A perspective from author Kathy Swiney, MA, CCC/SLP, BRS-FD, ASHA Fluency Specialist
Having a special interest in stuttering, I see a number of children and young adults who stutter (CWS). Clinical observations indicate, not unexpectedly, that these young speakers often have situational speaking fears associated with their fluency disorder. What was not expected, however, is the frequency that these same speakers exhibit pragmatic weakness as well. A simple but functional definition of pragmatic skills is knowing “when to speak, … what to talk about with whom, where, and in what manner” (Hymes, 1971, p. 277). The challenge is how to differentiate these intertwined conditions. Unfortunately, there isn’t a wealth of information available to assist the clinician with this task. Weiss (2004) is particularly helpful on this topic and every clinician working with children and young adults who stutter is encouraged to read this work.
It is not surprising that CWS often exhibit pragmatic language disorders (PLD) that either influence or complicate their speaking fears. Reports by Blood and Seider (1981) indicate that 68% of CWS have at least one concomitant disorder. Therefore, it is highly probable most clinicians have or will have at least one CWS with a concomitant pragmatic language disorder. The demands and capacities model, as explained by Starkweather (1987), indicates that a decrease in fluency can occur when speech demands exceed a child’s motor, linguistic and/or emotional capacities. Under this model, it is easy to understand how the linguistic and cognitive demands of dealing with the spontaneity of pragmatics, the most complex of language tasks, can increase disfluency in CWS.
Weiss (2004) suggests that the first step in defining the role pragmatics training should play in stuttering therapy is to establish the client’s current level of language competence. The author (Swiney, 2006) examined seven case studies to determine how PLD might be distinguished from speaking fears. Two tools were used in addition to a standard stuttering assessment. As measure of language competency, the Comprehensive Assessment of Spoken Language (Carrow-Woolfolk, 1999) was administered to each subject. The CASL battery provides a great deal of detail on lexical/semantic, syntactic, and supralinguistic skills, along with data from a standardized test of pragmatic language skills (Pragmatic Judgment). Checklists from Chmela, Reardon, and Scott (2005) were used as informal measures of speaking fears.
Data gathered from these three sources was extremely helpful in determining what part pragmatic skills played in these clients’ fluency and in setting remediation targets. Interestingly, in the seven case studies (Swiney, 2006), the CWS with the most severe stuttering as measured by the Stuttering Severity Instrument for Children and Adults – 3rd Edition (Riley, 1994), were not always the children with the most significant speaking fears or pragmatic weaknesses. Clinicians are encouraged to include some measure of pragmatic competency in their fluency assessments and provide specific training in these skills as part of their therapy plan. Weiss (2004) reports that increasing a client’s pragmatic skills also improves narratives and expository discourse and points out that all fluency therapy eventually covers these types of conversational interactions.
Article reprinted with author approval.
Blood, G. & Seider, R. (1981). The concomitant problems of young stutterers. Journal of Speech and Hearing Research 46, 31-33.
Chmela, K.A., Reardon, N. & Scott, L. (Eds.) (2005). The school-age child who stutters: Working effectively with attitudes and emotions…a workbook. Memphis, TN: Stuttering Foundation of America.
Carrow-Woolfolk, E. (1999) Comprehensive assessment of spoken language. Circle Pines, MN: American Guidance Service.
Hymes, D. (1972). On communicative competence. In J. Pride & J. Holmes (Eds.) Sociolinguistics (pp.269-293). Harmondsworth, England: Penguin.
Riley, G. D. (1994). Stuttering severity instrument for children and adults (3rd ed.) Austin, TX: PRO-ED.
Swiney, K. A. (2006). Differentiating speaking anxiety from pragmatic language disorder in children who stutter. A paper presented to the annual convention of the Texas Speech-Language-Hearing Association (Grapevine, TX).
Weiss, A. L. (2004). Why we should consider pragmatics when planning treatment for children who stutter. Language, Speech, and Hearing Services in Schools. 35, 34 – 45.