A recent facebook post raised the question about goal-writing for stuttering, and it prompted me to put some thoughts into a blog post.
I’m always glad when I see people discussing goals for children who stutter, because I think it’s one of the key areas where we as a field can improve our clinical practice. Too often, I see goals that are focused primarily or solely on fluency. Of course, there is much more to stuttering than just the speech behavior, but in particular, I want to be sure that people are also focusing on more than just a percentage of fluent or stuttered speech even when they write their speech-related goals.
Put simply, goals such as “Child will be X% fluent…” are inappropriate. Here are some thoughts about why…
First, fluency is not what we are teaching in therapy, so it doesn't make sense to use that as the goal. What we teach in therapy (when we are working on speech aspects) is the technique that the child can use in order to enhance fluency. Therefore, we ought to be writing the goal and measuring the child's success in using the technique (whatever that technique might be). Thus, a goal like "child will be X% fluent" is not consistent with what we do in therapy because we're not teaching fluency. Instead, we could write a goal like "child will use X technique" since that's what we've been teaching him to do.
Second, we are supposed to write goals that relate to our state learning standards. I guarantee you that nowhere in your state learning standards does the word "fluency" appear—except as relates to reading fluency and language fluency. Speech fluency isn't there. Therefore, we shouldn't be writing goals on speech because that isn't consistent with the learning standards.
Third, the level of fluency that a child exhibits does not reflect the difficulties that he might have in communication. Some children may stutter severely yet experience no negative impact as a result of their stuttering; others may stutter mildly yet be devastated by it. If we focus on fluency in our goals, then we are missing what we are truly supposed to be working on, and that is diminishing the adverse impact associated with the child's speaking difficulties. Fluency really has little to do with that.
Think of it this way: which child experiences greater adverse impact on his educational attainment...the child who stutters (even severely) but reads out loud in class and participates fully and interacts with his friends OR the child who doesn't stutter much because he never talks? Clearly, our job is not just to address the fluency.
Finally, remember that there is far more to stuttering than just the stuttering behaviors. So, all of this discussion on what types of goals we write for speech behavior should be taken in the context of a broader, more comprehensive approach to addressing stuttering that includes therapy for the child's reactions to stuttering, the functional communication difficulties the child experiences, and the impact of stuttering on the child's quality of life. This is where we are actually supposed to be measuring our success anyway: the reduction in the adverse impact of stuttering.
There’s lots more about goal-writing in our books, including goals for children ages 2 to 6 in Early Childhood Stuttering Therapy: A Practical Guide and goals for children ages 6 to 18 in School-Age Stuttering Therapy: A Practical Guide.
We also have a free Practical Tip Handout on goal-writing for school-age children.