لکنت زبان و درمان آن در دوران نوجوانی: درک و برداشت از افرادی که لکنت زبان دارند

Adolescence is a complicated phase of maturation during which a great deal of physical, neurological and social development occurs. Clinically this phase is thought to be the last chance to arrest the development of the disorder of stuttering before it becomes chronic in adulthood. However, little treatment development for this age group has occurred. Previous research on the impact of stuttering during adolescence presents a complex picture of apprehension about speaking which does not, however, appear to interfere with social life. The purpose of the present study was to investigate further the experiences of adolescents who stutter with respect to: (1) their experience of stuttering during the adolescent years, (2) reasons for seeking or not seeking therapy during the adolescent years, (3) barriers to seeking therapy during the adolescent years, (4) their experience of therapy during the adolescent years, and finally (5) suggested improvements to therapy for adolescents. Two focus groups and seven individual interviews were conducted with 13 adolescents and young adults. The major finding was a perceived lack of awareness about stuttering by teachers and parents, as well as other adolescents. In addition it appeared that having a stutter was, in itself, not enough reason to seek treatment. However when adolescents did seek treatment, for reasons such as joining the workforce, group therapy was well liked. Educational objectives: The reader will summarize key features that characterize: (1) the complex developmental phase of adolescence, (2) evaluate the experience of stuttering during the adolescent years, (3) discuss the experience of stuttering therapy during the adolescent years, (4) list adolescents’ reported barriers to seeking therapy during the adolescent years, and (5) suggest possible ways to improve management of stuttering in adolescence.

Adolescence is a unique period in life, marking the transition from childhood to adulthood. In addition to physiological maturation, this is a time of complex cognitive and social growth (Coleman & Hendry, 1999; Hall, 1904; Harter & Mansour, 1992; Masten, 1991; Spear, 2000). Physical maturation is certainly the most noticeable feature of adolescence, however, changes are also taking place in the brain. Neuronal connections that are not used disappear, while those that are used remain intact—the use it or lose it principle ( Giedd et al., 1999). Changes predominate in the frontal lobe, which is the seat of executive functions, planning, impulse control and reasoning. Development also occurs in the parietal lobe, where auditory, tactile and visual signals are integrated. Given this significant development in the brain it is not surprising that adolescents do not function like young adults ( Giedd et al., 1999, Gogtay et al., 2004 and Rapoport et al., 1999). Cognitive development involves adolescents beginning to master what Piaget terms ‘formal operational thought’ (Kelly, 2007). With these capabilities, they start to think abstractly, hypothetically and logically (Cobb, 1995; Coleman & Hendry, 1999; Gowers, 2005; Steinberg, 2004). They also develop a coherent sense of self which relates closely to the development of independence and autonomy (Kelly, 2007 and Padilla-Walker, 2007). In addition to increased self-reliance, there is also an increase in the importance of the peer group (Spear, 2000). While parental advice is typically still sought and followed on important matters, such as career goals and further study, adolescents rely more on their peers for information about money, fashion and lifestyle (Noller & Patton, 1990). With this comes pressure to conform to group norms (Heaven, 2001), which is conceivably significant in terms of the disfiguring effects of a stutter. In addition, a decline in motivation has been observed across adolescence (Anderman, Maehr, & Midgley, 1999; Kurita & Zarbatany, 1991; Murphy & Alexander, 2000; Midgley & Edelin, 1998; Wentzel, 1989). This has potential implications for treatment of this age group. It is clear that adolescence is a period of much change and growth. While many adolescents pass through this phase of development without significant levels of stress, others do not (Dubas, Miller, & Petersen, 2003; Spear, 2000). It is conceivable that the additional burden of a stutter in this complicated period of development may increase the level of stress an individual experiences. Hence, given the complexity of this age group and the need to provide treatment before stuttering becomes chronic in adulthood, it is surprising that there has been so little development in stuttering treatments for this age group. Student texts typically discuss stuttering in adolescence in the context of stuttering in adults. No treatments have been specifically designed for this age group and treatment trials that report on adolescents typically include findings for them with adult participants or school age children (e.g., Craig et al., 1996; Hancock et al., 1998). Treatment trials in which results for adolescents are discernable include those based on (1) speech restructuring (e.g., Andrews & Harris, 1964; Boberg & Kully, 1994; Harrison, Onslow, Andrews, Packman, & Webber, 1998), (2) time-out (e.g., Hewat, Onslow, Packman, & O’Brian, 2006), (3) regulated breathing (e.g., De Kinkelder & Boelens, 1998), (4) self-modelling (e.g., Bray & Kehle, 1996), (5) electromyographic (EMG) feedback (e.g., Craig et al., 1996; Huber, O’Brian, Onslow, & Packman, 2003), (6) an eclectic approach (Hasbrouck et al., 1987) and (7) maintenance of treatment effects (Blood, 1995). The latter appears to be the only intervention (albeit part of a treatment) designed specifically for adolescents. Blood, Blood, Tellis, and Gabel (2003) presented a study of 48 adolescents, investigated self-esteem, the extent of stigmatization because of stuttering, and the extent to which adolescents discussed stuttering. Interestingly, as a group they demonstrated positive self-esteem and did not consider their stuttering to be a barrier to making friends or to affect whether people liked them or asked out socially. This was confirmed in a later study of 53 adolescents who stutter (Blood & Blood, 2004). Further, most responded that they rarely or never spoke about their stuttering to others, even though most thought their friends knew they stuttered. Notably, the older adolescents (16–18 years) were less reticent (45%) than the younger ones (13–15 years). The authors acknowledge that the findings of this study may have been influenced by the fact that all participants were currently in treatment, although there was no apparent relationship between scores and extent of previous treatment. These findings are interesting in light of the findings of an earlier study by the same group (Blood, Blood, Tellis, & Gabel, 2001), which compared 39 adolescents who stutter with 39 who did not, on a measure of apprehension about communication and a measure of self-perceived communicative competence. The adolescents who stutter indicated more apprehension about speaking than the controls and there was a correlation between apprehension scores and stuttering severity. They also indicated less perceived competence in communicating, although they felt as competent as controls in meetings, when speaking publicly, and with friends. Together these studies paint a complex picture: while adolescents who stutter appear to be apprehensive about talking, it also seems that stuttering does not interfere to any great extent with their social life and their ability to make friends. We agree with Blood (1995) that working with adolescents who stutter is different from working with children and adults, and that consequently interventions need to be tailored especially for this age group. A recent attempt by the present research group to conduct a randomized controlled trial of treatments for adolescents was abandoned due to major recruitment difficulties (Huber, Packman, Quine, Onslow, & Simpson, 2004). The reason for adolescents not presenting to clinics is unclear, but could be due to the fact that the treatments on offer have not been designed with their special needs and interests in mind and so do not appeal to them. The aim of the present study was to increase understanding of why adolescents are apparently somewhat reticent to seek treatment for their stuttering using qualitative methods. These methods allow the researcher to use in-depth and open-ended questions to gain a full understanding of behaviors, attitudes, and/or motivation of participants. The reader is then presented with a rich description of the data and can make decisions about whether the findings are supported by the data (for a discussion of qualitative methods see Tetnowski & Damico, 2001). Qualitative methods are increasingly being employed to investigate stuttering and its treatment (Cheek, Onslow, & Cream, 2004; Finn & Felsenfeld, 2004; Hayhow & Stewart, 2006; Huber et al., 2004). While there are a number of qualitative studies of the experiences of adults who stutter (e.g., Anderson & Felsenfeld, 2003; Corcoran & Stewart, 1995; Cream, Onslow, Packman, & Llewellen, 2003; Crichton-Smith, 2002 and Finn et al., 2005) the study reported in this paper is, as far as we know, the first qualitative study of stuttering in adolescence.