Stuttering, or "Dysfluency," is a complex speech issue that about 5% of children experience at some point in their development. Most of those kids move past it by late childhood; however, about 1% of the population continues to experience stuttering long-term, (Craig et al., 2002). Although we are still learning about what causes stuttering, we do know that a variety of factors impact how it is expressed.
One framework that speech-language pathologists (SLPs) use to understand the dynamics of stuttering is called the CALMS model, (Healey et al., 2004). The components of this acronym describe certain processes that can impact someone’s fluency. "CALMS" stands for:
- Cognitive: Addresses the thoughts, perceptions and awareness that a person has about stuttering. When a SLP targets cognitive processes, they may help the client understand the anatomy and movements involved with stuttering as well as the nature of dysfluency. They may also work on reframing ideas and beliefs about stuttering and developing some problem-solving skills.
- Affective: Speaks to the emotions and attitudes that an individual has towards their fluency. SLPs, families, and clients work together to address issues with self-esteem, expectations, and self-empowerment. They may also confront negative issues such as teasing, bullying, fear, and motivation. Individuals who stutter are supported in developing healthy attitudes and ownership of their communication.
- Linguistic: An individual’s level of fluency can sometimes respond to the complexity of a language task. For example, a child may not stutter while describing an object in front of them (concrete), but become dysfluent when describing the rules of a complicated game (abstract). In this context, the SLP will work with the client on strengthening specific language skills so that they become less-demanding tasks while they are speaking.
- Motor: Looks at the sensory and motor control an individual has over their speech movements. Treatment in this area could involve teaching a child techniques for “fluency shaping” or “stuttering modification.” The goal isn’t necessarily to eliminate stuttering, but to manage it and give the speaker more control in situations where they want to be more fluent.
- Social: Addresses the fact that an individual’s fluency can change in various situations or when speaking to different people. This component of therapy targets listening and interaction skills in a variety of social situations.
Fluency is more than a motor issue, and therapy involves more than practicing techniques to help the person eliminate stuttering. Many of the techniques an SLP would use onsite work well in telepractice settings. There may even be some resources that are more accessible through telepractice! There are various online and multimedia tools that can be used to target cognitive, affective, motor and social processes around stuttering. Additionally, parent and other family members can more easily participate in understanding and changing affective and social factors. Likewise, some telepractice platforms allow the SLP to connect clients with one another in a supportive way. Someone can literally be the only person for 100 miles who stutters, and still benefit from group therapy sessions with peers.
There are a few studies which demonstrate that fluency therapy can effectively be delivered through telepractice. Two Canadian studies, Sicotte et al., (2003) and Kully, (2000), showed that clients who received stuttering therapy through telepractice made and maintained gains through this mode of service delivery. In Australia, Carey et al., (2010) and O’Brian et al., (2008) found that telepractice was an effective alternative for administering the Camperdown Program- an application for addressing stuttering.
Fluency is a complex issue that needs to be approached from a variety of angles. Telepractice has the potential to allow SLPs to understand and directly address the different needs of people who stutter. It can also facilitate families in supporting loved ones who stutter and provide access to a wide range of resources.
- Carey, B., O'Brian, S., Onslow, M., Block, S., Jones, M., Packman, A. (2010). Randomized controlled non-inferiority trial of telehealth treatment for chronic stuttering: The Camperdown program. International Journal of Language and Communication Disorders, 45, 108– 120.
- Craig, A.; Hancock, K.; Tran, Y.; Craig, M.; & Peters, K. (2002). Epidemiology of stuttering in communication across the entire life span. Journal of Speech, Language and Hearing Research, 45: 1097-1105.
- Healey, E.C., Scott Trautman, L., and Susca, M. (2004). Clinical applications of a multidimensional model for the assessment and treatment of stuttering. Special Issue on fluency disorders in Contemporary Issues in Communication Disorders, 31, 40-48.
- Kully, D. (2000). Telehealth in speech pathology: Applications in the treatment of stuttering.Journal of Telemedicine and Telecare, 6, S39– 41.
- O’Brian, S., Packman, A., Onslow, M. (2008). Telehealth delivery of the Camperdown Program for adults who stutter. Journal of Speech, Language and Hearing Research, 51, 184– 195.
- Sicotte, C., Lehoux, P., Fortier-Blanc, J., Leblanc, Y. (2003). Feasibility and outcome evaluation of a telemedicine application in speech-language pathology. Journal of Telemedicine and Telecare, 9, 253– 258.
- Wilson, L., Onslow, M., Lincoln, M. (2004). Telehealth adaptation of the Lidcombe program of early stuttering intervention: Five case studies. American Journal of Speech-Language Pathology, 13, 81– 93.