Wendell Johnson’s Indirect Therapy

Wendell Johnson, Ph.D., developed the diagnosogenic theory of stuttering between 1934 and 1939. Johnson proposed that stuttering begins with anxious or perfectionistic parents. These parents react negatively to normal childhood disfluencies such as repeating words or phrases, hesitations, or using filler words such as “uh” and “um.” The child then develops anticipatory avoidance reactions, i.e., tries to anticipate normal disfluencies and physically struggles to avoid these disfluencies. The struggles and avoidances, together with learned fears and anxieties, develop in stages into stuttering. Johnson wrote that stuttering begins “not in the child’s mouth but in the parent’s ear.”

Johnson developed indirect therapy to treat childhood stuttering. The child doesn’t participate in the therapy. Instead, the parents change their behavior.

Johnson’s reputation took a hit in 2001 with news reports that he’d tried to teach orphans in Iowa to stutter but Johnson’s theories continue to be popular.

What the Experts Say About Indirect Therapy

Let’s look at the Stuttering Foundation website:

Try to model slow and relaxed speech when talking with your child, and encourage other family members to do the same. Don’t speak so slowly that it sounds abnormal, but keep it unhurried, with many pauses. Television’s Mr. Rogers is a good example of this style of speech.

When your child talks to you or asks you a question, try to pause a second or so before you answer. This will help make talking to your child less hurried, more relaxed.

The National Institute of Deafness and Other Communication Disorders advises parents to

Speak in a slightly slowed and relaxed manner. This can help reduce time pressures the child may be experiencing.

KidsHealth.org advises parents to

Provide a calm atmosphere in the home. Try to slow down the pace of family life. Speak slowly and clearly when talking to your child or others in his or her presence.

The American Speech-Language-Hearing Association (ASHA, the professional organization for speech-language pathologists) recommends

Indirect treatment focuses on counseling families about how to make changes in their own speech and how to make changes in their child’s environment. These modifications are used to facilitate speech fluency and may include

• reducing the communication rate,
• using indirect prompts rather than direct questions,
• recasting/rephrasing to model fluent speech or techniques, and
• resilience building within the child and family

Johnson’s theories have become increasingly popular in recent years with a movement among parents to pull their children out of speech therapy, on the belief that speech therapy makes stuttering worse.

The Evidence

A 1995 literature review of 13 studies found indirect therapy to be ineffective.(1) The reviewers found

…little convincing evidence…that parents of children who stutter differ from parents of children who do not stutter in the way they talk with their children. Similarly, there is little objective support…that parents’ speech behaviors contribute to children’s stuttering or that modifying parents’ speech behaviors facilitates children’s fluency.

A 2007 literature review repeated the 1995 literature review’s conclusions that indirect interventions are “not effective by themselves in eliminating the problem.”(2) The review concluded with a warning that

…the complexity of input language is a very potent predictor of children’s later language profiles—greater sophistication in parental input language is positively associated with children’s language proficiency.

In other words, “dumbing down” how you talk to your child might achieve nothing but dumbing down your child.

(1) Nippold, M., & Rudzinski, (1995). M. Parents’ Speech and Children’s Stuttering: A Critique of the Literature. Journal of Speech and Hearing Research, 38. See also Kloth, S.A.M., Jannsen, P., Kraaimaat, F.W., Brutten, G.J. (1995). Communicative Behavior of Mothers of Stuttering and Nonstuttering High-Risk Children Prior to the Onset of Stuttering. Journal of Fluency Disorders, 20, 365-377.

(2) Bloodstein, O., & Bernstein Ratner, N. (2007). A Handbook on Stuttering, Sixth Edition. Clifton Park, NY: Thomson. ISBN 978-1-4180-4203-5, page 366.