"An attitude is a hypothetical construct that represents an individual's degree of like or dislike for an item. Attitudes are judgments. They develop on the ABC model (affect, behavior, and cognition). The affective response is an emotional response that expresses an individual's degree of preference for an entity. The behavioral intention is a verbal indication or typical behavioral tendency of an individual. The cognitive response is a cognitive evaluation of the entity that constitutes an individual's beliefs about the object. Most attitudes are the result of either direct experience or observational learning from the environment." (www.google.com)

As a clinician who treats many children and teens who stutter, modifying negative attitudes about communication is an important aspect of the treatment process. Many children and teens who stutter have been discouraged by comments from peers or advice from listeners. Difficulty communicating in certain speaking situations also contributes to these negative attitudes. Various evaluation tools help to define a student's attitudes, but helping a student modify negative thoughts about his/her communication requires a variety of activities. In my experience, no two clients have moved through this process in exactly the same way, but several types of treatment activities appear to have facilitated attitudinal change.

First: Learn vocabulary to describe stuttering, the speech process and techniques to modify rate and tension.

Many children/teens who stutter have misconceptions about stuttering or various "tools" that might help them to speak fluently. Initially, the concepts of "talking and stuttering" need to be defined; what do both of these terms include, what happens during a moment of stuttering and during smooth speech. A list of terms about speaking and stuttering along with diagrams of the speech mechanism help students develop objective descriptions. A student reviews a list of words that describe communication and selects characteristics typical of his/her speech pattern. During this process, a student learns how to describe variations in tension, timing, the speech mechanism and various targets. (See attached: Terms about Speaking & Stuttering) In addition a review of the speech mechanism allows students to understand tension points and the process of normal speech production. For any student, using object vocabulary to describe a behavior is helpful for selecting tools to help modify stuttering and to change behavior.

The other aspect of this part of treatment is to introduce vocabulary for describing stuttering moments. Providing simple, easy to read definitions of the various fluency targets/tools allows the student to develop a personalized treatment approach based on past experiences. In treatment sessions, students choose either tension reducing strategies (easy starts, light contacts) or timing strategies (pausing & chunking) for various speaking tasks understanding that all depend on adequate breath support to help support speech. Experimenting with these tools both within the session and in outside communication activities allows the student to make decisions concerning which treatment techniques help them reduce tension, manage timing and improve breath support. What do these activities have to do with attitude? The students talk about stuttering in more object terms by describing increases/decreases in tension, lack of breath and speed/timing in various speaking situations. Problem solving difficult speaking situations or analyzing a problematic speaking interaction is empowering for students to manage communication and cope with challenging speaking interactions.

Second: Learn to analyze and problem solve approaches to various Speaking Situations

The variability of speaking situations is frequently confusing for students who stutter. Results from subtests of the Behavior Assessment Battery (Gene Brutten & Martine Vanryckeghem, Plural Publishing, Inc., 2007) measures changes in attitudes along with the child's behaviors and perceptions about stuttering in various speaking situations. Clinician created lists specific to the student's environment can also be effective. Once challenging situations are identified, the student and clinician can create a hierarchy of difficulty, develop ideas for managing communication and analyze changes while speaking in these situations. Creating Power Point slides is an effective tool to stimulate the problem solving aspect of treatment as the student is evaluating the use of the timing and tension strategies. During this type of treatment activity, the concepts of Time Pressure and Avoidance are also important to address. (See Time Pressure and Avoidance Power Points). The value of Power Point teaching tools is that students can create a personalized slide describing various speech behaviors with suggestions to modify thinking in various speaking situations.

Treatment needs to address what happens during these difficult speaking situations using objective statements (i.e. I have difficulty stopping for a breath. I feel tension in my throat, etc.) Simulated speaking situations during treatment sessions, in small groups, talking with familiar listeners, etc. are good practice steps for the student to feel success.

Third: Understand the impact of negative thinking on attitudes while speaking in difficult situations; transfer negative thoughts into positive ones.

Performance variations by various athletes provide a natural connection to speaking in difficult situations, i.e. athletes cannot perform against every team and in every game with the same outcomes. Again, the use of PowerPoint can facilitate comprehension of how thinking impacts attitudes about communication and gain a perspective on how to "think" about communication in a more positive manner. A PPT activity titled "What was I Thinking?" allows students to define positive and negative thinking and predict the outcome of each in challenging speaking situations. Students define both types of thinking and create both positive and negative statements. The PPT comments can be archived for the students to review at any time or for students new to stuttering treatment to read. A student can also create slides demonstrating what positive statements are useful for dealing with difficult speaking situations in his/her profile.

Fourth: Tell Your Story; Read the stories of other children/teens!

This also can be accomplished in a Power Point format such as "My Story" which provides a simple framework for children/teens who stutter to describe their communication pattern, feelings and ideas concerning his/her stuttering. The framework does not restrict the student's ideas or comments. The benefit of using this type of interactive activity is that students can connect with other students who stutter. A summary of this activity can be accessed at My Story: A PowerPoint Teaching Tool.

Fifth: Meet other people who stutter

Students who stutter often feel isolated or alone. Finding ways to have adults/teens who also stutter visit the sessions of younger students is a powerful way to facilitate this type of interaction. With permission, sharing videos of other students who stutter talking about various issues related to stuttering can facilitate this type of learning. Students learn about the variability of the fluency patterns and benefit from hearing what students suggest. Talking openly about stuttering is also a valuable lesson. Videos and information from the Stuttering Home Page (http://www.stutteringhomepage.com), the Stuttering Foundation of America (http://www.stutteringhelp.org)and the National Stuttering Association (http://www.westutter.org) also facilitate this process.

In conclusion, changing attitudes concerning communication is a process that involves many variables and takes time to modify. Changing attitudes involves not only the child/teen but the adults who surround the child; and this change can be impacted by many experiences and interactions both positive and negative. However, modifying attitudes is important aspect of treatment. In the words of Winston Churchill, "attitude is a little thing that makes a big difference".

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