(The following is a handout that accompanied a presentation at the ASHA Convention in Seattle, Washington, November 1996. It is reproduced below with permission. JAK)

To help the child, through instruction and practice, to better understand stuttering, and reduce or prevent the development of negative emotions and attitudes. In doing so, we pave the way for a better chance to successfully manage stuttering emotionally and motorically.

A. Stuttering is a complex problem consisting of speech motor behaviors, emotions and attitudes which for many children becomes intertwined with issues of self esteem.

B. Most children who stutter experience varying degrees of emotional problems with their stuttering. Negative emotions and attitudes associated with stuttering magnify the disorder, increasing avoidance/struggle behavior and interfere with children's ability to acquire speech management skills.

C. Common emotions which are paired to stuttering include anxiety, fear, and sometimes anger. Underlying these feelings are the two emotions of shame and guilt.

D. Shame and Guilt. The following are working definitions of adult shame and guilt. For children these emotions may emerge in more subtle and diffuse ways.

1. Guilt is the uncomfortable or painful feeling that results from doing something we think is wrong. Guilt concerns behavior. Guilt seems to be correctable or forgivable.

2. Shame is the uncomfortable or painful feeling when we realize that a part of us is defective, bad or a failure. We feel shame for being not doing. There seems to be no way out of shame.

3. Shame and guilt may be the cornerstone for the development of other emotions related to stuttering, e.g., anxiety, etc..

4. Shame and other emotions become demands or pressures on the speech motor system which exacerbate stuttering behavior and interfere with recovery at all age levels.

E. Self management of stuttering is a complex, highly cognitive task, CHILDREN FAIL OFTEN .

F. When stuttering is met only with messages to do better, to work harder, and use speech techniques more with no acceptance of failure, then guilt and shame are increased.

G. A conspiracy of fluency

H. Shame and guilt are reduced or prevented through gentle supportive exposure.

I. We need to NORMALIZE stuttering. We need to NORMALIZE failure.
We need to DE-AWFULIZE stuttering.

J. Concepts central to progress.

It's not your fault.
It's not mom's fault.
It's not dad's fault.
It's nobody's fault.

Sometimes we can smooth our speech out BUT sometimes we can not. Trying to help stuttering a secret makes us stutter more and feel badly.

K. Experience without fear or embarrassment (desensitization)/de-awfulize.

1. Externalize stuttering using pseudo-stuttering, smashing clay stutters, or popping balloon stutters, etc.

L. Teach others how to stutter.

1. You're the expert
2. You're the teacher

M. Dealing with teasing and ridicule of stuttering

1. Discuss how teasing feels.
2. Why do people tease?
3. How can we react to teasing?
4. Develop simple scenarios.
5. Video tape scenarios.
6. Watch with significant others.
7. Choose "best" one(s).
8. Continue rehearsal.

N. LETS TALK TO YOUR CLASS

The use of self disclosure as a means to reduce/prevent shame and embarrassment, eliminate teasing, develop peer support and aid in the transfer of speech management techniques to the classroom.

1. I'm a speech teacher and this is what I do.
2. How many of you have been to speech before?
3. Different types of speech problems.
4. My speech problem is stuttering (if clinician stutters).
5. Who else stutters? (famous people)
6. Define stuttering.
7. What causes it?
8. No one's fault.
9. Different ways to stutter.
10. Ways to help have smooth speech.
11. Can't be successful 100% of the time.
12. Things that make it hard to change our speech.
13. Why some people laugh and tease us. (elicit other children's fears)
14. How would this make you feel?
15. Better ways for people to respond.

    Appropriate discussions and self disclosure of stuttering take the disorder out of the closet. It takes the sting out of a secret that everyone knows, but no one talks about, thus reducing shame, fear and mystery. Self disclosure and other forms of desensitization must be done repetitively but in safe socially appropriate contexts, e.g. group presentations, plays or videos about stuttering.

O. Parent Education: Reducing parent guilt and encouraging pro-active behaviors.

1. Educating parents about stuttering
2. Helping parents educate others about stuttering
3. Helping parents be an advocate for their child
4. Helping parents to normalize stuttering behavior
5. Helping parents to develop their child's positive self esteem

added with permission, December 18, 1996