54 Chapter 3
improper diagnosis of stuttering by parents that could make Alice self- conscious and anxious
about her speech. This is done carefully, without casting blame. The clinicians conclude the
diagnostic report with the observation that many factors may be involved in Alice’s stuttering,
including an inherited gene, and that possibly nothing could have prevented it. They also convey
their optimism about the potential for successful treatment, especially since the prob lem was
diagnosed early.
Over the next 2 years, Alice responds well to the prevention and treatment program. Initially,
she is seen three times per week at the clinic and her parents are counseled weekly. Alice meets
with a clinician in the Kids’ Room and plays with the multitude of dolls, cars, kitchen devices, and
games. The clinician works on improving Alice’s speech- related self- esteem, removing speech anx-
iety and increasing her tolerance for and ac cep tance of dysf luent speech. Gradually, Alice’s anxiety
about speech f luency dwindles. During the first year, she continues to be excessively dysf luent,
but as she matures neurologically, her speech becomes more and more f luent and eventually her
language demands parallel her neuromotor speech capacity. At home, Alice’s parents help remove
unrealistic f luency expectations and create an environment where nonf luencies are expected,
accepted, and, in some situations, even encouraged. When Alice starts school, the speech- language
pathologist is notified of her stuttering history so that booster therapies can be provided if neces-
sary. Fortunately, therapy is not necessary, and today Alice is a normally speaking 12- year- old girl
with only vague memories of stuttering and the games she played in the Kids’ Room at the speech
and hearing clinic.
Case Study 3-2: An Individual With Intellectual Disability
Who Stutters
Seventeen- year- old Walter does menial labor, and his primary job is to keep the Vintage
Clothing Store stocked. Although Walter has a tested intelligence quotient of 63, he knows that the
store is a big source of income for the Center for Human Development, which provides jobs, food,
housing, and therapy for 12 intellectually disabled individuals.
Walter cannot remember when he first started stuttering; it seems he has stuttered all his life.
He continues to have stuttering therapy three times per week provided by student therapists from
the university, but over the years there has been little improvement in his speech. His case man ag-
er has made an appointment with a stuttering specialist to see if continued therapy is warranted.
The specialist will decide if Walter can benefit from stuttering therapy and, if so, what programs
will result in improvement.
Walter enters your office and takes a seat at the diagnostic table. You and the clean- cut teenager
share a few pleasantries. The case man ag er’s report states that Walter was first diagnosed with
stuttering when he was 5 and has been seen by nearly 20 therapists since then. Initially, stuttering
therapy was provided concurrently with language stimulation and literacy training. At about the
time he entered middle school, it was deci ded that his language acquisition had plateaued and he
had achieved his maximum literacy skills. Special education resources focused on eliminating his
severe stuttering. The most recent f luency test showed him to have extremely severe stuttering with
many accessory features.
During the many years of stuttering therapy, Walter has had every conceivable treatment. Early
in the development of his stuttering, prevention strategies were used in the belief that he simply
had many normal nonfluencies that he would eventually outgrow. Later, his speech was desensi-
tized and modified, and he was taught to stutter f luently. He was encouraged to talk more slowly,
breathe deeply, and pace his speech to a metronome. For a while, he even used a special hearing
aid that helped only initially. When you read the report, you see that a well- intentioned physician
suggested that clipping his lingual frenulum might be helpful. Fortunately, this surgery was not