Friday, January 8, 2010

The label stutterer vs a person who stutters

Today I received a call from a parent of a child who stutters.  This week happened to be an unusually difficult speech week for me as I had trouble sleeping at night.  As a result I had to focus even more on my fluency tools but also realized the world was not going to end if I stuttered.  As I spoke to this mother, she asked if I used to be a stutterer. I answered that I still was.  Usually I don't care if people use the word stutterer or person who stutters, but this time I did.  I felt like it was asked with judgement and the fact that I was a successful speech pathologist was being ignored.  I don't have anything to prove to anyone at this point in my career as I have helped many people, but I do want to educate the public.  If someone had asked this mother to describe her son, would she have said, "Joe ( not his real name) is a stutterer and goes to school."  She probably wouldn't have even mentioned his stuttering as that does not define him.  The point is we who stutter are people first.  It does matter that we are viewed as people who stutter and not labelled as stutterers.  We are not defined by how we speak.  People who walk with a limp are not defined by how they walk.  People who lisp are not called lispers.  To the public who is not familiar with stuttering, please realize we are people, students, friends, spouses and parents who happen to stutter.  Some of us happen to be very fluent and some of us happen to stutter openly.  Most importantly we want to be heard, listened to, not interrupted and respected.  I feel very strongly about this post as too many people who stutter have grown up with shame forgetting that they possess so many wonderful qualities.  Thanks for reading this post.  I would appreciate any comments.

Monday, January 4, 2010

Can we make a 9 year old go for stuttering therapy?-Part 1

About 4 years ago I was treating a wonderful nine year old girl I will call Dori. (not her real name).  Dori was discharged from speech therapy in school because her SLP said she hadn't noticed any dysfluencies in the speech room.  Dori was thrilled to not be pulled out of class anymore for speech therapy.  Her parents brought her to me because she was stuttering significantly at home. Dori later admitted that she became a pro at hiding her stuttering in speech in school.  She was bright and could easily subsitute words.

Dori was approximately 33% dysfluent in my speech sessions (this was an average over 5 sessions).
She presented with whole word repetitions, part word repeitions and laryngeal blocks. She also displayed lip tremors.  At the end of 4 months, Dori's fluency had increased dramatically as did her eye contact and communication skills (we worked on these too).  She was giving oral presentations in front of the class and tried out for the school play.  One day, Dori asked me why she still had to come to speech therapy .  She was adorable and trying not to hurt my feelings. She explained that she enjoyed our sessions and the fact they were fun, but she was happy how she spoke.  She said her friends didn't care that she stuttered and she spoke all the time. In fact, her teacher called her parents reporting that she was disrupting the class by talking to her friends often.  (This was actually music to all of our ears). I brought her parents in for the next session to talk about progress and whether she should continue. Dori's parents were torn.  They thought she had progressed and was doing great, but they could not let go of the dream of total fluency.  I think we resolved this conflict in a positive and healthyy way.  This blog post will be continued at week's end, but I would love to hear how other parents, grad students or speech paths. have resolved this issue.  What do we do as professionals when a family wants perfect fluency and the child is happy with the progress made? Please share your thoughts with me. tks Lori

Sunday, January 3, 2010

The economy, insurance and stuttering therapy-Hope this helps!!

Hi all-
Hope it is warmer in your neck of the woods. It is freezing in NY. I have gotten over 10 calls for stuttering therapy in the last 3 weeks so I wanted to clarify a few things about insurance and options for effective and realistic fluency therapy.

First, please visit (the stuttering foundation of america website) and click the link on insurance. This is very helpful and provides very useful information on stuttering for individuals and families.

First, stuttering for preschoolers might be covered by your local school district so contact them for an evaluation. Lidcombe is a wonderful and effective program. I modify it slightly and call it P.A.C.E. (please see I highly recommend it. Even if your school district does not cover it, it is worth trying to eliminate such a devastating disorder during the preschool years.

The insurance ICD code for stuttering is 307.0. Many insurance companies don't cover stuttering therapy and I find more lately. Many times they will pay for the initial evaluation but not therapy. Why? I don't know the exact reasos except they don't consider it a medical expense. If you call your insurance company, don't just ask if they cover speech therapy. Often they will say yes for 30 visits. You must specifically ask if stuttering therapy is covered. Please get a contact name and someting in writing. If you call a speech provider and ask if they take insurance, it does NOT mean stutering is covered!!! Every plan is different. You can sometimes fight a rejection by appealing it but all this takes time.

So what does one do in a tough economy? First let me say if you are motivated or your child is we can always set up an initial 3 month trial and see if therapy helps. Once it works, it might be easier to pay for. Also, receipts can be submitted to flexible spending accounts. The other options are inquiring about group therapy of to reduce costs. In general the more you practice, the sooner you can go on maintenance. I have several teens and adults who are coming now once every two or three weeks on a maintenance schedule. They are maintaining a realistic amount of fluency and appear satisfied as are there parents. They talk to others weekly to increase opportunites for practice. Sign up for practice groups with my practice. Sign up on my facebook page, The Long Island Stuttering Connection and connect with others who stutter. (If you are under 18, please ask your parents before signing up). It is vital to go to a speech pathologist who specializes in stuttering therapy. (referral list In the end, it will save you money. I have many clients who have seen less experienced therapists before me and in the end have spent more money.

Remember, efffective communication is important and vital. Look for my open house in s few weeks on Long Island, NY to receive more information on stuttering and see a wonderful screeing on an adult who stutters. If you are out of state, think about coming in for an intensive weekend or via webcam. I am here to help all parents and people who stutter. Lidcombe for preschoolers can definitely be provided for international parents and children as well. It has worked well.  Also, don't assume that just because you or your child has received therapy before and it wasn't effective that there is no hope.  There is LOTS of it!!!

No one knows the pain of stuttering and having to put money aside for therapy or having a family member out of work. It is tough!! Let's try and work together so I can help you. Sometimes it is hard to see the light at the end of the tunnel, but I am here to tell you the light can be so bright!! A happy and healthy New Year to all and thank you for everyone who has been following my blog.  I welcome and appreciate all comments.

Friday, January 1, 2010

Looking for a job-Should I tell my potential employer I stutter?

Happy New Year to all. Hope everyone had a safe and enjoyable New Year's Eve. I watched Dick Clark every year for the sake of tradition. I couldn't help but to admire this man who had a stroke. He was working so diligently at pronouncing his words and being understood. I was so glad to see him on TV. After all, what is New Year's Eve without Dick Clark?

I have recently gotten many calls from adults out of work. It is a tough economy and my heart goes out to those who are suffering. My husband was out of work several years ago and it was a very difficult time in our lives. Many have asked me my opinion disclosing the fact they stutter on an initial or phone interview. I thought I would share a story with you concerning my second job after I received my masters degree many years ago.
I will start off with my first job out of school. When I graduated in 1992, there were more jobs than speech pathologists. I interviewed at UCP and got to the interview two hours early. I went into a coffee shop and literally breathed for two hours. The precision of my speech tools was still rough at that time so I knew my fluency would be shaky at best. When I went into the room I was approached by two women (two was always harder than one). They seemed very pleasant and when I started to answer their questions, I started blocking. I immediately explained that I stutter and had to use certain tools to talk. I was so nervous that I can't say if I used my fluency tools of easy onsets and continuous phonation, but the self disclosure improved my fluency. They said they wanted to do outreach on stuttering for preschool children and liked my experience with developmentally delayed adults. They offered me the job two days later. It was a wonderful experience. My colleagues knew I stuttered and respected me for it. At that time I was dating my husband and he lived up in Binghamton ( I lived on LI). The strain of a long distance relationship was starting to become difficult so I decided to move upstate after 4 months of working and look for a job. As I said, at that time there were many speech jobs. I sent out resumes and had 3 interviews set up within two weeks. I interviewed at a few places and was hired by a rehabilitation site. It sounded like a great opportunity. They treated children and adults with other speech pathologists on staff who seemed supportive and educated. I thought it would be a terrific learning environment. One huge problem, I was fluent on this interview and never even thought to mention my stuttering. I quickly moved upstate and starting working. I should mention that the woman who interviewed me was a SLP who had worked in the field for over 12 years. Everything was fine until my mother n law unfortunately became very ill with cancer. My then fiance had to spend many days on LI with his mother and I was alone in a strange city and a new job. Within a few weeks, my stuttering increased and I started to have difficulty maintaining fluency during speech and language evaluations with parents. Yes, it is true-I stuttered during these evaluations. Looking back I should have been open and honest with these parents, but I still was experiencing shame about stuttering. One day I got called into my boss' office. I will call this woman Anna. Anna abrubtly told me that two parents had inquired about my stuttering and it would not be tolerated. I told her I stuttered and was trying to work on my fluency. I also told her my future mother n law was terminal and it was very stressful. She told me that this was a for profit rehabilitation facility and they would not tolerate losing money. I looked at her and promised that I would try to improve my fluency.(this was ridiculous because I was selling my sole to the devil so to speak) This was the beginning of what I now call mental and verbal abuse, but also a very painful situation I learned from. She kept harrassing me and telling me I had to be fluent. She always made sure her office door was closed and we were alone when she spoke to me. Guess what? As you might have guessed my fluency decreased. I decided to practice 45 minutes a day and I will say after a month it really helped. My easy onsets and full breaths were back and my fluency improved. Anna was always testing me, but I did excel. She would come to school district meetings with me and listen to my fluency. I was very fluent and also spoke very well. I was not going to let her win. No Way!!!!! The situtations that were hardest for me were weekly department meetings because I felt like the speech pathologists were always judging my expertise based upon how fluent I was. At that time, I had a supervisor for my clinical fellowship year (this is needed to get your permanent license). This woman was always being pressured by Anna to make sure I was fluent. I would have left sooner but I promised myself I would finish and get my permanent license no matter what. To make a very long story short, I became permanently licensed, married my husband, and my mother n law unfortunately passed away before we got married. (That was worse than any stuttering).

When I got back from my honeymoon, my supervisory period was almost over. My immediate supervisor told me Anna was bad mouthing me while I was gone but knew I could invoke the American Disability Act if she fooled around with termination related to stuttering. I had talked to a lawyer at that point and didn't hide the fact. A month later I became permanently licensed and interviewed at Boces by a wonderful special education administrator named Elaine. She hired me on the spot. I was mostly fluent during this interview, but had learned my lesson. I said that I wasn't sure if she noticed that I stuttered, but wanted her to know it is the reason I became a speech pathologist. I also added that it didn't interfere with my job. She looked at me with warm compassion and said she wasn't worried and figured that was why I chose the profession. She also said it was why she was hiring me. I worked there for over a year before I moved back to LI. I went to meetings, worked with children who stutter, had articulation issues and learning disabilities. I have to say this woman was wonderful to work for. She had compassion I had never seen before. I went to meetings and spoke not only fluently, but effectively. Did I ever stutter? Sure I did, but I wasn't ashamed of it.

In conclusion, we have to accept who we are. I do suggest educating your interviewer on the fact that you stutter, but I also don't suggest dwelling on it. They are there to here what you can offer their company. I will never work for or with anyone again who doesn't accept me for who I am. I do not and will not judge my self worth on how fluent my speech is, however, I learned that I wanted to be as fluent as I could be. That is why I never gave up. This is why I teach more fluency shaping tools than stuttering modification tools. I am open to whatever helps my clients, but I don't think you should think that improved fluency isn't possible. This is why I talk to the teens especially projecting their voice with confidence, densitizing themselves to talking on the phone and education their parents and friends. I try to give all children and adults an increased sense of self worth and control of their lives. I hope I can provide postitive memories of successful speaking situations. Anyway, you are probably tired of hearing me lecture by now. I would love to hear from others regarding this topic. Again, happy and healthy New Year to you and your family. I look forward to reading your comments as always.

Thursday, December 31, 2009

Stuttering in Children -Helpful tips for parents-Parent Magazine


by Lori Melnitsky, MA CCC-SLP

What is stuttering? What causes it? Although, the exact cause is unknown, there are known environmental factors that contribute to stuttering. Ideally, it is the goal of working with young children who stutter to eliminate disfluencies while involving parents in the process. Stuttering is an interruption of the continuous flow of speech. It can be characterized as prolongations (sssssssssnake), repetitions of words (I I I want milk) or phrases (I want I want milk), frequent use of filler words (uh, um), blocking (silence and struggle before saying a word).

Between the ages of 2 and 5, many children experience stuttering. This is often considered a period of normal disfluencies. Why? One reason is that children are still coordinating their speech patterns and acquiring language during this stage. Will these children outgrow it? The majority will, but there is no way of knowing for sure. This is why consulting a speech/language pathologist at the onset is vital.

Did you know that approximately 1 % of the population stutters? Additionally, 4 out of 5 people who stutter are male. Many times there is a family member who stutters. One known fact is that parents are NOT at fault. Also, stuttering is not a contagious disease. No one will start to stutter if they hear another person stuttering.

What are some of the characteristics of normal developmental disfluencies?

1. The child does not exhibit struggle behaviors (such as kicking his foot) or display awareness of how they sound.
2. Disfluent moments can disappear and then unexpectedly reappear days or months later.
3. The child is not avoiding speaking situations or displaying frustration.
4. Easy repetitions of words and short phrases.

When does stuttering become more of a concern?

1. Children who are at risk usually exhibit struggle behaviors while forcing words out (such as unusual breathing patterns, or facial grimacing).
2. They often avoid feared words or speaking situations. Fear and frustration is often visible.
3. Saying “I don’t know” often in response to obvious questions or changing words. These are forms of avoidance.
4. Using filler words often (like, um, uh).
5. Prolongations of sounds (ssssssssnake). Stuttering might become longer in duration.
6. Change in intonation patterns (rising pitch during the period of stuttering).
7. Blocking on words, such as opening mouth with no audible sound coming out. Disruptions in breathing patterns.
8. Stuttering becomes more frequent.

What do you do if you suspect your child is stuttering?

1. Seek out the help of a speech/language pathologist experienced with stuttering. Often, doctors and family members will say ”Wait, the child will grow out of it”. This is often incorrect and increases tension in the family. Always consult with a SLP for advice. They may monitor the child or provide parents with information to help their child. They might use a direct therapeutic approach with the child or with both the child and parents.
2. Be a good listener--pay close attention to what is being said NOT how it is being said. Look directly into the child’s eyes to show that you are truly listening to the message.
3. Reduce questioning. This will decrease demands placed on the child.
4. Avoid putting the child in the spotlight-ex: “Tell Aunt Sue what you did in school today”. This puts too much pressure on the child.
5. Avoid comments like talk slower. Try and model a slow relaxed natural sounding speech pattern. (This is difficult. SLPs will demonstrate this for you).
6. Delay responding to allow for more pauses and reduce time pressure for the child.
7. Don’t ask the child to repeat the sentence. It will only increase awareness and frustration.
8. Most importantly, don’t panic!!! Although we can’t identify who will eventually stop stuttering, we can give advice to parents on how to talk to a child who stutters and model the appropriate way to respond.
9. Remember it is not your fault. Parents are NOT to blame.

All of these strategies will be easier to follow once you have met with a speech/language pathologist.

There are also more direct therapy approaches available if stuttering persists. For the school aged child who continues to stutter, there is still hope. Although the chances of outgrowing stuttering decrease after age 6, there are strategies available to improve communication and decrease stuttering. Children at this age often become highly aware of being different from their peers. It is important to work with a SLP on not only speech strategies, but ways to handle everyday speaking situations.

Remember parents your words, are like candy to a child. They eat them up. Be kind, patient and loving. Most importantly, consult a speech/language pathologist if you suspect your child is stuttering.

For more information, please contact Lori Melnitsky. Lori is a speech language pathologist (SLP) who stuttered severely as a child and specializes in treating children and adults who stutter in Plainview, NY. She is available for therapy, parent workshops at schools, consultations, and presentations at local universities. She is the chapter leader of the National Stuttering Association Adult and teen chapters on LI and founder of the LI Stuttering Connection. She is in private practice and treats children and adults who stutter as well as other speech and language disorders. Lori can be contacted at 516-776-0184 or via e-mail: (

Happy and Healthy 2010!

May we all judge our self worth not by how much we stutter or are fluent, but by who we really are inside. If you choose improved fluency as a goal, I am here to tell you it is possible. Peace to all!!

Wednesday, December 30, 2009

Continuous phonation-How important is it to fluency?

I am back. I didn't think I would get a chance to write another blog before 2010, but I got up early today and had time.

I was recently reading an article about continuous phonation and linking words together. As many of you know, I am a graduate of the Precision Fluency Shaping program. I teach many of the skills I learned along with cognitive modifications and some stuttering modification tools. It was a wonderful program and I recommend it if you live in Virginia. I would recommend either follow up by a local SLP weekly, practice groups or even me via a webcam. The carryover is the tricky part. I like doing this program on consecutive weekends with older teens and adults in groups of 2, 3 or 4.

Getting back to continuous phonation. Many times when I am working with people who stutter, I will close my eyes as I am linking my words together. I don't do this in real life situations, but in exaggerated practice. Why, because it allows me to feel the vibration on the voiced sounds (ex: vowels,and consonants: b, d, g, j, l, m, n, r, v, w, x, y, z). If you put your hand to your throat and contrast cognates g (guh) and K (kuh), you will feel the guh is voiced and a buzzing will occur as your vocal folds meet. This doesn't happen for kuh (unvoiced sound) so you would have to feel the vibration on the vowel. This is how an easy onset starts. People who are naturally fluent do not break up their words and sentences. The sentences and words flow together. In the early years I was so jealous of this. Such an easy task, but so difficult for people who stutter. Later on , I realized I had to almost examine and dissect fluent speech to change my dysfluent speech patterns and treat others who stutter. When my clients link their words together, they are generally increasingly fluent. Many times this has to start with adequate full breath breathing. If you start to exhale all your air and then talk, stuttering and tension will occur. If you don't take in enough air, words will sound pushed and struggle will occur. This is why people who block in the laryngeal area have silent blocks when air capacity is reduced. I know this is hard to visualize in writing. I will try and make a you tube video tomorrow if my new flip camera comes. Continuous phonation and easy onsets are important and require intense practice. Please e-mail me with any questions. Also, SLPs on LI, please e-mail me if I can provide any inservices to your districts. tks Lori