School speech-language pathologists: Learn about neurodiversity-affirming speech therapy goals for your students who stutter.

<h2>Teaching Self-Regulation</h2>

<p>"What I take from the neurodiversity movement, and where I think it applies to stuttering, is that differences can be valuable, and treatment should not focus on normalization. 
  It should focus on improving quality of life." – 
  <a href="https://leader.pubs.asha.org/do/10.1044/2022-0707-transvoices-podcast-constantino-stuttering-neurodiversity" target="_blank">Christopher Constantino, PhD</a>	
</p>
</br>
<p> The neurodiversity movement aims to reframe how we perceive differences among 
  individuals, including those with speech fluency issues like <a href="https://www.crosscountryeducation.com/blogs/stuttering-awareness" target="_blank">stuttering</a> 
  and 
  cluttering. Speech-language pathologists can benefit from exploring concepts 
  around neurodiversity and examining how the neurodiversity perspective fits 
  into their own philosophy and practice. Neurodiversity is not without 
  controversy, so SLPs should always 
  check with their district, school, and/or employer to align the approach. 
  </p>
  </br>
  <p> Here, we'll cover the concept of neurodiversity, how it applies to speech fluency, the controversy around the concept, and neurodiversity-affirming speech therapy goals, tips and activities.</p>

  <h2>About Neurodiversity</h2> 
<h3>What is neurodiversity?</h3>

<p> Neurodiversity refers to how each individual's brain develops differently and how 
  these differences affect how each person feels, thinks, behaves, and perceives the 
  world (<a href="https://www.speechease.net.au/our-voice/neurodiversity-affirming-speech-therapy/" target="_blank">SpeechEase</a>). The term was coined in the late 1990s by Australian sociologist 
  Dr. Judy Singer, who had a mother and a daughter with autism spectrum disorder. 
  While initially used to address autism, neurodiversity can be applied to any 
  perceived "disability" or "disorder," including fluency challenges like 
  stuttering and cluttering.  

</p>

<h2>Neurodiversity Controversy</h2>
<h3>What is the controversy between neurodiversity and applied behavior analysis (ABA)?</h3>
<p> Individual differences can be viewed along a spectrum. At one end, a difference can be 
  seen as a "defect" to correct and, at the other, an "asset" to celebrate. Since these 
  two views can have extremes, proponents of applied behavior analysis or ABA 
  (which focuses on using conditioning to change behavior) and neurodiversity 
  (which focuses on acceptance of behaviors) are often at odds. This conflict 
  can lead to blame and labeling within the field, including ableism 
  (discrimination in favor of "able-bodied" people) at one extreme 
  and neglect (not helping those who need it) at the other. 

</p>

<h3>How does the controversy around neurodiversity relate to speech therapy?</h3>
<p> Unfortunately, SLPs may find themselves caught in this controversy (
  <a href="https://leader.pubs.asha.org/do/10.1044/leader.FTR2.25102020.52/full/" target="_blank">ASHA</a>). 
  That's because some therapists may have training in applied behavior analysis, 
  and of course, SLPs use interventions to help improve speech and daily living 
  activities. Fortunately, there's a middle ground.
</p>
</br>
<p>In "What Can Stutterers Learn from the Neurodiversity Movement?" published in 
  <a href="https://pubmed.ncbi.nlm.nih.gov/30142648/" target="_blank">Seminars 
  in Speech Language</a>, Christopher Constantino, PhD, Assistant Professor of Communication 
  Sciences at FSU, says, "The conventional view of disability, the medical model, 
  situates disability within the individual as pathology…Rather than focusing on 
  pathology and impairment, neurodiversity emphasizes natural variation and the unique 
  skills, experiences, and traits of neurodivergent individuals." He recommends that 
  speech therapy focus on the subject's "well-being and not normalization of superficial 
  behaviors." 

</p>

</br>
<p><strong>A note about autism, stuttering and neurodiversity:</strong> Many individuals 
within the autism community have spearheaded neurodiversity advocacy. This is partly 
because of the prevalence of autism. In theory, people with autism should not have to 
adapt to fit in. Instead, society should adapt to accept individuals with autism. 
Just as the concept of neurodiversity can empower those with autism, it can also 
help individuals who stutter. What's critical is finding the balance between 
acceptance and interventions that improve quality of life and ease of communication.

</p>

<h3>How can neurodiversity be applied to speech therapy and stuttering?</h3>
<p> Neurodiversity can improve the delivery of <a href="https://www.crosscountryeducation.com/blogs/slp-resources-activities-to-support-fluency" target="_blank">speech therapy services</a> 
for all involved: 
  the individual, the therapist, the family, and the education team. 
  "Neurodiversity is both an empowerment movement and a way of thinking 
  about disability, according to <a href="https://pubmed.ncbi.nlm.nih.gov/30142648/" target="_blank">Constantino</a>. 
  It can help speech therapists realize that neurodivergence, such as stuttering, is 
  not a flaw that must 
  be corrected. 

</p>
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<p>Instead, according to <a href="https://www.speechease.net.au/our-voice/neurodiversity-affirming-speech-therapy/" target="_blank">SpeechEase</a> SLP practice, "The therapy goals that are set and 
  approaches that are used support the neurodivergent individual's quality of life…and 
  while there is an inherent strengths-based approach in 
  delivering neurodiversity-affirming care, speech therapists also acknowledge that 
  there are situations and scenarios where neurodivergent clients may need additional 
  support." 

</p>

<h2>Neurodiversity-affirming Speech Therapy</h2>
<h3>How can SLPs approach speech therapy from a neurodiversity-affirming mindset?</h3>
<p>To practice neurodiversity-affirming speech therapy, SLPs can (<a href="https://leader.pubs.asha.org/do/10.1044/2022-0707-transvoices-podcast-constantino-stuttering-neurodiversity" target="_blank">ASHA</a>)
</p>
<ul style="list-style:none;">
  <li> -	Focus on unique skills and advantages that come with differences.</li>
  <li> -	Shift language away from deficits, impairments, and disorders.</li>
  <li> -	Aim to improve quality of life versus eliminate stuttering.</li>
  <li> -	Help individuals stutter more comfortably and say what they want to say.</li>
  <li> -	Consider stuttering as a path to increased fluency.</li>
  <li> -	Aim to help individuals not think about their stuttering all the time.</li>
  <li> -	Help parents with acceptance around stuttering. </li>
</ul>

<h2>Neurodiversity-affirming Speech Therapy Goals</h2>
<h3>How can SLPs write neurodiversity-affirming <a href="https://www.crosscountryeducation.com/blogs/speech-therapy-voice-and-fluency-goals" target="_blank">speech therapy goals</a>?
</h3>
<p>According to <a href="https://www.speechease.net.au/our-voice/neurodiversity-affirming-speech-therapy/" target="_blank">SpeechEase</a>, when writing goals, SLPs can:</p>

<ol style="margin-left:25px;"> 
    <li> Celebrate and incorporate individual students' special interests.</li>
    <li> Give students a choice in how they respond to others.</li>
    <li> Use neurodiversity-affirming language.</li>
    <li> Consider the words used to write speech therapy reports.</li>
    <li> Consider the language used when writing speech therapy goals. </li>
</ol>

<h2>Neurodiversity-affirming Speech Therapy Activities</h2>
<h3>What neurodiversity-affirming activities can speech therapists use with students who stutter?</h3>
<p>Examples of neurodiversity-affirming speech therapy activities include:</p>
</br>
<p><strong>Stuttering game</strong> (<a href="https://leader.pubs.asha.org/do/10.1044/2022-0707-transvoices-podcast-constantino-stuttering-neurodiversity" target="_blank">ASHA</a>) – 
This turn-taking game is designed to desensitize students from fear of showing their 
stuttering. To play, one student begins speaking. While they are speaking, the other 
student holds up a finger to make the speaker deliberately stutter. Then, the other 
takes a turn. Afterward, the group discusses whether stuttering becomes less scary 
when told to stutter. They can then practice the game while making a phone call 
(to a parent or, for example, to order pizza). This helps remove the stigma and 
fear around stuttering.
</p>
</br>
<p><strong>Practice responding</strong> (<a href="https://leader.pubs.asha.org/do/10.1044/2022-0707-transvoices-podcast-constantino-stuttering-neurodiversity" target="_blank">ASHA</a>) – 
In this activity, SLPs can lead students in practicing how they react to inadvertent "microaggressions" 
(instances when the person they're speaking to doesn't know how to respond when the 
individual stutters). For example, if someone finishes words for the student when 
they stutter, the student can say, "Please don't do that. It makes me feel rushed. 
Instead, I would prefer if you waited patiently for me to get the word out."

</p>

<h2>Supporting Neurodiversity in School and Beyond</h2>
<p> School-based SLPs are uniquely positioned to support neurodiversity. This means 
  accepting students and embracing them for their differences. SLPs must also implement 
  tools, strategies and interventions to help kids succeed in school and beyond. 
  Finding balance is key! 

</p>

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<p>To learn where kids need your specialized skills in exciting locations across the 
  nation, search our school speech language pathologist jobs at 
  <a href="https://www.crosscountry.com/education" target="_blank">Cross Country Education</a>.

</p>

SLP Goals: Neurodiversity-Affirming Speech Therapy