日本特殊教育学会 第59回大会で講演いただいたScott Yaruss先生への質疑応答を掲載しました。

１．
Thank you for your very exciting presentation. I have a question about the part that teaches the foundation. When teaching about the mechanism of speech production, do you also teach
acoustic phonetics, such as differences in vowels and consonants? I would be grateful if you could let me know if there is a reference that describes the details. Thank you very much.
 
Keichi Yasu
Tsukuba University of Technology.

Hello Keichi, Thanks for your question. It’s a terrific one! My answer is that it depends upon the specific client. For some, I definitely get into details such as vowels vs. consonants, articulatory factors such as place/manner/voicing, and even formants. This is more common in adults and older children; I don’t get into the full details with younger ones. One of the factors involved in the decision is how engaged they are; another is just how much detail I think the client will need in order to better understand their stuttering. Some students (particularly younger ones) don’t really need that higher level of understanding, but I enjoy when I do get to get into that level of detail.

２．
Thank you for your presentation. Your comprehensive treatment inspired me very much. In my country, I suppose that learning basic knowledge about stutters and speaking processes is prone to be treated perfunctorily.

Yukino Sawai
University of Tsukuba.

Thank you, Yukino, for your kind words. We face the same here in the USA, as well. Many people try to jump right into the techniques without providing the background that students need.

So, I think your attitude toward stuttering treatment significantly impacted the Japanese audience, including me. I have two questions about the therapy.
Firstly, how should we balance clients’ desire to speak fluently without stuttering and the therapists’ aim to approach comprehensive aspects like communication skills? More specifically, I assume that some children and teens strongly expect to cure their stutters completely through therapy. Do you have any suggestions as to how to deal with their high expectations and not make them feel disappointed?

This is a really great question that reflects a significant challenge in working with people who stutter. Indeed, many do want to eliminate their stuttering – and they may have gone through their lives believing that this is possible if they only try hard enough. Prior speech-language pathologists, teachers, and parents have probably reinforced this message for them – just keep at it and you will eventually stop stuttering. The problem is that this is not going to be the case for most (nearly all) school-age children or teens who stutter. They will continue to stutter – and this is going to be very difficult news for them to come to terms with. Until they come to terms with it, however, they will continue to struggle. The key to lifelong success in coping with stuttering is acceptance of stuttering, and the sooner that we can help students get to that point, the better off they will be.
Unfortunately, they will experience disappointment when they begin to come to terms with stuttering… but we can offer them hope, as well. They need to learn that there is no cure, but they also need to learn that this does not mean that stuttering has to cause a negative impact on their lives. When we shift our focus from fluency to the broader impact of stuttering, and when we show them that they can do whatever they want to do in their lives regardless of whether or not they stutter, and when we show them that stuttering does not have to be as frightening as it seems like it was, then, and only then, can we help them reduce their fear, increase their comfort, and ultimately, learn to live more easily with their stuttering.
Unfortunately, there’s no easy answer for this, but they will have to go through this (and the parents, too). The more that we need to create a sense of acceptance, optimism, and hope for them, so that they can learn that they are okay even if they continue to stutter.

Secondly, I believe that you have met many children that had experienced difficulties throughout your career. If it is possible, could you please share a client’s success story? Do you have any positive comments or (if you have) negative comments about your therapy? I’m interested in knowing how it has changed over time.

Oh my goodness, yes, there are many wonderful stories of children’s success. In fact, I was just corresponding with a former student of mine – now an adult – who had extremely severe stuttering when he was younger. We worked together to help him come to terms with his stuttering, to accept it, and to stop struggling to always try to be fluent. Today, he is a successful, award-winning filmmaker who leads large teams of people on complicated projects. Of course, he still stutters, but the stuttering does not hold him back. Another – a student I worked with when he was in high school – who now is a VP of Engineering for Google. He still stutters significantly, of course, but it does not interfere with his great success.
I have also faced some difficult situations in therapy – these are often associated with a student’s readiness for facing stuttering. I have had some students where I was very eager to move toward some of the acceptance work, but the student was still not ready for that. It is always a hard challenge to know just hard hard to push – sometimes students need a little encouragement and then they are ready to take big risks; other times, pushing will cause them to pull back. I’ve had a few situations where I pushed too hard too quickly and the student pulled back. In some of those situations, the student came back later when they were ready; in other situations, they went elsewhere for therapy that was focused on their fluency rather than their overall communication, and I ultimately lost track of them.

３．
What should we keep in mind when supporting a child who stutters with ASD or ADHD? Does Dr. Yaruss think that stuttering is more difficult to treat in these overlapping cases?

Kanako Sugimura
Speech-Language-Hearing Therapist.

Hello Kanako – Thank you for your email. This is indeed a difficult situation. When a child has ASD or ADHD or LD or any other concomitant disorder, it can be much harder. Some reasons include:
　Difficulty putting in the additional effort or concentration required to engage in therapy, to do ongoing practice, to evaluate success, etc…
　Reduced self-awareness or understanding of what stuttering is, what therapy goals are, what the techniques or strategies are, when to use them, how to generalize, etc…
And, there is the basic fact that stuttering is much more likely to persist in children who have concomitant issues, so it is something that they will need to come to terms with – just as they will need to come to terms with their other condition.

Finally, this is harder for the parents, who may cling to the idea that the stuttering needs to be “fixed” so that it doesn’t get in the way of the other issue that the child is facing. They may have an easier time accepting that the ADHD is chronic but a harder time recognizing that the same is true about stuttering. (This has to do in part with the variability of stuttering.) Therefore, it is doubly important to help the parents get to the point of acceptance just as it is important to help the child get to that point of acceptance.