I’m so incredibly excited to hear from six amazing SLPs volunteered to share their experience when overcoming a challenge. These posts are filled with practical tips and tricks.
Next up is… Myra! She’s sharing her experience with fluency.
Tell us about your experience as an SLP! Where did you go to school? How long have you been an SLP? What settings have you worked in? Where do you currently work?
I received my B.A. in Communicative Disorders from the University of Alabama in 2003. I received my M.S. in Speech-Language Pathology from the University of South Alabama in 2005. I have worked for a contract therapy company (one year), for my own private practice (part-time, three years), and for public schools (13 years). I currently work in an alternative placement public school setting. I serve students ranging in age from kindergarten through 21 years old. I have 21 students on my caseload. Many are on the autism spectrum, and all are in an alternative placement due to significant behavioral needs. This is my first year in this position, but it is my sixth year with Mobile County Public Schools. In the past, I have had as many as 75-80 students on my caseload in regular public elementary schools.
Describe the problem you faced. Tell us a little about the situation and how you felt tackling the problem.
I have found that therapy for fluency is difficult because fluency disorders themselves are so inconsistent. For example, a student may be perfectly fluent in my office during therapy but have severe primary and secondary characteristics in the classroom or at home. It is also difficult to put environmental modifications in place because the things that parents and other communication partners need to do in order to help are often counterintuitive. Also, the SLP must function as a “communication counselor” at times for both the person who stutters and for their support system. The biggest challenge I have ever faced with a student who stuttered was two years ago. I had a student who exhibited the most severe stuttering behaviors I have ever encountered, AND he was on the autism spectrum. He exhibited the full range of primary stuttering behaviors: initial syllable/sound repetitions, final syllable/sound repetitions, prolongations, and blocks. His blocks were sometimes 3-5 seconds long with overt signs of tension and struggle. He stuttered FREQUENTLY. He had serious secondary behaviors: loss of eye contact, blinking, head bobbing/jerking, and knee slapping. Compounding all of this was the fact that his receptive and expressive language were delayed, AND his ability to understand/express emotions and feelings was limited, as is common to persons with autism. I had NO idea where to begin with planning and executing efficacious therapy for this student.
Which resources did you use when solving the problem?
I did a lot of reading online. I can’t remember all the sites, but I pretty much Googled “stuttering and autism” or some variation of those keywords and scanned everything that popped up from blog posts to research articles. Ultimately, I decided to begin “at the beginning.” I used a combination of resources, pulling from both the Color Me Fluent and Focus on Fluency programs, as well as relevant children’s books and coordinating materials.
What did you try that worked really well?
First, I taught “speech helpers” until he was able to identify and label each one, as well as to provide a description of what each did (in his words, not mine). Then, we practiced controlled breathing exercises. Surprisingly (to me), this turned out to be a HUGE help for this student. It helped his receptive language skills (following directions, vocabulary), as well as helped him to regulate his rate of speech. Then, we did activities that involved using our voices in different ways. We read books, and I modeled character voices for him to imitate. We worked on basic concepts (loud, soft, high, low, fast, slow, up, down) and descriptive words (angry, spooky, sad, happy, excited, bored) by watching videos (e.g., Winnie the Pooh/Eyore for a sad voice example) and using our voices or saying words in the different ways. Once he was pretty good at controlling his voice, we started working on how to control our stuttering. Portions of Color Me Fluent were very helpful in teaching the techniques because the explanations and use of manipulatives were very concrete ways to teach these abstract concepts (e.g., stretchy speech using a slinky to stretch as you talk). Over the next two years, I saw major improvements in his ability to control his speech, as well as his confidence in speaking (the best part). His parents and teachers saw the change, and they were much more willing to listen to my recommendations because of the progress that they recognized.
What did you try that didn’t work?
Initially, I tried working in a group of four students due to time/caseload size restraints. It just didn’t work. I had to get creative with scheduling and make time individually in the beginning. I was eventually able to work up to a group of two so that we could get some good old-fashioned verbal competition going to practice application of learned skills.
What did you do when things didn’t go as planned?
I engaged in reflective practice and was honest with myself about what wasn’t working and why. It made me a better clinician to recognize things I needed to change and to seek out evidence-based ways to improve.
What was the end result? Was it what you expected?
The end result was gains for my student. His communication disorder was much less severe when he completed 5th grade than when he began 3rd grade. He made more progress than I expected because he was surrounded by a great team!
What did you learn?
I learned that being out of your comfort zone is a GOOD THING. If you approach a challenge with the attitude that you don’t know how you’re going to do this YET, then you can do things you once thought were impossible. Be willing to learn, and let failures motivate you to seek out resources and information to improve your practice.