviour change that allow the individual to attain
fluency in speech. Reducing anxiety and fear which arise from anticipation is
important if the client strives to achieve controlled to mild fluency.

When treating tweens and teens, SLPs have to take into account individual
fluency goals. While the ultimate goal is to acquire spontaneous fluency
irrespective of the situation, the duration to achieve the goal can vary
significantly. After extensive treatment, the clients can achieve periods of
spontaneous fluency that can last between weeks to months. However, stuttering
can return in high octane situations like pre-exam periods, viva voce, or
talking to the opposite sex.

Is there a treatment or cure for stuttering in adults?
In the case of adults, first, the SLP needs to find out what is causing the 
stuttering [__GHOST_URL__/stuttering/]. If the stuttering is not developmental
by neurogenic or psychogenic
[https://ghost.stamurai.com/neurogenic-stuttering-vs-psychogenic-stuttering/]or
pharmacological in nature, then the therapist has to work with general
physicians and other experts to address the dysfluency.

For adults with developmental stuttering, the intervention of a speech therapist
and a cognitive behaviour therapist is indispensable. Adults should remember
that treatment can take quite a long time since by adulthood stuttering has
caused them to develop strong negative feelings, avoidance behaviour and certain
beliefs that act as guards.

A good speech therapist always tailors the treatment for the client’s needs.
This includes addressing the severity of their stuttering, the intensity of
negative emotions associated with their speech dysfluency and setting the goal
realistically. The success of therapy depends on reducing avoidance behaviour
and increasing approach behaviours in adults.

Typically, adults who stutter [__GHOST_URL__/stuttering-treatment-for-adults/] 
continue to experience speech-processing deficits, though they can successfully
compensate for them. Since stuttering is a complex speech disorder that stems
from aberrant brain activity and neural connections, it may be impossible for
some adults with severe stuttering to achieve complete fluency. Therefore, the
measurement of progress is of utmost importance to keep their spirits high.

For daily motivation, you can download mobile speech therapy applications that
help with daily exercises. You must remember that your treatment does not stop
the moment you step out of the therapist’s office, but it continues throughout
your daily routines. Make speech exercises a part of your daily routine for the
best results.

So, how to stop stuttering at any age?
When someone says “cure,” we tend to picture it in the form of a pill
[https://ghost.stamurai.com/medicine-for-stuttering-what-we-know/]. Sadly, in the case of
stuttering, there is no easy cure, especially if one has been stuttering for
more than a few years. Children often take lesser time to recover as compared to
adults, despite the severity of their stuttering.

You can achieve controlled fluency or superfluency with speech and cognitive
behavioural therapy if you are an adolescent or adult. However, you must
remember that it takes time and a lot of hard work to become fluent and make up
for the speech deficits that you may be facing right now.

Sources
1. https://www.stlouischildrens.org/conditions-treatments/stuttering
[https://www.stlouischildrens.org/conditions-treatments/stuttering#:~:text=There%20is%20no%20cure%20for,learn%20to%20breathe%20while%20speaking.]
2. 
https://www.healthychildren.org/English/ages-stages/toddler/Pages/Stuttering-in-Toddlers-Preschoolers.aspx
3. https://www.stutteringhelp.org/stuttering-therapy-children
4. https://pubmed.ncbi.nlm.nih.gov/18617050/
5. https://www.nhs.uk/conditions/stammering/treatment/
6. https://www.medicalnewstoday.com/articles/321995#long-term-treatments

How to stop stuttering?

Stuttering has been present across almost every culture with similar incidence
and prevalence. In the early days of medical sciences, experts considered
stuttering to be the result of physical abnormalities of the tongue and larynx.
As a result, surgeries to correct these anomalies were frequent.

However, clinical treatments that targeted the larynx and the tongue rarely
showed any improvement of the symptoms. Finally, in the early 1900s, Travis and
Orton postulated that stuttering may have its roots in brain function rather
than a physiological abnormality of the tongue or larynx.

Most modern theories of stuttering are based on the work of Travis and Orton
[https://pubs.asha.org/doi/10.1044/jshd.0504.309] in the 1930s. The
establishment of the possibility that stuttering emerges from anomalous cerebral
activity paved the way for new theories and inspired modern medical research.
After much debate, research and taboo, the Diagnostic and Statistical Manual of
Mental Disorders (DSM 5) now defines stuttering as a childhood fluency disorder.
It typically results from the underactivation of the primary speech centres in
the brain.

Why is there no stuttering medicine yet?
Individuals who stutter and their loved ones have always hoped for a
pharmacological cure for stuttering. Currently, there are no pharmaceutical
compounds that can fully alleviate the symptoms of stuttering
[https://ghost.stamurai.com/stuttering/]. There are no FDA-approved drugs for the cure of
stammering.

[https://stamurai.app/z4HKmlNXigb]Genetics play a significant role in the
incidence of developmental stuttering. Familial studies and twin studies by
Yairi and Ambrose suggest genetic dependence of stuttering. Genes related to
stuttering have been mapped to chromosome numbers 1, 7, 12, 13, 15 and 16 in
recent genetic studies linked to stuttering in children and adults.

Newer studies by Montag et al published in 2012 and Chen et al in 2014 show that
there is an association between the dopaminergic genes (SLC6A2 and DRD2) and
stammering. However, almost all available dopamine blockers come with
significant side effects that dilute their efficacy in reducing the repetitions,
blocks and prolongations in dysfluent speech.

Like most genetic and developmental disorders therapists and doctors can
prescribe medication for the management of stuttering. However, there is no
medicinal treatment that cures the childhood onset fluency disorder. Combining 
cognitive behavioural therapy
[https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/] with
medication often shows better outcomes than using medication only.

Haloperidol and reduction in stuttering intensity
Data from the 1980s show that there is enough correlation between
first-generation dopamine-blocker haloperidol. The compound can improve the
fluency by increasing brain activity in the primary speech centres, but
haloperidol can have serious side effects. The constant use of haloperidol has
been linked with extrapyramidal symptoms, dysphoria, sexual dysfunction and
tardive dyskinesia.

Research shows a relationship between stuttering and elevated dopamine levels.
Moreover, drugs that enhance dopamine activity like L-dopa make stuttering much
worse in people who stutter.

Another dopamine blocking agent – Pimozide, which is similar to haloperidol, has
shown positive responses in clinical trials. However, it has significant side
effects upon prolonged usage. Contraindications include an elevation in the
prolactin levels, tardive dyskinesia, extrapyramidal symptoms, dysphoria and
cardiac conduction concerns.

Not all antipsychotics and antidepressants reduce the stuttering intensity
On the other hand, paroxetine, the antidepressant that reduces the reuptake of
serotonin (SSRI) does not exhibit any clinical response in stammering.
Similarly, tricyclic antidepressants show little effect on the symptoms of
stuttering. A comparative study of clomipramine and desipramine show that
clomipramine show increased improvement as compared from the latter based on
self-reported fluency scales according to two studies published in 1995 by
Gordon et al. and Stager et al.

[https://stamurai.app/z4HKmlNXigb]New-age dopamine blockers work better with
fewer side effects
Second generation dopamine blockers like olanzapine and risperidone have better
effects on stuttering symptoms and exhibit lower side effects as compared to
first-generation dopamine blockers like Haloperidol. Both these compounds have
are better tolerated than haloperidol.

Risperidone shows increased activity in the cortical speech areas and striatum.
According to research, doses between 0.5mg and 2mg per day decreases stuttering
intensity significantly. Although risperidone is well-tolerated, it can increase
overall plasma concentration of prolactin leading to severe side effects
including sexual dysfunction, amenorrhea, galactorrhea and dysphoria upon
prolonged use. Patients treated with risperidone also exhibit increased
metabolism of the left striatal function as per FDG PET studies conducted by
Maguire et al in 2000 (as compared to patients treated with placebo).

Olanzapine has a different tolerability profile as compared to risperidone. It
has lower risks of causing dysphoria, sexual dysfunction and amenorrhea, but it
can contribute to drastic weight gain in patients. Doses of olanzapine between
2.5mg and 5mg can effectively reduce stutter, but these doses can also result in
an average of 4 kg (11 pounds) of weight gain.

A recent study shows that olanzapine might be more effective than haloperidol in
reducing the intensity of stuttering. The compound downregulates the
post-synaptic GABA-A receptors. They act as complete or partial GABA-A agonists
and contribute to decreasing the intensity of stuttering in the targeted
population.

Treatment of stuttering with new and unique pharmaceutical compounds
Ziprasidone is another compound that is well-tolerated and effective for the 
treatment of stammering [__GHOST_URL__/treatment-for-stuttering/]. It is also an
atypical antipsychotic. Another newer compound that has fewer side effects but
reduces the intensity of stuttering is asenapine. It leverages the sublingual
administration and does not contribute to unwarranted weight gain like
olanzapine. Aripiprazole is another compound that acts as a partial agonist of
the D2 and 5HT1a receptors. Aripiprazole is an FDA-approved drug for the
treatment of Tourette’s in children.

Other alpha receptor agonists like Clonidine, calcium channel blockers like
nimodipine and verapamil, and selective GABA-A agonists like Pagoclone have
limited efficacy with a flurry of side effects.

New drugs as stuttering medicine
A new category of drugs that inhibit the vesicular monoamine transporter 2
(VMAT2) is under review as you read this blog. These compounds decrease the
synthesis of dopamine through the VMAT2 inhibition. These drugs including
valbenazine and deutetrabenazine have shown significant promise in the treatment
of tardive dyskinesia, Tourette’s, and abnormal movements associated with
Huntington’s Chorea. At the same time, these compounds pose the risk of
precipitating depression via the non-selective inhibition of monoamines and a
sharp decrease in serotonin levels in the brain.

Should you take medication for stuttering?
The perfect medicine for the treatment of stuttering is still far away. The
ongoing research does hold promise and keep the hope for a medicinal cure of
stuttering alive. Right now, almost every pharmaceutical compound available in
the market for the treatment of stuttering belongs to groups of antipsychotics,
atypical antipsychotics or medication for Tourette’s syndrome. Therefore, there
are scores of side-effects the patient and their loved ones have to deal with
during constant use.

There is no replacement for a good speech language pathologist for the treatment
of stuttering. Even if you are taking medication, you should not discontinue
speech therapy. A combination of speech exercises
[https://ghost.stamurai.com/stuttering-exercises-for-adults/] and medication has been most
effective in treating the signs and symptoms of stuttering.

Is There A Stuttering Medicine Available Right Now?

A big part of the daily struggle every person who stutters (PWS) is facing their
anxiety, fear and anticipation of stuttering. A person who stutters needs to
fight the negativity that shrouds their thinking every waking moment. It
requires more than the daily pep talk and inspirational post from Instagram.

Research shows that mindfulness and meditation can manage the negative attitudes
and emotions in people, and it can help the person relax physically.

What Is Mindfulness?
According to Paul Brocklehurst, PhD, Founder and Director of The Stammering
Self-Empowerment Programme, mindfulness is distinct from meditation.
Brocklehurst, who practices Zen, advocates a form of mindfulness that may be
unique to many readers.

Mindfulness is not relaxation
[https://theconversation.com/we-dont-yet-fully-understand-what-mindfulness-is-but-this-is-what-its-not-110698]
. It is about becoming mindful of any state that we are in.

You can be mindful of being happy and relaxed, the same way you can be mindful
of being anxious, afraid or angry. The target of mindfulness is to make one
completely aware of the present and be open to the potential experiences that
may come in that moment.

What Is Mindfulness Meditation?
Meditation can be one way to achieve mindfulness. However, it does not involve
trying to empty one’s mind completely. It is only natural for anyone to have a
nonstop train of thoughts. Stopping that forcibly is not the target since
thoughts are not the obstacle but the tools to achieve mindfulness.

Mindfulness meditation for stuttering enables you  to become more aware of
 thoughts that cross your mind. Over time, you will develop the skill to assess
how much attention you pay to each thought, how different thoughts arise in your
mind and control the importance you give to each thought process.

Meditation can help you slow your thoughts, eliminate the negative thoughts and
calm your mind. If you are trying mindfulness for the first time, meditation can
be of help.

You can try guided meditation techniques for stutterers that include breathing
practice. You can begin with the assistance of apps. Stamurai
[https://ghost.stamurai.com/stamurai-app-to-stop-stuttering/] - a speech therapy app for
people who stutter, offers guided meditation options. This smartphone app also
helps you learn and practice various stuttering exercises and is available for
both Android
[https://play.google.com/store/apps/details?id=com.stamurai.stamurai&hl=en_IE] 
and iOS
[https://apps.apple.com/us/app/stamurai-stuttering-treatment/id1488071175] 
users.

How Can Mindfulness Meditation Influence Stuttering?
Mindfulness Can Tell You What You Do When You Stutter
Researchers have explored the relationship between meditation, mindfulness and
stuttering time and again. Mindfulness meditation aims to make you more aware of
your mental and physical state.

Achieving mindfulness is not easy. You may need to dedicate between twenty
minutes to an hour every day to practice meditation for stuttering to achieve
the mindfulness necessary to assess what you do when you stutter.

Mindfulness can help you delve beyond the verbal description of stuttering
[https://ghost.stamurai.com/causes-of-stuttering-in-adults/]. You can directly realize the
sensory experiences that accompany each stutter. What you do when you stutter
can become the starting point of your cognitive and speech therapy.

Being Mindful Can Improve Your Communication Skills
PWS are often scared of public speaking
[https://ghost.stamurai.com/public-speaking-with-a-stutter/] because of past experiences. How
people have reacted to their speech in the past shroud the reality of how their
listeners are reacting to them in the present.

It is particularly true in case of the bad days when your stutter seems to be
worse than it typically is. In cases of stubborn blocks, prolongations or
repetitions, we often don’t perceive how the listeners are reacting. We are too
engrossed in bad memories
[https://ghost.stamurai.com/stuttering-and-lasting-emotional-effects/] of unpleasant
encounters.

Mindfulness meditation can help you remain in the present to see and assess the
reactions of the listeners. It can also empower you to determine the most
appropriate way to relate to your listeners and react accordingly. It can
improve your communication skills and break the vicious cycle of anticipation
and stuttering.

Mindfulness Can Reduce Secondary Stuttering Behavior
As adults, almost all PWS have well-established secondary behaviors
[https://www.stutteringtherapyresources.com/blogs/blog/even-more-thoughts-about-secondary-characteristics]
. These may include rapid blinking, shrugging of shoulders, clenching of fists
or twisting of lips. People who stutter develop them over the years because they
tend to believe that these behaviors somehow help them “unstick” the words.

Being mindful will make you more aware of such secondary symptoms. The
consciousness extends to the subtler secondary symptoms including delays,
unnatural changes in pitch, and emphasis.

Mindfulness is a wonderful practice since the more conscious you become of these
actions, the more likely you are to overcome them on your own.

Mindfulness Helps Build a Realistic Self-Esteem
A majority of PWS suffer from low self-confidence and self-esteem. Mindfulness
gives you the chance to slow down and look at your life from a different
perspective. You gain an understanding of your core and secondary stuttering
behaviors. You get to understand how your listeners are reacting.

Practicing mindfulness meditation daily gives you the opportunity to be more
forgiving towards yourself. Stuttering is not something
[https://ghost.stamurai.com/cellular-causes-of-stuttering-in-adults-and-children/] that you
can control. It’s something beyond your control, but not beyond your
understanding.

Interestingly, with increasing mindfulness we become more accepting
[https://pubmed.ncbi.nlm.nih.gov/23218212/] of the lack of control we have over
our lives. It is impossible to have complete control over what we do, although
we would like to believe otherwise.

This understanding and acceptance brings a feeling of empathy towards oneself
and the others (including the listeners). With the new understanding you will
slowly gain the self-esteem you thought was only entitled to the fluent
speakers.

Can Meditation Cure Stuttering?
Medical professionals, speech therapists, researchers and PWS have been looking
for the cure of stuttering for almost a century.

Is meditation a cure? Yes, and no.

Meditation can reduce your anxiety and stress. Both of these factors contribute
to pre-existing stuttering. Mindfulness can make you more aware of the emotions
you feel and the movements you carry out while you stutter.

In a way, mindfulness and meditation can help you realize everything you are
doing wrong and the things you are doing right while stuttering.

Self-realization and growing confidence levels can contribute to an increasing
fluency.

However, calling it a complete cure for stuttering would be grossly wrong. It is
a treatment for adults who have been stuttering for years. And it has been shown
to yield positive results in hundreds of case studies.

How Can Meditation Help You Stop Stuttering?

What happens when you alter the speaking environment of a person who stutters?
Research shows that making a few changes including - the introduction of noises
that prevent the speaker from hearing their own voice and manipulating the sound
of their voice before they can hear it - can induce fluency.

Over the years, several types of speech manipulations
[https://www.mnsu.edu/comdis/kuster/TherapyWWW/Electronictechnology/FAQelectron.html] 
have been introduced including –

 * Introduction of a slight delay between speaking and hearing
 * Shifting the frequency (up or down) of the voice of the speaker

Both the delayed auditory feedback stuttering therapy techniques work towards
inducing fluency in a majority of speakers who stutter. Interestingly, the two
techniques mentioned above work for children, teenagers and adults.

How Does DAF Work?
Currently, both prosthetic devices that induce a delay of a few microseconds and
state-of-the-art smartphone apps such as Stamurai [https://stamurai.com/] can
produce similar outcomes in inducing fluency in people who stutter
[https://ghost.stamurai.com/what-is-stuttering/].

Delayed auditory feedback (DAF) devices and software work on the principle of
choral effect. They introduce a delay between speech production and auditory
perception. The delay can be typically customized to be between 50 and 70
milliseconds.

Researchers have observed [https://pubmed.ncbi.nlm.nih.gov/8944848/] that a
delay of 50 to 70 milliseconds can reduce stuttering by around 70%.

Using DAF to reduce speech disfluency doesn’t require any previous training and
conscious effort. It doesn’t lead to abnormal sounding speech. Speakers can
maintain a normal speech rate while using a DAF hardware or software to reduce
their stutters.

Is DAF Stuttering Therapy Effective in Reducing Stuttering Permanently?
One of the most common questions experts hear from people who stutter (PWS) is
“can DAF cure stuttering?” The results of using DAF can vary depending upon the
guidance the user receives while they use the DAF device or software (app), and
the nature of their auditory processing.

Speech experts now use DAF to improve fluency especially by slowing the
speaker’s speech rate up to ten times. Initially, the delay between speech and
auditory perception can be 200 milliseconds.

For best results, anyone who stutters should work with a speech pathologist with
the goal of shaping their speech for higher fluency. A trained speech language
pathologist may gradually reduce the delay from 200 milliseconds to 50
milliseconds.

Alternatively, people who stutter can use Stamurai [https://stamurai.com/] - a
cutting edge speech therapy (with DAF) - for guided stuttering speech therapy
and exercises.

The ultimate goals of guided DAF therapy for stuttering is to increase the
stress the PWS feels during speaking and to reduce their dependence on the
device at the same time.

Multiple studies show
[https://onlinelibrary.wiley.com/doi/abs/10.1080/1368282021000042902]that DAF
reduces stuttering by 70% almost immediately. A combined approach that uses DAF
and FAF (frequency altered feedback) reduces stuttering by around 80%. A
combinatorial approach rarely reduces anyone’s stutter beyond 90% or less than
50%.

Using DAF in conjunction with other conventional stuttering therapies can reduce 
stuttering relapse
[https://ghost.stamurai.com/high-relapse-after-stuttering-speech-therapy-understanding-the-reason/] 
rates, increase the fluency and hasten positive outcomes in adult clients.

What is a DAF Device?
A user can access DAF technology in the form of hardware or software. A hardware
could be a portable altered auditory feedback device that introduces the
necessary delay to induce fluency.

Currently, there are two main types of DAF devices available in the market –

 * A single-component DAF device – it looks and fits similar to a hearing aid.
 * A multi-component DAF device – it consists of an earphone and a box (similar
   to old-school hearing aids). The connection between the box and earphone
   might be wireless. A wireless device makes its presence less prominent akin
   to a single-component DAF device.

A few manufacturers offer try-before-you-buy options for the users. If you have
never tried a DAF anti-stuttering device in therapy before, you should go for a
trial run before investing.

Opting for smartphone-based software
[https://ghost.stamurai.com/stamurai-app-to-stop-stuttering/] that offers DAF through
Bluetooth or wired headphones is also a good option for the novice users.

Can A Mobile App Provide DAF Stuttering Therapy?
A smartphone app can provide DAF services. However, the user needs to be
cautious that they have access to a verified speech therapist who can guide them
properly. Integration of a DAF stuttering app with conventional stuttering
therapy [__GHOST_URL__/stuttering-treatment-for-adults/] can improve speech
fluency at a faster rate.

Depending on the DAF mobile app you are using, you may have access to multiple
features. Some of these features may include –

 1. Recording the user’s voice – you can record your voice while using DAF and
    play it back for yourself to hear how much your speech has improved.
 2. Use it regularly – most Pro apps have a “running in the background” feature
    that allows the user to constantly use the app while conversing, presenting
    and attending meetings. Many apps offer pro/paid versions that work even
    when you lock the phone screen.
 3. Measuring speech rate – several iOS and Android apps have a speech rate
    indicator. The aim of DAF for stuttering is to reduce the speech rate so the
    user’s speech is comparatively relaxed and clearer. A DAF app with this
    feature will notify the user if they speak too fast.
 4. Training sessions – although there is no learning curve for using a DAF
    device successfully, you may want to use a training session or two before
    using your DAF app during an important meeting or career-defining
    presentation.
 5. Speech exercises – not all DAF apps have speech exercises
    [__GHOST_URL__/stuttering-exercises-for-adults/]. You should look for the
    ones that do. Exercises will help you apply the speech techniques you learn
    during stuttering therapy, and give you the chance to couple them with DAF
    to induce higher levels of fluency.

How to Use DAF for Stuttering?
DAF is an effective assistive technology for stuttering even when it is the only
one someone who stutters employs outside a therapeutic environment.

PWS can opt for DAF devices or smartphone apps. If you are using a smartphone
app, you will need to install the app and couple a Bluetooth headphone or a
wired headset to your phone.

DAF works best under the guidance of a professional and experienced speech
therapist or an app that serves a similar purpose. Someone who has the expertise
in DAF devices and DAF mobile apps can help PWS to enhance their fluency.

Speech therapists typically recommend a slow-speaking test to determine the
progress. Any DAF device works perfectly when the user masters slow-speaking.

Only an expert therapist can guide the user based on their improvements in
fluency. With constant guidance the user should be able to reduce the delay from
200 milliseconds to 75 milliseconds and ultimately decrease their dependence on
the DAF device.

Common Mistakes People Make While Using DAF To Reduce Their Stutters
For the best results of DAF, you can couple it with speech therapy. While you
can approach a speech-language pathologist, you can also follow exercises and
receive guidance from speech therapy apps like Stamurai.

Wholesome speech therapy apps can tell you how to use DAF correctly for
achieving speech fluency.

Avoid the following mistakes if you are using DAF for the first time –

 1. Setting a longer delay for higher fluency – if you are using a
    normal-speaking rate, set the delay between 50 milliseconds and 75
    milliseconds. Setting it to a longer delay will make the auditory processing
    worse in those with existing atypical auditory processing.
 2. Expecting speech fluency to increase exponentially – PWS often experience
    50% fluency at a delay of 50 milliseconds. They also experience close to 75%
    fluency at a 75 millisecond delay. However, it does not mean that increasing
    the delay will also increase your speech fluency.
 3. Not speaking at a slower rate – working with a therapist can help you
    achieve a slower rate of speaking. Once you have achieved five to ten times
    slower speaking rate, you can set the DAF delay to 200 milliseconds.
 4. Using DAF only in low stress situations – don’t use DAF in just low stress
    situations like reading aloud
    [__GHOST_URL__/why-dont-we-stutter-when-talking-alone/] or taking in front
    of a mirror. You need to test your DAF induced fluency in high-octane
    situations like in a meeting, during public speaking or live presentations.

Notable Research Findings on DAF and Stuttering
Since stuttering is a heterogeneous disorder not everyone responds to DAF
therapy the same way. For example, the Charles A Dana Foundation reported in a 
NIH study
[https://www.researchgate.net/publication/8187159_Aberrant_auditory_processing_and_atypical_planum_temporale_in_developmental_stuttering] 
that they had found two sub-groups of PWS – one with atypical auditory anatomy
and the other with typical auditory anatomy.

DAF was only helpful in inducing fluency in people with atypical rightward
planum temporale asymmetry (auditory anatomy). The other group didn’t become
fluent with DAF therapy.

Will DAF Work for Me?
The only way to find out if DAF will work to enhance your fluency during speech
therapy is by trying it.

You can either seek help from a SLP or you can rely on a verified speech therapy
app like Stamurai to help you out. Using it at the right time in the correct
manner makes all the difference.

You need to find the delay that suits your speech rate at the moment. You can
use Stamurai to make a list of your feared words and find out how fast you
speak. Both of these factors will help you improve your fluency while using DAF
for stuttering therapy.

DAF & Stuttering: Can DAF Help Reduce Stuttering?

Stuttering is a speech disorder, which cannot always be cured. Teens and adults
who have been struggling with stuttering for years face difficulty in attaining
fluent speech.

What Is Fluency Shaping?
Fluency shaping (FS) includes multiple operant techniques that may replace
stuttered speech with fluent stuttering.

In the early days of speech therapy, fluency shaping was used by experts without
the aid of modification techniques. The trend was to provide little attention to
the emotions, attitudes, and feelings of people who stutter (PWS)

According to Barry Guitar, in his 1982 publication
[https://journals.sagepub.com/doi/abs/10.1177/152574018200600106] in the Journal
of Childhood Communication Disorders, fluency shaping works best when Speech
Language Pathologists (SLPs) use it in conjunction with other techniques. It
works most effectively as a part of broader speech therapy programs.

One of the unique features of fluency shaping is that it does not teach people
who stutter to confront their disfluencies for speech modification. SLPs who
advocate stuttering modification techniques teach their clients to confront
their stuttering.

[https://stamurai.app/z4HKmlNXigb]In stark contrast to stuttering modification
techniques, fluency shaping does not delve deeper into the feelings and
attitudes that result from stuttering.

SLPs use a combination of fluency shaping techniques to address a client’s
stuttering. The techniques depend on the age of the client, and the severity of
their stuttering among other factors.

Here in this post, we will shed light on some popular fluency shaping techniques
you may come across during stuttering therapy.

Several speech therapists utilize a variation of the original prolonged speech
technique described by Goldiamond in 1965. Deliberately prolonging one’s speech
can modify stuttering in clients of any age.

An SLP can utilize the following fluency shaping techniques to prolong their
client’s speech –

1. Slowed Speech or Stretched Syllable Technique
The first step to fluency shaping is mastering very deliberate and slow
speaking. The typical rate recommended by an SLP can be around 40 to 60
syllables per minute.

How to Practice Slowed Speech or Stretched Syllable Technique?
 1. Break every word down to its syllables. For example, “Lemon” would be broken
    down to “le” and “mon”.
 2. Try to stretch out every syllable for at least 2 seconds. Make sure to
    stretch the first sound in the syllable.

For example, in “Lemon,” you should stretch out the “L” for a second before
saying “e” for the next 2 seconds. Do the same for “mon”. It should sound like
“Llll (1 second)-eee (2 seconds)” (rest) “mmm (1 second)-ooon (2 seconds).

This rate sounds quite unnatural. Without the guidance of a trained speech
therapist or an interactive speech therapy app [https://stamurai.com/], you may
find it challenging to attain this speech rate.

However, once you master slowed speech, the SLP will introduce you to faster
speaking rates of up to 150 syllables per minute. It is the typical syllable
rate of adults who are fluent.

B, D, G, H, F, K, P, S, T, SH, CH, and TH are unvoiced or stop speech sounds
which you should never stretch. When you encounter these sounds, instead of
stretching them, move through them quickly and stretch the next stretchable
sound, which may include – A, E, I, O, U, J, L, M, N, R, V, W, Y, Z, or a voiced
TH.

[https://stamurai.app/z4HKmlNXigb]2. Diaphragmatic Breathing
People who stutter may develop poor breathing strategies as they struggle with
 blocks and repetitions for many years. Quick and shallow breathing, gulping for
air, or trying to squeeze out air are some practices PWS acquire due to their
struggles with long-term disfluencies.

Costal breathing or diaphragmatic breathing techniques can help you take back
control of your breath and voice.

How to Master Diaphragmatic Breathing?
 1. Place one hand on your chest and one on your belly. Feel your mouth, jaw,
    throat, and neck relax as you breathe out.
 2. Take a deep breath. Feel your belly rise to the fullest extent.
 3. Breathe out all the air. Feel your belly fall. Relax your diaphragm.

Keep following steps 2 and 3 till you feel yourself completely relaxing.
Diaphragmatic breathing is all about relaxing completely. It will also relax
your articulator muscles. You will require diaphragmatic breathing in all the
fluency shaping techniques we discuss subsequently.

3. Light Articulatory Contacts
While pronouncing words like “Put,” “Butter,” or “Pet,” we have to bring our
lips together briefly to produce the initial sound. Similarly, while saying
words that begin with “E,” we need to pull our vocal cords together.

These point-contacts can lead to blocks. Light articulatory contact (LAC) can
help you overcome these blocks and move on with the word.

Steps to Apply  Light Articulatory Contracts (LAC) Fluency Shaping Technique
 1. Your first task is to determine which articulators you use to make a sound.
    For example, to say “ball,” you are primarily using your lips to make the
    /b/ sound.
 2. Next, feel your mouth come into that position to say that sound.
 3. Make the lightest touch of your lips (in this case) to make the /b/ sound
    and continue with the word.

It’s as simple as that! LAC can help you say even the worst-feared-words with
the least bit of stuttering.

4. Gentle Initiation Technique
One of the foremost goals of fluency shaping is to lessen the tension on the
muscles involved in speech production. Excess pressure on the laryngeal muscles
can prevent them from coming together and moving in harmony with one another to
produce smooth speech.

People who stutter face blocks too often due to vocal cords “turning on”
suddenly or abruptly.

In easy phrase initiation, the SLP teaches the client to not apply hard force
while producing the first sound of every word or syllable.

How to Practice Gentle Initiation Technique
 1. Assume a low volume and begin speaking with the lowest vibrations of the
    vocal cords.
 2. Gradually increase the volume, and strength of your voice to a level that
    feels normal for you.
 3. Decrease the strength and volume back gradually to the initial soft level
    once again.

You don’t have to stretch. Apply this technique to each syllable. It may sound
artificial and unnatural at first. However, once you master this fluency-shaping
technique, you can apply it organically for achieving fluent speech sans blocks
and repetitions.

[https://stamurai.app/z4HKmlNXigb]5. Passive Airflow Technique
To master the passive airflow technique, you should already be familiar with
diaphragmatic breathing and stretched syllable techniques discussed above.
Passive airflow technique should ease the beginning of sentences and maintain
fluency.

Follow These Steps to Practice Passive Airflow Technique
 1. Take in a complete breath (like diaphragmatic breathing).
 2. Let out a little bit of air (the passive exhale).
 3. Start speaking using the stretched syllable technique you have already
    learned, once you have let the passive exhale out.

The small volume of air you let out before you begin speaking will keep your
vocal folds relaxed and open. It will prevent blocking while you finish your
sentence.

Just remember not to rush through, but to apply the stretched syllable technique
and LAC wherever necessary.

6. Continuous Phonation
It borrows a leaf from singing to keep your speech smooth and effortless. Think
of it as a way to keep your voice “turned on.”

You will need to practice diaphragmatic breathing, stretched syllables, and
passive airflow techniques to learn and apply continuous phonation.

How to Practice Continuous Phonation
 1. Focus on your articulators once again.
 2. Maintain constant and continuous airflow as you speak.
 3. You should aim at reducing the break between words.

It is important not to rush through. Continuous phonation is a little difficult
to master. You may need the help of an experienced speech therapist. They can
help you get the feel of the continuous vibrations as you keep your voice
“turned on”.

It is imperative for anyone who stutters to master the previous techniques
before they can start with continuous phonation.

[https://stamurai.app/z4HKmlNXigb]What Is the Difference between Fluency
Enhancement & Stuttering Modification?
Fluency shaping or fluency enhancement involves techniques like deep breathing,
slowed speech rate, light articulatory contact, and gentle initiations. These
are all strategies that facilitate more fluent speech.

Fluency shaping strategies aim to help you speak with increased fluency.
Improving your fluency of speech makes you confident and reduces negative
feelings regarding stuttering.

Stuttering modification strategies, on the other hand, involve exercises and
techniques that work directly on one’s stuttering.

These are exercises that help people increase their awareness about how and when
they stutter. They may decrease one's fear of stuttering by facilitating
desensitization and reduction of avoidance behaviors. Stuttering modification
involves predicting and catching one’s stuttering as it’s about to happen. Then,
applying strategies to reduce the struggles
[https://ghost.stamurai.com/overcome-stuttering-blocks/] and allowing stuttering
in a more relaxed manner.

Stuttering modification techniques involve strategies like catching the stutter,
relaxing the stuttering, pulling out, and cancellation.

Long-term Effects of Fluency Shaping Techniques
In recent publications, researchers have demonstrated that practicing fluency
shaping techniques has a long-term impact on the auditory-to-motor pathways
inside the human brain.

It is well-known that fluency-shaping enhances the speech fluency of the person
who stutters. However, the neuroplasticity-related impact of fluency-shaping was
unknown until recently. The new research sheds light on what happens after you
master and practice fluency shaping techniques daily.

According to Korzeczek et. al
[https://www.sciencedirect.com/science/article/pii/S1053811921010089]., it
increases the connectivity within the sensorimotor integration network. The
enhanced fluency comes from a strengthened auditory-to-motor coupling and
enhanced integration of the command-to-execution pathway.

Thus, speech therapy can “rewire” your brain and help you speak more smoothly.

Conclusion
Fluency shaping techniques have helped reduce stuttering and induce fluency in
thousands. However, it is most effective when used with speech modification and
cognitive behavioral therapy on clients.

The success of fluency shaping techniques also depends upon one’s willingness to
practice and apply them to everyday conversations. Tracking one’s progress is
also of utmost importance while implementing these techniques.

You should work with your speech therapist to learn and use fluency shaping
techniques. Or, you can use an app like Stamurai [https://stamurai.com/] to
master fluency shaping techniques discussed in this post and various stuttering
exercises [__GHOST_URL__/stuttering-exercises-for-adults/] that we
have discussed in another post!

Stuttering: 6 Fluency-Shaping Techniques

Stuttering in children can begin when they are as young as 22 months old. The
incidence of stuttering in preschool-aged children is almost as high as 5%.

More than 76% of the children who begin stuttering at an early age recover
spontaneously.

There are several speech-language pathologists, speech therapists, and
pediatricians who are of the opinion that early childhood stuttering does not
need intervention due to its high probability of natural resolution.

That, however, begs the question, how do we know if the child will recover
spontaneously or they will be a part of the 24% who grow up with a stutter for
life.

Why Should You Seek Early Intervention For Your Child Who Stutters?
As per the research of Anne Smith and Christine Weber, recent studies provide
evidence that children as young as 3 to 5 years old with early-onset stuttering
begin showing atypical patterns of neural connectivity and activity that are
characteristic of stuttering.

In families with a history of stuttering, there’s  high likelihood that children
who begin stuttering as early as 22 months to 3 years may continue to do so as
adults. However, there is no guarantee that they will not spontaneously recover
especially if one parent has no history of stuttering in their family.

Stuttering can become a reason for emotional distress among children soon after
onset.

 1. Other children recognize stuttered speech. They may react negatively to
    speech disfluencies, resulting in isolation and emotional agony of the child
    who stutters.
 2. Researchers have observed and measured negative attitudes among children as
    young as 3 years to 6 years old during communication with those who stutter.
 3. By the time children who stutter are 7 years old, their attitude towards
    communication worsens.
 4. Facing bullying at school and playgrounds can result in severe anxiety
    disorders later in life. School-aged children who stutter often face more
    bullying as compared to their peers.
 5. Recurring negative perceptions concerning communication can make it
    difficult to form  relationships later in life.

Research by Robin Jones, Dahye Choi, Edward Conture, and Tedra Walden shows that
children who stutter exhibit significant differences in overall emotion and
temperament as compared to children who don’t stutter.

Not treating it when the child is young can result in the persistence of
stuttering in adulthood. Stuttering can attract psychological, educational,
occupational, and social problems. Therefore, the management of childhood
stuttering should begin as early as possible.

What Are The Advantages Of Early Intervention Of Stuttering In Children?
Treating stuttering in adolescence and adulthood can be challenging. Apart from
speech therapy, the treatment demands concomitant behavioral therapy or
psychological counseling sessions to address anxiety and stress.

At the same time, speech therapy for adults can be costly, time-consuming, and
prone to relapse.

According to multiple speech-language pathologists and leading researchers in
the field of speech pathology, the Lidcombe Program is one of the most efficient
treatment programs for toddlers and young kids.

The first thing to do if you notice disfluencies in your child’s speech is to
consult a speech-language pathologist.

Only an expert can assess your child’s speech and tell you -

 * Whether immediate intervention is necessary.
 * Or, if you should wait a couple of months before intervening.

If you notice your child stutter, it’s important that you seek professional
help. Finding the right speech therapist is not always easy. You can use a
cutting-edge speech therapy app like Stamurai [https://stamurai.com/] to contact
a speech therapist and gain a preliminary understanding of your child’s
stuttering severity.

What is the Lidcombe Program?
The Lidcombe Program is a behavioral treatment targeted at children who stutter.

The Lidcombe treatment guide is now easily available over the web. Parents and
guardians can easily use operant conditioning principles for guiding their
children towards a stutter-free future.

During this program, parents don’t try to change how their children speak. At
the same time, parents don’t change their pattern of speaking or language
habits. There is no change in family lifestyle.

 1. Operant conditioning principles include praises when the child speaks
    fluently without stuttering. The parent offers verbal contingencies during
    practice sessions and natural conversations with the child.
 2. Occasionally, they may request the child to repeat themselves in case of
    particularly-strong stuttering. However, there should be no criticism. They
    may ask questions like “was that smooth?” or “could you say that for me
    again please?”
 3. Parents should also measure their child’s stuttering severity with a
    severity rating (SR) that ranges from 0 to 9.
 4. The parent(s) or guardian(s) visit the clinician every week for around 45 to
    60 minutes. They learn how to conduct the treatment properly and report the
    outcomes.

The first stage of the Lidcombe program focuses on  training the parent on

 * How to recognize stuttering
 * How to note the severity
 * Organizing the conversations that aid treatment
 * Giving (verbal) positive reinforcement.

Here, the goal is to achieve an SR of 0 or 1.

The second stage involves the goal of ‘no stuttering for a prolonged duration.

How is Early Stuttering Intervention Helpful for Children?
Most children who begin stuttering at an early age outgrow it without any
external help. However, a small percentage of children continue to stutter for
longer than 2 years post-onset. These are the same children who are at high risk
for adulthood stuttering.

During the onset, it is impossible to tell who will recover spontaneously and
who will need speech therapy intervention.

Teaching speech exercises to children is difficult and it may prove to be
counterintuitive to their natural language development.

The Lidcombe Program is one of the best, proven techniques for treating
stuttering in pre-school-aged children. It is an indirect method that uses
verbal positive reinforcement and operant conditioning principles for addressing
early developmental stuttering in children.

Stuttering in Childhood: Early Intervention Is Important

Stuttering is not just the inability to speak fluently, but it is a speech
disorder that affects roughly 1% of the entire population.

It is heterogeneous in nature. However, most adults who stutter have been
struggling with the speech disorder since childhood. This type is referred to as 
developmental stuttering [__GHOST_URL__/causes-of-stuttering-in-adults/].

Adults who begin stuttering suddenly in their adulthood may do so due to 
neurogenic, psychogenic
[https://ghost.stamurai.com/neurogenic-stuttering-vs-psychogenic-stuttering/], or
drug-induced causes.

Drug-induced stuttering or drug-induced stuttering is when a person develops
speech disfluencies suddenly after starting to take a new medication. Chances
are that the stuttering will reduce or vanish after they reduce the dose or stop
taking the drug.

We already know that there are no FDA-approved drugs
[https://ghost.stamurai.com/stuttering-medicine/] targeted to treat or cure stuttering.
However, some drugs like olanzapine, risperidone, and clozapine have been used
to treat stuttering in adults.

[https://stamurai.app/z4HKmlNXigb]Which Medications Can Induce Stuttering?
Recent research shows that several antipsychotic drugs including those mentioned
above can cause stuttering in adults
[https://ghost.stamurai.com/causes-of-stuttering-in-adults/] who have never shown any signs
of speech disfluency. 

In a recent publication, Trenque and Morel
[https://pubmed.ncbi.nlm.nih.gov/33337944/] list the 22 compounds that increase
the risk of drug-induced stuttering in patients.

Medication for ADHD Can Cause Stuttering
Methylphenidate [https://pubmed.ncbi.nlm.nih.gov/31418914/] is the active
molecule in Concerta, Metadate ER, Methylin, QuilliChew, and Ritalin variants.
It is a compound extensively prescribed by doctors for the treatment of
attention deficit disorders (ADD) and attention deficit hyperactivity disorders
(ADHD).

It belongs to the family of central nervous system (CNS) stimulants. Hence, it
is also used to treat excessive daytime sleepiness and narcolepsy.

Older research indicates the use of methylphenidate for the treatment of
stuttering.

It works via a dopamine/norepinephrine based pathway. It can cause a decrease in
the dopaminergic receptors in the brain due to its amphetamine-like traits.
Methylphenidate-based drugs can increase the levels of dopamine and
norepinephrine.

The excess of dopamine in one’s system can contribute to the sudden onset of 
stuttering in adulthood
[https://ghost.stamurai.com/the-unexpected-development-of-stuttering-in-adulthood/].

The Relation between Stuttering and Anti-Epileptic Drugs
Doctors have been prescribing pregabalin and topiramate to help patients control
convulsions and in the treatment of epilepsy. In the US, pregabalin is the
active ingredient in Lyrica and topiramate is present in Qudexy XR, Topamax,
Topiragen, and Trokendi XR.

Patients who have been taking these drugs in combination with others for
treating epilepsy have reported the unexpected incidence of stuttering
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424827/].

These drugs work by enhancing the activity of gamma-aminobutyric acid (GABA)
receptors. They have an inhibitory effect on the CNS. The disturbances in the
white matter fibers in the areas of the brain responsible for speech production
like the Broca’s area can potentially increase one’s risk for developing
stuttering in adulthood.

Antipsychotic Medication and Stuttering In Adults
Several studies [https://pubmed.ncbi.nlm.nih.gov/15179972/] have previously
described the onset of stuttering in relation to treatment with antipsychotic
drugs. Clozapine, risperidone, and olanzapine have been mentioned extensively in
both treatments and causes of stuttering in adults.

Clozaril, FazaClo, and Versacloz are all brand names of clozapine
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528227/], a medication used to
treat schizophrenia and schizoaffective disorders. One of the potential side
effects of the compound includes stuttering. Experts note that stuttering occurs
predominantly when the dose is increased and ceases when the dose is decreased.

Murphy et al have noted the prevalence of stuttering to be 0.92% in
clozapine-induced cases.

Risperidone is present in Risperdal M-Tab, RisperiDONE M-Tab, and RisperDAL.
Psychiatrists recommend it in cases of bipolar disorder, schizophrenia, and
irritability associated with autism spectrum disorder (ASD).

While risperidone is a highly effective drug for the treatment of dysphoria and
mania related to bipolar disorder, schizophrenia, and acute irritability
associated with ASD, it can cause stuttering in patients.

Olanzapine is a constituent of ZyPREXA. It is also used to treat schizophrenia
and bipolar disorder.

All of these compounds exhibit anticholinergic properties. That is a pathway
implicated in stuttering.

The long-term use of clozapine, risperidone, or olanzapine, or the increase in
dosage can cause stuttering in adults receiving one or more of these
antipsychotics.

Quetiapine is another compound used for the treatment of depression. It has a
strong preference for dopaminergic and serotonergic receptors. It is an atypical
antipsychotic that causes stuttering in rare cases.

Bupropion is an antidepressant, which is used for the treatment of seasonal
affective disorder and atypical depression. It inhibits the reuptake of
norepinephrine and dopamine. It is currently available under the brand names
Aplenzin, Budeprion SR/XL, Buproban, Forfivo XL, WellButrin, and Zyban.

It increases dopaminergic activity in the frontal cortex, which has previously
been implicated in speech disfluencies. Bupropion treatment has resulted in
quite a few cases of stuttering in the past.

Asthma Medication and Stuttering
Theophylline is a common drug used to treat shortness of breath, wheezing, and
chest tightness due to asthma, emphysema, bronchitis, and other lung diseases.

Theophylline is the active component of Phyllocontin, TheoCap, Theochron,
Theo-Due, Uniphyl, and Norphyl. It is a bronchodilator that opens the air
passages and makes it easier to breathe.

Theophylline can cause acquired-stuttering irrespective of the patient’s age.
Theophylline increases the neurotransmitter dopamine by inhibiting adenosine
receptor activity. According to research
[https://pubmed.ncbi.nlm.nih.gov/15607558/], theophylline creates a
hyperdopaminergic microenvironment that mimics the state necessary for
developmental stutters.

[https://stamurai.app/z4HKmlNXigb]Do All People On These Medications Experience
Stuttering?
Medication-induced stuttering is a common occurrence especially among patients
taking psychoactive drugs. Most of the drugs that cause stuttering work via the
neurotransmitter systems. Many tricyclic antidepressants work via the
cholinergic systems. Bupropion, theophylline, methylphenidate, and other
antipsychotics target the dopaminergic systems.

On the other hand, clozapine targets several neurochemical receptors, which can
trigger stuttering in a number of known and unknown ways.

The inherent properties of multiple compounds that are used for treating various
types of depression, bipolar disorders, and schizophrenia lead to
medicine-induced stuttering.

Some people are more at risk for stuttering. They have a higher chance of
developing drug-induced stuttering during their treatment.

Each medication has different prevalence and incidence rates for stuttering. The
under-reporting of stuttering as a side effect of these drugs has made it
difficult to predict what percentage of the population will develop stuttering.

However, almost all active molecules that affect neurotransmission or activate
the dopaminergic system increase the risks of drug-induced stuttering among the
adult patients.

Can Some Medicines Make Stuttering Worse?

Does your child often block or repeat while talking? Is your child between the
ages of 18 months and 6 years? Has s/he been doing it for over 8 weeks? Then,
your child may have childhood onset fluency disorder or stuttering.

Adults may stutter [__GHOST_URL__/causes-of-stuttering-in-adults/] too. Some
adults stutter since their childhood and are said to have developmental
stuttering. Others may develop stuttering suddenly, which experts refer to as
acquired stuttering.

What Do You Do If You Notice Your Loved One Stuttering?
Speech therapy is one of the most effective stuttering treatments that is ideal
for children and adults [__GHOST_URL__/stuttering-treatment-for-adults/].

Early intervention [__GHOST_URL__/stuttering-in-childhood-early-intervention/] 
in the case of developmental stuttering
[https://ghost.stamurai.com/causes-of-stuttering-in-adults] in children can reduce the 
intensity of stuttering
[https://ghost.stamurai.com/understanding-degrees-of-stuttering-severity/] and even prevent
it from becoming a lifelong problem.

The frequency of sessions, types of exercises and duration of speech therapy
will depend on the severity of stuttering.

Beginning Speech Therapy
Case studies show that speech therapy is most effective for children up to the
age of 7. Stuttering treatment for older kids
[https://ghost.stamurai.com/parental-guide-to-teenage-stuttering/] works as well. However, it
may take longer and the child may require more frequent sessions with the SLP.

Therefore, early intervention is of utmost importance for childhood-onset or
developmental stuttering.

It may be difficult for a parent or a doctor (pediatrician) to tell the
difference between normal disfluency in children and childhood onset fluency
disorder.

SLPs are responsible for the screening, assessment and intervention of
communication disorders in all ages. However, the role of an SLP is most crucial
in the screening and detection of communication disorders in toddlers and
children.

How Can A SLP Help You And Your Child?
An SLP looks after the holistic development and wellbeing of the child besides
treating their stuttering.

SLP services adhere to 4 basic guidelines that aid in the effective and early
interventions for children.

SLPs Provide Family-Centered and Culturally Responsive Services
The SLP aims to provide early and effective intervention that addresses the
family’s concern regarding the child’s needs and learning ability. An
experienced SLP is able to individualize his/her service for the family
according to their culture, unique situation, priorities, resources and
preferences.

It is important to note that the entire family, and not the individual child, is
the recipient of the SLP’s services. Family-centered services offer the family
members a more active role in planning, implementing and decision making during
stuttering treatment.

These are all integral components of indirect therapy
[https://ghost.stamurai.com/five-stuttering-exercises-to-help-your-child/] for toddlers and
preschoolers, who may benefit from the Lidcombe program.

An SLP Provides Services That Are Developmentally Supportive
Simply treating stuttering isn’t the ultimate goal of any stuttering treatment
[https://ghost.stamurai.com/treatment-for-stuttering/] plan. Stuttering may result in a
reduction of self-esteem and confidence in a child.

It is the responsibility of the SLP to take the emotions associated with
stuttering [https://www.stutteringhelp.org/new-look-stuttering-and-emotions] 
into consideration before they proceed with treatment.

The SLP proceeds with the hypothesis that the acquisition of communication
skills occurs based on a child’s social and cultural framework. The early
intervention practices include active exploration of experiences, cognitive
abilities, interests, interactive participation appropriate for the child’s age
and the family’s concerns.

The optimal early intervention practices for childhood-onset fluency disorder is
provided in a natural setup (such as the child’s home). It also offers realistic
learning experiences that the child can apply during their daily interactions.

SLPs Provide Comprehensive and Coordinated Services
SLPs may act as the first point of contact for families who may need expert
interventions for their children’s speech.

In the case of developmental stuttering [__GHOST_URL__/what-is-stuttering/],
SLPs often provide the complete guidance necessary for primary intervention and
maintenance therapy.

However, if the SLP deems that your child may have auditory disabilities,
anomalies in behavior or congenital conditions that imply developmental delay,
he/she may refer you to the necessary medical expert.

SLPs Provide Services That Meet the Unique Needs of a Child and Their Family
An SLP has the qualification, training and experience to provide tailored
services that meet the unique needs of the child and the family in need.

SLPs provide uniquely personalized services to their clients for the following –

Prevention
Not all communication disorders and fluency disorders can be prevented. However,
an early intervention may mitigate the risks on the child’s development.

SLPs can even help a few children, who are predisposed to stuttering
[https://ghost.stamurai.com/cellular-causes-of-stuttering-in-adults-and-children/] (genetics
and family history), reduce the symptoms of their stuttering. SLPs can promote
the positive communication interactions between the toddlers and their
caregivers as a part of primary prevention.

As a part of secondary prevention, they can also mitigate the negative emotional
effects of stuttering in children. Finally, they can address an existing or
long-term stuttering problem by providing intervention services to prevent
future complications as a part of tertiary prevention.

Screening and Assessment
An SLP can screen for the communication needs of a toddler or child. They are
responsible for the identification of children who are at risk for stuttering
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6154780/].

Based on their observation, a team of speech-language experts and medical
professionals can evaluate and assess what intervention program a child may
require.

Planning and Implementing Therapy Plans
When a child is at risk and the SLP tailors a stuttering treatment program that
suits the needs of the child and the family, the SLP coordinates with other
members of the team including audiologists, special educators, and home trainers
to provide services and support.

Consultation With and Education of Family Members
One of the crucial responsibilities of the SLP is to inform and educate the
family members about their child’s speech problem. This includes the causes of
stuttering, potential treatment options, stuttering treatment goals and what to
expect at the end of speech therapy.

In the cases of stuttering in preschool-aged children, the SLP assumes an
indirect or consultant role only. He/she communicates with only the parents and
guides them to modify their communication with the child. He/she takes feedback
on the progress of the child’s speech.

Providing Up-To-Date Information
Research on stuttering [https://www.stutteringhelp.org/basic-research] is still
continuing. Several new factors, and models for stuttering treatment are coming
to light.

The SLP always informs the family of the advancement in research on stuttering
and their options.

The SLP has the best interest of the family and child in their mind, and they
inform the families regarding the new treatment methods that may suit the unique
needs of their child.

Wrapping It Up
Speech-language pathologists aim to prevent, evaluate, assess, reduce, diagnose
and treat speech disorders including stuttering. However, you can expect much
more than traditional speech therapy or stuttering exercises from SLPs once you
step into their office.

SLPs not only treat toddlers and children, but they also address speech issues,
social communication, cognitive communication and language disorders in
teenagers and adults.

Stuttering Treatment: How Can A Speech-Language Pathologist Help?

Psychotherapy is an umbrella term that covers talking to a mental health
professional about one's challenges, fears, insecurities, thoughts, and ideas.
Psychotherapy may be in the form of psychoanalysis, cognitive therapy, behavior
therapy, or humanistic therapy.

During psychotherapy [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929220/] for
stuttering, a person gets to learn more about their own feelings, emotions,
moods, and stuttering behaviors.

Just like stuttering treatments [__GHOST_URL__/stuttering-treatment-for-adults/]
, psychological counselors and therapists use a combination of multiple
techniques for psychotherapy. Cognitive-behavioral therapy (CBT) is one of the
most common and effective approaches used to address stuttering in children and
adults.

Do People Who Stutter Need Psychotherapy or Psychological Counseling?
People who stutter (PWS) may feel apprehensive about speaking in public. This
may happen due to the negative emotions [__GHOST_URL__/stuttering-depression/] 
associated with memories of stuttering in public.

Similar situations may evoke unpleasant memories and trigger anxiety, fear
[https://ghost.stamurai.com/how-to-overcome-fear-and-tension-if-you-stutter/], and, even,
shame.

“People will laugh at me”, “people will think less of me”, “they’ll think I’m
stupid”…thoughts like these can cross your mind quite often if you stutter.

Stuttering results in more emotional tumult and physical tension in the speaker,
which makes them more likely to stutter.

Alternatively, they might compensate by acting introverted, trying not to speak,
or avoiding social gatherings.

PWS often find themselves in a vicious cycle of negative self-talk, unhelpful
coping methods, and emotional turmoil that reinforces one's anxiety of speaking
rather than diminishing it. Psychotherapy or psychological counseling can help
help a person who stutters deal with such challenges.

How Can CBT Help Someone Who Stutters?
In therapy, the professional helps the client explore the possible link(s)
between their actions, thoughts, feelings, behavioral responses, and
physiological reactions. The clients may find it easier to identify which coping
mechanisms are unhealthy and develop new skills to manage their stuttering
behaviors.

Therapists may also encourage the client to “experiment” with their assumptions
and predictions to see how accurate they are. For example, the therapist may
suggest ways of advertising stuttering
[https://ghost.stamurai.com/self-advertising-stutter-or-stammer/] to the client and give them
ways to note their listeners’ reactions.

A good therapist will never decide for the client or judge them. They will only
provide empathetic listening and emotional validation, so that the client can
form their own conclusions.

Cognitive-behavioral therapy
[https://www.simplypsychology.org/cognitive-therapy.html] aims to work
coordinately and collaboratively with the client. The idea is to avoid
arguments, debates, and instructions. Instead, a mental health professional
encourages the client to ask questions like –

 * What are the pieces of evidence that support my assumption and prediction?
 * Can there be another way of looking at the incident?
 * Is there a reason for my prediction to be inaccurate?
 * Are my listeners truly trying to belittle me, or are they simply feeling
   awkward or insecure due to my stuttering?

How Can CBT Help Break Unhelpful Thoughts & Beliefs About Stuttering?
Throughout our lives, we find ourselves in multiple "thinking traps." These are
unhelpful patterns that we have developed to find meaning in our struggle.

For example, you may believe that stuttering is completely in your control, and
you stutter when you are afraid or anxious.

These unhelpful thoughts and beliefs about stuttering not only
[https://www.uts.edu.au/asrc/resources/utbas] arise from the anticipatory fear
of stuttering but also feed the social anxiety that makes stuttering worse.

Cognitive-behavioral therapy may help you break free from this unhelpful pattern
of thoughts. With every session, you may be able to identify, check and,
eventually, stop the thinking trap from taking over your confidence.

Here are some of the unhelpful patterns of thinking that adolescent and adults
who stutter have recognized during therapy –

Mind Reading
It is quite common for PWS to assume that they know that other people are
thinking. We are quick to believe that people will think less of us if we
stutter while speaking.

In truth, it is impossible for us to read someone's mind. You may be able to
read their expressions and gestures. However, your judgment of a person may be
clouded by your emotions related to similar circumstances in the past.

CBT can help you distinguish between the presumed reactions and the real
reactions of your listeners.

Catastrophizing
There are times when you feel that the world is coming to an end or the worst is
going to happen if you stutter.

It happens when other possibilities seem too far-fetched. It may also be
possible that you catastrophize because you believe that you no longer deserve
good things in life.

Psychotherapy can help you explore various other positive fantasies and
possibilities that you may not be able to see on your own right now.

Selective Filtering
You tend to dwell on the words you repeated or blocked on, but you forget about
the others you said smoothly. It is easier to remember the negatives and magnify
them, but focusing on the positives at all times isn't as easy.

A good psychological counselor or therapist will help you build your resilience
and explore the positive qualities you already have inside. With a little help,
you should be able to focus on the positive aspects of your speech, regain
confidence and reinforce the fluency shaping skills you are learning at speech
therapy [https://stamurai.com/].

Over Generalization
You may make sweeping conclusions based on one event. For example, when looking
at a situation, you may perceive it to be an “utter failure” because you
stuttered twice.

However, that is far from the truth. You may have been fluent for 90% of the
conversation and stuttered on only 8 to 12 words. Your disfluency doesn’t
determine the success or failure of a conversation.

Maybe you are unable to perceive that right here, right now. Nonetheless, with
regular therapy, your counselor may be able to help you gain a new perspective
on similar situations in the future.

What Does Psychotherapy (CBT) Not Do?
Therapists using the CBT approach don’t “teach” their clients to think more
positively or be rational. It is not the therapist’s responsibility to judge
their client’s behaviors or thoughts.

Therapists are not here to provide their clients with ready solutions to their
problems. They are here to enhance the client’s problem-solving skills and
resilience towards life’s hurdles.

Therapists do not make the decisions for their clients. Psychotherapy focuses on
helping the client cope with daily struggles. Continuing CBT may help a client
assume a new point of view so that conflicts appear as challenges.

CBT is concerned with helping the clients lead a more productive and happy life.
Counselors may provide empathetic listening, unconditional support, and
emotional validation to help their clients make their own decisions.

Psychological counselors, therapists, or psychotherapists do not teach fluency
[https://ghost.stamurai.com/stuttering-fluency-shaping-techniques/] skills, exercises
[https://ghost.stamurai.com/stuttering-exercises-for-adults/] and stuttering modification
techniques to clients. Clients may undergo psychotherapy alongside their speech
therapy sessions to gain a better understanding of the secondary behaviors of
stuttering.

Can Psychotherapy Help in Stuttering Treatment?

When an individual knows what to say, but their speech is interrupted by
involuntary repetitions, prolongations and blocks, they might have a childhood
onset speech fluency disorder or stutter.

Early intervention [__GHOST_URL__/stuttering-in-childhood-early-intervention/] 
of stuttering in childhood may improve a person's fluency and ease of speaking.

Most children who stutter do not receive timely therapy and they grow up into
teens and adults with anxiety and fear of stuttering. In such cases, stutter has
profound negative impacts on the mental health of the person.

What Does Cognitive Behavioral Therapy Address?
Negative psychological impacts of untreated stuttering (mild and severe) may
lead to anxiety, self-doubt, fear, frustration, avoidance, anger, and a negative
attitude towards speaking in public
[https://ghost.stamurai.com/public-speaking-with-a-stutter] in adulthood.

A relapse after stuttering treatment [__GHOST_URL__/treatment-for-stuttering/] 
may cause severe demotivation, anxiety disorder, and depression.

Negative emotions and attitudes may interfere with the individual’s ability to
participate in daily activities. It may even diminish their overall quality of
life.

Therefore, treating stuttering [__GHOST_URL__/stuttering-treatment-for-adults/] 
with speech therapy and exercises may not be enough to motivate a person towards
fluency. A teen or adult who has been stuttering for years requires more than
conventional speech therapy to accept stuttering or work towards better mental
health.

Cognitive behavior therapy (CBT) targets the biopsychosocial
[https://ghost.stamurai.com/stuttering-and-lasting-emotional-effects/] crises experienced by
those who stutter. It is a multi-disciplinary approach that focuses on the
behavioral, cognitive, and emotional aspects of stuttering.

It is important to note that CBT is not a cure for stuttering. It is a form of
talking therapy under the guidance of a professional and qualified psychological
counselor or psychotherapist. It can help
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3137813/] an individual deal with
the effects of stuttering in their life.

What to Expect During the First Days of Cognitive Behavioral Therapy?
Receiving pertinent information about stuttering is part of CBT for the client
and their family. The psychotherapist addresses the client’s avoidance behaviors
and unhelpful thoughts.

The next step typically involves helping the client face their feared
[https://ghost.stamurai.com/how-to-overcome-fear-and-tension-if-you-stutter/] and avoided
situations. The therapists chalk out behavioral experiments that enable the
client to face these situations, such as speaking in public.

Based on their interactions with those involved in the experiment, the therapist
may guide them to modify their stuttering-related behaviors. It facilitates a
slow but steady modification of the client’s self-focused behavior over the
sessions.

How Can CBT Help You?
The therapist analyzes the cognitive errors
[https://www.healthline.com/health/cognitive-distortions] and their observer’s
perspectives. Both of these are crucial for the modification of behaviors
associated with stuttering.

While cognitive therapists refrain from labeling behaviors as “right” or
“wrong”, they also encourage their clients to think –

 * What are the reasons behind the negative emotions that they are feeling
   during or after an interaction?
 * Is there another perspective? Will another way of looking at the interaction
   give their actions and emotions a new meaning?
 * Is there evidence that what they are feeling may not be entirely true?
 * Can there be another version of the truth that they can explore by
   themselves?

Often, people jump to conclusions and predict the worst outcomes based on past
unpleasant interactions that bear resemblance to the current ones. CBT can help
them reduce these cognitive errors by adopting a different point of view and
equipping them with skills that may help them respond differently.

Anxiety, negative thinking, and withdrawal from social interactions result in a
thinking trap. The vicious cycle can be broken by adopting this line of
self-inquiry. With CBT, the clients can learn to challenge their fear of
negative interactions. They may acquire the necessary skills that can help them
deal with similar issues in the future.

How does CBT Address Stuttering Related Issues?
The common components of CBT that may help in managing anxiety include
attentional training, cognitive restructuring, and behavioral experiments.

 * Attentional training – Working on the skills that help the client focus on
   their actions, words, emotions, and surroundings at a given time.
 * Cognitive restructuring – Developing the skills necessary for recognizing the
   cognitive errors, analyzing them, and taking appropriate action accordingly.
 * Behavioral experiments – Learn strategies that help the individuals deal with
   situations that evoke negative feelings associated with stuttering.

The CBT approach may include one or more methods of cognitive interventions and
a dysfunctional thought record scheme.

A dysfunctional thought record scheme works through self-monitoring. It focuses
on the identification and analysis of the dysfunctional thoughts of the client.
The therapist helps the client replace these dysfunctional or negative thoughts
[https://benevolenthealth.co.uk/12-ways-to-recognise-negative-thoughts/] with
positive, functional, and more realistic ones.

The goal of a dysfunctional thought record scheme is to help the client practice
alternate patterns of behavior that may change their cognitive distortion.

Cognitive interventions include sessions for the identification and modification
of cognitive distortions, examination of facts, listing the alternatives, and
enlargement of one's perspectives.

Can Mindfulness Work With CBT During Stuttering Treatment?
Studies show that CBT works best when coupled with mindfulness techniques. Some
of the more popular mindfulness approaches leveraged in stuttering management
including mindfulness-based stress reduction (MBSR), acceptance and commitment
therapy (ACT), and mindfulness-based cognitive therapy (MBCT).

Combining CBT with mindfulness techniques
[https://ghost.stamurai.com/stuttering-and-meditation/] can help a person become more aware
of their speech and develop a positive attitude towards communication and social
interactions. In addition to reducing the negative emotions and attitudes
associated with stuttering, these therapeutic strategies may help the clients
improve their quality of life, self-esteem, and control over their emotions.

How Long Does CBT For Stuttering Take To Work?
The duration of CBT depends upon the severity of one’s symptoms. Typically, it
may range from 3 months to 3 years.

The goal of therapy is to restore the client’s resilience and enable them to
think with a new perspective. The therapist tries to empower the client to set
new goals and achieve them too. Therefore, the duration of therapy depends
greatly on the individual needs of the client.

The client may require frequent sessions during the beginning of CBT. The
frequency of sessions may reduce as they begin to show significant improvement.
The client may also require booster sessions during follow-ups to maintain their
positive outcomes or talk about new issues.

How Can CBT Help People Who Stutter?

When we are alone, we often revisit the interactions that caused us
embarrassment. For people who stutter, these interactions are quite frequent.

You think of the times you blocked while speaking to a teller at the bank. Or
the times you blocked while placing your order at your favorite restaurant and
now you try hard to avoid the place.

You think of all the fun you could have had if you went to the party this
weekend, but then you decide against it because avoiding the trigger words is
too much work anyway.

Even hanging out with friends seems exhausting because you have to rehearse
every word in your mind multiple times before you can speak.

Do you see a pattern?

You are tired from the unwanted advice, looks of pity, and interjections. Many
of us who have been stuttering for a long time find it easier to avoid the
emotions [__GHOST_URL__/stuttering-and-lasting-emotional-effects/], situations,
and conversations that may trigger our stuttering than facing them head-on.

Make Room for Positive Thinking
We should begin our journey towards fluency by altering our thought patterns.
Avoidance is the most harmful habit. It deprives the speaker of positive
experiences that could have been, had they taken a chance. Avoidance worsens
[https://www.stuttering.co.nz/news/avoidance-reduction-therapy/] the fear and
anticipation of stuttering.

If you have been stuttering for years, there is a good chance that you have
already faced all types of listeners possible. You have met with the genuinely
supportive ones and the critical ones. You already know what types of reactions
you will receive while speaking in front of friends and strangers, and how to
respond to them.

As a matter of fact, the constant vigilance is quite tiring. Keeping a mental
note of all the words that make your stuttering worse and avoiding or replacing
them may be extremely taxing if you have developmental stuttering
[https://ghost.stamurai.com/what-is-stuttering/].

It is much easier to just say what you want to say and stutter throughout your
speech. It is a temporary discomfort that is a welcome relief from the
continuous alertness you have been exercising so far.

Take Steps to Face Your Fear
Instead of avoiding all the situations and people that might make your
repetitions or blocks worse, you should try to face them. You may believe that
facing these situations contributes to anxiety, but that anxiety is temporary.
Imagining all the things that could have gone wrong and subsequent avoidance
starts a vicious cycle
[https://www.goodtherapy.org/blog/can-anxiety-cause-stuttering-a-look-at-speech-and-mental-health-1130189] 
of anxiety that makes it incredibly challenging for the PWS to face their fears.

How can you start confronting your fears?
You can take the first step even if you haven’t started speech therapy formally.
Here’s what you need to do –

 1. Begin by making a list of the words and situations that you fear most.
 2. If you stutter on a particular word, begin using that word deliberately and
    repeatedly in conversations.
 3. You can use one or more of the fluency shaping
    [__GHOST_URL__/stuttering-fluency-shaping-techniques/] and block reduction
    [__GHOST_URL__/overcome-stuttering-blocks/] techniques while saying a
    feared-word.
 4. Keep saying the word every day until you can say it smoothly and with ease.
 5. Then start practicing with the next word.

Continue this exercise until your fear of each word is gone.

Yes. It is a time-consuming process. You may fail the first five times. But,
there is nothing to lose. Imagine yourself saying the words without fear and
hesitation. Exercise the confidence you gain from that mental image.

If you are afraid of certain situations, try to go back to similar situations.

Don’t avoid your feared words. Instead, search for ways to reduce that fear
[https://ghost.stamurai.com/how-to-overcome-fear-and-tension-if-you-stutter/] and discomfort.

That also means bearing temporary embarrassment at times. However, for most of
us who have stuttered for a long time, embarrassment or shame is not a new
feeling. The only difference, in this case, is that we are in control and, this
time, we will ride it out towards fluency.

Explore the Depths of the Unknown
Our fear keeps us from exploring the unknown.

Stuttering has never left your side when you were introducing yourself in
primary school, presenting middle school projects, doing projects in college,
and speaking during office meetings. You have learned to be afraid of the
unpredictable nature of your stuttering. So, when you are stuttering, your
natural instinct is to get out of the block or repetition as soon as possible.

In the hustle, you rarely pay attention to what your lips, tongue, jaws, and
throat muscles are doing. Sometimes, you may blink rapidly, scrunch up your lips
or tense up your jaws to get out of a block. These are all secondary behaviors
of stuttering that don't help you get out of a block but may make it worse.

You may have engaged in similar behavior almost involuntarily in the past.
However, paying close attention to what you are doing while blocking, repeating,
or prolonging can not only help you recover from a block but even prevent it.

You may not have realized this in the past but most of these behaviors are
controllable. You need to make small changes to the things you are doing while
stuttering. Focus on the actions that seem to interfere with your fluency. To do
that you will need to explore the areas of your stuttering that may seem
daunting right now.

Once you find the courage to explore these areas, you will realize that
stuttering is not a negative magical force. It is simply something you do while
speaking. And soon you will also discover that you are able to exercise control
over your stuttering and the fear of stuttering.

A good speech therapist and a psychological counselor may help provide you with
the tools necessary to explore the roots of your fear and anxiety related to
stuttering.

Celebrate the Small Victories
Setting achievable goals [__GHOST_URL__/goals-for-people-who-stutter/] is one of
the most crucial parts of recovering from stuttering. You cannot aim to achieve
absolute perfection the moment you begin exploring fluency shaping and
stuttering modification techniques.

You must remember that it is not an all-or-nothing process. Even the best-spoken
public figures struggle with some level of disfluency in their speech.
Therefore, if you start speech therapy today and notice that you are stuttering
on half of your feared words by the end of the week, it’s not a sign of failure.

In fact, it shows that you are a person with tremendous willpower and dedication
who has overcome the fear of saying some of their feared words.

Gunning for absolute fluency with zero stutters should never be your goal. That
is an unachievable target even for professional speakers. You have lived with
stuttering for years. So, expecting to rid yourself of it completely is not only
unrealistic but also unhealthy for your self-confidence and self-image.

Instead, you should focus on the small gains that bring you great satisfaction.
For example, saying “good morning” with a smile and lowered anxiety at the
checkout of a mall. Or, receiving a phone from an unknown caller and introducing
yourself as someone who stutters.

In place of hoping for complete fluency, set realistic goals like working on
your breathing and lessening the tension on your lips during therapy.

Remember That Relapse Isn’t a Failure
Relapse is always a real threat during stuttering therapy. You should not quit
practicing once you see improvements in your speech. That typically happens
because you have learned and relearned stuttering and associated behaviors over
time. Discontinuing therapy or personal practice allows the acquired stuttering
behaviors to return.

A relapse
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can make you feel demoralized, but there’s always a different way to look at it!

If you are experiencing a relapse or you are afraid of relapsing, instead of
courting failure you can think about the arsenal of fluency shaping and
stuttering modification techniques that you already know.

You already know the particular exercises that can help you defeat your fear and
anticipation of stuttering. You have already found ways to deal with
embarrassment and anxiety.

Therefore, a relapse simply gives you the chance to exercise the techniques you
have already internalized over the past few weeks or months.

You may consider taking your time to complete the three stages of learning –

 1. Establishing the new habit
 2. Transferring the habit to new and different situations
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 3. Maintaining the new behavior

Reduce the Importance of Stuttering In Your Life
Take every chance you get to reduce the importance of stuttering in your life.

Put yourself out there. Go to parties, dinners and speak up at meetings. At
first, it may seem terrifying, but soon, you will begin to enjoy the relief you
get from facing your stuttering rather than circumventing every feared word and
situation to avoid it.

You can attend group stuttering therapy. In stuttering groups, you will meet
other adults who share similar feelings and attitudes about stuttering. You can
explore the different aspects of speech disfluency and explore the various ways
in which you are working on your speech.

Group sessions can be incredibly helpful in boosting your self-confidence and
restoring your self-image.

Never forget the truth about stuttering
Stuttering is only a part of your speech. It need not define you or limit you.
The truth is that you can do most of the things you want to do in life even if
you stutter. A trip to Paris, applying to culinary school, playing pro-football
or bungee jumping from the Burj Khalifa – your stuttering won’t come in your
way!

Speech Therapy for Stuttering: 5 Attitudes for Better Results

Different Approaches for Treating Preschool Kids Who Stutter

Speech therapy is an integral part of the lives of thousands of children and
adults living with speech and communication problems. Between 5% and 10% of
Americans have speech and communication disorders.

The demand for speech therapy from licensed speech-language pathologists (SLPs)
is rising steadily across the world. Online speech therapy allows the SLPs to
provide much-needed therapy to clients irrespective of how far they live.

Online speech therapy has allowed thousands of people to find the professional
guidance they need for themselves and their family members. While one-on-one
speech therapy sessions are still ongoing, many clients have found online
therapy for stuttering
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, speech delay, aphasia, apraxia,
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and autism spectrum disorders
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During online sessions, clients are still working with a certified and licensed
speech therapist or SLP. Additionally, clients can verify their credentials and
double-check the client reviews before signing up for a session!

Are you wondering if you should try online speech therapy? Have you considered
cutting-edge apps like Stamurai [https://stamurai.com/]to avail of affordable
online speech therapy?

If you are wondering if you should try online speech therapy, you should check
out the unique benefits that it offers –

Your Location Won’t Limit You
Maybe, you live in a remote area or the fringes of a city, or simply 40-miles
away from your therapist's office. The distance between your residence and your
therapist's office will no longer impede your speech therapy.

We have all missed doctor's or speech therapist appointments due to bad weather
or traffic. Online speech therapy ensures that you no longer have to brave poor
weather conditions or terrible traffic to access speech therapy.

Online therapy will give you access to new therapists who may be better than the
ones in your immediate vicinity.

Online Speech Therapy Incredibly Convenient
Today, even children have busy schedules. Many people discontinue therapy due to
busy schedules. Discontinuing speech therapy contributes directly to an
increasing rate of relapse of stuttering
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and other speech problems.

Thankfully, you won’t have to get dressed, leave home, and drive for miles to
reach a clinic. You or your child can attend therapy with a certified therapist
between school, work and other activities.

Since most in-person sessions are available within business hours, attending
in-clinic therapy for most adults and children becomes inconvenient.

On the other hand, you can always sign up for sessions with your online speech
therapist without losing hours at work or missing classes.

Online Speech Therapy Is More Cost-effective
If you have attended in-person speech therapy you already know that the fee of
the speech therapist isn't the only cost involved. You need to account for the
travel expense, office, and the hours you are losing at work/school while
calculating the total cost of therapy.

Since online therapy is flexible and accommodating, you don't have to cancel
your shift or skip classes. You don't have to worry about travel expenses or
paying facility fees.

You can contact the speech therapists who are offering online sessions directly.
Or, you can just download Stamurai [https://stamurai.com/]and book speech
therapy sessions right away.

It Maybe More Comfortable
Children with autism spectrum disorder
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(ASD) or social anxiety disorders may not react positively to a conventional
clinic setup. Online speech therapy gives them the chance to interact and learn
from certified SLPs and therapists right from their homes.

It is no surprise that several SLPs, as well as, parents of children with
communication disorders now prefer online therapy over in-person therapy.

For adult clients, it means avoiding the unnecessary calls to book appointments
and talking to the receptionist at the front desk. Online speech therapy allows
adults with speech disorders to bypass unnecessary conversations and paperwork.
You can directly complete your booking online.

It’s Easy To Continue Online Speech Therapy
Several children and, even, adults have to discontinue therapy since in-person
therapy is costly. Moreover, the session timings tend to conflict with work or
school hours.

Online therapy offers the much-needed flexibility that allows children and
adults to continue attending sessions for as long as necessary. Online therapy
is also more affordable as compared to in-person therapy, as we have discussed
above. It contributes to the positive experience of the clients.

The availability of multiple platforms also contributes to a client's
willingness to continue therapy. Therapists typically rely on readily available
video chat services to cater to the needs of their clients. They can also use
online interactive tools and activities during their session with the clients.

Online sessions seem to be less distracting and more comfortable for most
clients as well as their SLPs. Both parties report shorter waiting times, as
they know the exact hour when a session will begin and end. Factors like
weather, traffic, and mixed up appointments at the front desk do not disrupt
online sessions.

Things to consider before opting for Online Speech Therapy
While we are talking about the benefits of online speech therapy, we must also
put forth a few drawbacks. Unless you have a reliable smartphone or laptop with
an uninterrupted internet connection, you may face issues while staying
connected with the therapist.

At the same time, if you or your child has hearing disabilities or attention
deficit disorders, online therapy may prove to be a challenge.

Both online and offline speech therapy have their niche pros and cons. Both can
help you or your child deal with speech and communication disorders.

You should discuss the potential benefits and downsides of online therapy with
the SLP before you choose a medium.