Combined Modality Fluency Therapy in a Teenager with Severe Stuttering
Fluency therapy can be challenging when clients have a long-standing history of stuttering. This case describes the utility of concurrent standard behavioral fluency-management strategies and altered auditory feedback (AAF) via the Speech Easy device (Janus Development Group). The clinical activities described in this case occurred in the context of a research study.
T was a 16-year-old male with a history of severe stuttering, which was characterized primarily by lengthy word-initial disfluencies, most of which involved audible sound prolongation or cessation of articulatory movements during speech-sound production (i.e., inaudible prolongation or “blocking”). Many of T’s stuttering-related disfluencies featured noticeably excessive physical tension in speech-related muscles, along with extraneous limb and torso movements. Onset of stuttering symptoms reportedly occurred at the age of 3 years, following a period of ostensibly typical speech development. Family history was significant for a sibling with developmental stuttering. T had worked with several speech-language pathologists over a span of 9 years in public school settings, which, he said, resulted in “some improvement” in communicative functioning. T reported stuttering most severely during group conversations and oral reading, and least severely during one-on-one conversations with family members or friends. Although T reported feeling embarrassed about his disfluent speech, he stated that he seldom used word substitution or circumlocution to cope with or conceal anticipated instances of stuttering-related disfluency. He restricted his participation in verbal interactions, particularly at school, because of his fluency difficulties, and he expressed a desire to “get rid of stuttering.”