Paste1.0 INTRODUCTION
Being a university student where I am required to participate in discussions, ask questions and present ideas to the whole class myself, I have moments when I became extremely nervous and anxious and my speech production disrupted. In simpler words, I stutter. What I am having is considered normal as it happens only occasionally, every now and then. However, when it happens a lot to someone, that person may be diagnosed with stuttering, a speech disorder. Blomgren (2013) defines stuttering as a speech, communication and fluency disorder in which the forward flow of speech is disturbed by repetition of sounds, syllables, or words; prolongation of sounds; and speech interruptions or blocks.
People who stutter actually know exactly what they want or are trying to say but unlike normal people who make speech sounds through muscle movements that involve breathing, phonation and articulation, they are unable to do so (NDICD, n.d.). These speech disruptions also come in package with distinctive body languages and gestures such as rapid eye blinking or lips twitching. Also known as stammering, the severity levels of this disorder range from mild, moderate to severe. Generally, stuttering happens to both children and adults thus making the severity of one’s stuttering to also be variable, depending on age and external factors such as speaking context and situation. In this paper, the focus is on children who stutter and one of the ways to treat it which is Response-Contingency Therapy.
2.0 CHILDREN WHO STUTTER
2.1 SIGNS AND SYMPTOMS
More than a total of 70 million people around the world stutter, but as mentioned earlier, this occurs to both children and adults, with statistics figures showing that the disorder is most common and prevalent in children by 5% while only 0.5% to 1% among adults (Blomgren, 2013). The disease typically begins before children turn 6 years old and usually around the time they are 2 ½ to 3 years of age. This may be linked to the fact that stuttering is parts and parcel of learning how to talk and speak for these young kids and for some cases, the disease even begins after a period of normal speech and language development (“Stuttering and Children,” n.d.). To be able to detect stuttering, it is crucial for parents and families of children to pay attention to alerting red flags and know the following types of disfluency symptoms:
• Part-word repetitions – "I f-f-f-feel sick."
• One-syllable word repetitions – "Nice to-to-to meet you."
• Prolonged sounds – "Mmmmmother is pretty."
• Blocks or stops – (pause) "My name is (pause) Lily."
According to Mayo Clinic (n.d.), besides rapid eye blinks and tremors of the lips or jaw, speech difficulties of people and children who stutter may be accompanied by facial tics, head jerks and clenching of fists too. Till this date, there are no direct causes or reasons as to why stuttering happens but underlying and possible factors of the disorder include one, genetics and family history and two, differences in the way the brain works during speech or abnormalities in speech motor control. More risk factors of the disease are gender (as boys tend to stutter more than girls), delayed childhood development, family recovery patterns, mood and temperament, and also stress (Mayo Clinic, n.d.).
2.2 NATURAL RECOVERY FOR CHILDREN WHO STUTTER
All across the internet, clinicians and speech experts contend that many children who begin to stutter prior to starting school will naturally recover by the time they are adolescents. Within 6 months, the bouts of stuttering that these children are having will get better and resolve on their own with no help from any formal treatment or therapy (Clark, 2017). Unfortunately, your mileage may vary, every children is different and it is impossible to predict which children will recover in that way. As a matter of fact, Blomgren (2013) notes that only fewer than 10% of children recover during the first year after onset. For others, their stuttering became a chronic condition that persists into adulthood and this means nothing other than it is high time for consultation, treatment, and intervention with help from speech-language pathologist. Had this not been done, children are to face the music of being teased and bullied by their peers, the disorder becoming harder to treat and bigger problems coming later in life such as confidence and communication issues (“Stuttering in children,” n.d.).
3.0 RESPONSE-CONTINGENCY THERAPY FOR CHILDREN WHO STUTTER
3.1 WHAT IS RESPONSE-CONTINGENCY THERAPY?
Based on Oxford’s Advanced Learner’s definition of the word contingent, it means “depending on something that may or may not happen”. This gives an easy basic principle to contingent responding, which is one of the three behavioural markers for Language Modelling: the teacher gives contingent responding to a child and follows the child’s conversational lead (Hadden, 2015). Whatever it is that the teacher says depends heavily upon what the child says. Following examples are provided to illustrate contingent responding better:
Conversation 1
Child: I like the colour purple.
Teacher: Oh, really? Purple is a really nice colour! Do you know what we are going to learn about today?
Child: I don’t think so.
Teacher: We are going to learn about colours!
Conversation 2
Child: I like the colour purple.
Teacher: Oh, you do? Purple is a really nice colour! You must have many things in that colour, don’t you?
Child: Yes, I do! I buy everything that is in purple.
Teacher: Do you happen to have purple ribbons too?
Child: Of course! I have purple dresses too! And purple skirts! Also, purple hair ties! Even the walls in my room are painted in purple. Mommy says I have too much things in purple but I still haven’t had a purple backpack just yet.
Teacher: I see, you really love the colour purple that much! I think you should ask for a purple backpack from mommy as a reward when you get excellent results in exams!
In Conversation 1, even though there is a normal brief back-and-forth exchange which is a part of frequent conversation, there is no contingent responding because the replies that the teacher gave were not built upon what the child says. The teacher even changed topic and talked about what they were going to learn about on that day instead. Contrastingly in Conversation 2, the teacher gave contingent responding by depending and relying upon what the child says to carefully build her answers. In return, the child became even more interested in sharing her stories in the conversation.
Applying this into a means of therapy for children who stutter, response-contingency therapy involves the communication partner (the therapist or parent) responding differently when the child is fluent (no stuttering) vs. when he is disfluent (stuttering). Bothe (as cited in Clark, 2017) believes that this therapy is the most effective approach in treating stuttering and should be conducted under the supervision of a licensed speech-language pathologist. The way this approach works will be elaborated in the next part, with one stuttering treatment organization program, Lidcombe Program, being used for exemplary purpose.
3.2 LIDCOMBE PROGRAM: PARENT VERBAL CONTINGENCIES
Lidcombe Program is a great example of stuttering treatment program that includes and uses response-contingency therapy as one of their behavioural treatment to target the stuttered speech of young children below 6. During this program, neither the child nor the parent should in any way alter or change their customary speech patterns, language habits and family lifestyle (Packman, 2014). Lidcombe Program is executed and delivered by parents with qualified clinician being present to train them and supervise the whole process. Parents are expected to give verbal response contingent stimulation, measure their child’s stuttering (Severity Rating (SR) scale: 1 = no stuttering, 2 = extremely mild stuttering, 10 = extremely severe stuttering), and visit the clinic each week.
Parent verbal contingencies in Lidcombe Program are divided into five types with three of them being made for stutter-free speech and another two for moments of unambiguous stuttering.
Stutter-free speech
1. Praise
Parents are trained to give compliments and praise their child when they are not stuttering. It is important for parents to do this in their own ways as different children like to be praised in different ways and only parents know the how-to.
Examples: “Great, you said that fluently!”, “No bumps at all, that’s wonderful!”
2. Request for self-evaluation
When there is no stuttering for a certain time interval, be it as short as a one word utterance or as long as a few hours, parents may ask the child to evaluate and reflect on their speech.
Examples: “Did you stutter just now?”, “Isn’t that smooth?”
3. Acknowledge
This type of verbal contingency is different from the previous two as it does not include positive remarks and it requires no self-evaluation as well. A simple matter-of-a-fact statement is given to acknowledge fluency of the child’s speech.
Examples: “No bumpy words.”, “Smooth talking!”
Unambigous stuttering
4. Acknowledge
Similarly, when a child stutters, parents should give a simple notice of acknowledgement about it and carry on.
Examples: “A stuck word there.”, “A little bumpy.”
5. Request self-correction
This type of verbal contingency requires the parent to ask their child to correct a stuttered speech. When the child tries but to no avail, it would be best for parents to not persist.
Examples: “Try saying (stuttered word) smoothly.”, “Let’s see if you can say it without bumps.”
Packman (2014) writes that while carrying out this therapy, parents need to remember that they should teach verbal contingencies on fluent speech first, use them correctly, later apply them on unambiguous stuttered speech, make the whole process a positive experience for their child, give as many verbal contingencies their child needs, and lastly be sure that they are accurate.
3.3 EFFICACY OF LIDCOMBE PROGRAM
Lidcombe Program is divided into two stages with different goals set respectively. For Stage 1, the goal is to achieve no stuttering or almost no stuttering while for Stage 2, they simply aim to sustain no stuttering or almost no stuttering for a long time. Parent verbal contingencies as explained above is only a part of Stage 1 of the program. In Stage 2, usage of parents’ feedback and number of clinic visits is reduced given the fact that stuttering of the children is still at the low level it was at the start of Stage 2. Overall, Onslow et al. (2012) comments that the treatment is 7.5 times more likely to reduce stuttering than natural recovery. While there is no direct explanation to the efficacy of this program, one of the possible reasons why this program works effectively is because the verbal contingencies are based of the “reward and punish” system which is essential in learning (Kinnane, 2016). Not everyone will like this program, but many have already do, so to say that verbal contingencies for stuttered speech are unnecessary is rather groundless and unattested.
4.0 CONCLUSION
Taking everything into account, it can be deduced that stuttering in general need treatments and interventions and response-contingency therapy as provided by Lidcombe Program is only one of the many other options that can produce the desired results of improving speech productions especially among young stutterers. Claims that say paying attention to a child’s stuttering may worsen and exacerbate the condition is only a mere myth. Parents, families and caregivers should keep an eye for warning, alarming signs their child might show and realize the multitude benefits that early treatment and therapy can bring. Stuttering, if left untreated can be even more damaging in adulthood and the only prevention to that is intervention.