In my practice as a speech-language pathologist, I am very lucky to hold two very different positions. The first involves working with children on their social communication and self-regulation skills alongside occupational therapists. Together, we help our clients by providing both one on one and group support.
My second position involves working with preschool and school age children who stutter. In the course of my work, I have learned that a child’s ability to regulate his or her emotions can have a large impact on his or her ability to communicate fluently. Children that have difficulty regulating their emotions can exhibit disruptive behaviours and have a hard time calming down when feeling big emotions,e.g., excitement, elation, anger. As a result, if a child is having a hard time responding to events in his or her environment and/or internal emotions, this can lead to a demand on the speech motor system which makes it more challenging to produce fluent speech. Studies have shown that children who stutter experience more emotional reactivity and have a harder time regulating their emotions compared to children who do not stutter (Karass et al., 2006).
With this in mind, I have started to combine the knowledge I have gained from my two positions by implementing self-regulation work with children who stutter. The way I implement these skills depends on the child; however, I often target emotional literacy and vocabulary, the zones of regulation, internal and external body clues for different emotions, e.g., when I am annoyed, I feel hot and sweaty and my heart starts to race), triggers for different emotions, e.g., when my parents say no, I feel angry, and tools to manage big emotions, e.g., breathing and taking a break), both positive and negative. It was not until I read a recently published clinical trial that I was able to confirm that this work is, in fact, evidence based and valid.
In the article, published by Druker et al., in September 2020, the authors examined whether targeting self-regulation and stuttering together has a greater impact on both regulation skills and fluency skills than targeting fluency skills alone. The authors completed a clinical trial and found that the group of children that received both self-regulation treatment and stuttering treatment showed a greater reduction in stuttering frequency than the children that only received stuttering therapy after the program and at follow up. The self-regulation support consisted of evidence-based parenting support. Parents also reported significant improvement in their child’s behaviour and parenting practices.
With this study in mind, I was recently working with one of my client’s who stutters and his mom reported that his stuttering seemed to increase on days where he was experiencing big emotions. As a result, I started to work with him on the zones of regulation and we made a toolbox of ways for him to get back to the green zone. We will see what type of impact this has on this particular child’s self regulation and fluency skills; however, his excitement to make a toolbox in addition to his understanding of what makes him feel big emotions leads me to believe he will actually want to implement these strategies at home and at school.
While not all children who stutter will require treatment for self-regulation skills, this study is very helpful for guiding a speech-language pathologist’s practice. If a child has difficulty regulating his or her emotions, behaviours and impulses, this can have a direct impact on the child’s speech motor system to fluently communicate. Whether we work with parents or directly teach children some of the self-regulation skills listed earlier, I believe that treating the whole child and not just their communication challenges can leave a lasting and more meaningful and significant impact on the child.
If you have other ways to work on self-regulation or experience working on self-regulation skills with children who stutter, let me know!
Druker, K., Mazzucchelli, T., Hennessey, N., & Bailey, N., (2020). An evaluation of an integrated stuttering an parent-administered self-regulation program for early developmental stuttering disorders. Journal of Speech and Language hearing Research, 63(9), 2894-2912. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/32812840/
Karass et al., (2006). Relation of emotional reactivity and regulation to childhood stuttering. Journal of Communication Disorders, 39(6), 402-423. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1630450/