Case Study

Jay: A Preschooler with Stuttering

Jay was referred to me by his parents. He was 4 years, six months old and had been stuttering for well over a year. His parents were advised initially to just ignore the stuttering. They reported their son’s stuttering as “coming and going,” primarily in the form of repeating the first word of a phrase (“can can can we go”); at the time of referral, however, the stuttering had gotten more pronounced. There was more tension in the sound of the disfluency, and Jay began stuttering on part of the first word (“cuh cuh cuh can I go”) and sometimes would squeeze his eyes shut as he tried to get the word out. Jay’s grandfather on his father’s side had severe stuttering as a young man, and never did talk very much, according to the parents.

Jay’s family brought him in for a speech evaluation. The stuttering was occurring on about 10 per cent of what Jay was saying, was not effortless, and was calling undue attention to Jay and interfering with conversation. Three times when Jay stuttered he also squeezed his eye shut. I decided to initiate speech therapy with this little boy to teach him to use a new, easier way of taking with slower speech, stretched vowels, and easy starts (saying the beginning of the sound gently). I explained to his parents that we would work directly on Jays stuttering, that we would call it bumpy speech, and that I would in a very calm and matter of fact way explain what stuttering is and show Jay how to say words easier. Since some parents worry that directly talking about the stuttering will make it worse, I explained there is no evidence of that and to the contrary, years and years of clinical observation and research indicate much benefit for children working in a calm way directly on their bumpy speech.

I had a parent (Jay’s mother usually brought him) sit in our therapy room and observe and practice with us as we went. First we taught Jay how to start vowel words easily (“apple” became “aaaaaple,” “inside” became “ iiinside,” and “under” became “uuunder”), then we contrasted easy starts with regular speech and then with hard starts (getting stuck on purpose). Then we had Jay listen to my words and tell me if I said them easy or hard (bumpy). At the same time, to increase his awareness of bumpy speech in a low key fun way, I taught Jay how to play bump tag. When he heard me m- m- m-aking a bump (repeating the first sound of a word), he was to raise his hand. I praised him when he did so and after five of these, he got to play with a toy. As I handed the toy, I would say its name (for example, “bubbles”) in a slower, stretched way with an easy start at the beginning of the word, and he had to copy the word.

I saw Jay for two half hour visits per week, with he and his mother practicing five minutes each night at home. We practiced the easy voice first on single words, then short imitated phrases and sentences, then on longer sentences including some Jay composed himself. We talked about toys and pictures. After six weeks of speech therapy, we began to encourage Jay to use his easy voice in conversation, first with me and then at home with his mom. In speech therapy, Jay and I played a game called scoreboard, where he got a point when he used his new way of taking and I got a point if there was any bumpy speech or if he forgot to use the new speaking voice. Two months into speech therapy, Jay and his mother were using the easy voice about 30 minutes each day, playing with toys, looking at pictures, and reading books. We did the same activities in speech therapy and also continued to contrast easy voice with regular starts and with hard onsets. After three months, Jay’s family noticed he was stuttering significantly less at home. His at- home conversation (just regular conversation, not making a specific effort to use the easy voice) was delivered in a slightly slower voice. After 4 months of speech therapy, Jay’s bumpy speech had disappeared. I released him from speech therapy and rechecked his speech six months later and then 12 months after that. The stuttering did not return.

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