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March 26, 2020

Meet Holly - SLP and mother of a child who stutters

Holly is a mother of two boys, Grayson who is six and Beckett who is four. Beckett, the youngest one, started to talk very early and had a lot to say, but around three years of age, he started stuttering. Holly immediately went to Dr Suzi Fosnot and began speech therapy sessions. After several months of regular therapy, Beckett had become a fluent speaker. During this interview Erich, co-founder of Say It Labs, Fluency Specialist Dr. Suzi Fosnot, and Holly unpack this mother-child journey, explain some of the science and techniques behind the therapy, and address how the Fluency Friends video game integrates the science and therapy.

Erich :

Good afternoon Holly, let’s dive right in. So how old is your child, who's your child? Just tell me about it. That would be a great place to start.

Holly :

Okay. So I have two boys, Grayson is six and Beckett is four, and Beckett has talked, talked so early. He has a lot to say. He talks constantly, all the time. And right when he turned three, he started to bump a lot. He didn't really notice or care. It was hard for him because he talks nonstop, like, nonstop. He's a very chatty little boy and he tries to keep up with his big brother and he has lots of thoughts and he wants to get them out as fast as he can because he wants to hold the floor because he's the little brother. And he started to bump quite a bit right after he turned three, and when I was in grad school, I remember being in Dr. Fosnot's class, and I really feel like in speech, we kind of have to do ... I was a school speech therapist, so you have to do a little bit of everything, kind of like a general practitioner for a doctor.

But I remember being in the class and thinking to myself, because my dad stuttered when he was a kid, thinking, "If my kids stutter, I am not going to touch this. I'm going to call Dr. Fosnot and do it." And sure enough, I must have just jinxed myself because then, my three-year-old started stuttering years later, and I called her because I really think that stuttering is a specialty and it's not like expressive language or articulation even really. You can do stuttering therapy wrong, I think. Totally, totally wrong. Because my husband said, "Well, why can't you just fix his speech? You're a speech therapist." I was like, "But I'm not a stuttering specialist." 

That's when I contacted her and he did speech therapy and he loved it. We did it remotely, which, at first I was a little worried about, but he was totally fine, he loved it, and we banged it out in around 10 sessions. And now he doesn't do any abnormal stuttering. He'll still do phrase repetitions or revisions, but that's all, as you know, normal and it's totally fine.

Erich :

So when he started and you noticed his stutter, how long did you wait to contact Dr. Fosnot?

Holly :

I think I waited maybe two months just to see because it also ... His third birthday coincided right with the beginning of the pandemic, and I thought maybe, because we pulled him out of school and our whole lives are changed and different, so I thought maybe it was something to do with that. But the way he stuttered wasn't ... It was single sound repetition, it wasn't normal stuttering. I just wanted to get it over with and I remembered her class and I thought, "She could fix it. I can't. Let's just do it."

Erich :

Wow. Okay. So the interesting thing is, you said your husband, he stuttered as a child?


Holly :

No, my father stuttered. My father stuttered when he was younger. He doesn't stutter now, but he's a really soft talker. I think, obviously, like the easy onset, like the whisper speech kind of. He's a really soft talker. He doesn't stutter now, but he remembers having a really hard time in school. And we know it's probably genetic, so I figured my kids might.

Erich :

Do you think that now that your child has gone through the therapy that they'll need additional treatment? 


Holly :

No, because honestly, I really feel like Dr. Suzi is just kind of magic. We forget that he even stuttered. This past week, we went hiking at this spot we haven't been to in a year. No, probably a year and a half. And I remember the last time we went there, he was so excited and wanted to tell me something and he could barely get it out. And then, this time when we were hiking there, I thought, "Oh my gosh, last time we hiked here, he could barely get a full sentence out." And now it's like, blah, blah, blah, perfectly.


Erich :

As you said, there were certain things about prosody or there were certain sentences that were purposely constructed, they weren't randomly selected. They must have had some linguistic thought behind the sentences that she built into these targets that would maybe build his confidence. Were there any things that stood out?


Holly :

I think it was really all of it. I don't think any regular parent would maybe notice how the targets did build on each other, but since I have a background, I could see it and I knew. I could see what she was doing, but I don't feel like I have the background, the research, and the decades of experience to have done it myself. But I could tell that all of the targets were purposeful and every single one written for a reason, and it works. It just works. It just makes sense to the kids. 


Dr. Suzi Fosnot :

One thing I wanted to share is that it was all based on Piaget's model of pre-operational children. I studied that during my dissertation and I thought Piaget was brilliant because he found the way children learn about the world and what they were using to experience that world. And I put that in. You can't tell a child, for example, to slow down. They don't know what it means. They think it's punitive. But they've watched animals move and change and airplanes take off and go fast, and boys love speed, so if you talk to them about, "Well, speed might not be all it's cracked up to be. We have to regulate that speed." So that's where the racehorse and the turtle came in. With the turtle teaching the racehorse not to get his legs tangled. Kids get that immediately because that's what they've been watching for the first three years of their life. And then, that kind of took care of slowing the rate and regulating.

But then, what do you do with the bumps? Well, kids are used to looking at bumpy and smooth things. They play with their tractors outside in the dirt and it's bumpy, and then they smooth the road, just like they see in real life. So that became getting rid of that repetition. And then another thing, through altruism, kids have to learn to take turns and they don't know how to take turns at three. It's all about them because you've spent the first two years of their life making them the center of attention, so why should they stop now? "Oh, I have a brother. I can't do all the talking." So the rules came together in a way in which we tested them and they were working, and the kids would come up and say things like, "Oh, you want me to drive my Volkswagen on the Autobahn instead of my Porsche?" My German children would say things like that and I'd write these things down.

Behind the rules, I don't teach the parents about Piaget and the preoperational child, but it works. And there's where the magic of the program comes in because we took that developmental acquisition that had not been applied, as far as I know, to speech pathology prior to that.


Erich :

Actually, to your point about Piaget, we don't, in our video and the game that we're building, we don't say slow down. We have, for example, a slowness game, several slowness games where we have to say words slowly, and we're in a swamp, basically. So there's one game I'm thinking of and you have to walk over these crocodiles, but you've got to tiptoe. If you go too fast, you don't want to get eaten. Or the other one is you have to have the words hold hands. So there, once you cross the swamp, climb this rope and you're on top of the trees, swinging like Tarzan. And you wanted the words to hold hands, otherwise, you fall down. And all of these Piaget-style, these visualizations are so, so useful.

I mean, if you tell a child to be quiet, they might be quiet for 10 seconds. But if you tell a child, "Pretend you're a soldier." They'll be quiet for two minutes. It's all about, how can you get into the imagination of the child? To your point, Suzi, it's so powerful.

A lot of pediatricians or a lot of doctors say, "They're going to outgrow it, just don't worry about it." What advice would you give to other moms who have kids who stutter?


Holly :

I wish that they would just trust their instinct because I feel like you obviously know your kids better than anyone. And I think that where sometimes pediatricians go wrong is that some stuttering is normal, but not all of it is. My older child stuttered, too, but it was very, very normal and typical for his age, and it didn't last, he had no frustration, and he grew out of it perfectly fine. He doesn't remember stuttering at all. But there are different types of stuttering and if you have those part word repetitions, I just don't think those are going to go away on their own. So I think I guess it would be trust your instincts, and like you said, just getting more knowledge out there. If more parents knew and if more pediatricians knew, I just think that ... I knew Beckett wouldn't have outgrown it, I could just tell the way he did it. Also because he was starting to get self-conscious about his stutter. 


Erich :

I was going to ask you, I mean, if you could tell me about that. What did that look like? He was, what, three and a half, four, you said, at the time?


Holly :

No, he was just three. I could just tell he was starting because he has a lot to say and he's a bright, chatty little boy, and he wanted to hold the floor for himself so he could get out what he wanted to say. And he has an older brother who is very sweet, but still a little kid who never wanted to really wait for him to finish, and you could just tell he was starting to get frustrated that he felt like he couldn't get his thoughts out and hold the floor for himself. I knew we needed to do it and bang it out and we did. It was literally 10 sessions.


Erich :

That's amazing. Because as a parent, we all want the best for our child. We always want to see our child without issues because we know the world can be really tough. The world can be cruel and to be ostracized by friends or siblings at an early age, that impact later on can be devastating. I mean, some people really can cope with it, but most people really have issues, so I wanted to know if you could talk about maybe your stress level or your happiness. Just from an emotional point of view, how you felt then, how you feel today?


Holly :

Oh, I obsessed about it before we started therapy. It kept me up at night because your voice is your voice, and then it doesn't work the way it should or you want it to. I couldn't even fathom having him go through life not being able to get his thoughts across. Today, we don't even think about it. He barely remembers it. I told him I was going to talk to Ms. Suzi this morning and he was like, "Oh, okay. All right."


Dr. Suzi Fosnot :

What does your husband say now?


Holly :

Oh, he said he's so happy we did it because he, at first, thought I should just be able to fix it. But he's a doctor and I said, "If you had a torn meniscus or ACL, would you go to your internal medicine doctor or would you go to an orthopedic surgeon?" He was like, "Well, okay. That makes sense. But I thought speech therapists did everything." And I said, "Well, just because they do everything doesn't mean they do it well." I wish in speech it was more common to specialize because for him, he's a radiologist, so he had to specialize in radiology. But for speech, they just pop us in the schools and they just think that we should be able to do a little bit of everything and we can, but that doesn't mean we can do it well. But he also kind of, with Beckett's speech, we literally don't think about it anymore. For me, I was really stressed out about it when he was bumping really severely at first, and then I had friends say, "Oh, he sounds like he's started to stutter." And I said, "Yeah, but we're going to fix it." It used to keep me up at night.


Erich :

Yeah. I mean, obviously, congratulations. I really congratulate and laud you for your patience, for taking it upon yourself to seek help. I think a lot of us LPs, because they have the title SLP, they might have to ego to say, "No, I'm an SLP, I'll fix it myself."  And it's remarkable because you recognized the issue and you found the perfect person to help you.How would life look like for you today if you hadn't seen Dr. Suzi? What do you think life would look like for Beckett?


Holly :

Oh, it would be hard. You can say, "Yeah, it's everyone else's problem and they have to accept you." But people are people and little kids can be cruel. And even if everyone accepted him, I still think he would be frustrated that he couldn't get his thoughts out in a coherent, easy way. It would still be hard. I just think that if you employ the acceptance, stutter more freely, you're just relegating those kids to a life of difficulty, no matter what. Even if they accept their voice, it's still going to be difficult. I mean, there's a little girl in my older son's class and I'm just desperate to tell her mom to get the game because her daughter is six and she stutters. Not a lot, but one of my son's friends said, "Why does Ava say it over and over again when she talks?" His friend's mom said, "I don't know what to say to him. I don't want him to be mean to Ava and hurt her feelings." And she knows I'm a speech path, so I was telling her how to tell him, "Ava bumps sometimes." But poor Ava is in class and the kids are talking about how she talks and they're only six. And life's going to be harder for her because of that.

Erich :

Yeah. I mean, I really respect people who choose to accept what they have, but if you could treat this, wouldn’t you want to get the best help you could possibly get? I'm going to switch gears a little bit. So you know we're making a game. Our video game is coming out. You saw the earlier versions I think, right?

Holly :

Yeah. We did a little bit with Dr. Suzi. Beckett loved it. He thought it was so cool.

Erich :

Awesome. So we have done a lot of work this past year so that the game is now an entire video game, with a narrative, all based on Suzi's therapy and the magic that she does for her clients. People don't always have access to the right therapy at the moment and I hope that we will be able to remedy that. But will have to overcome the skepticism people might have. This is going to be the biggest struggle for us. So your feedback and honesty would be really welcomed.

Holly :

Oh yeah, we'd love to. Beckett loved the game when he saw it, he thought it was so cool. And one thing from the game I remember I really loved was, he would try to get his whole thought out in one breath. The part where you have to blow the sailboat with your big breath, that was really, really helpful for him because he used to talk until the very, very end of his breath and then he would start to bump at the very end. But it's just so cool that you can take her therapy and put it on a game that you could get it and therapists could use. I mean, right now I'm just a stay-at-home mom, but if I was practicing, that's what I would want because I would feel way more confident having the game that encapsulates all that knowledge and all of the targets, the linguistic background and everything, it has everything in it, it's so cool.

Erich :

That's our hope, that it'll be clear to everybody. We also put scaffolding into the game. Which is an artificial intelligent system that offers support and guidance whenever a person playing is learning a new skill or whenever the system recognizes that the player is incorrectly speaking the target utterance. In this case, any helper character active at that moment will offer guidance that is specific to the produced error with the single aim of teaching the targeted speech skill to the point where the player can advance without support from the game.  That'll be something you'll recognize as an SLP. But I think there will be some other things in there, hopefully, that the boys will enjoy and maybe you'll enjoy, too. Allright, I’ll put an end to our discussion. It was so good to meet you and I want to thank you so much, Holly, for your time and the very honest and open conversation, I appreciate it so much.

Holly :

Yeah, of course. No problem. Any way we can help. All right, take care.


Erich Reiter

Erich holds a Masters in Computational Linguistics from the State University of New York at Buffalo and a Masters in Communication Disorders from Massachusetts General Hospital. Erich brings 15 years of industry experience working as both a speech recognition scientist (Nuance Communications) and speech and language pathologist.

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