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Stuttering therapy refers to the various treatment methods that attempt to reduce stuttering to some degree in an individual. There is a lack of evidence-based consensus about therapy, which can make stuttering a challenge to treat.It is believed that there is no cure for the condition, and experts have argued that the preferred treatment outcome is one that involves satisfaction on the part of the stutterer, with both his communicative performance and the therapy process. While there is disagreement about acceptable treatment outcomes from stuttering therapy, a wide range of methods have been developed to treat stuttering, and these have been successful to varying degrees.

Goals

In general, stuttering therapy aims to reduce stuttering to some degree in an individual, although there is disagreement about acceptable treatment outcomes from stuttering therapy.Some believe the only acceptable therapy outcome is a significant reduction in or total elimination of stuttering, others believe that speech which contains some stuttering, as long as the stuttering has become less tense and effortful, is just as acceptable, and yet others believe that the most important therapy outcome is the increased confidence a person has in his or her ability to talk, whether or not stuttering continues to be present. Additionally, the many different methods available for treating stuttering, and a history of promoting unsuccessful treatments, have left both stutterers and clinicians left confused and frustrated about what can be accomplished with stuttering treatment.

In 1997, experts argued that in the case of a stutterer seeking professional treatment from a clinician, the "preferred treatment outcome" is that the stutterer will demonstrate feelings, behaviors, and thinking that lead to improved communicative performance and satisfaction with the therapy process. They argued that the criteria for a treatment to be viewed as successful includes the stutterer being satisfied with her therapy program and its outcome, feeling that she has an increased ability to communicate effectively, feeling more comfortable as a speaker, and believing that she is better able to reach her social, educational and vocational goals.

Robert W. Quesal, an associate professor who teaches courses in fluency disorders, anatomy, and speech and hearing science, defined successful stuttering therapy as one that leads to a change in speech fluency, a reduction in the impact of stuttering on an individual's life, and an increased acceptance of stuttering on the part of the stutterer; and J. Scott Yaruss, Ph.D., an assistant professor of Communication Science and Disorders at the University of Pittsburgh, suggests three instruments for clinicians to use to document changes in the stuttering of their clients: the reaction of the stutterer to the fact that she stutters, how much stuttering interferes with the stutterer's ability to perform daily tasks, and the impact that stuttering has on the client's ability to pursue their life goals.

Approaches

There are many different approaches to stuttering therapy. While it is believed that there is no cure for the condition, stuttering can be reduced and even eliminated with appropriate timely intervention, and various therapy methods have reduced stuttering in individuals to some degree. In any case, for all persons who stutter, the successfulness of speech therapy depends on the combination of education, training, and individualized treatment provided.

For a child that stutters, the focus of treatment to prevent the worsening of the condition, and families play an important role in the process. Successful elimination of mild stuttering is likely when treatment is initiated before four years of age. For those who have more advanced forms of stuttering and Stuttering#Secondary behaviors, therapy is generally a variation or combination of two approaches: a fluency-shaping technique that replaces stuttering with controlled fluency, and stuttering modification therapy, which focuses on reducing the severity of stuttering.

Therapy for children

Treatment of mild stuttering in children younger than six years of age focuses on the prevention or elimination of stuttering behaviors. Families play an important role in the management of stuttering in children: therapy is usually characterized by parental involvement and direct treatment, and providing an environment that encourages slow speech, affording the child time to talk, and modeling slowed and relaxed speech can help reduce stuttering events. For example, the Lidcombe approach, which has become prominent in recent years and is effective in preschoolers who stutter, involves family members providing an environment that encourages a child to speak slowly, and one in which the child receives praise for fluent speech in the child’s daily speaking, and occasional correction of stuttering. Some of the most effective preschool intervention programs call for direct acknowledgment of stuttering in the form of contingencies such as “That was bumpy” or “That was smooth.”

Fluency shaping

Fluency shaping therapy focuses on changing all the speech of the person who stutters, and not just the portions of speech in which he stutters. This type of therapy involves teaching the stutterer to use a speaking style that requires careful and prominent self-monitoring,, for example one in which the stutterer slows his speech down and smoothes out all his words. Fluency shaping therapies do not address attitudes, feelings, and self-concept issues under the assumption that eliminating the stuttering will eliminate these issues. Proponents of this type of therapy believe that the outcome of any therapy depends directly on its focus:"if clinician and client focus on changing stuttering, they'll get stuttering; if they focus on changing fluency, they'll get fluency". This type of approach can reduce stuttering, although in children its effectiveness decreases if stuttering persists after eight years of age.

Certain devices, known as fluency-shaping mechanisms, use this approach in an attempt to reduce stuttering. For example, delayed auditory feedback devices encourages the slowing down of speech by replaying the stutterer's words. The stutterer is then forced to slow her rate of speech to prevent distortions in the speech that is heard through the device. The effectiveness of such devices varies with stuttering severity.

Stuttering modification

Stuttering modification therapy, also known as traditional stuttering therapy, focuses on reducing the severity of stuttering by changing only the portions of speech in which a person stutters, to make them smoother, shorter, less tense and hard, and less penalizing. This approach attempts to reduce the severity and fear of stuttering, and strives to teach stutterers to stutter with control, and not to make the stutterer fluent. Therapy using this approach tends to recognize the fear and avoidance of stuttering, and consequently spend a great deal of time helping stutterers through those emotions. This approach generally does not eliminate stuttering events, but it helps minimize the impact and occurrence of stuttering

Integrative approaches

Integrative approaches combine fluency shaping and stuttering modification techniques.

For example, the speech processing approach goes below the surface of perceived behaviors in treating stuttering, and sees stuttering as a deviation in the normal functioning of a stutterer's speech production system. These distortions in an individual's speech processing usually leads to perceived stuttering events, which include repetitions, prolongations, and blocks, and a stutterer may experience a stuttering condition even when a listener cannot perceive disruptions in the flow of the speech. The goal of speech processing therapy is to enable the stutterer to use the same processes that normally-fluent speakers use, thereby generating the same quality of fluent speech. The stutterer is taught to allow all of the components of her speech production system to function in a highly automatic way.

Additionally, another type of integrative approach, offered by Memphis Speech Solutions, combines fluency shaping and stuttering modification techniques by first teaching the stutterer fluency to slow down and smooth out his speech in order to eliminates most of the overt stuttering behavior, and then teaching him to manage any remaining stuttering "moments" with stuttering modification strategies. The stuttering modification phases of motivation, identification, and desensitization are incorporated into such therapy to help the stutterer manage the negative emotions that have built up around the stuttering.

Contemporary devices

Contemporary devices used to reduce stuttering alters the frequency of the speaker’s voice to mimic the “choral effect”, a phenomenon in which person's stutter decreases or ceases completely when she is speaking with a group of others, or slows the rate of speech through delayed auditory feeback (above). Studies on the long-term outcome of these devices have not been published.

Self-therapy

Some stutterers are only able to seek self-therapy because adequate clinical treatment is not available to them. In any case, some experts in the field believe that stuttering therapy is largely a do-it-yourself project. For example, Malcolm Fraser, founder of the Stuttering Foundation of America and life member of the American Speech-Language-Hearing Association recommends the following guidelines for stutterers needing immediate relief, even temporarily.

1. Make a habit of always talking slowly and deliberately whether you stutter or not.

   This guideline is recommended because it will result in a more varied and relaxed manner of speaking, which is more responsive to therapy procedures, and will counteract the feeling of time pressure that sometimes aggravates stuttering.

2. When you start to talk, do it easily, gently and smoothly without forcing and prolong the first sounds of words you fear.

   This guideline will lessen the severity and frequency of stuttering, and substitutes "easier ways of stuttering for... abnormal and frustrating habits".

3. Stutter openly and do not try to hide the fact that you are a stutterer.

   This guideline helps to reduce what shame and embarrassment a stutter feels about his or her difficulty, which may in turn aggravate his or her stutter.

4. Identify and eliminate any unusual gestures, facial contortions, or body movements which possibly you may exhibit when stuttering or trying to avoid difficulty.
5. Do your best to stop all avoidance, postponement or substitution habits

   This guideline helps to reduce a stutterer's fears, which aggravates stuttering if increased.

6. Maintain eye contact with the person to whom your talk.

   This guideline helps to reduce a stutterer's feelings of shame and embarrassment.

7. Analyze and identify what your speech muscles are doing improperly when you stutter.

   This guideline helps a stutterer discover what his or her muscles do incorrectly, so that he or she can work on correcting them.

8. Take advantage of block correction procedures designed to modify or eliminate your abnormal speech muscle stuttering behavior

   This guideline helps a stutterer take advantage of the study of his or her blocking difficulties, as discovered using the previous guideline, by applying procedures that include planning and preparing for a block so that it will not occur.

9. Always keep moving forward as you speak (keep moving your voice from one word or sound to the next, without repeating or back-tracking)
10. Try to talk with inflection and melody in a firm voice
11. Pay attention to the fluent speech you have

    Mentally replaying successful speaking situations helps a stutterer build confidence.

Pharmacologic therapy

Several pharmacologic, i.e. drug-based, methods to control or alleviate stuttering events have been studied, but each has either proved ineffective or have had adverse effects. In addition, no large-scale trials on pharmacologic therapy have been published, and there are no trials including children. A comprehensive review of pharmacologic interventions for stuttering showed that no agent leads to valid improvement in stuttering or in secondary social and emotional consequences.