Unbabbled: Stuttering

Stuttering and Other Fluency Disorders with Dr. Kia Johnson

Dr. Kia Johnson discusses childhood fluency disorders, including stuttering and cluttering. Dr. Johnson explains the differences between typical disfluencies and stuttering behaviors, provides examples of stuttering behaviors, and indications that a child may be stuttering. She also talks about the importance of receiving an evaluation and therapy from a speech-language pathologist with a high level of familiarity with fluency disorders.

About Dr. Kia Johnson

Kia Johnson, PhD, CCC-SLP, is an associate professor with the Department of Communication Sciences and Disorders at the University of Houston where she specializes in fluency disorders, with a specific focus on young children who stutter. Her current research interest is in the examination of speech disfluencies in culturally and linguistically diverse children. Aside from teaching both undergraduate and graduate courses, she presents her research at local, national and international scholarly conferences and serves on the Board of Directors of the National Black Association for Speech-Language and Hearing (NBASLH).

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Stephanie (00:05):

Hello and welcome to Unbabbled, a podcast that navigates the world of special education, communication delays and learning differences. We are your hosts, Stephanie Landis and Meredith Krimmel and we're certified speech language pathologist who spend our days at the parish school in Houston helping children find their voices and connect with the world around them. This episode of Unbabbled was recorded live during the 2020 Texas speech language and hearing associations annual convention. In this episode, we sit down with Dr. Kia Johnson to discuss childhood fluency disorders including stuttering and cluttering. Dr. Johnson is an associate professor within the department of communication sciences and disorders at the University of Houston where she specializes in fluency disorders with a focus on young children who stutter. Her current research examines speech disfluencies in culturally and linguistically diverse children. Aside from teaching, she presents her research at conferences and serves on the board of directors of the national black association for speech, language and hearing. During the episode, Dr. Johnson explains the differences between typical disfluencies, fluttering and stuttering. She gives examples of stuttering behaviors, common red flags to look for and tips for parents to use at home. She also discusses the importance of receiving an evaluation and therapy from a speech language pathologist, the high level familiarity with fluency disorders.

Stephanie (01:29):

Hello. We're live at the Texas speech and hearing associations annual convention, speaking with Dr. Kia Johnson from the university of Houston. Welcome.

Kia (01:38):

Thank you.

Stephanie (01:39):

We're so excited to talk to you today about fluency influencing disorders. I'm particularly excited about this because to be honest, it's not something I practice on the daily, so I'm a little rusty and I'm ready to learn.

Kia (01:49):

Okay, great. That just know that you are not alone. The average SLP is going to probably feel about the same way that you're feeling.

Stephanie (01:56):

Yes and I have so many friends as parents reach out to me and I'm like, Hmm, I need to send you on to an expert and so this will also help me give them things to say as well.

Kia (02:05):

I just want to say the fact that you said that is really good because I think it's important for an SLP to know it's okay to say, let me send you to someone. If you came to me for voice or swallowing, I'm going to say, let me send you to someone who can.

Stephanie (02:20):

So that's great. So first we'll start off with having you give us a little bit of a definition about fluency and what a fluency disorder is.

Kia (02:28):

All right, so it's important. A lot of times we think about fluency disorders as main synonymous with stuttering and that's a huge misconception. Fluency disorders is more of an umbrella term that includes types of fluency disorders with developmental stuttering or childhood stuttering being the most common type. You have your childhood stuttering, which is the same thing as developmental stuttering. And then you also have acquired stuttering and um, under acquired you have neurogenic stuttering where stuttering is a result of some damage to the brain or disease happening to the brain. You have psychogenic stuttering. And then you also even have cluttering that a lot of SLPs don't know about. So it's important to keep in mind that when we say fluency disorders, there's an S on that because there is more than one type of fluency disorder.

Stephanie (03:16):

That's fantastic. And you're right, that people automatically jump into stuttering. So what makes stuttering different?

Kia (03:21):

So think of stuttering. So when we think of fluency, and as I talked to you right now, my speech should be flowing. Like if you had a river or a body of water, it should flow. But every now and then you may have, um, a tree log in that river or a rock or a big stone in that river that interrupts the flow. And that would be a fluency disorder. If you think about stuttering, you have disfluencies or episodes that interrupt the flow of the speech. So it could be repeating a word, it could be repeating a sound, a part of a word. Um, it could be holding onto a sound or a block things that interrupt the flow of, uh, the speech. And it's important to keep in mind that you can have disfluent speech as a part of other disorders, um, or other diagnoses of autism will have disfluencies. But when you think about stuttering, the location of those disfluencies is very important because it usually happens towards the beginning of the word, towards the beginning of the sentence. Things of that nature.

Stephanie (04:23):

When you're talking about stuttering like behaviors, can you list like the top people can look for?

Kia (04:29):

All right, so stuttering like disfluencies we consider those to be, some people may call them stuttering. Disfluencies abnormal disfluencies I use stuttering like so you have monosyllabic, whole word repetition. And it's important to say monosyllabic because if you don't, you know, elephant, elephant, elephant, that wouldn't be something you would see. So monosyllabic, whole word repetitions, sound or syllable repetition. Some people will call those part word repetitions. You have the audible sound prolongations most people just call those prolongations like the ball is mine. Then you had the inaudible sound prolongations what people call blocks. And that would be something like the ball is mine and it's interesting. That last one is a type of disfluency that if you're not really looking at the person, you may miss it. Um, then you have the non stuttering like disfluencies a phrase, repetitions. I want, I want a new pair of shoes. Um, you have revisions? I want, no, I think I need a new pair of shoes and then interjections interjections to us the ums, something that we do a lot are the likes. Like yesterday, like I went to the store and like then I did that. So the like would be an interjection. I'm going back to this stuttering light, disfluencies whole-word repetitions. That's the one type of disfluency that you could also see manifest itself in kids with language. So if you have a kid with a language disorder, they sound a little disfluent, not really stuttering. They have a whole-word, a lot of whole-word repetitions that could be because of language.

Meredith (06:09):

You mentioned a childhood stuttering or developmental stuttering. Can you explain what that is?

Kia (06:14):

The most common type of fluency disorder that we see in speech pathology would be developmental stuttering. Thinking that the child or individual began to stutter as a child. So you could even have an adult who has been stuttering all of their life. If they started stuttering when they were a kid that is childhood stuttering. I always tell my students that this term childhood stuttering is the same as developmental stuttering. So professionally I make the decision, if I'm talking to an adult, I'm going to say you have developmental stuttering. I'm not going to tell the adult you have childhood stuff, but no one that is the same thing. It starts when they're a kid. Usually around the time that you see a lot of growth and speech and language and um, some of those kids, it will go away. They call it natural recovery. We used to say spontaneous recovery, that term has migrated to natural recovery and that most kids who start to stutter, it will poof, disappear, go away and they won't need any even any treatment for it. Then you have those individuals or kids who it doesn't go away in and it stuttering continues on and we consider that to be persistent stuttering and that's when we really want to come up with a game plan to figure out how to address it. Um, the one thing that I will often say to, uh, people in when we talk about this, usually the first line of defense is a pediatrician. The parent notices something's going on, they go to the pediatrician and the pediatrician usually will say, wait and see. Yeah, don't worry about it. They'll grow. Most kids grow out of it. And as the SLP with expertise in stuttering, I'm going to say that's true. Most kids do grow out of it, but we would rather that the pediatrician refer them to us as speech pathologists so that we can start to monitor, see what's going on. Because there are some signs that I could notice or recognize that would probably suggest whether or not this kid is going to recover or persist. And so we always tell parents, yes, pediatricians know a lot, but when it comes to stuttering, refer so that we can, you know, figure out what may be going on.

Stephanie (08:27):

Plus it opens you up to the chance that your child might not be the one that it just poof goes away and you don't exactly know earlier. You can get them that intervention. Then the better at having strategies before they start really coming into difficulties.

Kia (08:41):

Exactly. Because, and that's one of the reasons I like to work with kids because if I can somehow address the stuttering before you have the extra baggage before these kids have experienced teasing, bullying, those negative experiences that just add extra layers onto their case. If I could help them with the stuttering at a younger age, then who knows what their future is going to look like. And when I say help, it may mean that they continue stuttering, but are they okay with stuttering and knowing that I can say whatever I want to say. If I have some strategies that I want to use, that's fine. If I don't, that's fine too. But if I can work with kids at a young age before they get to adulthood, that to me would be the best scenario. So to the pediatricians, you know, we don't know who's going to spontaneously or naturally recover. So I'd rather monitor that.

Meredith (09:38):

So if a parent is listening and their child has some disfluencies, you want them to go to a speech language pathologist rather than wait. I know as a speech language pathologist that fluency, like you said, could be a typical part of language development. Yes, but is there a magic number? Oh my kid is this age and still stuttering or my kid centers this many times in a day. Is there something we should be looking forward to know, okay, now is the time we need to go to an expert?

Kia (10:02):

Well, one thing before I answer that and hopefully my mind will let me remember. One thing you said that's important is that everyone's disfluent right? And I even demonstrate to my students when I'm talking and I'll say, did you just hear that? Disfluency so it's important for parents to know that speech disfluencies they are a natural, normal part of speech and language development. What I tell parents or a speech pathologist, I always ask the question, when did it start? Not necessarily when are you first concerned, but when did you notice your child repeating words or repeating sounds and then getting a sense of how long has it been going on? If it's a couple of months, six months, seven months, ah, how old are they? If they're young, three-year-old, six months or so. What I would say is, okay, let's monitor it in about a year. If you're still noticing things have progressed in severity, then okay, let's do something. So I always look at how long it's been going on, but in this, I don't want to get too much into politics and things like that. If you had the ability to just do an evaluation, it's always safer to just say, let's, let's go ahead and do one. I'm not going to tell the kid, Hey, I think you stuttered, let's do an evaluation. But it allows me to take some baseline data and see if there is a concern ever from a parent, an SLP, there's no harm and getting an evaluation.

Stephanie (11:26):

Are there any clear red flags that parents should be looking for?

Kia (11:31):

That's good to know. That's good to ask. So as a parent, especially if you start to see some frustration from the kid, most preschoolers, you're not necessarily gonna see frustration, but if I have an evaluation and even if the kid hasn't been stuttering for that long, maybe they only have been stuttering for about 11 months or so and I'm noticing frustration, I'm more inclined to say, let's start doing something because for whatever reason that child has started to learn or starting to learn that there's something different about their speech and prohibiting them from saying what they want to say. So for parents, if they notice that there's some frustration going on and frustration at that age is usually something like, Oh, I just can't get it out or forget it. They're not going to say, mommy, I have a stuttering like disfluency that is prohibitive. They're not going to do that. Also, if you feel like the child is having some difficulty with communicating their thoughts, because sometimes at the young age with normal speech development, the parent may just need strategies on how to deal with that. So sometimes you could be work as the SLP working with the parents to say, here are some things to do, here's some things not to do. Parents will often feel like they are because of it. Countless stories of the parents saying, well, it's because we got divorced or it's because we moved or maybe I should homeschool because maybe he started school or he started all of those types of things. So parents come in with the idea of them maybe having caused it. And so I tell parents, you couldn't have caused it if you tried, but here are some things that you can do that could help facilitate fluency while we determine is this child going to naturally recover or a persist.

Stephanie (13:26):

What are some of those tips that you give parents?

Kia (13:29):

Oh, that's a great one. And I will give this full disclaimer and saying, I have two children, five and seven. So I understand as a parent that some of these will sound crazy, like there's no way I can do that. But it's like weight loss. You take it in small baby steps and any of these suggestions, I would never suggest that a parent does 24/seven I would say five to seven days a week, 15 to 20 minutes. These are the things I would want you to do. First would be eliminating simul-talk where we talk over each other and it's important for parents, especially in thinking of cultural diversity. Some cultures it is normal, expected typical conversation to talk over whoever talks the loudest gets the floor, but we have to sort of retrain parents to think that if when you respond to Johnny, that's a random name. You want to pause for one second before responding. So if Johnny says, what are we having for dinner? Recommending that the parent pause for one second before responding, what does this do? What it does is it gives the kid time and it starts to teach the kid that there's no real reason to rush. There is no need to talk really fast because mommy's going to give me all the time I need to respond. I never tell the parent. Okay, tell Johnny, you're pausing one second. Just do it. Modeling that behavior over time will help. If speech rate is an issue, we'll help to slow Johnny down and helping him to understand that he doesn't have to rush because I won't be interrupted. A lot of times if you think about you have a three year old or four year old or a five-year-old who is trying to communicate with the big people in their world who are talking over them. So how can we create a space where they have that cushion of empty talking time around their their utterances. So simul-talk, that would be one thing. Eliminating rapid fire questions. What do you want for breakfast? Do you want pancakes for breakfast? What about cereal for breakfast? Or you can go to McDonald's for breakfast, but then there is a Chick-fil-A for breakfast or how about we just don't eat breakfast? So a lot of times parents will throw a lot of questions at the kid and while the kid is trying to get their speech and language development together to respond to the first question, the parent has already moved on to question four or five. So I always recommend ask one question when he responds. Pause for one second before moving on. Um, the other thing would be keeping things simple if especially when with preschoolers, they are learning speech and language. Their, their vocabulary is growing, their syntax or grammatical structure is maturing. So when they are responding to you, they're trying to sort all of this stuff out. So keeping things simple, not dumbing down their speech but keeping it simple. Example I give is, um, if the kid, you have a pin and the kid says, what is that? Parents want their kids to know a lot of stuff. So they give them a lot of information. It's a pin. It's different from a pencil because a pencil has an eraser on it. So when you use a pencil, you don't have to be as careful, but what do you use a pen and you have to be careful. And pens come with blue ink and black ink. That's a lot of information. The kids simply asked, what is it? Answer that question. It's a pen. If the kid wants to know something else, then they'll ask. So those are just some examples of things. And it's interesting because all of those things are strategies that are good with kids, period. Developing speech and language. So I give parents those suggestions. And the last one I'll mention is nonverbal time here in the States. We have this mindset that when people are not talking, something must be wrong. Are they having a bad day? Are they not liking you? We consider nonverbal time awkward, awkward silence. Yes. Yes. But why? You know, why there is nothing wrong with having dinner and not talking. My mentor, I'll have to give a disclaimer. All of these suggestions come from my mentor who trained us, Dr. Ed Contour. So I don't want to take any credit for, for this, but um, one of the stories we would hear we heard was a parent who said, we did no talking at dinner time. And the kids said, you know, this is a very nice dinner. I really like this. So taking off the pressure of the kid feeling like they always have to talk.

Meredith (18:01):

That's interesting because when you talk to speech language pathologist, so rarely is the answer. Stop talking. Yes.

Kia (18:07):

So it's funny you mentioned this. And um, so I radically no family history of stuttering in my family, my seven year old sons debtors, and I recognize him to speech disfluencies when I recognize his first whole word repetition. I remember it, he was two and a half. I was buckling him in a car seat and he said a whole word repetition. I said, mental note. Okay. And then maybe two years later I was doing some strategy changes at home, things that I would suggest to parents. And finally I reached out to some of my stuttering friends and I said, okay, here's some videos of my kid. Here's the history. I think it's time for therapy. What do you think? Um, and they, so he's been influencing therapy for um, probably about two little over two years now. But second grade, the number one thing he gets in trouble for at school is talking, is talking. And so, um, as a parent and an SLP in stuttering, you know, it's awesome that my kid is getting in trouble for talking. So I find myself having this conflict in my mind of telling my son, okay, you're getting in trouble for talking at school. On the other hand, I want you to be comfortable talking, but then you don't have to talk all the time. So what do you do? So I've been telling him, you know, talk when you're supposed to talk and listen when you're supposed to listen and hope for the best.

Meredith (19:33):

If only it was that easy. I know sometimes we talk when we're supposed to be listening. It's hard to figure out something.

Kia (19:40):

But I will say I have a second grade kid who stutters, who is completely comfortable with this speech, confident in speech, talks in class, and I told the teacher, I said, the fact that you have a kid who stutters in your number one complaint is he's talking a lot. I think we're doing really good.

Meredith (19:57):

Yeah, that's awesome. Earlier you mentioned cluttering. Can you talk a little bit about what that looks like?

Kia (20:03):

So the one thing I will tell speech pathologist about cluttering, when you see a case and you're thinking, huh, they sound disfluent, but I don't see a lot of stuttering like disfluencies but man, they sound as fluent. I can't understand what they're saying. Then that should be a huge red flag to start thinking about cluttering. So think about cluttering as irregular speech rate. Often rapid,, pauses and awkward places intelligibility could be low depending on how fast they talk or how irregular the pauses are. And a lot of the intelligibility comes from co-articulation, a lot of co-articulation going on. So instead of, um, mathematics it might mathematics instead of elephant in might be elephant. So there's a lot of co articulation that's going on in addition to the rapid speech, right? So in conversation, maybe you may have some unintelligible [inaudible] going on. The big difference between stuttering and cluttering is that with stuttering, you're going to have a high amount of stuttering, like disfluencies, monosyllabic, whole word repetitions, sound syllable repetitions, audible prolongation and inaudible prolongation. With cluttering, you don't have a high amount of stuttering like disfluencies you have a high amount of non stuttering like this fluencies the phrase repetitions, the revisions interjections you may also see it manifested in their writing. So if you take a writing sample, you may see some, the, the clarity of the writing is not there. The organization of the writing may not necessarily be there. Um, you can also have it manifested in reading. Um, so some of their academic skills and one big thing is that for a developmental stuttering, it usually begins younger in age two and a half, three years of age. Cluttering, you're more likely to see that manifest itself around age seven or eight or nine. So later, a little later in the speech and language development.

Stephanie (22:11):

Earlier you mentioned that parents don't cause disfluencies and stuttering. Can you touch on one of the, what might be behind disfluency?

Kia (22:21):

That's a great question. That's a great question. One of the things I like about stuttering is that no matter how long we've been researching stuttering, no matter how long we have records of a stuttering has been around for, for a long time and still yet we can't identify. We don't look at it as one sole cause of stuttering. Um, so I tell parents that we really don't know what causes stuttering, but we do know what factors may, um, cause you to have a greater risk to stuttering or factors that may agitate stuttering. So a family history of stuttering would increase your, um, chances of also having stuttering depending on the gender of other family members. There are some data to support, you know, if it's a female versus a male. But also thinking about, um, not only in internally when you think about the process of planning and producing speech, some people may say that there's a disconnect somewhere and the timing of you being able to plan and also produce what you want to say while also being fluent there is, so the genetic component is there. There is some, in my opinion, we don't always agree, um, environmental component as well. So if the person has some disfluent speech, you also have some reaction from their environment that could play a role. Some kids you have temperament going on. What I tell parents is that what's most important is that we focus on how can we help the situation and not necessarily focus on what may cause it. Because the cause is going to vary from person to person. People will say, you know, family history causes it. And I say, well, you know, that increases your risk but it doesn't cause it because you can have a kid who stutters my child with no family history. Right? You can have a kid with a family history who doesn't stutter. So you can't really say that it causes it. It may increase your risk of it, but not necessarily cause it. Right. Does that make sense? Yeah. I want to go back to cluttering for a second. Sure. Um, something to add about cluttering is that sometimes individuals, most times the individual who clutters does not know they clutter. Oh. So from an SLP standpoint, I had never experienced where the person calls you to say, my child needs an evaluation because I think they clutter. Usually the parent will say, I want, or the person will say, I want to get an evaluation for stuttering. And then they come in and you say, yeah, um, I know you think it's stuttering but it's really cluttering and then the person goes cluttering. I've never heard of that. Um, so a lot of times the person who clutters doesn't know that they clutter. And I would argue that there are a lot of people walking around, you know, on a day to day basis who clutter and have no idea.

Meredith (25:17):

Yeah. So when you're an SLP working with someone who stutters or clutters, what does treatment and prognosis look like for them? Because a lot of people I know who stutter, they started stuttering as children and continue to set her into adulthood. Do you discontinue someone when they have the strategies and they feel comfortable using the strategies or you know, what does that look like for them?

Kia (25:38):

So I'm a part of it has to do with age. I'll be honest. So I'm with young kids. My goal would be to figure out is there a way that we can address it where they really don't have to think about it later in life and we can just, you know, they're still within that age range that this could possibly just go away. But as they get older, if they continue to stutter, I at some point, uh, think about, uh, tweens and teenagers. Prognosis is also going to involve what does a kid wants to do? I have seen teenagers where the parent is dragging them in to give fluency therapy and the kid goes, look, I'm good, I'm good. Right? And then the parent goes, Oh, well make Johnny didn't want to do therapy. I can't make Johnny want to do therapy. But what I would tell the parent is that we're here. So if Johnny does not want to do this, it's going to be a difficult situation for the parent, for Johnny and for the SLP. But if Johnny changes his mind, Johnny can definitely come back. So that's a hard conversation with parents because parents are looking at you as SLP to say, well, make Johnny want to do therapy. If Johnny's a teenager, I'm going to tell Johnny, look, what do you want to do? Because the only way that we can make any progress is knowing that you want to do something. And if Johnny doesn't, then I'm going to tell Johnny, okay, that is not a problem. If you change your mind, we're here. And that's what I'm going to tell the parent once shift that I'm so grateful that we've made. Um, but I'm hoping that we can get all SLPs on board with this. Our clinicians used to go into stuttering therapy with the mindset of I need to fix you. I need to fix this. Stuttering, stuttering treatment is not successful until I get your stuttering to go away. Right? And that's where we have thankfully evolved because my job as a clinician is not necessarily to fix you, but to give you intervention in a way that is going to make you comfortable to say whatever you want to say, whether it's fluent or not. And that is an important piece that I want more of us to get. So I'm, yes, I'm going to give you some strategies, okay? If you're stuck on a word, let's practice or go over some things that you can, you can use. But if you're in a situation, you're like, I don't want to use my strategies, that's okay too. You know, um, how can we work on, especially for those individuals, adults, we know, um, well not even just adults, teenagers, we know at some point the stuttering is not going away. They're outside of the window of recovery. So my job at that point is to help you feel comfortable saying whatever you want to say, whether stuttered or not. Because I've seen cases where you can get their speech to be within normal disfluent range and if they're still not comfortable talking, then what have you done? Um, and the goal is never 100% fluency, never 100% fluency. The goal should be for the younger kids striving to get them as close to normal disfluencies as possible. Um, but as you get outside of that window of recovery, I need you to be comfortable in saying whatever you want to say.

Stephanie (29:05):

Yeah. I had a friend in graduate school that when we were in class, I didn't notice any disfluencies and then we went out for drinks afterwards and I was like, Oh yeah, yeah, I don't have to try as hard here. Like I feel comfortable like this is good. And the same thing with other colleagues and friends that they're, they're embracing it. And I love that there is a shift towards embracing it. And I think that hopefully that'll help parents feel less stressed and the kids more comfortable too, that there's, yes, it's an embraced more and that they can feel confident in being disfluent in front of others.

Kia (29:40):

And going back to something you said really early, the average SLP has had coursework influency and sometimes that coursework is a part of another course, so they may get a few weeks of fluency. Um, you can have individuals that may see one client in grad school on fluency, all of that to say that you have SLPs that could be seeing kids or even adults that may not necessarily feel comfortable and are still in that mindset of I need to fix you. And if you come into contact with an SLP with that mindset at a young age and you're stuttering, does it go away? Then what does that do for that person, you know, um, does that person then feel like I'm a failure or this the therapy was a failure? Or could it be that you just needed to go to an SLP who was,

Stephanie (30:39):

So where would you suggest that parents or even clinicians turn to find people who are experts in disfluencies and stuttering?

Kia (30:47):

What I'll say, we have a number of experts, but you can easily be in a state where there's only one in that entire state. So one of the reasons I went into academia is because I feel like I would have a greater impact on the area of stuttering if I were able to train future clinicians on how to do an awesome evaluation, how to do something in treatment or find someone who they can refer and know that at least they did an awesome assessment. Um, so I usually will recommend that the parent asks questions. Where did you go to school? What do you know about stuttering? How many clients do you see on average in stuttering and being okay that if they say, I don't, I don't work with stuttering or I haven't seen anyone. Okay, then let's go look somewhere else. Um, even within school districts, one thing that school districts I think should do is identify is there an SLP and your school district that you know, likes fluency, that has some extra experience with fluency? What would it look like if a school district would be able to say, this is the SLP that you can call, here's a list of SLPs in your school district that knows something about stuttering. Not saying that the kid has to see that person, but maybe that SLP can talk to that other SLP. Here's what I'm thinking about doing. Here's what I have been doing. What do you think about it? Like a resource or a mentor sorts. Yes. Yeah, and I don't, I'm not suggesting that, you know, my phone ring off the hook, but I do that. If I have a parent who's, you know, the kid is in some school district, I will tell that person, that parent, I'm willing to talk to that SLP. I'm willing to see what they're doing, offer suggestions because it's all about the kid. It's all about the kids. So I would tell parents, if you're working with an SLP that may not have enough, a lot of experience or may not feel comfortable, maybe link them with an SLP who does that. They can talk to you by phone. Stuttering Foundation has a nice referral website by state. There also is a board specialty recognition, in. fluency disorders. There's a website with the list for that. Um, but I think it's important and I feel bias. I think it's important that for kids who stutter individuals who started, that they're being seen by an SLP who either has another SLP as a resource or that feels comfortable with stuttering.

Meredith (33:20):

I agree. Yeah. Yeah. I think for me with experience, I've learned that I can't know it all yet and I can't treat it all. Yes. So I'm referring, there's nothing wrong with referring, but I think a lot of us, especially straight out of school or are really young in our careers. We feel like, but I'm an SLP. I'm supposed to be able to do all this. But in reality we can't, our field is so large. Yes, our scope of practice is so wide.

Kia (33:42):

Yes. And we have to sort of change that mindset to think that way. And not to plug another podcast, but there is one called Stutter Talk and they did a segment on should the average SLP treat stuttering. And one of the dilemmas that make sense. If a school has hired you, you are certified state licensed speech pathologist, but then you come to that school and say, I need to refer this kid to another SLP for stuttering. Then that school could look at you and say, but we hired you. So if you can't do what we need you to do, then why don't we hire someone else? We see the dilemma. And that's why I think it's okay to have a resource and say, um, I'm going to, you know, phone this person. And, and that'd be okay. Yeah, I'm not going to treat voice. Nothing against voice, but I know ethically that's not where my experience is. I know what I'm comfortable with. I know what my experiences in and if someone comes to me, if I do an assessment and I notice the kid has a language issue, even though within the scope of practice I can do that. I'm going to say your kid does not stutter. However, I've noticed some concerns with language and would like to refer you to get more evaluation in that area. I do want to just share that I am, the chair of the national black association for speech language and hearing and just a plug that um, we are having our, we have an annual convention every year, just like TSHA, just like ASHA, it happens every April and this is the first year that we would be coming to the great state of Texas. So as chair of the board, I'm very excited to say that the convention will be happening in Houston, Texas April 15th through the 18th. And I will say the first question I'm always asked is, do you have to be black to come? The answer is no. Um, what we do is we provide a lot of knowledge in this profession, um, knowledge on different areas within this profession from a cultural standpoint. So if you are looking for knowledge that's culturally based, trying to increase your cultural competence and Basel would be the convention to come to you.

Meredith (35:54):

And I'll be there. I'm so excited. The Parish School is going to have a booth. They're excited about that and our head of school will be presenting as well.

Kia (36:01):

Yes. She's a highlighted presenter and I would, I mean just as chair, the fact that it's in Houston, I'm so excited about that.

Stephanie (36:08):

That's awesome. I do have one question. Yeah. On that same note for we in Houston, we have a lot of bilingual families. We're very culturally diverse. Is stuttering or disfluencies going to look similar or present differently in children who happen to be bilingual?

Kia (36:22):

That is a great question. I actually have migrated into bilingualism and stuttering. So I've done some research looking at Spanish and English and also even Urdu in English because a lot of what we know is based on Spanish, English and I I want to see does that apply to other bilingual populations? That is a great question because we know that what is considered normal disfluencies for monolingual English kids is different than what is considered normal for bilingual kids. Um, bilingual kids are usually going to have a higher rate of disfluencies, but it's still considered normal. Interesting. So when you think about frequency bilingual kids who do not stutter, their frequency of speech disfluency is going to be higher than monolingual kids. Everything we have in the area of stuttering is based on monolingual English speaking kids. So if you're using the SSI with bilingual kids, the tax with bilingual kids, nothing against those instruments, nothing against those instruments. They were created based on monolingual English kids and shout out to the tox people because in the manual first page it says, this is not for bilingual kids, but there are some resources like the Oasis that has been translated in, um, normed on different populations. So if anything, I would tell SLPs to use caution when diagnosing stuttering and bilingual kids because if you're comparing them to what we are taught, that is considered the criteria for stuttering. That's based on monolingual kids and the bilingual kids are going to have more normal disfluencies. And even my research says that they will have a lot of stuttering like disfluencies, but they're mainly repetitions.

Meredith (38:20):

And in a bilingual speaker who stutters, will you see the stuttering in both languages?

Kia (38:24):

Okay. So when you think about actually diagnosing stuttering in a bilingual kid, most cases you're going to see it in both. Okay. Because if you see it in white, especially if you see it in the language they're learning and not their primary language, then that would be an indicator to me that maybe this is language learning disabilities from language and learning versus versus stuttering. Um, something else that you'll see, you may see the prolongations and the blocks. Um, in addition to the repetitions. So the bilingual kids who don't stutter, they're going to have sound syllable repetitions, monosyllabic, codeword repetitions, no problem. Gate prolongations and blocks. The kids who stutter will have all of those are more likely to have all of those. Um, and then thinking about, um, their feelings and attitudes, things like that, family history. But a lot of times we pull out the SSI and say, well, according to SSI, no we can't do that.

Stephanie (39:23):

Well, at the end of every podcast episode we ask our dress a surprise question. Okay. So we ask, and it can be related to disfluencies and stuttering or it can just be any great advice. Said you're a mom, moms give great advice. What piece of advice would you like to give to our listeners?

Kia (39:42):

Oh my gosh. Now I have to think. Let's see. The, the piece of advice that I would give is no matter what you want to do, go for it. Don't let anyone ever tell you that it's not possible. If someone tells you no, you keep going for it. Go for what you want. Go for what you want.

Stephanie (40:00):

I love that. Great. That's great advice. Well, thank you so much. I learned a lot today. Very excited for this episode, and we appreciate your time. Thank you.

Kia (40:08):

And thank you so much for having me. This was fun. This is definitely fun.

Meredith (40:14):

Thank you for listening to the Unbabbled podcast. For more information on today's episode, please see our episode description. For more information on the parish school, visit parishschool.org and if you're not already, don't forget to subscribe to the Unbabbled podcast on your app of choice. And if you like what you're hearing, be sure to leave a rating and review a special thank you to Stig Daniels, Amy Tanner, Amanda Arnold, and Stella Limuel for their hard work behind the scenes. Thanks again for listening.