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Topic Overview

Two speech therapies for stuttering are indirect treatment and direct treatment.

Indirect treatment

Mild stuttering may require indirect treatment if it doesn't resolve on its own or improve with parent counseling within about 6 weeks. Indirect treatment uses elements of parent counseling, such as creating a comfortable and relaxing environment in which the child's speech can improve naturally, and also includes limited involvement with a speech-language pathologist, who evaluates and monitors progress while observing and interacting with the child.

For example, you may be taught more ways to slow down your own speech and how to provide opportunities for quiet exchanges with your child, where speaking is optional. Some programs focus on continuing to learn creative ways to give your child positive reinforcement during periods of speech fluency. You will also be shown how to track your child's progress and to keep detailed records.

Direct treatment

The focus of direct treatment is personal interaction between a speech-language pathologist and the child who stutters. The therapist teaches your child:

• How to form words, speak slowly, and relax even while stuttering. Your child can practice these exercises outside of instruction time.
• How to manage the physical symptoms of stuttering, such as eye-blinking.
• How to deal with the emotional difficulties that may result from speech problems.

Role-playing is often used as a way to help your child learn how to apply these strategies. For example, the child may be asked to imagine different situations as he or she speaks and to role-play how others would react. A child can practice responses and learn to anticipate and manage stressful situations. Similarly, a therapist may have your child practice speaking in different settings and with different people. For example, your child may start with speaking alone, then in front of a small family group, and then gradually work up to reading aloud in front of others, speaking on the telephone, and talking in front of a classroom.¹

The therapist also often works with you and other family members. The therapist teaches the family some techniques for building an accepting and calm environment, which is important for improving your child's speech. This training is an extension of indirect treatment, where a calm environment is provided for speech to resolve naturally with little intervention.

You also may be asked to keep detailed records of your child's progress with using specific techniques in the home setting.

Stuttering usually improves gradually over a year or more with direct treatment. Some children may even lose all trace of speech problems. The success of treatment largely depends on:

• The cause of the speech problem.
• A child's strengths.
• The therapist's abilities.
• The amount of support from parents and family.