A clinician recently asked about a 5th grade student who stutters. She indicated that he does not seem to be very aware of when he stutters. He will sometimes say that he hasn’t stuttered in a long time, even though his observable stuttering is quite noticeable to listeners.
Awareness is one of the biggest challenges we face in stuttering therapy. One the one hand, we want the child to be sufficiently aware of his stuttering so he will have motivation to work on it; on the other hand, we don't want him to be so concerned about it such that he starts to withdraw and hold back from communicating. Where is the right line?
There's no easy answer... but, the first question I ask is this: Is the child experiencing adverse impact as a result of his stuttering?
If he is negatively affected by his stuttering, and he's still showing this low report of awareness, then we ought to consider the possibility of denial. Is he more concerned than he's letting on? Is his fear of stuttering causing him to hide the fact that he’s stuttering? If so, then he is definitely in need of supportive therapy to help him learn that it is okay to stutter—even while he is learning to make changes in his speech so he can communicate more easily and more effectively.
If he is not negatively affected by his stuttering, then it's likely that he doesn't really care about stuttering and so he's not noticing the times that he's stuttering.
One way to assess the child’s awareness of stuttering and the impact that stuttering causes for the child’s life is through the Overall Assessment of the Speaker’s Experience of Stuttering (OASES). If the OASES shows that the child is experiencing minimal negative impact, then it wouldn't surprise me if he does not tend to notice his stuttering much because it's simply not standing in the way for him. In that case, I'd have to ask whether he even needs to be in therapy at this juncture: if he's communicating freely, not held back by his stuttering, not experiencing negative reactions to his stuttering, etc., then he may not need therapy just now. Sure, we could work on him to practice speaking strategies, but he would have little or no incentive to use them if he's not bothered by his speech.
If the OASES shows that he does have negative impact, then I would absolutely be working on increasing awareness so that he can have the opportunity to use management strategies (if appropriate) to diminish the impact of stuttering on his communication. Videos, speech detective and “catch me” games, pseudostuttering, activities such as “Ways our voices work,” and such can help with this. (You can find more information about activities for creating awareness in a supportive way in School-Age Stuttering Therapy: A Practical Guide.)
Either way, I would approach it cautiously so as not to cause the child to feel bad about his stuttering. Put simply, we don't want to create a problem in the child just so we can treat a problem, and just because a child is stuttering doesn’t mean that he needs therapy to change his speech (he may need therapy for other aspects of stuttering, or he may not need therapy at all).
By carefully considering the reasons for an apparent lack of awareness, we can ensure that the child is getting the treatment he needs when he needs it.