Developing Fluency Goals and Choosing Activities for Children Who Stutter


Listen, take a quiz, and earn a certificate of completion! Listen to this episode course at the bottom of this page or on your favorite podcast listing platform (Spotify, Apple Music, etc.). ASHA requires that CE courses take attendance (your unique login) and learner earns a certificate of completion (by passing the quick quiz). This program has been approved for 1 clock hour of continuing education credit by the Texas Speech-Language-Hearing Association (TSHA). TSHA approval does not imply endorsement of course content, specific products, or clinical procedures.

TSHA continuing education (CE) hours can be used toward renewal of your Texas license (and most other states too) and as professional development activities for the maintenance of your ASHA Certificate of Clinical Competence (CCC).

The Pep Talk Podcast for SLPs podcast episode courses have been planned and implemented in accordance with the policies of the Continuing Education Board of the American Speech-Language-Hearing Association (ASHA). TSHA is accredited by the ASHA CEB to provide continuing education for speech-language pathologists and audiologists.


This course reviews stuttering in children. It explains how to write
appropriate fluency goals and choose engaging fluency activities. 1 clock hour of continuing education credit
(Introductory Level, Professional Area).

The following learner objectives will be discussed in detail to ensure
achievement of objectives:
-Learner will be able to identify why using self rating scales during
stuttering therapy is beneficial.
-Learner will be able to list possible fluency activities to use in speech
-Learner will be able to describe characteristics of appropriate fluency


Michelle Andrews M.S. CCC-SLP

Michelle Andrews M.S. CCC-SLP

Founder and Managing Director

Michelle has been a speech-language pathologist since 2014. She has worked in the schools, private clinics, and home health. She started creating speech therapy materials for SLPs years ago and founded Pep Talk LLC. She discovered her passion for education and developed this continuing education podcast for SLPs everywhere. She desires to help SLPs feel confident and to produce the best treatment by increasing knowledge and skills.

Martha Horrocks M.Ed. CCC-SLP

Martha Horrocks M.Ed. CCC-SLP

Guest Speaker

Martha Horrocks is a Maine-based speech-language pathologist. She is the owner of Martha Speech & Stuttering Therapy, a private practice providing speech/language teletherapy for school-age children. Martha is passionate about working with people who stutter, and shares the latest research, treatment ideas, and resources with people who stutter, speech-language pathologists, educators, and parents.

Learn more about Martha here.


Michelle Andrews’ financial disclosers include: She has a Teachers pay Teachers, Boom Learning, and Teach with Medley store under Pep Talk LLC. She is also the founder and manager of Pep Talk and the Pep Talk Podcast. Teach with Medley Educational Games is a sponsor of this podcast.

Michelle Andrews’ non-financial disclosures include: She has a stock participation plan with Teach with Medley Educational Games.

Martha Horrocks’ financial disclosers include: Martha has a Teachers pay teachers and Boom Learning store called, Martha Speech, where she sells materials related to treating speech and language disorders.

Martha Horrocks’ non-financial disclosers include: No relevant non financial disclosers.


10 min: Introduction, bio, disclosures, learner objectives

5 min: review

20 min: Goal writing

20 min: Activities

5 min: summary, “take away” points, closing


Click to expand this episode's transcript.

Michelle Andrews: Hey, there, I’m Michelle Andrews. And I’m your host for the pep talk podcast. episode is all about developing fluency goals and choosing activities for children who stutter. Maybe like me, you learned some during your grad school fluency course. And you have even treated kids who stutter here and there, but if you want to increase your knowledge and skillset in this area, this episode is for you.

Our guest speaker today is Martha Horrocks. A Mane based speech language pathologist. She is the owner of Martha’s speech and stuttering therapy, a private practice providing speech and language teletherapy school-aged children. Martha is passionate about working with people who stutter and shares the latest treatment ideas and resources with people who stutter speech-language pathologists, educators, and parents.

If you’re listening along while you’re driving a car on a run or can’t find a pen. This episode is transcribed for you to refer back to easily. So you don’t need to worry about taking notes. learners prefer or need to read along. So a transcription of the [00:01:00] entire episode is provided in a link in the show notes.

First, we have to go over some formalities for the course, by going over our financial disclosures. My financial disclosures include, I have a teacher’s pay teachers, boom, and teach with medley store all under pep talk, I am also the founder and manager of pep talk and the pep talk podcast. Teach with Medley is a sponsor for this podcast. My non-financial disclosures include, I have a stock plan with teach with medley. Now, here are the learner objectives for this course. One, you’ll be able to identify why using self-rating scales during stuttering therapy is beneficial. Number two, you’ll be able to list fluency activities to use in speech therapy. three, you’ll be able to describe characteristics of appropriate fluency goals.

Okay. That’s out of the way. So let’s get started. This episode of the pep talk podcast is all about fluency, a topic I’m always looking to further my knowledge in, [00:02:00] I hear all the time about SLPs, not feeling confident when presented with a child who stutters, what exactly do I do? How do I write goals? What types of activities should I be doing this episode will answer all of those burning questions and more. I am thrilled to introduce today our guest speaker, Martha Horrocks. Hi there, Martha.

Martha Horrocks: Hi!

Michelle Andrews: I’m so happy. You’re here with us. Let me tell you guys a little bit about Martha and we’ll and then we’ll get started. I’m so happy. You’re here with us. Martha, let me go over your financial disclosures for everybody. Uh, Martha has a teacher’s pay teachers, and a boom store called Martha’s speech. Her non-financial disclosures include no non-financial disclosures. All right. So Martha, go ahead and tell us a little bit more about.

Martha Horrocks: Sure. So I’m a main based, uh, speech language pathologist. I am a career, a career changer. I started out, um, as a special education teacher and [00:03:00] met a speech language pathologist and fell in love with speech language pathology and went back to school. And then when I graduated, I became a school-based therapist. Um, and that was really my first exposure to kids who stutter. Um, and we can talk more about that, but, um, I thought that working with kids who stutter was amazing, and was working in the school up until the pandemic, and fell in love with my other love, which is teletherapy , , and decided to open my own private practice and so today I work with kids across Maine, via teletherapy. My practice is geared towards school-age kids who stutter, but I also see other pediatric clients, On the more professional side, I run a Instagram called Martha speech where I talk all about school, age, stuttering. Um, I like to [00:04:00] share resources for speech, language pathologists, but there’s also teachers and parents who follow me as well. Um, and I’m also really fortunate to have a good following of adults who stutter and connect with that community as well, which I think is really important when you’re a professional who’s specializing in, um, in a certain area that you really listen to the community that you’re, that you’re working with. Um, so I’m very, uh, humbled that I have so many people that follow along with me that, that stutter themselves as I do not.

Michelle Andrews: That’s amazing. You’re great for that community. That’s awesome.

Martha Horrocks: Thank you.

Michelle Andrews: Tell me how you began to specialize in fluency.

Martha Horrocks: I’m not sure that I would call it specializing. Um, specializing is really a term that I would reserve for, um, board certified fluency specialists, um, and people who are board certified go through a whole, um, [00:05:00] additional coursework and they have a lot of client hours. They have a mentor. It’s a, it’s a long process. So when you see somebody who’s board certified, they’ve done a ton of work to earn that specialized title. So I won’t, um, I won’t make it seem like I am board certified at all, much respect to those people. Um but. Yeah, well, that’s really cool. Um, and they, they have meetings and it’s a really nice community of people I’m just not there yet.

Um, in my practice, I don’t, I don’t get the hours that I would need, um, to become board certified, but I greatly admire everybody that is, in terms of nicheing down is kind of more what I would say. How did I become really interested in fluency? How did I learn more about it? Um, I. So, like I said, I, I started out in the schools and I had a relatively high number of kids who [00:06:00] stutter on my caseload and I quickly learned that I didn’t really have a lot of tools from graduate school and I was kind of lost. Um, and my students really helped support my understanding and taught me a lot about stuttering and so that was the first place that I, I really learned a lot. I also felt like I needed to really expand my information based. And so, there’s a ton of great courses out there about stuttering, the stuttering foundation, in particular has great, great resources. Um, Scott Yaruss has a million different, um, professional developments for like speech pathology, um, EDU and things like that. Um, and so I’ve done a lot of those and then just read a ton of research. And the more that I got, kind of rabbit hole, [00:07:00] I guess the more that I found out, the more I wanted to know. Um, and, uh, I also got really excited about sharing it with other SLPs on Instagram. And I think that also spurred my interest in, in translating all the things that I know into ways that a busy speech language pathologist, especially a school based could immediately implement into their own approach and in their own speech rooms.

Michelle Andrews: That’s awesome. I love when I hear you find your passion and you just run with it and you learn all you can. And that’s amazing. Okay. So let’s get started with a quick review on evaluating and qualifying for stuttering therapy.

Martha Horrocks: Yeah. The, this is a huge topic. I think when we’re in graduate school, um, and we think about evaluation, usually we’re taught, or at least I was, with a lot of emphasis on dysfluency counts and how to do a proper  [00:08:00] dysfluency count. How to know, what counts as like a part word repetition. Um, maybe you even learn how to notate it on your paper. And that’s a, a skill certainly, but, um, stuttering evaluations are so much more than dysfluency counts. And in fact, I don’t actually do dysfluency counts that often, we could speak about dysfluency counts first, and then I can talk about what I do for an evaluation.

Dysfluency counts are a specific measure of stuttering in a certain moment of time. So the child comes into your room, maybe it’s 10:15. Um, you give them a passage and they stutter with a certain percentage, but that percentage might not be the same 10 minutes later. It might not be the same the next day. Um, and that’s because discipl fluency counts, don’t really account for the variability and stuttering. , one of the things that we know [00:09:00] really definitively about stuttering is that it is variable, which means it’s variable across people, but also for the experience for the individual. So, um, a child who is 2% dysfluent one day might be. Whatever the next day. Um, and so dysfluency counts are really not an accurate measurement of where a child’s at in terms of stuttering. They also just measure one aspect of stuttering. And now I can talk a little bit more about the evaluation in general. Seth Tichenor and Scott Yaruss did a fabulous, um, research study that I talk about. If you follow me on Instagram, I talk about all the time and what they did is they did a huge survey at a conference of adults who stutter and all they asked is what is stuttering and I reference this all the time because I think it really helps to, put into perspective. [00:10:00] What are some of the things that we need to be thinking about when a person stutters?

 One of the responses that the people had was that there are certain behavioral experiences and this, this is kind of what the dysfluency counts as getting at those repetitions, those blocks, those prolongations. Um, but dysfluency counts. Won’t see any physical tension, which would be a behavior. Um, any secondary characteristics like eye blinking, shifting in your chair, some people do behaviors with their mouth or their face, or like avoidance behaviors like choosing a different word to say. One part of the evaluation needs to look at what kind of behaviors are the child experiencing in their, um, in their life as people who stutter, something else that people who stutter talked about was, uh, was effective [00:11:00] experiences.

So the feelings and emotions that are associated with stuttering. So we need to make sure that for the evaluation that we’re checking in with, what experiences do they have, could be positive, could be, um, negative, but it also could be just like neutral. Maybe they don’t have thoughts or, or feelings one way or the other. We also need to be looking at their cognitive experiences with stuttering. So what are their thoughts? What do they know about stuttering? Do they have any, um, do they believe any myths about stuttering or have they heard any myths? So we’re gonna need to do some digging about, about their understanding. Something else that the adults who stutter shared with, Tichenor and Yaruss is social experiences really shape their experiences as people who stutter. So in an evaluation, we’re gonna wanna look at, um, what experiences have you had interacting with other people as a kid [00:12:00] who stutters? This might be like, um, they’re in their classroom and they raise their hand and they start talking and the teacher finishes the sentence for them.

Um, that. Social experience might really shape who they are as a person who stutters. So we need to make sure that we’re aware of those moments that have brought them to be this person who’s in our room that day. Something else that the adults shared was, um, really two feelings, two sensations, which was the feeling of being stuck and the feeling of loss of control and those were kind of universal across all the people that they interviewed. Um, whereas the feelings and the thoughts really varied. The, the feelings of being stuck and loss of control were the most common themes in the research and so that’s something that we wanna check in with as well. Um, do these things resonate [00:13:00] for you? Because then we can really think about how to gear our therapy so that they don’t feel as stuck or stuck, and that they have some sense of control back. So, um, I just talked a lot but to summarize, there’s a couple things that we’re looking at so we’re looking at, um, Their thoughts and emotions. We’re looking at, their behaviors, we’re looking at their social experiences. And then we’re trying to see if they’re feeling stuck or if they’re not feeling in control. And those are our big evaluation goals. You might be wondering like, well, that all sounds really qualitative. Like we’re just gonna have a, a discussion. And when I go to the I E P I’m just gonna have like a narrative of our discussion of stuttering. And how do I convince, um, the IEP team that this child needs therapy. If they’re not even openly stuttering, I might not have data to show. [00:14:00]

Michelle Andrews: um, there’s the question I was thinking in my head. Yeah. When you’re at a school. What do you use to make sure that they qualify, especially in a school?

Martha Horrocks: It’s so hard because I, at the school district that I was in, um, the school really wanted to qualify based on those dysluency counts. So what can you do to show data other than, counts that aren’t always an accurate representation of the child’s experience. So there, um, there is a, a wonderful, , Evaluation, a standard assessment, called the Oasis, the overall, oh my gosh stuttering experience. Scott Yarrus. Don’t judge me. I can’t remember what the A stands for right now. Um, oh, overall assessment of stuttering experience. um, anyway. If you look it up, you’ll be able to find it, it gives a standard score and it looks at [00:15:00] literally all of the things that I just mentioned there’s, the way it works is it is questions based and I, I work with school-aged kids, so I’ll just go through, , and we’ll answer the questions together, but you could, if you worked with older students, like middle school, high school, you could give it to them to fill out on their own and they’re also coming out with sometimes soon, an early childhood version, which I think will be amazing. Um, so that’s a standard assessment that you can go out and purchase but if you also need numbers, There are some other assessments out there that provide numbers, , but are more informal but you can also look at incorporating self-rating scales that you can make on your own. And this, I think is really nice because you can customize it to the child and to their experiences but it also provides a way for you to show tangible data and then tangible growth. It might [00:16:00] not be feasible to give the Oasis every couple weeks, but it would be a lot more feasible to go back and reference a self-rating scale that you did in the evaluation and say, Hmm. When we met in September, you gave a rating. For your confidence about stuttering as a two out of 10, where do you think you would be now? Um, and or where would you like to be? And so there’s a lot of really great data specific things that you can do that are quantifiable that don’t, that aren’t just qualitative, like the child didn’t feel confident, and helps to show specific progress in, in your speech therapy.

Michelle Andrews: That’s awesome. There’s a lot there. There’s a lot to look at when a kid walks into your therapy room evaluating, but that’s, that’s awesome. I think maybe let’s go ahead and dig a little deeper into those self-rating skills, because, sounds like that is a great tool to know about, to be able [00:17:00] to check in with your student, to monitor their progress and how they’re feeling and doing. So you, you mentioned there was a self-rating scale about their confidence. What are some other scales that you use? Can, I guess, dig deeper into the self-rating scales?

Martha Horrocks: Yeah. So what I do is a generally, um, I have those five areas that I was talking about from that study for adults. So I know that I might make a self-rating scale around feelings or specific feelings. I might make a self-rating scale around thoughts or social experiences or, um, behaviors, but the way that, , self-rating scales usually happen in my sessions is I like to start off, , every session by asking my clients, if there’s something that I can help them with. I just did this the other day. It’s the, the start of the school year here. And, um, one of my clients said, I don’t really wanna [00:18:00] talk in my classroom. He has a new teacher this year and he was like, I’m just not feeling it I just don’t want to participate. We could take that at face value. Right. We could write that down in his file. He does not wanna talk in class, but we could explore that from a feelings perspective. Okay. So how does that make you feel or how do you feel in your room? And maybe he says, I feel really, annoyed with stuttering and so I don’t wanna talk or I don’t feel comfortable or whatever it is, we could take it from that perspective.

Um, and I could ask him, I like to do on a scale of one to 10, but however old your, your student is, some people do percentages with older kids. We might look at that. Um, I might look at, , What are, what are you doing instead? , so I don’t wanna talk in my room, so I am, um, I am just staying silent. Okay. So how, [00:19:00] how much do you feel like you’re staying silent? If, if zero is like, I’m participating all the time and 10 is, or the other way around, whatever. Um, but 10 is, I am silent and I never participate. Where do you think you’re at? And they say I’m a 10. I never participate. Then we might talk about what, how much would you like to participate in your brim in your, in your classroom? They might say, well, um, I’d like to try to participate a little bit more, so maybe I’ll try to move to nine. And then we might think about for the rest of the session, what could that student do then to, to work on those goals?

So it’s really, um, it’s really integrating a concept called solution focused brief therapy, which comes from counseling from, um, from mental health professionals. But the idea is instead of focusing on the [00:20:00] things that they are struggling with, or they’re not doing well, how. How can we create a self-rating scale where you see where you’re at, but we also talk about where you’d like to be and then we make goals for the rest of the session around that. Um, so, um, with this student the other day we decided that we were gonna talk about, he, um, felt very frustrated with himself and we decided that the feelings of frustration were the highest thing that was bothering him. , and he gave it, I think, like an eight out of 10. So, he decided that he would really like to work on feeling less frustrated. And I think he wanted to reduce that to a five. So then for the rest of the session we talked about what could he do. What’s been successful for him in the past. What strategies have we talked about together that [00:21:00] he might wanna integrate? Um, so he chose, he wanted to try to do a little mindfulness. He wanted to try to, when he felt himself getting frustrated and not participating, he wanted to take a deep breath just silently and then see if he could get reassess and, and feel a little less frustrated and, uh, so we worked on the session on that and practiced that. And then we created a little experiment, um, that he was going to do for the next time, which was, he was going to experiment with taking a breath and seeing if he could reduce his frustration in the classroom. So we’ve taken this big problem and kind of just. Looked at it through one perspective using self-rating scales to help us really narrow our therapy focus and see if we can create a solution that helps him to feel like he’s managing his experiences and he’s giving him back that [00:22:00] feeling of control.

So we’ll see how it goes next time, he might come in and say, well, that didn’t work at all. I, I felt just as frustrated and then we can reassess, we can think about, do we need to come up with news solutions? Do we need to look at another piece of why participating in the classroom isn’t working for you?

So we’re constantly coming back to that, that really simple self-rating scale as a way to guide our sessions as a way for him to build awareness of how he’s really feeling, on paper, but also see that these things can change that he has some control that him feeling frustrated is just one experience that he’s having and that he can that he has some solutions already. Um, and it’s just finding what works best for him in those moments.

Michelle Andrews: I love that. That’s so important to. Let those kids know [00:23:00] that they can have some control, especially when they’re feeling stuck and that they don’t have control. Like you said, those were the top things that people shared that those were the feelings that they had. That’s so important. Awesome. So say you have a child  ready for therapy. Let’s go over how we would write some goals for stuttering therapy. Um, what are some key components to writing sufficient goals for stuttering?

Martha Horrocks: So we’re gonna, again, I go back to, um, those, those components that I was talking about for adults who stutter  that really translates to children which is what are the experiences that they’re really struggling with? Where would they like to be, to be more effective and so if it’s possible, sometimes in the schools, it’s not, but part of your evaluation process, at the end of your evaluation could be, what goals do you have for yourself? What would you like to work on? A lot of [00:24:00] times I’ll share I’ll if, um, if we’re doing the Oasis, or we’re doing, any, you know, basic checklist, I’ll show them, the areas that they really noted were areas that they’re struggling with and I’ll say, Hmm, what, you know, what should we pick as some goals that you wanna work with, work on in the room together.

Um, so don’t be afraid to go back through the evaluation and they can really clearly see, um, oh, okay these, these are things that I noted are really giving me a hard time, it might be, thinking of the Oasis it might be, they’re they don’t have a lot of knowledge about stuttering, it might be that they don’t feel, um, comfortable speaking in certain situations. They feel badly about themselves and that can really help to support our goal making. And it it’s really more child centered. You can also, um, at the IEP [00:25:00] meeting, get parent input. And I think that’s also a good gauge for where parents are at, in terms of their, their mindset when it comes to stuttering. But what are the parents hoping, especially of school, age kids? Um, what are the parents hoping to get out of, speech therapy? What are they hoping their child will be able to do? so sometimes having parent input can be really helpful. Um, I think the more client centered that you can be the more successful the therapy will be.

I think a lot of times when, uh, when we hear about children who stutter, stuttering, um, needing therapy, we often assume that it’s to manage those behaviors. But I think when you dig a little bit deeper, there’s also a lot of other experiences that they need support with. And sometimes those experiences, they need more support with, you know, maybe it’s not actually the physical active [00:26:00] stuttering that is the hardest for them. Maybe it’s managing those social experiences or managing their thoughts about themselves. Um, and so really going back to the evaluation and looking for clues, asking for their input, um, I know, there’s, there’s a, really fabulous person who started his name. Gareth Walkom He’s uh, has a company where he’s making virtual reality, a whole virtual reality platform for speech therapists to use and other therapists to use with, um, children who stutter. Anyway, he, something that he told me over the years was, thinking about what would you like to do instead? Okay. You stutter, you have moments that are challenging, but what is it that you’d like to be able to do? And I think that’s a really interesting reframing, thinking about, okay, you don’t wanna participate in the classroom right now, but what would you do? What would you like to be doing? And thinking about, well, I’d like to [00:27:00] be able to raise my hand. Okay. And so there you have a goal and it’s really not about, I’d like to have less repetitions it’s I’d like to, you know, be able to participate like my classmates, really important.

Michelle Andrews: Yes. Yeah. Stutter or not, they want the confidence. Yeah.

Martha Horrocks: Right, Exactly.

Michelle Andrews: that’s really cool. Okay. That was so helpful to think through all those ideas. Could you give a few goal examples? I know it’s, I know these are super specific to each kid and you can’t just go to a goal bank. Cause that’s not gonna work cause it it’s all about how that child feels and, and all that, but even saying that, just to get kind of a framework of how it would look, do you have some examples of some goals maybe you’ve used, or that would be, um, a great goal that you could use?

Martha Horrocks: Yeah. Um, I don’t know that it would be the most helpful for me to like, read off a goal that I use in my therapy, because I feel like [00:28:00] we all have different styles, but I think. What, what I usually try to do is I try to pick a part are, um, what specifically are we targeting? So are we looking at maybe helping the child to feel more comfortable?Are we working on confidence? So I, I usually look, I like to write goals around comfortability, usually that has to do with like the behaviors, physical tension, um, secondary behaviors. Um, I like to look at confidence. Um, I like to look at self-compassion how do they feel for themselves about themselves? And I like to look at self-advocacy, are they able to advocate with others? So those four areas that I write a lot of goals about, um, and then I might use the Oasis. I might say, that they might improve from a, not, not a standard score, but maybe [00:29:00] more of a qualitative measure, like, go from sometimes to always, or, if it’s, uh, you know, that they feel really negative about themselves, maybe we’re trying to reduce from always to sometimes, if we’re using self-rating scales, then I might use that in a goal. I might say, they’ll improve their overall, you know, confidence, um, mindfulness strategies or whatever strategies, that, that I, that come up in the evaluation, but we might, um, improve their confidence from like a three to a five if we’re referencing those self-rating scales. And I usually like to do across sessions, I think, um, as we talked about before, variability is really common and so, I often have clients who come in, who are, , feeling great about stuttering one day, [00:30:00] um, and having great experiences and then something happens that really shakes their confidence. Maybe it’s a social experience, uh, experience in their life. Um, and so I wanna make sure that I’m writing a goal that really provides space for variability and making sure that I’m not dismissing anyone, before we’ve built, some more consistency around their feelings of confidence or, or comfortability and they’ve had support from, from me on that.

Michelle Andrews: Very helpful. That that makes so much more sense than just seeing those goals that say child will reduce fluency by whatever percent. I mean that, you know, it can vary on the day. I mean, those are, just needs to be something of the past. We need to focus on their feelings and so much more than just a percentage of dysfluencies. Um, that’s so important. speaking of feelings and emotions, it sounds like you really need to, have a great rapport, a great [00:31:00] relationship with your students, for them to open up, to share these feelings. What are some early rapport building activities that you could start off with to start building that?

Martha Horrocks: Uh, rapport is so important. And with some children who stutter, it can take a long time. Um, and even if you have a great rapport with a child, they, there might be things that come up that they don’t really wanna share about. Um, especially if they’ve had an, a pretty negative experience or, or they might just not have awareness of how something’s impacting them. So to start off, I think, and this is just like good for any therapy. Right. But, um, is, is really making sure that you spend the time to get to know them and their interests. I always, I have so many clients that are really into like Minecraft or, you know, whatever video game kind of thing. And I just, I try to make time if they say, oh, I, I, you know, I’m really excited about this new [00:32:00] level in Minecraft and I’ll be like, tell me about it. And even if I’ve heard about it a million times, letting them be the expert on something, is, is really important. , I will, I do teletherapy. So, um, I’ll be like, let’s pull up some information about that. Let’s read about it. I also think that, so it’s, so you’re learning about their interests, but you’re also providing them time to just openly talk. Um, some children who stutter don’t have, don’t have a lot of experiences with having the floor. Sometimes they come from a really busy house. Sometimes they are getting reinforcement at home that like, their parents don’t wanna hear their stuttering or, you know, whether that’s intentional or not. Um, or at school they feel like they can’t participate or they’re not, they don’t want to participate because they stutter. So giving them the floor where they’re the expert and they’re confident about this [00:33:00] subject matter and letting them know that I’m listening and I’m really engaged with what you’re saying, whether you’re stuttering or not, um, I think can be a really powerful experience. So that, that’s definitely something that I like to start with. I also wanna make sure that. My clients know that stuttering is welcome in my space that I expect that they will stutter. Um, if they’re a person who stutters, they’re probably gonna stutter at some point, and that’s, you know, totally fine.

It’s totally value neutral. It’s, you know, I don’t, I’m not saying stutter all the time, you know, I’m not promoting it one way or the other. It’s just who they are and I just want them to be themselves. So, um, the way that I, the way that I do that is by including stuttering voices in my sessions. Um, so because I’m on social media, way too much. Um, [00:34:00] I will, I’ll often, um, will start the session with, you know what, you know, what’s going on, what can I help you with? We’ll make a plan and then I’ll say, can I just show you something? And I’ll usually pull up a video on TikTok. He also has an Instagram. Marc Winski is an adult who stutter. He’s an actor. Based in New York. Um, but he does a lot of stuttering awareness and advocacy. Some of it’s more appropriate for teenagers and college students and older, and, but some of it’s great for kids. And so I’ll pull it up and say like, what do you think? You know, and I think it’s important. I don’t stutter and I don’t want the child to think that when I come to speech therapy and I’m working with someone who doesn’t stutter, that that’s how I’m supposed to sound. Um, so I wanna make sure that I’m including videos of people, stuttering, the university of Texas at, uh, Austin also has a great [00:35:00] social media page. They have fabulous videos of kids talking about stuttering. Um, and so I’ll include those too. Like, Hey, I saw this video of this kid, your age, let’s check out what they have to say about stuttering. Do you agree? Do you disagree? What do you notice? What are your thoughts or feelings watching it? Um, I also, often, especially in Maine, um, it’s a smaller, smaller population here. Um, frequently kids who stutter will be one of the few, or maybe the only kid in their school, not just their class who stutters. And so they’ve never heard anyone else stutter. I think a lot of times as speech language pathologists, we know this, but the general public thinks that stuttering just means repetitions and it doesn’t, there’s so many ways to stutter and so it really kind of blows their mind to hear other people stuttering.

Um, and it might not sound like [00:36:00] how they stutter and that’s kind of interesting and thinking about that sometimes. I’ve had clients who stutter who are like, oh, I don’t know, like that’s kind of overwhelming to hear somebody stutter in a different way, or it’s kind of overwhelming to hear is that, is that what I sound like? Um, and, and that’s kind of a really interesting discussion and we can really dive into what, what thoughts and feelings are coming up for you about stuttering in general, but I always think providing opportunities to connect kids who stutter, even if it’s not with somebody that they’re, they’re um, you know, physically interacting with, but connecting with other stuttering, videos or audio, I think it’s so important and is, is just crucial in letting kids know that they’re not alone, that there’s some similarities. Um, and then I do love integrating some adults, because, who are openly stuttering, um, [00:37:00] because I think it provides some, some context for what they might be like as adults. Look, there are these people out there, like Mark’s an actor they’re out there living their lives, seemingly very happy. Um, and you can be like that too. Um, so, so those, that was like the longest answer ever too, um, rapport building, but, um, I wanna make sure just to summarize that I’m integrating their interests, but I’m also including stuttering and I think those are two, the two really big key things.

Michelle Andrews: I love that. I love showing them other people who stutter, so they don’t feel alone. They can feel like I’m not struggling with this all by myself. There’s other people out there and there’s other people out there that are successful, that are famous, that are doing well. This isn’t something that can, is going to stop me from achieving my dreams and goals. That that’s great. That’s awesome. Um, [00:38:00] okay. So once you build that relationship and trust with a child, what are some stuttering activities that you usually do?

Martha Horrocks: So we talked about a little bit earlier drawing on counseling. Um, I, as I said, I’m really interested in solution focused brief therapy right now, but certainly, there’s other there’s other areas in counseling that you can pull from there’s, um, avoidance reduction, there’s cognitive behavioral therapy and we’re not mental health counselors and I don’t want anybody listening to be like, I went to speech pathology school. I didn’t go to school to be a counselor. Um, and I get that, but, if we’re going to help, uh, the experiences of kids who stutter, we have to provide space for those more counseling aspects, um, to help them to be more effective communicators, we have to address, the emotions that might be providing them from communicating or the thoughts that might [00:39:00] be preventing them from communicating.

So I, I always recommend that, um, SLPs look into these concepts as, as a way to really honor those, honor, those experiences that kids are having. So, and we, I had talked about for solution focused, the reason why I’m so into it right now and probably will be forever and ever, um, is that, it acknowledges where they’re at right now, which is typically a more negative space, but it looks ahead to the future, um, of where they want to be going the solution. But it also reinforces to them that they are already good at handling some of these issues. so like my client who was annoyed, he already had some things that he could do to feel less annoyed, but in the, in the moment in the classroom, he had just kind of forgotten those. Um, and which makes sense, you feel annoyed. [00:40:00] You’re probably not thinking the most rationally about how you’re gonna handle it. And you’re, you know, 11 years old. And but I like that it reinforces to him that you, you can, uh, change your situation that you are, you have some of that control that we were talking about earlier. So, so I think counseling is really, really crucial, um, with that and it really is a lot of talk therapy. you don’t, uh, I know it’s controversial to say as a, um, teachers pay teachers and boom seller, but you really don’t need a specific activity. Um, this is something that you can just go off of what the, the child is talking about and conduct some experiences, uh, experiments, um, and, and look at, use sself-rating scales. You can create those all with a piece of paper or a whiteboard, um, as you go along, , something that [00:41:00] I have gotten into, um, which is kind of funny, cause I’m not so much into it in my own personal life. Um, but I’ve started really integrating a lot of mindfulness and sort more holistic activities. So looking at things like scan, doing a body scan for tension. Um, where are you feeling? A lot of physical tension when you’re communicating? Let’s see if we can let some of that tension go thinking about breathing, not as a fluency shaping strategy, but as a, let breathing, as a way to cope with those, um, effective or cognitive experiences and then I think a huge one is, um, identifying emotions and feelings. We’ve been talking about that a lot today. Something that always shocks me is when I have a 10 year old or an older elementary student who comes for stuttering therapy and all they say [00:42:00] is that they feel mad, but what does mad really look like? And we end up talking a lot about that. There’s actually some other emotions they might be feeling frustrated. They might be feeling worried. Um, they might, and really learning and directly teaching about emotions is actually, um, what a lot of kids need at first, so that they don’t really have the words to describe, um, to describe how they’re feeling. I think we often work on emotions and feelings with our autistic students and clients. Um, and this is totally different. Children who stutter experience emotions and feelings differently, but I think the concept is really similar that we can’t, assume that a child who stutters knows how to describe how they’re feeling and so I do a lot of activities around what are some of the, some feelings.

Um, I’m not gonna assume that they know what frustrated [00:43:00] means or what it feels like in their body so we’re gonna do a lot of identifying that. Um, and then there’s a ton of just very classic activities that, people who work with kids who stutter talk about all the time. I think the most like classic, I don’t know, trademark one is the iceberg. Um, and Joseph Shean was a speech pathologist. He wrote about this, um, I believe in the seventies. Uh, but the idea is for the iceberg, you have the attributes of stuttering that the listener. Observes or hears is the type of the top of the iceberg. And then everything that the actual person who stutters experiences is below the water is the iceberg underneath. And you don’t know how big it is, etc. and so an activity that we might do that could also be turned into a self-rating scale if you wanted, um, is to have them draw their own iceberg, identify [00:44:00] what are some things that, that, are on the outside that people notice. And then what are some things that are going on for you, um, underneath. And that can be a really helpful visual, particularly for older elementary and the middle school high school. We spend a lot of time, uh, drawing. You could have them draw their stutter. You could have them, if your stutter was a, I don’t know, a superhero, what would it look like? Or, um, it was a flower. I don’t know, um, what trying to get a lot of the goal of the activities is to try to something that’s engaging enough, that they can really share their perspective and experiences. Um, I’m not doing a ton of activities where I am, um, doing more of like an articulation approach where I’m like, this is, this is this technique, and I’m gonna teach it to you and we’re gonna practice. That’s not really [00:45:00] what stuttering therapy looks like. I mean, you can of course teach some of the stuttering modification and the fluency shaping strategies, but I would say 95% of the time I’m picking activities that engage the child to share their perspectives, share their current thinking, and then problem solve and work on advocacy around those things. Um, so really trying to think of creative activities where I start the activity and the child takes it and runs with it.

Michelle Andrews: I love that that really pulls out their creative side, drawing, drawing your stutter. If your stutter was a superhero, that’s fun.

Martha Horrocks: Yeah. Um, so some something that we haven’t really talked about a lot today as well is working on self-advocacy. So we’ve been talking a lot about what can the child change within themselves, but a big part of stuttering speech therapy is supporting the child to make changes in their [00:46:00] environment and so that might be advocating with their teachers, with their parents, their friends, um, people, they don’t know, grandma, I don’t know whoever it is that they want to connect with. Um, a lot of times children assume that adults know everything about stuttering, It’s always interesting to ask a child, you know, what do you think, um, Mrs. Smith or whatever your teacher knows about stuttering? Um, they’ll be like everything. They’re the teacher. Um, and so, but it’s interesting for them to consider that maybe, they are the expert on stuttering because they stutter and, and Mrs. Smith doesn’t and, and they are the expert on their own experience and so something that we do a fair amount in, in my room is looking at ways for them to connect with other people in their community. Um, so it might be writing a letter well, and now [00:47:00] we’re more like, you know, writing an email, text message, whatever, whatever preferred, um, modality they might want, uh, create a poster. I could see for older kids, like, you know, making like some sort of social media thing, if that’s appropriate, but what do you want people to know about stuttering? Um, if something happens, so my client that came in and doesn’t wanna participate in the classroom, if he decided that he felt like he didn’t wanna participate because of something that somebody, some sort of social experience, maybe the teacher, um, uh, finished his sentence for him. What would he want her to know about stuttering that he thinks that maybe she’s missing? So spending time creating activities where, where my clients or the students in your room can, can do [00:48:00] some self-advocacy. I know when I was in the schools, um, I might have like a challenge where I would, they would pick a fact and maybe they’d go to the receptionist and share that fact with the receptionist or go down to the lunchroom and share with one of the, um, chefs in the kitchen or a custodian. Um, they might, they might create some information to share on a school bulletin board. Sometimes they might wanna present information to the class. It’s really what they’re comfortable with. but self-advocacy is a huge, huge piece and, uh, there’s tons and tons of activities that you can do around that as well.

Michelle Andrews: I love that. I love the idea of giving them that title of you are the expert. I want you to advocate for yourself. Like you, you share information about stuttering to teachers, to adults, you know, even as a kid, [00:49:00] like you are the expert, you know, giving them that power and that control that’s. Oh, I love that. I was getting kind of emotional thinking about it. That’s really cool. Um, awesome.

Martha Horrocks: I love that too. That’s like one of the, my favorite things about doing stuttering speech therapy is I feel like, really you’re, you’re helping kids who stutter to realize that they’re amazing the way they are, and that they can make little changes to, you know, their experiences, but I feel like there’s also this huge self-advocacy piece. That’s like, if you’re not happy with, or you don’t feel like you’re being represented or you’re able to participate and you need more access working on their sense of agency is just the coolest. Um, and I think when, um, when you’re looking at adults who stutter, um, a lot of times what they’ll discuss is how important self-disclosure is, um, which [00:50:00] is this idea that when they, like, if they’re in a, a meeting, they might say, oh, I’m a person who stutters. So I might need an extra moment but really advocating for yourself so that your social experiences are more manageable and then all the other experiences. So helping children who stutter develop those skills so that they become adults who communicate effectively. Um, I, I feel like that’s our whole goal is how, how to help them represent themselves and carve space, whether they’re stuttering or not,  in communicative environments.

Michelle Andrews: I love that, that’s so important.

Martha Horrocks: Okay. So to summarize, I know we’ve talked about like a million things today. Um, I feel like what I, what I’m trying to, share with you all, is that when we’re thinking about stuttering speech therapy, that we really have to consider all of the different experiences that [00:51:00] a child who stutters has, um, that there’s, there’s a lot more that’s going on than what we perceive as the clinician or that the parent perceives, um, or the teacher. And so we need to make sure that we’re really digging with the child to figure out what experiences are keeping them from being a competent communicator.  I think also a big part of being, um, effective, in terms of stuttering speech therapy is this idea that you can stutter and be a great communicator. Um, and it’s really about being confident about being comfortable, about being compassionate with yourself and about self-advocating. If somebody says to me, oh, I said, or I just need a few minutes. I might need a lot of extra time. I, we all have a little time we could give, I think it’s, I would rather hear what someone has to say than, [00:52:00] have a rushed version. I think we all feel that way. Um, and so if we gear our practice towards that, we can help children to feel empowered as communicators that really shapes the rest of our therapy. We’re gonna be evaluating for that. We’re gonna see what’s holding them back in terms of being effective in their communication. We’re gonna be looking at, in our sessions, what are their experiences? What are they currently, um, having trouble with that we can support so that they feel, that they feel great about, about communicating, I think also something that we talked about with the variability, variability piece is that, is this idea that, uh, stuttering speech therapy is gonna change? Um, it’s not really linear, like articulation therapy. There isn’t like a, you know, a sentence level and then a conversation level. And then we discharge. [00:53:00] Which hopefully people who specialize in that area don’t get upset with me for saying it’s not simple but what I’m trying to say is that, um, our goals might really shift over time and it doesn’t mean that the child isn’t making progress it just means that there’s some other experience that’s coming up for them that they need support with and progress is gonna be kind of, um, kind of hard to define in terms of, we might feel like they’ve made a lot of progress in their confidence, but they need, need more support in, in feeling comfortable, like, um, managing some of their tension.

Now I’m just adding more things, Michelle, but I, I feel like, I feel like we’re, what I’m I, what I’m trying to get at is, there’s a lot of flexibility that we have to have as clinicians. And that it’s really, so child led or adult led if you’re working with [00:54:00] adults and that we, we just have to listen to what they currently need and go with that and I feel like as a clinician, when I know that it’s a good session, even if I didn’t have like a fancy activity, I just annotated what they said. We talked about their interests. It might not look like this extremely organized therapy session, um, that we’re doing a lot. If we incorporate what their experiences are and then what they need help with. And that it, it just takes time and it’s it’s variable but I hope that this gives you, um, the listeners some, I dunno, some ideas for, for approaching stuttering speech therapy. I, I definitely acknowledge that it’s a different approach than some of the other areas of our field, but I think there’s a lot of things here that probably resonate for [00:55:00] a lot of SLPs as to why they wanted to become a therapist. I think we’re all interested in children being the best communicators that they can be and we’re all interested in helping our clients self-advocate for what they need. And if you can think of it that way, um, I think it all becomes more manageable and thinking of you as a partner with your client and that you don’t have to have it all planned out. Um, that it’s okay if it’s not a, um, Instagram worthy sessio, mine usually aren’t , that’s fine, and that’s just good therapy. So I don’t know. I think that was a summary

Michelle Andrews: Yeah, that’s perfect. Thanks so much. This has been incredibly helpful. This has been eye-opening and know I can walk away with ideas to use going forward. This has been extremely needed information. Thank you so much, Martha. [00:56:00] This has been great.

Martha Horrocks: I’m so glad. Thanks for having me on,

Michelle Andrews: Thank you so much. Thank you for listening. We hope you learned something today. All of the references and resources throughout the episode are listed in the show notes, also listed on the pep talk podcast for SLPs website. If you’ve been listening while you’re driving on a run, doing the dishes, this entire episode is transcribed for you to refer back to. Martha, thank you again for joining me today.

Martha Horrocks: Oh, no problem. Thank you so much for having me.


– Overall Assessment of the Speaker’s Experience of Stuttering (OASES) – https://stutteringtherapyresources.com/pages/oases

– Solution-Focused Brief Therapy (SFBT) – https://www.stutteringhelp.org/solution-focused-brief-therapyhttps://www.stutteringhelp.org/training/tools-success-solution-focused-brief-therapy-taster

– Cognitive-Behavioral Therapy (CBT) – https://www.stutteringhelp.org/introduction-cognitive-therapy

– Avoidance Reduction Therapy for Stuttering (ARTS) – https://www.sisskinstutteringcenter.com/articles/arts-therapy-overview

– Gareth Walkom, Founder of WithVR and Person who Stutters – https://withvr.app/

– Marc Winski, Stuttering Advocate, Person Who Stutters – https://www.tiktok.com/@marcwinskihttps://www.instagram.com/marcwinski/

– University of Texas Stuttering, Blank Center for Stuttering – https://www.instagram.com/utstuttering/

Gupta, A., Mongia, M., Vijay, A., & Sadhu, R. (2019). Management of stuttering using cognitive behavior therapy and mindfulness meditation. Industrial Psychiatry Journal28(1), 4. https://doi.org/10.4103/ipj.ipj_18_19

Nicholas, A. (2015, June). Solution Focused Brief Therapy with Children Who Stutter. Procedia – Social and Behavioral Sciences193, 209–216. https://doi.org/10.1016/j.sbspro.2015.03.261


The contents of this episode are not meant to replace clinical advice. Pep Talk Podcast, its host, and guests do not represent or endorse specific products or procedures mentioned during episodes unless otherwise stated.

TSHA approval does not imply endorsement of course content, specific products, or clinical procedures.


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