Referrals of pre-schoolers are welcomed at the Michael Palin Centre because research and our clinical experience show that an early start in therapy is of real benefit, and in many cases may help the youngster achieve a more long term and stable level of fluency.
While it is not always clear which children will grow out of the problem and which are more at risk, we think that there are a number of key "risk factors" which help us to make a clinical decision about whether to start therapy or not.
Parent-Child Interaction Therapy (PCI) - For the younger child
Parent-Child Interaction has been developed by the Centre and has been designed for the younger age group; it may also form a basis of therapy with older children and this approach has been published as a book for speech and language therapists. Click here for more information.
We need to stress again that parents do not cause the stammer, but they can have an extremely positive influence on helping their child to develop more fluent speech.
PCI therapy consists of six one-hour weekly sessions followed by a six-week consolidation period with additional appointments as necessary to monitor and review progress. The main aim of this therapy is to identify the "interaction styles" within the family which may help the child towards more fluent speech. A key goal is to improve the family's confidence and skill in managing their child's problem.
We know that young children's fluency is highly variable and that periods of fluency can suddenly be disrupted by another phase of stammering. The task of the therapist and the parents is to identify the aspects which might be influencing the "good" patches and the factors which may be less helpful at the moment.
Instinctively parents want to tell a child to slow down, to take his or her time, to think before he or she speaks, to calm down and relax. However clinical experience tells us that telling children to do these things doesn't necessarily work - they can't do it for more than a few moments at a time.
We also know that if we ask an adult to do these things - they can't do it for long either. Just try it!
Communication is a two-way process, the way we talk affects the other person and vice versa. If the conversation is rapidly paced, with everyone talking at once, we automatically do the same. In a calmer, more relaxed situation, we have more time to think about what we want to say and listen more carefully to what the other person has to say, and probably talk more slowly too.
Stammering and a fast pace of life don't go well together
We have noticed, for example, that if a child is trying to speak very quickly he or she is more likely to stammer. In therapy we need to find out what influences a child's rate of talking and how we, as adults, can help a child to give himself more time when he is talking.
The therapy sessions are set up in such a way as to make the child feel that it is a really fun playtime.
During the therapy sessions, the child is videotaped playing with each parent in turn. Then the parents and the therapist (and the child if he wants to) watch a re-run of the play session. Firstly it is important to reinforce all the good things that happen in the playtime: how much the child is enjoying playing with his parents, the warmth between them, and the helpful interactions.
Next, the parents and the therapist consider aspects which might be useful to change a little, as these could influence fluency. We emphasise throughout that parents are not doing anything wrong! But because they are the most influential people in their child's everyday life, they are the best ones to try out the ideas. The therapist is there to support, encourage, guide and discuss why particular changes could be beneficial.
Many parents initially express surprise to discover that their role in therapy is such an active one, and sometimes feel worried about trying to make changes. While few of us find making changes "easy", the rewards for their hard work quickly become clear. There is a rapid development of confidence that they can help their child, a feeling of being more "in control" and less worried about "doing the right or wrong" things.
Between the therapy sessions, "changes" are practised during regular 5-minute "special times" at home.
Sometimes during the initial six-week period of therapy, time is also taken to discuss other parenting issues as appropriate. Parenting is hard work at times and it is common for parents to want to find other ways of dealing with behaviour such as temper tantrums, difficult bedtimes, poor eating etc which can be causing extra anxiety or frustration - and of course, because of the stammering, many parents are worried about being overly strict with their child in case it makes the problem worse.
For some children it may also be important to work on other speech and language skills if these are a bit behind in development.
