School of Speech Ep 22 === [00:00:00] Carolyn Dolby: Welcome to the School of Speech podcast presented by SpeechTherapyPD. com. School of Speech is designed specifically for the school based SLP to come together to discuss current topics, tackle difficult situations, and share our insights. Our goal is to bolster confidence, celebrate our triumphs, and foster a community Dedicated to the excellence in the school setting. [00:01:07] Carolyn Dolby: Welcome everyone. Thank you for joining us. I am Carolyn Dolby and I am your speechtherapypd. com podcast host for School of Speech. School of Speech is designed for school based SLPs to come together, to explore trends share insights and champion our expertise. Our goal is to bolster confidence, celebrate our triumphs and foster a community dedicated to the excellence in the school setting. [00:01:34] Carolyn Dolby: Today's episode is Stuttering Service Delivery in the Schools, Early Childhood Edition. In this episode, we welcome back Nina Reeves and we are going to be shifting our focus to stuttering support with our early childhood population. Nina is here to discuss effective tactics and techniques for supporting our young children and their families. [00:01:56] Carolyn Dolby: I'm so excited that Nina is going to be helping us determine appropriate treatment approaches and develop. Really goals that are attainable. She'll be navigating our discovery of innovative strategies that increase fluency, enhance communication skills, ensuring that our young learners have the tools and the confidence to succeed. [00:02:17] Carolyn Dolby: Just a little housekeeping. I'm going to do our disclosures. Nina receives royalties for intellectual property and has ownership interest in stuttering therapy resources. She's also receiving an honorarium for her participation with, with us today. Non financial, she is on the National Stuttering Association Volunteer Consulting and Advisory Board. [00:02:40] Carolyn Dolby: For me, I am a salaried for my district as a district support SLP for dysphagia and public school system. I am compensated for my graduate work for the University of Houston, and I'm a consultant for school districts across the nation supporting their program development and staff training. I also receive compensation from Speech Therapy PD for her hosting this non financial. [00:03:05] Carolyn Dolby: I'm a member of Texas Speech and Hearing Feeding and swallowing task force. I volunteer for feeding matters. And I'm also a member of ASHA's special interest groups, 13 and 16. Without further ado, I really want to tell you more about Nina. She is a board certified specialist in stuttering. She is nationally recognized workshop presenter in the area of of stuttering and is the author of clinic. [00:03:32] Carolyn Dolby: She's a co owner of Stuttering Therapy Resources. She is a recipient of many awards, including the ASHA Foundation Van Hatten Award. And she's also an ASHA fellow. She's amazing. And we are so happy to have you. Welcome, Nina. How are you? [00:03:51] Nina Reeves: I'm doing well. Thanks for having me back. [00:03:53] Carolyn Dolby: I know. Well, by popular demand last episode, we we were talking about school aged students and our audience was amazing and basically begged you to come back. [00:04:06] Carolyn Dolby: And here you are. And I love that you're going to really this focus is going to be on early childhood. And that's where we're going to go. But before I start, if those that are listening, I don't want you to forget the her first episode was called Embracing Verbal Diversity, Navigating, Stuttering Service Delivery in the Schools. [00:04:25] Carolyn Dolby: I'm going to say that again for our listeners again at the end, but I want to make sure that everybody goes and listens to that episode as well. But I say we jump right in and we're going to be talking all about early childhood. So do you want to start us off about what assessment looks like with children coming into our child our early childhood special education programs? [00:04:45] Nina Reeves: Yes, I think, I think that's a good place to start. I want to frame the discussion by sort of leaning towards that verbal diversity idea because it's, pardon me, it's applicable for early childhood. stuttering therapy as well. You know, there's been a lot of changes in therapy for students who stutter and it continues to evolve in the neurodiversity era. [00:05:09] Nina Reeves: The same holds true for work with young children who stutter. And what I want to start us out with is that the most important understanding is that we want to see our early childhood kiddos and our therapy with a twofold goal. Number one, we want to increase the potential that our early intervention, our appropriate early intervention for stuttering is, To guide Children and help them have a larger opportunity to not become chronic to have stuttering not become chronic, right? [00:05:43] Nina Reeves: We're not going to cure them. We're not going to make their stutter go away, but we are supporting that opportunity for Children who have started to stutter to maybe move through the stuttering. Okay, we're also going to create those communication environments that are stutter affirming. I know, stay with me, stutter affirming environments because we're creating that comfortableness. [00:06:12] Nina Reeves: No matter how I talk at three or four or four and a half years old, everybody loves me just the way I am. Okay. Now this is, we have been talking about this for decades. My coauthor and I Scott Yarris, we talk about this all the time. Somehow. We've been talking about how it's okay to stutter for quite a few decades, but I'll date myself, but that somehow now we have this language and this groundswell of the neurodiversity era. [00:06:44] Nina Reeves: And now there's language surrounding it and everybody's starting to actually listen. And so it's really exciting for us to go, yeah, no, not just okay to stutter a little bit. It's okay to stutter the whole thing. And that can be a huge paradigm shift for caregivers, for teachers, for kids, and especially our profession, who has been rooted in the medical model for quite some time. [00:07:12] Carolyn Dolby: Agreed. Yes. Agreed? [00:07:14] Carolyn Dolby: Agreed. [00:07:14] Nina Reeves: And the medical model is fine for certain things that we work on, but as far as kids with a neurodiversity and stuttering is neurologically based. We can't, we can't get away from that. That is science. It's genetic for some and neurological for all. And so since we're not going to rewire anyone's brain, you know, We're just now having said that the cool thing about early childhood is is that their little pliable brains are not hardwired yet. [00:07:48] Carolyn Dolby: Wow. [00:07:49] Nina Reeves: No, that's why we hear in our graduate programs. And when, you know, when we talk about early childhood, we know that many, if not most kids who start to stutter will move through that. Okay, they throw around the, the. The zeitgeist is that it's 70 to 80 percent of the kids who start to show stuttering will move through it. [00:08:13] Nina Reeves: But that, you know, that sounds great, right? Yeah. 80 percent, unless you're the parent of the kid with the 20 percent chance of chronic stuttering. Okay. That doesn't feel so comfortable. No, it does not. Right? 20 percent's a big number. And so our job is to take that population. And we're going to talk about how can we figure out who is who, but we don't have guarantees. [00:08:41] Nina Reeves: How can we take that population and increase the opportunity for them to move through it? Okay. So as we think about that, we can talk about the assessment as finding out what has happened before this child has gotten to us. What is happening now, right? And we're going to look at those key factors that maybe lean towards persistence. [00:09:10] Nina Reeves: And we're going to figure out if this child is more or less likely to continue to stutter. So we're going to talk about that in our assessment. [00:09:19] Carolyn Dolby: Okay, so, what is the, when you said what's happened before, as in, are you asking, like, how long have they been studying? Is that that? Okay, [00:09:30] Nina Reeves: Absolutely. So let's, let's lean right into that. [00:09:33] Nina Reeves: We're going to do a background. about this child. We're going to, you know, use some checklists, some forms, some interviews. We'll get the general background information with which we do with all our kiddos. You know, we want the medical history and any past therapy. What's been going on with this kiddo and what have the parents or the, you know, caregivers heard. [00:09:57] Nina Reeves: About what's going on. How long has it been going on? So, so we want this general background and the stutter related background info. Yeah. And yeah. And we're, we're going to interview the child, which sounds like, okay, how do you interview a three or four year old? But we're going to talk about talking child and we're going to see how things are going, right. [00:10:22] Nina Reeves: We're going to interview those caregivers about their concerns. If there's any other concomitant or coexisting things going on with the kiddo. And what advice have they been given? [00:10:35] Carolyn Dolby: Okay. I see where you're going here. Cause I'm thinking you're going to, we need to know what they, what they know or what they think they know. [00:10:44] Nina Reeves: Yes. [00:10:45] Carolyn Dolby: I'm starting to feel we're going to get into some re education components. Okay. [00:10:51] Nina Reeves: And you said it in the intro, of course we can support the kiddos, but more importantly, we are going to support the families. Any early childhood educators surrounding this child, because this is that, this is that time where we're going to create or help to support the comfortable communication environments, not ones that say, now, honey, stop, slow down, start over, take a deep breath, think about what you're going to say, just relax, [00:11:21] Carolyn Dolby: right? [00:11:23] Nina Reeves: All of that well meaning advice that comes from people Who don't really understand what stuttering truly is. [00:11:32] Carolyn Dolby: Oh my gosh. I know. I know. This is just, I know everybody else also that's listening, we're all going, oh, I know that I've done one of those before. I know. I know. I've said, oh wait, just a moment. [00:11:48] Carolyn Dolby: Take a deep breath. Give it a minute. I mean, I, I know we're all of us listening, but you know what? We're here and now we're going to, we're going to learn because when we know better, we're going to do better, better. But anyway, I don't want to stop. I want to go back a little bit to the, to that, how important that piece is to understand what the caregiver, the teacher, what are their beliefs? [00:12:17] Carolyn Dolby: What do they think about it? [00:12:20] Nina Reeves: Yes, [00:12:21] Carolyn Dolby: I haven't heard that before. I need everyone to hear that. How important it is to ask that direct question. What do you think stuttering is and what have you been doing? What do you think works? What? [00:12:34] Nina Reeves: Yes. Yes. So how do you and if you're just listening, Nina's holding up the air quotes. [00:12:39] Nina Reeves: Yeah. Help your child when they're having some trouble talking, right? Cause that's usually stop, slow down, start over, whatever, you know? So we're going to, we're going to find out what's been going on, how long it's been going on, because one of the things we know about stuttering in general, and we talked about this last episode is that it's variable at its core. [00:13:03] Nina Reeves: And in early childhood, we talk about sort of that cycles as well. It's here, it's gone, it's back, it's higher, it's lower. So it's maybe cyclic and variable. And that's what keeps caregivers from getting the kid in the door, is because the kid started to stutter and then they didn't hear it for a while. [00:13:22] Nina Reeves: And it went, quote unquote, went away. And then it comes back. And then it's, but what happens is this is sort of, For many children, not all, some start to stutter and they just stutter and you know, there's no cycles. It's just variable. And the parents are like, Oh my gosh. And, but we know that that sort of prolongs the referral sometimes because another thing is that, you know, well meaning pediatricians say, don't worry, they'll grow out of it. [00:13:53] Carolyn Dolby: Yes, I feel like that is their catchphrase for almost everything. I'm coming from the feeding world and when a parent says, well, I went to the pediatrician, they said, Oh, they're a picky eater. Oh, they'll grow out of it. [00:14:05] Nina Reeves: Oh, I know. And so that's been a big part of the stuttering world's trying to educate pediatricians, which is great. [00:14:13] Nina Reeves: However, that again, we have to be cognizant that the parent is or the caregiver has gotten conflicting advice prior to what, you know, they've gotten on the internet, which is, you know, very dicey. And they've gotten the pediatrician or they got aunt Betty or, Oh, don't worry. Your cousin grew out of his, you know, whatever. [00:14:37] Nina Reeves: And so, It's all everybody has an idea, except no one really knows what stuttering is. And so this, this, this caregiver is like, Oh my gosh, what am I doing the right thing? Did I wait too long? And then the guilt and the worry starts to compound, right? So we want to gather all of that. We want to know what's going on with the caregivers as well as with the child. [00:15:03] Nina Reeves: Because How the caregiver believes is what they're going to then behave. Okay? Beliefs drive behaviors. Yes. And so, you know, they're talking faster than they can think. Oh, let's slow down, honey. Oh. They're thinking faster than they can talk. Just think about what you're gonna say and then say it. Okay, not realizing that's just a trick in the moment to get a different neurological pathway to happen, and it didn't make the child fluent. [00:15:36] Nina Reeves: It just switched the neurology and there may be fluency in that track. I don't know. So it's very complicated, but also. Extremely scientific. This is not some aberration that sort of appears. It's, it's, you know, very science from neurologically based to the factors that impact it. All right. So speaking of factors that impact it, [00:16:01] Carolyn Dolby: let's yeah, let's get into that. Right? It goes [00:16:03] Carolyn Dolby: out on me. Yeah. [00:16:04] Nina Reeves: So, as always, I'm going to refer every listener to the ICF Framework, okay, the International Classification of Functioning, Disability, and Health from the World Health Organization. And they can find so much about that on our website. In all of our writings Scott Yarris was one of the co authors of the ICF as it relates to stuttering. [00:16:26] Nina Reeves: Okay, so it's there for the understanding that we are going to look at function, reactions, environment, and impact, function, reaction, environment, environment, impact, and impact. And that's how we're going to think about the referral. It's how we're going to think about the assessment. It's how we're going to think about writing goals and doing therapy. [00:16:52] Nina Reeves: Even with early childhood. You know, solidly in the school age, but even with early childhood, I want us to think about that bigger picture because everyone for hundreds of years has only been focused on the moment of stuttering. True. And I'm going to say this, the moment of stuttering that we can see, which is not Very many of them. [00:17:17] Carolyn Dolby: Okay. If those of you that are just listening, I kind of have an I guess this is an aha because you're what this is a tip of an iceberg that you just hit. Yes. When you just said that we judge stuttering from what we can see and you're telling us that we are not seeing it. Okay. Even [00:17:41] Nina Reeves: we're seeing some that we're seeing. [00:17:46] Nina Reeves: That is why you're not going to hear me say, let's count some stutters. [00:17:51] Carolyn Dolby: Okay. Right. Like how many times are they stuttering? [00:17:56] Nina Reeves: Right. How many times are they stuttering? Well, only it's only the amount of times you saw them. Yeah. I bet. I bet some of our listeners remember Sheehan's iceberg, Joseph Sheehan's iceberg, where the tip of the iceberg is what you can see above the surface. [00:18:13] Carolyn Dolby: Yeah. [00:18:13] Nina Reeves: So it's as Scott and I play around with these words. It's the listener's experience of the speaker's stuttering, but it's not the speaker's experience of their stuttering. The internal I'm stuck. We may never see. Okay. How, I mean, we'll see it, but Yeah. No, no, I know what you mean. We won't won't, yeah. [00:18:36] Nina Reeves: Yeah. The internal stuckness in that vocal tract and in that whole system. Mm-Hmm. of, you know how speech happens, there's a moment of stuckness and then there's like, okay. Trying to get it out. Yeah. So we may see the re repetition, the prolongation or the. Block, we may see it, or it may be subclinical. Like it's, you can't even, it's there, but it's, you can't see it. [00:19:06] Nina Reeves: So that's why counting stutter is, is a total waste of time, but I digress. We'll, we'll talk about it. [00:19:12] Carolyn Dolby: Okay. Okay. It is, you know, we're not going to be cutting, counting, stuttering. Okay. [00:19:19] Nina Reeves: No. And, and I will talk about, and you're going to remind me to talk about the fact There are many people that expect in the public schools that we have a count. [00:19:30] Carolyn Dolby: Yes. [00:19:30] Nina Reeves: So let me just get that off the table right now. [00:19:33] Carolyn Dolby: Let's talk about that. [00:19:34] Nina Reeves: Let's talk about that. I have counted my students stuttering over the past 20 years, once every three years, because I'm forced to. [00:19:42] Carolyn Dolby: Right. [00:19:43] Nina Reeves: That's it. I never count a stutter in between. I don't care how many times I see their stuttering. their surface stuttering because that doesn't translate into their experience of stuttering. And so, but we do have to be observers. I am not going to take that away because three year olds usually can't say, you know, I'm feeling stuck in my vocal cords. And You didn't see that, but I was stuck like for three seconds. [00:20:14] Nina Reeves: They're not going to be able to tell us that. So we will need that observation. I'm not taking it away, but I'm taking away, if I could be so bold, the the reliance on that for number one, eligibility. It should never stuttered or didn't. Cause it's not real. And number two, any kind of progress in therapy cannot be measured by how many times you saw that child stutter. [00:20:48] Carolyn Dolby: Okay. [00:20:49] Nina Reeves: I know it's big. [00:20:50] Carolyn Dolby: This is big. This is a mind shift. So I'm going to just, as I'm soaking in, this is my question, because I know that a lot of times we will write as in the eligibility, that they are mild stutter, they are severe. Severe and pro so you're saying that that is our experience and therefore it's not a true, it's not true representation. Therefore, that eligibility should not be that they're a mild stutterer because that is our perception of what it is. Okay, I hope all the listeners and watchers, you just got to [00:21:37] Nina Reeves: stay with us. Stay with us. [00:21:39] Carolyn Dolby: Okay. [00:21:39] Nina Reeves: This is big. This is a shift. It's a, it's a culture shift, culture shift. It's a culture shift, which is slow and you have to be patient and persistent. [00:21:52] Nina Reeves: Right. Yeah. And you have to be understanding and give grace, but you're, you're also not going to wait forever. It's like, okay, come on people. Let's move because here's the deal. Neurologically based neuro diversity. Which means it's a difference, not a defect. [00:22:10] Carolyn Dolby: I like it. Yep. [00:22:11] Nina Reeves: That's, you know, that's a singer Judy Singer, right? [00:22:15] Nina Reeves: Mm hmm. 1999, I think. And, and everybody before her, that was just, she coined it in, in writing. I think she has already said, I just I know it from all my discussions with neurodiverse people start listening to neurodiverse people, as we know, with the autistic community and all of that. So that's what that groundswell has become is that it's now looking at not just what you see on the surface, but what the person is experiencing. [00:22:44] Nina Reeves: So let's just take this for a moment. I know we're, we're moving a little different, but we have to stay here. If I'm going to talk about what we're going to assess. And how we're going to look at progress in therapy and write goals. We can't move from this spot till we think about the fact that the, the speaker's experience of stuttering doesn't always translate to what we see. [00:23:09] Nina Reeves: So if we're relying on what we see to determine eligibility or determine progress in therapy, we're looking at the wrong thing. Okay. We just are. Okay. All right. So we're going to shift away from that and use that ICF model. That's why I, I so talk about the ICF model, which is in our scope of practice, by the way, because it tells us this, it's the bigger picture. It's not just the impairment of body structure or function. It's the reactions, the environment, and the impact. That is, and they all feed on each other. All right. So, okay. So when we get those observations, it's still very important to, to take a look at what we see. We just can't stop there. Yeah. If you're forced to count some stutters, count some stutters once every three years for the triennial and move on. [00:24:04] Carolyn Dolby: Got it. [00:24:05] Nina Reeves: Right. Okay. There may be something someday, maybe about. Assessing without counting stutters, maybe, wink, wink, but right now not yet. So. Let's talk about the fact that we're, if we do it, we're just gonna say, this is a snapshot of what I could see on these two days with this, you know, in these two speaking situations, or three speaking. This is a great snapshot of what I observed. [00:24:33] Carolyn Dolby: I think that's important. What you're saying is when we're writing that up, that we need to say, we need to be transparent. That what we're saying is, this is what I ob, the clinician observed this. Not saying that this is the end all because we're just saying during this time, this is what my impression, what I experienced. [00:24:57] Nina Reeves: Yes. [00:24:58] Carolyn Dolby: Yeah. [00:24:58] Nina Reeves: What I observed about your child's surface stuttering behaviors. Okay. [00:25:04] Carolyn Dolby: Did you hear that everyone? This is what I observed of your, of your child's surface stutters. Yep. So I had to repeat that Nina. That's. Powerful. Thank you. [00:25:18] Nina Reeves: Well, I love that because it's the idea of saying, okay, this is why you're not going to hear me talk about. Now we're going to try to decrease those moments of stuttering. Okay. Right. Cause that's going to be chasing a grease pig. Cause you know, stuttering is variable and you're not seeing all of it anyway. What if the child, let's just say a five year old. That's not in kindergarten yet, and it is in your early childhood has already figured out. [00:25:47] Nina Reeves: That people don't want to see him stutter or he's uncomfortable with his stutter. So he just changes the word or he doesn't say as many words. So he has apparent fluency, but he was stuttering on the inside. Wow. And that is not something we want to rejoice about. No. Yay. You hardly stuttered at all. When we praise fluency, we are looking at the wrong thing. How about we shift to communication? Let's praise communication. Stuttered, non stuttered, high, low, fast, low, smooth, bumpy. Let's just praise communication and look for, is this child communicating effectively, getting their point across in a variety of settings, Which is most state standards, you know, [00:26:39] Carolyn Dolby: yes, [00:26:40] Nina Reeves: child will communicate effectively in a variety of settings. It doesn't say the child will communicate fluently. No, there's some reading fluency stuff that everybody gets all confused about. But this does not say fluency anywhere. And if it does, somebody better contact their state, right? Because nobody's fluent. Everybody's disfluent and some people stutter. [00:27:05] Carolyn Dolby: Okay. You just said that everyone is disfluent, but only some stutter. [00:27:13] Nina Reeves: We are, we all jumble our words. So when everybody goes, Oh, I stutter too. It's like, no, you don't. Do you have an out of control, physical motor manifestation of a neurologically based condition? No, you don't. You, that was a language thing or just a moment of word finding or you revised. [00:27:33] Nina Reeves: Yes, we are disfluent, but there is research and this is Scott's research and his colleagues it's stuckness. There has to be some stuckness. That's the, the, the, the rubber meets the road. They're trying to move forward with their speech and they can't, they know what they want to say. They can't get it out of their mouth and how tight, you know, a little tight, a lot tight. [00:28:00] Nina Reeves: And I'm just going to say this is going to be heresy for some people, but I took, I took the, the severity ratings off of whenever I was working with a district, the severity ratings had to go. [00:28:12] Carolyn Dolby: Okay. That's kind of, I couldn't remember that. That's what I was kind of getting to earlier. And then I couldn't remember what it was called the severity rating. Yeah. [00:28:21] Nina Reeves: So it's fine. They're on the assessments. It's fine. But when you say to a, to a parent, Or, you know, the grandparents that are taking care of the child, whoever it is, the caregiver. And you say this child has a severe stutter. I mean, why? First of all, the child is not severe all the time because stuttering is variable. [00:28:44] Nina Reeves: It was that snapshot in that moment. They had a significant amount of stutters or that was pretty tight. So let's use descriptive words, right? We can talk about, you know, there was a significant impact. Okay, but not that there's a significant stutter because what if there's a child who stutters big, but doesn't care and talks up a storm? [00:29:09] Nina Reeves: Oh, they haven't they have severe stuttering on the outside, but inside they're they're not as Impacted and they're just communicating. So it's not a one to one correlation how much stuttering you see Doesn't really define then how much impact the child has it's not a straight line You There can be a mild stutterer that is totally freaked out and doesn't want to open their mouth. [00:29:38] Carolyn Dolby: Which goes to when you were talking about the example when you talked about the kindergartner that figured out that certain words. So he, he shortened his MLUs, possibly. [00:29:50] Nina Reeves: Possibly. Or just switched the word, or, you know. I'm telling you, this is a, is something to be thinking about. Like, how did that child get fluent in that moment? [00:30:03] Nina Reeves: They could have just had some fluent speech. Kids who stutter have fluent speech. They have flow. They don't get stuck. They have regular disfluencies, you know, like we all have. And then they have some stutters and then they have some fluency. So it's a mix. So they could have just had some regular fluency. [00:30:19] Nina Reeves: They could have been avoiding. And of course you know, they could have be trying to manage it or control it with the old way of like turtle talk and all of that. We're getting rid of that. Let's have a funeral for the turtle. [00:30:34] Carolyn Dolby: Okay, everybody, goodbye. R. I. P. Goodbye. [00:30:39] Nina Reeves: R. I. P. Oh, we should do that little turtle upside down. [00:30:42] Carolyn Dolby: Yeah, totally baby. [00:30:44] Nina Reeves: Sorry, we're going to get to that. So anyway, this is all important because see how all this weaves together how the therapy we're talking about assessment. And right away we're understanding that the therapy is not going to look like what we thought it was going to look right. [00:31:02] Nina Reeves: We're going to do these background things. We're we'll back to that. Okay. We got the background and then we're going to do some observations, which I said are fine and great, as long as we don't put too much, you know, emphasis on them, the caregiver, I want to see the caregiver and child interact if, you know, caregiver can send me, you know, in the schools, we can't always have that. [00:31:26] Nina Reeves: So send me a video of just playing. Don't interrogate the child, just play, and let's just watch, okay? The child's speech in various situations, okay? Some videos from home, some things we do in the therapy room. You know, different, you know, speaking situations where, you know, they're just, we're just chatting and then we try to have them do the remote event. [00:31:49] Nina Reeves: Like, tell me about the time you went to the amusement park. So see how language load, we have to bring our language knowledge right to this. Okay. Cause language load impacts the system. Of a little kid. Yeah. And may impact how much stuttering you see or not. Okay. We just have to be, we have to be cognizant. [00:32:12] Nina Reeves: We're just not going to have the kid do one thing and go, here's your stuttering. It's going to have to be a couple of different speaking situations. [00:32:19] Carolyn Dolby: Okay. I see what you're saying. Yeah. Right. Just having them tell me about this picture. [00:32:25] Nina Reeves: Right. And that's great. Like, but then they describe or they point and they say, you know, words. Okay. And then we want to say, Oh, tell me about a time that you went to this amusement park or amusement park like this, and then the language loads gets going and then there's a different neurology happening and we just want to bring all that in. [00:32:44] Carolyn Dolby: Okay, [00:32:45] Nina Reeves: we're going to see that. And then we're going to do some baselines because kids who stutter don't always come with just stuttering, they may have some language. some articulation, some phonology. We want to make sure their hearing is fine. I love to have a little temperament scale if I can, but I know a lot of school districts don't have those, so I'm not even going to talk about it. But I do ask about it on these checklists. When we write our checklists and our things for parents to fill out, we do kind of write, you know, how does your child deal with, you know, changes and different situations and things just want to know. [00:33:21] Nina Reeves: And then when we do the protocols, okay. The protocols in the interviews, we're going to look back at that ICF, and we're going to realize we're going to do some age appropriate interviews with the child with others, and then the assessments of the speech fluency, right, and the stuttering. We have things like the. [00:33:44] Nina Reeves: Hmm. I think the SSI goes down that far. I don't think the TOCS, the TOCS does not go down to the preschool age, the test of childhood stuttering. So we do that. I haven't done, oh, I'm not going to say that. I don't, I use a, I do a transcription, like a language sample. Okay. I video every single. every single stuttering assessment ever. [00:34:12] Nina Reeves: There's no reason not to video these things because then you can see, is there tightness elsewhere? Are there secondary features? Did that child switch that word just now? What am I looking at? Okay, so we're still observing, still important. But I'm videotaping it. So I don't have to try to do something on a piece of paper. [00:34:33] Nina Reeves: I'm just listening to the child, letting the video roll. And then I'm going to go back and write a narrative about what I saw. [00:34:43] Carolyn Dolby: That is amazing. Think about thinking of me when when I was a campus speech path doing. Right. And they're watching you. What did you, [00:34:54] Carolyn Dolby: yeah. Rather than, okay. [00:34:56] Nina Reeves: They're watching you do pluses and minuses on a piece of paper. I even have clinicians have told me they do the clicker underneath. This is a fluent, I'm like, no, no, no, let's stop, sit back and wonder what is that child thinking while you're doing it. Some of them don't notice many of them do. Yeah. They know what a plus is and what a minus is something good and something not good. [00:35:21] Carolyn Dolby: Absolutely. [00:35:22] Nina Reeves: I'm going to do that. We're just going to let the video roll and we'll do that assessment, but we also want to do, okay. So that's the. You know, function, right? Observable seeming function. Then we're going to do the reactions. We want to know from others and from the child if how they feel about their communication. [00:35:45] Nina Reeves: Okay. Do you like to talk? Who do you like to talk to? All of those types of things. And then finding out if the caregiver has noticed any change in the child's You know, are they withdrawing? Do you feel like they're giving up? Or do they seem frustrated? Okay, I've had parents tell me, oh, mommy, you say it. [00:36:08] Nina Reeves: You know, three and a half years old, the kid's going, mommy, you say it. After they get stuck, not just because they're shy. I'm not trying to change a shy personality. They get to be shy, but if it's about the stutter, we can see some of those things. Yeah. And we can ask too, because not all preschoolers are three. [00:36:25] Nina Reeves: Some preschoolers are five. [00:36:27] Carolyn Dolby: Yeah, they are. [00:36:28] Nina Reeves: And you can have different conversations at different levels. Yeah. We're also going to find out what the environment knows. We already decided, you know, in those checklists and, and things, but we do have to take on the idea of making sure we know what the culture, we want to be culturally perceptive and, and understand to make sure, what does that culture view stuttering as? [00:36:52] Nina Reeves: How is it viewed in the family? Sure. How is it viewed in the classroom? Sure. And is there a cultural background to this? Okay. And then we want to find out about the impact. So it's the function reactions, the environment and impact. That's where the parents might say she's frustrated. She gives up. She holds her mouth over her, her hand over her mouth when she gets stuck or when her speech is bumpy, whatever they say. [00:37:20] Nina Reeves: And then we're going to also watch for those things while the child talks. As well. And what they're saying to us, you know, yeah, I've had little kids say I get bumpy and I don't like it. [00:37:34] Carolyn Dolby: Wow. That's your diagnostic right there. [00:37:37] Nina Reeves: That's that. That's reaction. And then probably impact follows. Right. And that might be internal, or it might be from the environment saying, now, honey, because everybody's trying to fix it. [00:37:52] Nina Reeves: Well, meaning boy, are they normal? I don't tell parents like, wow, that was, you know, not good. It's more like, hey, of course, you're watching your child struggle with something. And You want to help it. You want to fix it. All right. So we're going to gather all this information. We want to know how willing is this child to talk if they're bumping along and talking all over the place. [00:38:17] Nina Reeves: It's like great news because we're no longer focusing only on the bumping along. We're focusing on chatting up a storm. I'm getting my point across. I want to talk to everybody. But we have to then look at that persistent for stuttering analysis. And I told you I was going to get to that. So let me make sure I do. [00:38:36] Nina Reeves: You know, there's been a huge amount of research done. in decades and decades. There have been some really good reviews of the research of late that have kind of told us, okay, that no longer really stands. Somebody did that nice study with three kids and that no longer stands. That's good. We need to know that. [00:38:58] Nina Reeves: But the things that we want to think about children who persist compared to children who eventually move through this are more likely to be male. It just is. We have more males who have all kinds of communication issues. We have more males on our caseload. We just do. Yeah, we do. They catch up later, but you know, they're more likely to be male. [00:39:23] Nina Reeves: They begin stuck or they may begin stuttering at a later age. That's, that's a factor towards persistence or they have known family histories of stuttering. Okay. Either persistent or recovered. I want to know the family history. Talking to a parent this morning. Oh my gosh, but my, my, my husband had some speech impediment. [00:39:45] Nina Reeves: This is what she said. And he, he, he went, it, it, it went away. So we're hoping that for my son who's 12, by the way. Oh boy. All right. That's okay. But that's what they know. Then I found out her husband never stuttered. It was articulation. Everybody lumps speech together. He didn't grow through stuttering. He, he went to speech therapy and got some articulation. [00:40:13] Nina Reeves: He, he wasn't understandable at what, and so that child had been going, I want to be like dad. I want it. I want this to go away. Like dad's did. It never happened. No. So we have to be very, we have to grab, grab that information and pull it out. Is there a known family history of actual stuttering? Okay. Right. [00:40:33] Nina Reeves: Not an urban legend, but actual stuttering. And then we see kids with a higher rate of stuttered stuttered disfluencies, like a higher, there's more stuttered than non stuttered. Oh, okay. Because we don't just measure stuttered disfluencies, we look at non stuttered. The things that we do, the revision, the the is the child using an and because they're three and they're just learning language? [00:40:57] Nina Reeves: Or are they doing it to try to get a stutter started? We have to be watchful of that. That's why the video helps. Yeah. And then you know, we want to look at those other factors like speech, sound, accuracy, expressive language, receptive language. We want to see if there's any other things going on because that affects communication. [00:41:20] Carolyn Dolby: Sure. [00:41:20] Nina Reeves: And since we're looking at communication, we have to look at all of it. [00:41:24] Carolyn Dolby: Absolutely. [00:41:25] Nina Reeves: So the factors that have come out that have data that let us, you know, there used to be like 10 more and now we're down to those that really sort of, hold tight. Now I can have all of those going on and the kid can move through their stutter in six weeks. [00:41:40] Nina Reeves: I can have none of them going on and the child may stutter persistently. [00:41:45] Carolyn Dolby: Okay. [00:41:45] Nina Reeves: Okay. So we don't have a guarantee. These are what we do clinically with our evidence based practice that says, Okay, this child has some of these factors towards persistence. And so I'm, my my radar is up for eligibility for putting them into therapy. [00:42:07] Nina Reeves: Yeah. They don't have to have a lot of them, you know, to have therapy. I'm just saying we want to know these things. Okay. Right. And so that's, that's the assessment aspect. [00:42:22] Carolyn Dolby: I, I think my takeaway I mean. Everything's been amazing. I think the one takeaway is that video component, you're saying, and, and again, it's a comprehensive assessment is what you're saying. [00:42:37] Carolyn Dolby: It's not just counting stutters. It's the whole language and looking at it. I'm hoping, I'm just trying to get this for our listeners too. It's the whole language of communication. [00:42:50] Nina Reeves: It's the whole enchilada, the whole enchilada, we want this child's experience of communication, all of it. So that because those factors give us inform our decisions and then inform our therapy planning, which leads us right into goals. [00:43:08] Carolyn Dolby: Yeah, that is a great segue because I know that's a way right in there. Okay. So now we've done our assessment. We've got the eligibility. Now. Yeah. How do we even look at goals now? Because most of us are like, Oh, I did. I did the goal that they're going to decrease their fluency. Yeah, exactly. [00:43:30] Nina Reeves: Yeah. Now here's where this is. This is where we're still sort of, we have to think about this. Right? So, We don't want to be ableist and say this child needs to get fluent. Okay. Right. But in early childhood, not, but, and, and in early childhood, we want to also think about the fact that we have this little window of opportunity to try to move forward the, the needle, maybe away from persistence. Okay. So it's not a cure, but we're moving the needle away from persistence and back towards you know, non stuttered speech. Okay. Okay. Notice I didn't say fluent speech. [00:44:09] Carolyn Dolby: No, you didn't. Non stutter. [00:44:11] Nina Reeves: All right. Non stutter speech. So We, it's, I have a blog that I'm going to be writing in the next couple of months. [00:44:18] Nina Reeves: It is, it is, is it ableist to even talk about fluency and you know, I'm sure everybody has a different view of it. But I am thinking in this little part, it's okay to say we're going to try to help the child have some more flow. We're just not going to have them talk different. Like we're gonna, and we'll get to that in the, in the goals and, and then the therapy part. [00:44:41] Nina Reeves: How are we going to expand this opportunity for them to have easier communication? Mm-Hmm, . Okay. Well, we're gonna, we're gonna look at the communication environment that this child is under, and that's when we get into the parents, the teachers, the caregivers around the child and say, you know, let's set up a communication environment that decreases the stressors. [00:45:06] Nina Reeves: Okay, on the child's system and increases their opportunity for them to just take their time for talking, not slow down, not take a deep breath, right? They just get to talk without that stressor. Like I have to talk fast or my brother's going to interrupt me. I have to say it quick. You know, the kids aren't even cognizant that they're thinking this, but they're, they're like, blah, blah, blah, blah, blah, right? [00:45:32] Nina Reeves: And they're, they're three, they're four. They just want to talk. Right. So let's give them that space. Let's do the environmental things because stuttering does environment doesn't cause stuttering, but it can exacerbate it. [00:45:47] Carolyn Dolby: Right. Because you were saying that the environment. If you said we want to decrease the stressors, yeah, the stressors, the stressors. [00:45:57] Carolyn Dolby: So yeah, the environment's not causing the strut, the stutter, it's the stressors within that environment [00:46:04] Nina Reeves: can exacerbate it. They don't cause it, but they can, you know, you know, feeling like you have to talk fast you know, all of that. That's why people say slow down. But it's not about slowing down. You don't have to do artificial speech. [00:46:21] Carolyn Dolby: Did you all hear that? Not have to do artificial speech. [00:46:27] Nina Reeves: I want to ask just in their heads right now, as you're, you know, driving or listening, I want you to think how many times have you ever had a, an early childhood kid turtle talk outside of a therapy session. Do they ever go? [00:46:44] Nina Reeves: Oh, I love the turtle talk. Hi, Miss Nina. I'll tell you about the baseball game. They'll do it when you cue it and when you imitate it and, you know, they'll do it for you so they can get their turn at, you know, shoots and ladders, [00:47:03] Carolyn Dolby: right? [00:47:04] Nina Reeves: But it doesn't carry over because they're just developing speech and language. [00:47:11] Nina Reeves: They just want to talk. Yeah. Okay. So the system is fragile. The neurology, the system of this kiddo has some glitches right now, right now. So we want to create a space where we can just decrease some of those stressors. It's like stark weather and Gibbons, the demands and capacities model for those of us in, you know, back in our graduate school and like, Oh, I remember that. [00:47:37] Nina Reeves: So it's this idea, you know, we're just going to turn down the fire hose of communication. You know, you talk, I talk, I interrupt you, I'm talking fast, and I, listen, oof, obviously I'm a fast talker, okay? When I'm with my little kiddos, I try to tone it down a bit, but I used to, when I was a young clinician, talk like this, as if the three year old was going to follow that. [00:48:07] Nina Reeves: It's like, sometimes I look at old videos of me and go, really? [00:48:10] Carolyn Dolby: You're like, what was i? [00:48:11] Nina Reeves: When you know better, you do better. Yep. I love that. So now I just try to tone it down. Yep. Just, you know, speak in a way that allows some pausing, [00:48:24] Nina Reeves: you know, a little silence. I love it. To happen. Right? Yeah. And just take it down a notch. So, and creating that space where all kinds of speech are accepted. High, low, fast, low, smooth, bumpy, tight, stuck, stuttered, non stuttered. Nobody's going to stop a child, okay, and say, now try that one. Easy. Easy. Easy. [00:48:50] Nina Reeves: Right? Because isn't that a little like, oh, I don't know, ableist? No, but we are going to try to enhance the fluency enhancing environment, right? We're going to try to bring together a way that this child can feel, you know, a little more at ease with the communication. So that's the easy communication environment, healthy communication attitudes. [00:49:15] Nina Reeves: And I alluded to that with all kinds of, we have all voices. We have like verbal diversity. We have all these voices, the way our speech works and all of them are okay. We're not going to single one out and say, wait, that everybody's okay. Except when you do that. Yeah. And then we want to make sure we're writing goals that talk about expanding their participation, creating, you know, a space in those communication environments for any child that sort of started to pull back. [00:49:45] Nina Reeves: We want to increase their participation in communication, access, whatever their needs are by talking. Okay. Because we're all in essence, we're trying to decrease that adverse impact of stuttering on their quality of life. Now that's a lot to swallow. It is. You know, we're going to write those well formed treatment goals. So we're going to talk about what the child will do in what context. We all know how to do this. How much support are they going to get? What's the criterion level? How are we going to be measuring it? And what is, you know, in what frequency or period, you know, 36 instructional weeks, blah, blah, blah, blah, blah. [00:50:29] Nina Reeves: So we're going to, we're going to take all that we know about writing a well formed treatment goal. We're just going to switch away from the child will demonstrate, you know, less than 5 percent stutters in, you know, in the, in the therapy room with clinician cues. Okay. That is Having them speak in a different way or looking for progress by number of stutters that you can see, [00:50:56] Carolyn Dolby: right? [00:50:57] Nina Reeves: Yeah. [00:50:58] Carolyn Dolby: Yeah. Which you've already, I mean, I'm a believer. I know everybody we're believers now. [00:51:04] Nina Reeves: It's like, but then everybody gets nervous. Like, what am I going to do? How am I going to write it? [00:51:08] Carolyn Dolby: Okay. Okay. Now we all are on the edge of our seats. Like, okay. We've got to, we, we need now tell us. What are we going to, what [00:51:18] Carolyn Dolby: are we going to, [00:51:19] Nina Reeves: so we're going to grab that ICF. [00:51:21] Carolyn Dolby: Okay. [00:51:22] Nina Reeves: And we're going to find out what's going on with function reactions, environment and impact. And we're going to find the strengths in those areas to help, you know, we already know how to do this in language and in everything else. We're strength based. [00:51:39] Carolyn Dolby: Yes. [00:51:40] Nina Reeves: And then we try to narrow the gap of the challenges. Yes. And so that's where we're that's where we're working. I wish we could write goals for the environment. You know, the parents will the teacher well, but so we're going to write the goals that will talk about what the child will be doing as we are engaging with the caregivers. And educating the caregivers and helping them create communication environments. [00:52:10] Nina Reeves: Yeah. All right. And everybody's going to write that a little differently. I wish I could give you a goal bank, but we're never going to do that because that takes your brain away and it takes your knowledge of that child and dumps it on a page because you can write a great goal. But if you have no idea how to do it, it doesn't matter that you have a great, well formed goal that Nina Reeves said you should write. [00:52:36] Carolyn Dolby: Yeah. [00:52:37] Nina Reeves: Now that's on my paperwork, but I don't know how to do that therapy. So now we're going to go into therapy. Okay. All right. So now I'm just going to tell you, if you haven't been on our website, you know, I'm not here to sell you books, but I'm, or anything else, but if you haven't been on our website, you're missing a ton of free handouts, videos, blogs on this. [00:53:01] Nina Reeves: I think Scott has written, I've written a couple on early childhood, but Scott has probably written five. I don't know. About, you know, exactly what we're talking about, right? [00:53:11] Carolyn Dolby: Can we give the listeners and watchers your website? [00:53:14] Nina Reeves: Oh yeah, StutteringTherapyResources. com. There's our logo behind me and I'm going to tell you, we named the company what it is. [00:53:24] Nina Reeves: It's Stuttering Therapy Resources. And so when we went out to write the early childhood book, the comprehensive guide for assessment and blah, blah, blah, it was supposed to be half the size of our school age guide and it ended up being bigger. [00:53:39] Carolyn Dolby: Wow. [00:53:40] Nina Reeves: Because once we started writing, we started realizing these, this is when the parents and the caregivers are totally, they know nothing, or they think they know, but they don't know. [00:53:53] Nina Reeves: And we started writing all of these, you know, paragraphs about if the parent asks this, you, these are the concepts you need to consider. This is some things that we say, it's not a script, but why we say it. Here's the reason. So we give you the principle behind how this all comes out. And then we, I really want people to understand, even in the public schools, I had the preschool stuttering intervention groups in my district. [00:54:23] Nina Reeves: And I co taught with another SLP. I had the parents in another room while the kids were with the other SLP, we team taught, and it was just constant. This is what we're doing this week. This is what we're focusing on. You're going to have decreased verbal competition at your house. In other words, let's Let's decrease the interruptions and the rapid fire questioning, okay? [00:54:48] Nina Reeves: We're, we're still going to talk to our kids. We're going to ask questions. Don't be worried about that. But we're not going to rapid fire. What did you do today? How did you do it? What, what did you eat for lunch? You know, it's like the interrogation in the carpool line. We're just going to back off for a little while. [00:55:05] Nina Reeves: We're going to be interested in our child. We're not going to be afraid to talk or ask them questions. We're just going to take down. The stressors. Okay. And that sets up that easier communication environment and gives the parents something to do instead of stop, slow down, start over, take a deep breath. [00:55:25] Nina Reeves: Oh my gosh, let's get this done by kindergarten. And we validate that and we don't tell them they're doing something wrong. We just say, you know, let's just talk about longer term. We want them to feel okay, no matter how they're talking. Because if your child continues to stutter, and I do say those words out loud. [00:55:45] Nina Reeves: Because I don't have, I don't give guarantees. I don't say, you know, we're going to do this therapy for this long and they're going to be fine. Okay. If your child continues to stutter, we want them to have that feeling that they are okay just the way they are. We plant that seed right now and we do these other things to try to move the needle. [00:56:05] Carolyn Dolby: Okay. [00:56:07] Nina Reeves: So in, in therapy. And I, I don't want, I know we're getting to the time I can feel it but in therapy, it's just most important to you know, increase that likelihood of that return to non stutter disfluencies, but we want to have appropriate expectations for you and for the caregivers. Okay. You are not expected to cure the stutter. [00:56:33] Nina Reeves: Okay. It's what everybody wants from you. But in early childhood, we get a chance to move the needle. Okay. Maybe this child will move through this and we're trying to increase that likelihood. I'm never going to know if what I did or what the parent did was the reason this child is now on monitor and is now dismissed. [00:56:59] Nina Reeves: Okay, I'm never going to know because it's unethical for me to go, Hey kid, you don't get therapy. So I can prove my therapy works. Right. Right. It's not going to happen. So just helping them understand that variability is normal because you don't want the parent to constantly, the caregiver to the teacher to constantly, he was stuttering more today. [00:57:21] Nina Reeves: You know, should we practice, practice what? Right. Right. That. The child may stutter while they're in a hammock in the Caribbean, on the most relaxed beach you can ever see, and they could have their biggest stuttering ever. And it's not going to be anybody's fault. It's the nature of the condition. So having them understand that sort of relieves them of, he's stuttering more, I didn't give him a nap, should I have given him a nap? [00:57:48] Nina Reeves: Parents will drive themselves crazy. Sure. Okay. So we have to have that involvement. When I was in the public schools and the, the, the money started to dry up for us to team teach, it became apparent that I had to send home handouts. That's what ended up in, in this, in this book. It was the handouts about what you're going to work on this week. [00:58:11] Nina Reeves: You as mom, dad, grandma, whatever auntie, foster parent, doesn't matter. You're going to work on this one thing. Okay. And we might work on it for a couple of weeks. So, you know, and there'll be some feedback and I'll ask you about it. I'll send you an email. You write it. They have a stutter notebook. Even that early so that we can chat back and forth in an easy sort of effective and efficient way because none of us have time to pick up the phone every day. [00:58:42] Nina Reeves: Right. So we have to have that essential, essential involvement and don't forget those early childhood teachers because they're going to want to, you know, just wait, honey, you know. Yeah. They're so well meaning. We're going to think about cultural competence. We're going to make sure we're evidence based. We're going to decrease that adverse impact. And we're going to do that through that stutter affirming mindset we talked about in the verbal diversity. We switch the mindset, which then switches our model. Our model doesn't become, Oh, let's make that smooth. We don't send the message that you did something wrong when you stuttered. Oh, bumpy happens. Hi, low, fast, slow. All kinds of voices. That happens sometimes. Naturalize it normalize it. That child's neurology right now, maybe not forever, but that child's neurology right now has some stutters in it. [00:59:43] Carolyn Dolby: Mm-Hmm. . [00:59:44] Nina Reeves: And instead of thinking it as some aberrant thing that we've gotta fix, which is the medical model, it's a pathology. It's not, it's a neurodiversity. It's a verbal diversity. When we get that stutter affirming verbal diversity mindset, then the model changes. Then we can talk more about functional communication instead of fluent communication. [01:00:10] Carolyn Dolby: Okay. So I'm hearing like, rather than saying the child's going to have fluent Speech. [01:00:18] Carolyn Dolby: The goal would be the child's going to have functional communication, [01:00:22] Nina Reeves: easier communication. You know, the child is going to communicate effectively in a variety of settings. Boom. Boom. That's it. You don't have to have and with less stutters. [01:00:34] Carolyn Dolby: No. Right. [01:00:35] Nina Reeves: We do. [01:00:36] Carolyn Dolby: I know. And so everyone that is watching or listening, listen to that, hear that, that the goal is going to be that the child is going to increase their communication efficiency, their effectiveness, efficiency, [01:00:51] Nina Reeves: effectiveness, joy, spontaneity, Non worry don't freak out. Everybody's fine [01:00:59] Carolyn Dolby: And so that's what's going to drive the the change in your therapy is what you're saying is because now Your therapy is going to be working on Neuroaffirming stutter affirming, environment And then, what are we, so what are we, we're [01:01:18] Nina Reeves: doing, [01:01:19] Carolyn Dolby: what are we doing? [01:01:21] Nina Reeves: Well, we're creating that environment, we're, we're helping the people around the child. [01:01:25] Nina Reeves: Yeah. Okay. That's huge. And I think that was the child can't, yes. And so I want to say, no, it's, I'm sorry. Yes, this is all that sort of less direct therapy. Now, if you've got a four year old who is, can't get three words out of their mouth, Okay, we're not just going to go, Oh, I'll just talk in an easier way. [01:01:49] Nina Reeves: Good luck. No, we're going to have to, you know, we're going to have to talk about talking and we can talk about getting stuck. And all of this is, you know, in our books and on our blogs and everything. The idea is we talk about talking. It's a Dean Williams thing, right? Quintessential. Researcher clinician love him and it was all this idea that we're not gonna it's not gonna be like, oh, there's your stutter. [01:02:12] Nina Reeves: Oh, there's your stutter. It's more like, you know, how did that one feel? Is that one feel stuck? Okay. Yeah. So, and can we, can we ease it? Yes. Or Yep. Stuck. Stuck happens sometimes, but we're not going to make a child look at that and say, Oh, I've got to do something with that. Okay. Now, if they, if they feel, and let me just say, this is the toughest part for everybody to understand. This is the parent I was talking to this morning. The more a child tries not to stutter, the harder the stuttering is going to be. [01:02:49] Nina Reeves: The more a child tries to not stutter, [01:02:54] Carolyn Dolby: the harder the stuttering will be. [01:02:57] Nina Reeves: Yeah, that's the reactions component. That's the, Oh my gosh. And then let me push and then let me change and then let me not talk. Then everything becomes a reaction to the stuckness that is a negative reaction. Instead of a, here comes the stutter, there goes the stutter. Like it, so much of the struggle behavior that we see, those secondaries are secondary because it's the kid isn't going, let me, you know, blink my eye. [01:03:26] Nina Reeves: Right. And it'll come out, but they're pushing to get it out. That's the reaction to feeling stuck. Of course, if we felt stuck in our speech, we wouldn't be like, Hey, let me just ease that up. We'd be going like, Oh, it's a [01:03:41] Nina Reeves: normal reaction yet. continues to create more, more trouble. So there's nothing to suggest like a control or a masking or speaking in artificial ways there. [01:03:54] Nina Reeves: We talk about easy. We talk about not as tight. We can do all of that. Even with younger kids at their age, appropriate, you know, vocabulary, we just talk about talking. And if all kinds of talking are okay. Then the therapy environment and the home environment and the classroom environment becomes less, less focused on trying to quelch it. [01:04:22] Nina Reeves: Because what you're trying to do is tell a child in a neurological moment to not do that. That's like saying Scott uses the example, would you write a 20 percent less autistic goal? Oh, my gosh. [01:04:38] Nina Reeves: I know you're not. I guess another that was another mind blowing moment. We would never write a goal that the child will now be 20 percent less autistic. [01:04:50] Nina Reeves: Yeah. Now in the past, it's kind of what we were doing, but you know, because we were, we were Teaching them to mask and teaching them to fit in. And, you know, there are, there is a point at which many, you know, even the autistic community will say, Hey, I need to get through this, you know, the interview, like I could use some support in the communication. [01:05:10] Nina Reeves: Yeah. But I'm not going to turn myself into a non autistic person. [01:05:16] Nina Reeves: No, [01:05:16] Nina Reeves: I'm still going to show up as me. Otherwise, I'm never going to feel okay with myself. So [01:05:23] Carolyn Dolby: the therapy is what you're saying is where the therapy needs to, the goal needs to be on that total communication. Yes. Ease of communication, the effectiveness of their communication, and then therapy is providing them the environment with less stressor, but then talking about helping, helping them if they need it. [01:05:48] Nina Reeves: If they need more direct therapy, right? Or maybe they won't even need that. Who knows? Okay. Yeah. But I'm not saying you've got a kid and in the referral stage, they can't get two words out of her mouth. And all you're going to do is help the parents create an environment. No, you're going to have to be like, okay, this is the child who is struggling already. [01:06:12] Carolyn Dolby: And then we need [01:06:12] Nina Reeves: to figure [01:06:13] Carolyn Dolby: out where that struggle is and then [01:06:15] Nina Reeves: give them those tools. Of what they can do. Well, just give them the idea that it can feel easier. I don't know that a four year old is going to carry this over. But I also want them to know that first of all, it's okay that that happened. [01:06:31] Nina Reeves: Good. Okay. Number one. Always. It's not just okay to stutter the little ones. It's okay to stutter the big chunky ones too. Right. And so the more a child tries to control it, see, we have to be careful with the strategies or the skills. We have to be careful with that. Because if we're introducing a strategy so that the child will stutter less, we're ableist right there. [01:06:55] Carolyn Dolby: We're already backwards where I would go. I was already going wrong. Get [01:06:59] Nina Reeves: me back here. That's okay. This takes a while, right? I didn't, you know what I was trained. I was trained in medical model, not as much as other people were because I had a van Riper and trained guy who stutters teaching two courses in stuttering back in the day. [01:07:16] Nina Reeves: I know people don't get that anymore, right? So I was less involved in the ableism, but van Riper was, you know, A little bit of the, you know, manage and handle. And now it's more like, let's navigate it. Let's navigate that one. Okay. So that it can feel easier to you, but it's not for somebody else. It's not for the listener. [01:07:41] Nina Reeves: It's so you can have, you know, more spontaneous. I just want kids to feel spontaneous joy in communication and not be worried. Because the outside world has decided that stuttering is a defect. [01:07:56] Carolyn Dolby: And, and that's got to, that's the change. It's the change. [01:08:02] Nina Reeves: The social relational model will tell you that it's no longer on, incumbent upon a child who stutters to fit into the fluent society. [01:08:14] Nina Reeves: Okay. It is incumbent upon the society to accept verbal diversity. Okay. [01:08:21] Speaker 3: Yeah. [01:08:22] Nina Reeves: Wait patiently while someone stutters. Okay. Is that going to change overnight? Absolutely not. We've been trying to change it for decades, decades, probably longer than that. The idea is though, that once there is the environment, Becoming more and it isn't tolerance because tolerance denotes you got to sort of suffer through it. [01:08:48] Nina Reeves: Right, right, right, right. It's acceptance and then the child can be more self advocating and say, you know, first of all, sometimes I stutter. You're going to notice that now. I just went to, you know, older kids. My four year olds don't usually do that. But you know what I'm saying? It's more like I, I'm okay. [01:09:10] Nina Reeves: So you can be okay, but you really need to be okay too. So I can be okay. Yes. Right? It's not just the kid needs to be okay. So the listener can be okay. It needs to be reciprocal and really incumbent upon society to make that change. I love it. And we better make it in the therapy room or there's nobody to teach, you know, to show society how to do this. [01:09:37] Nina Reeves: Right. Right. We have to be a big voice in that chorus. We're allies. We are allies. We, you know, accentuate the voices. We raise the voices of people who stutter and give them a space to talk for themselves. Cause I'm not the expert on stuttering. The kids I work with are the experts on stuttering. Right. [01:09:59] Carolyn Dolby: If I'm hearing you right, our job is, oh, I was trying to write this down because it was really powerful that we're giving them in the, we're advocating and giving them the space. [01:10:14] Carolyn Dolby: I'm trying to say that again, cause I, I [01:10:16] Nina Reeves: maybe, yeah, we are, we are giving them the space to be who they are. It's incumbent upon society to be okay with stuttering. Okay. Not for the child. [01:10:26] Speaker 3: Advocate. For, [01:10:28] Carolyn Dolby: for this child that, so that everybody that's dealing with them understands that they're not wrong, stuttering is not wrong, and that that's their problem. [01:10:38] Carolyn Dolby: Right. And they need to realize that we need to, to not try to fix. Right. So we need to teach so we have the environment that they can communicate in any way that they're communicating. [01:10:54] Nina Reeves: There, we need appropriate accommodations, but not like, oh you know, like pathetic empathy where it's like, Oh honey, you don't need to do, you don't need to do that one. [01:11:06] Nina Reeves: Cause you know, cause you stutter, right. We, nobody needs that, right. We need to be more understanding and accepting as a society. And then that creates the reciprocal, you know, the child doesn't need to perform fluency. Okay. Right. Anymore. No. Right? And when they try, when they stop trying to perform fluency, they actually have easier communication. [01:11:32] Nina Reeves: It doesn't sound like that's a normal thing, but it's absolutely true. The more, the less they try not to stutter, the easier communication becomes. I'm sorry, say that again For the people in the back? Yeah, one more time. So let they try not to stutter. The easier communication becomes. Okay. Because [01:11:53] Carolyn Dolby: that is what we all need to take away from today, that we are not going to be there to get them to think about, not stuttering, [01:12:07] Nina Reeves: easier communication. [01:12:08] Nina Reeves: That's not code word for fluency. No. You can't just go, let's have an easier communication. Let's try that. Right. Let's make that one smooth because you already just made it code for fluency. Right. What it is, is just easier. Did that one feel easier that time? Did you, you know? Wow. It looked like you weren't pushing so hard. [01:12:32] Nina Reeves: Was that true? Because I'm not in your mouth. You have to tell me. Were you pushing that hard? No, that one was easier. Okay. Still stuttered. Still stuttered. Yep. Cause that's the neurology. Now, of course we're talking to older kids on that one, but though there are going to be kids who come out of the best early childhood therapy ever and stutter, right? [01:12:57] Nina Reeves: We just don't have the crystal ball. We don't have the guarantees. We are creating the space to move them back. If we can. But we can't give a guarantees. We don't take away hope, right? It's not the age of the child. It's not like if they're, if they're still shuddering by five, they're going to stutter, never say that. [01:13:18] Nina Reeves: What if they started stuttering at four and a half? Right. We talk about the longer a child, this is in our book, the longer a child continues to stutter, the more likely a child continues to stutter. It's the age of the stuttering, not the age of the child. Gotcha. Started at two and a half, kids now five, less likely to move through. [01:13:40] Nina Reeves: Studies will show that. All the Yairi and Ambrose from the U of I, longitudinal studies. And Smith at Purdue, lovely things that we're learning and have learned in the past few decades. So, but we don't go up there. Five. Oh, sorry. No, no, no, no. Yeah. We're going to continue. Yes. If your child continues to stutter, there will be other things that we will then get involved in. [01:14:09] Carolyn Dolby: Got [01:14:10] Nina Reeves: it. Okay. It won't just be all about you guys, you know, changing this and then the child, you know, having some, you know, fun talking in the therapy room easy and, you know, bumpy and high and low because easy speech is not, is not a problem. It's when you expect easy speech. Then it becomes the problem. [01:14:32] Nina Reeves: So I can do some easier talking and that doesn't make me an ableist clinician. Okay. What, what makes it go off of the stutter affirming is that when we expect it, and especially when we expect it from little kids, are you serious? Do you want to talk like the rabbit or the turtle? What kid is ever going to pick the turtle? [01:14:56] Nina Reeves: I've never had one in 30 years. I have never had a kid pick the turtle. When I was back then, when I was doing that stuff, and I was, as a young clinician, who wants to talk like a turtle? And it's aberrant, and they're just little, and let them talk. Just let them talk. Let them talk. [01:15:18] Carolyn Dolby: We need, that's, that's, that's going to be a bumper sticker. [01:15:21] Carolyn Dolby: That's going to be a t shirt. Let them [01:15:23] Nina Reeves: talk because here's the deal. We try to do the least amount possible, like to the child, like, you know, now if the child needs, I want to say this, if the child needs some support in having some easier communication, I'm in, right. I'm just not going to do it so that they sound fluent. [01:15:45] Nina Reeves: I'm going to do it so that they can feel the difference, you know, and yeah, some of that, some of that school age stuff, learning about tight, loose, and, you know, tight muscles and loose muscles. Yeah. Some of the times it pulls right into the early childhood. Okay. But, Not everything that's why we have two different books Right, right. [01:16:08] Carolyn Dolby: Yeah, right. I so everyone that is listening. I want i'm going to say your pot your website again it's stuttering therapy resources. com and I know that we are getting to the end of our our time today. I would love to keep talking as always with you but I know that I have I as I had the first time you came on how much I learned I fell back for one minute when I when I was like, oh wait We're going to give them strategies because it's ingrained ingrained. [01:16:37] Carolyn Dolby: I realized thank you for stopping me No, I need that shift We all need that shift that we are going To be working on effective communication and providing the environment to [01:16:55] Nina Reeves: better affirming [01:16:56] Carolyn Dolby: And a stutter affirming environment. [01:17:00] Nina Reeves: And let me just say before we end. Yes. Now I'm going to switch away from early childhood because one of the things that everybody gets very confused about when we talk about verbal diversity, and we did allude to this in our earlier podcast. [01:17:15] Nina Reeves: It's not that the strategies have no value whatsoever. It's not like you're never going to teach a strategy. With, with school age or adolescence, it's going to be, first of all, it's not all that you're doing because for so many years, that's all we've been doing, right? And we haven't been getting into how the child's experience is going, right? [01:17:37] Nina Reeves: And those strategies have always been introduced, mostly introduced to not stutter, to be fluent, to not show it, to show it less. So it's not noticeable. All of those messages are not neurodiversity affirming. None of those messages. So what we want to do is understand if the child wants to have a strategy to ease out of a stutter, right? [01:18:04] Nina Reeves: Then that's an appropriate thing to do. As long as they're not using it to mask. If they're using it to have an easier moment when they get really, really stuck and they're struggling and then they learn, but here's what happens. You've got to also then be working on acceptance [01:18:22] Speaker 3: because [01:18:23] Nina Reeves: once they, they won't be pushing and trying to get through that so hard when it's okay, that that happens. [01:18:29] Nina Reeves: And they'll need that strategy less and less and less and maybe never. Because they're going to let the stutter come, they're going to let the stutter go. Long term. Now, that's not like, hey, no problem. That only took three weeks, you know. Because the society stigmatizes this so much without even knowing it. [01:18:52] Nina Reeves: We send messages, well meaning people send messages of it's not okay that you just did that, even though that's not really what they meant. It's kind of like, I'm fixing you. So when society sends that message, kids get it even at early ages. [01:19:11] Carolyn Dolby: All right, listeners, I know we're coming to the end, but I think what Nina is telling us that we need to be advocates for the change. [01:19:23] Nina Reeves: Mm hmm. In our therapy room in society, and we're not going to be the only voices out there, we're going to help our students and families. Wow, what would happen with with when a caregiver goes, Oh my gosh, this is exact, which is what happened on that phone call today. She's like, he said that to me that I, I, I, when I'm in therapy, I think about it too much and it makes it harder for me. [01:19:46] Nina Reeves: Oh my gosh. I'm like, yes, he's trying to tell you. And the light bulbs went off in her head and now she'll be an advocate when other people in the family say, stop, slow down. She won't do that anymore. She'll say, no, let him speak. Yes, let him, this is the way of talking, speak, talk, let him talk, let him communicate. [01:20:09] Nina Reeves: This is the way I talk sometimes. You're going to notice a stutter. If you're confused, ask me. This is how I want my kids to get eventually. Like it's hard, but you know, are you going to continue to change yourself for other people? Because then you, you're not yourself in that moment. You're not that you're, you're not showing up. [01:20:35] Nina Reeves: It's vulnerable. It's risk taking. That's why counseling is such a big part of what we do in stuttering therapy. And that has to change all the unit Asha to the university programs. We have got to stop. If we're going to switch out of, you know, medical model and strategy, strategy, strategy, then we better fill somebody's bucket up with what you do instead, right. [01:21:00] Nina Reeves: Or in addition to, and so there is, there's a lot of people working on this and you know, we're still building the plane while we're flying in it. And you know, there's give yourself grace, shift your mindset and other things will fall into place. Thank you. You're welcome. [01:21:22] Carolyn Dolby: I want to end right there. [01:21:23] Nina Reeves: There you go. [01:21:25] Carolyn Dolby: That you're amazing. I thank you so much for coming back. Those of you that haven't heard the first episode, it's called embracing verbal diversity, navigating stuttering service delivery in the schools. I urge you to listen to that one as well, but I want to just say your website one more time. I, you guys, it's free resources. [01:21:45] Carolyn Dolby: So much on there, all sorts of resources. It's stuttering therapy, resources. com. Nina, thank you. [01:21:53] Nina Reeves: Yes. Hey, listen, you know, follow us on social media. Cause I've just been doing just in this moment, I know this podcast will last a long time, but I've been doing things about stutter, how to be a stutter affirming therapist on our Instagram and our Facebook. [01:22:07] Nina Reeves: So follow us on social media. Cause you know, not everything gets on the website. Sometimes it's a post, sometimes it's a blog. Sometimes it's a practical tip handout. Sometimes it goes in a book, you know, we just have stuff everywhere. So. Hang out with us and keep us keep us all moving forward together. [01:22:25] Nina Reeves: Absolutely. [01:22:26] Carolyn Dolby: Okay. Thank you Bye bye. I hate to say this, but bye [01:22:31] Nina Reeves: All right. [01:22:32] Carolyn Dolby: Bye bye [01:22:34] Speaker 2: Thanks for joining us on today's podcast. Remember to go to speechtherapypd. com to learn more about earning ASHA CEUs. We appreciate your positive reviews and support, and would love for you to write a quick review and subscribe. If you have indicated that you were part of the ASHA registry and entered both your ASHA number and a complete address in your account profile prior to the course completion, we will submit earned CEUs to ASHA. [01:23:14] Speaker 2: Please allow one to two months from the completion date for your CEUs to be reflected on your ASHA transcript. For our School of Speech listeners, we have a special coupon code to receive 20 off any annual subscription to speechtherapypd. com. Head over there to get ASHA CEUs for listening to this podcast and all other episodes. [01:23:34] Speaker 2: The code is SCHOOL20. That is S C H O O L 20. Hope to see you on our next episode. Also, please don't hesitate to tell us which topics you would like us to cover in future episodes. To get in touch, drop us a line in the comment section or send us a message on social media. [01:24:03] Mhm. Mhm. Mhm. Mhm. Mhm. Mhm.