I received an email from a graduate student this week, asking for advice about a fluency client in an upcoming school placement. The student described a very, very common scenario that school-based SLPs encounter with stuttering students who have IEPs. If you’re a school-based SLP diving back into IEPs after summer break, there’s a good chance you’ll encounter one or two students like this:
"The student does not describe his disfluency in any specific way. His current goals include working on breathing techniques and easy onsets. He is unaware of his difficulty with coordinating speech with breath, and talking too fast through each breath. My supervisor noted that he is very unmotivated to participate in therapy. She expressed that this became even more difficult with the transition to remote therapy in the spring, and that is how we will be delivering his services this fall as well. He is entering 4th grade, and apparently is very 'over' going to speech therapy."
- Kid with disfluent speech pattern has goals to “modify” the atypical patterns.
- Kid doesn’t care to work on modifying his speech.
- Kid is “over” therapy in general.
- Kid has an IEP, so you have to meet the minutes.
- BONUS: we’re doing telepractice! *sobs*
Where Do I Start?
If you have one (or two, or a few) of these kids on your caseload this fall, and are dreading the thought of spending 30 minutes on Zoom trying to convince a 9-year-old that he should monitor the way he breathes while he talks...I have good news for you.
Just because a student stutters, does not mean you need to work on speech goals.
Just because a student stutters, does not mean you need to work on speech goals.
JUST BECAUSE A STUDENT STUTTERS, DOES NOT MEAN YOU NEED TO WORK ON SPEECH GOALS.
...but I have to meet minutes...and I’m legally obligated to treat their stuttering…and I do want to help this kid!
More good news. You can meet minutes by treating stuttering in a way that is helpful and relevant without targeting physical speech goals.
Not only that, you can write evidence-based, IEP-compliant speech therapy goals that do NOT require actively modifying physical speech behaviors.
(Obviously, if you are working with a child who is troubled by their physical speech struggle and wants to work on speech goals, you should do that! This post is specifically for the kids who are “over” that approach.)
There are two basic categories of goals and therapy activities that can be used for kids like this: education goals, and empowerment goals (these categories come from our 3Es model of stuttering therapy). In this post, we will focus on education goals for stuttering that are appropriate for a school-based setting.
Writing Goals for Education
Broadly speaking, we can think about two types of stuttering education goals:
- Learning about stuttering in general
- Learning about my individual stuttering experience
This is a VERY important distinction, especially for IEP students who are not enthused about therapy. As clinicians with “progress” mandates, we often default directly to addressing the person’s individual experience. This is the case when we are working on goals that target behavioral and physical components of speech.
Many speech therapy clients, children and adults, even people who seek out therapy by choice, are not fully prepared to confront their personal experience with stuttering. In the case of school-based therapy that is mandated by law, this direct approach can cross the line from overwhelming the client, to actually being invasive. Demanding that a person change themselves when they don’t want to, aren’t ready to, or explicitly feel that there’s nothing wrong in the first place is disrespectful and harmful. It is unethical.
(Yes, unethical. For more on this, check out this excellent mini-series on StutterTalk, What I Wish My SLP Knew About Stuttering, featuring a series of interviews with SLPs who are also PWS and had negative therapy experiences as children.)
For a student who is sending signals or directly telling you they don’t care to work on their personal speaking patterns, we can respect individual autonomy in therapy while maintaining IDEA compliance. The school setting is all about education, so speech therapy can center on educating the student about stuttering as a broad concept, without getting into their personal experience.
Some examples of this that most clinicians are familiar with include:
- Learning about the vocal mechanism and speech production
- Learning about the facts and science of stuttering (physiology, genetics)
- Learning about the experiences of people who stutter (PWS) in general (celebrities, etc.)
- Learning about different high-level communication skills (organization, pragmatics, etc.)
While that’s a solid starter list, it might not be enough to fill an entire semester or school year’s worth of IEP minutes. More good news: there is a LOT more to learn when it comes to stuttering…
- Learn about the social model of disability and how it relates to stuttering
- Learn about the different speech therapy philosophies (fluency shaping, stuttering modification, avoidance reduction)
- Learn about myths about stuttering
- Learn about what people have believed about stuttering throughout history
- Learn about the latest stuttering research (genetics, neuroscience, stigma, and more)
- Learn about the field of speech-language pathology
- Learn about stuttering communities, self-help activities, and activism initiatives
- Learn about the Americans with Disabilities Act and how that applies to PWS
“Learn” is a broad term. You can read, watch, or listen to information about these topics with kids. You can then debate the merits of the content with kids (“Do you agree with what Joe Biden says about stuttering?”). You can generate questions together and research the answers with kids.
How can I justify this?
One, there is lots of evidence to support targeting these knowledge areas in therapy. In fact, there is so much evidence that if you aren’t working this into your IEPs, there might be a question of how EBP your approach really is.
These areas can be justified using rationale goal language:
- “To increase knowledge of stuttering management approaches…”
- “To improve ability to independently problem-solve social and environmental challenges related to stuttering…”
- “To effectively self-advocate in communication situations…”
- “To ensure informed decision-making regarding speech therapy skills…”
These areas can be measured using “product delivery” goal language:
- “...by explaining three ways that [the social disability model/ADA/communication principles] applies to stuttering”
- “...by completing a report/presentation to [person/peers]”
- “...by creating a video/visual timeline/[other media] describing [at least 3 historical periods/current research findings/therapy approaches]”
- “...by verbally [summarizing/comparing and contrasting/critiquing] the [differences/pros and cons/alternative methods] of [therapy methods/beliefs about stuttering/community activism principles]”
These goals can be time-bound using deadline goal language:
- “...by the end of the term/semester”
- “...within X weeks/sessions”
...But They Still Need To Work On Their Speech
No. They don’t.
Again, a specific client profile we’re talking about here.
You may feel like the child needs to work on their speech. Parents and/or teachers may feel like the child needs to work on their speech. Adult discomfort does not mean the child needs to work on their speech.
Yes, the child may have very overt and severe disfluency patterns that are functionally interfering with their communication. It truly does seem like they would benefit from being able to speak more easily. However, if the person—even a child-person—does not want to change the way they talk, it is unethical to insist that they should.
Physical speech skills can be explored non-invasively, if presented using this education lens. Learning about speech skills can be an education topic, which comes with some hands-on activities—doing the skills! Using this lens, speech skills should be presented as an academic topic that you “play around with” in therapy, and the child can indicate interest in pursuing more learning or moving on to a different topic.
It is very, very normal for school-age children to be uninterested in or actively resistant to speech modification. This education-centric approach to speech skills places the value on exposing the child to the existence of speech modification as an option, but not demanding they start using these tools here and now. This is knowledge they can review every year, so that they can make an informed choice when (if ever) they desire to physically address their stuttering.
Speech goals that target common skills like easy onsets, cancellations, pull-outs, voluntary stuttering, and tension should be written using the same goal language frames as above. Rather than a traditional “Student use cancellations in 80% of stuttering moments in a 5-minute conversation” goal, consider a semester-long, product-delivery structure like “Student will describe, compare, and demonstrate examples of easy onset and cancellation techniques in a 5-minute presentation”.
Just because a student stutters, does not mean you need to work on speech goals...and why would we, when there is so much MORE?
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