Conversation with Dr. Joe (Joseph) Donaher

Introduction

Uri Schneider, M.A. CCC-SLP, co-director of Schneider Speech Pathology and faculty at University of California at Riverside School of Medicine, hosts a fascinating conversation with Dr. Joseph Donaher. 

Joseph Donaher, PhD, is the Academic and Research Program Director of the Center for Childhood Communication at Children's Hospital of Philadelphia. Dr. Donaher is an Assistant Professor of Otorhinolaryngology at the University of Pennsylvania. He is a board-certified specialist in Fluency and Fluency Disorders. Currently, Dr. Donaher serves on the Editorial Review Board for ASHA’s Perspectives on Fluency and Fluency Disorders and the Research and Publications Committee of the International Fluency Association. His clinical and research interests focus on the assessment and treatment of school-age children who stutter and disfluency patterns secondary to neurological conditions such as attention deficit hyperactivity disorder.

Dr. Donaher can reached at DONAHER@email.chop.edu

TOPICS INCLUDE:

- Early influences and career path

- Most memorable encounters and experiences

- True stories of human spirit and success

- Research and practice

- ADHD, stuttering and everything in-between

- Vision for the future

Resources and Links

Published research by Dr. Joe Donaher

Stuttertalk episodes with Dr. Joe Donaher (including “ADHD and Stuttering”)

Transcription

10:42 US: What would you say would be some legitimate ways for parents, clinicians, and teachers to help with avoidance?

11:41 JD:  If you think about it, how would we get anyone to do anything and how do we motivate people to do things? I think the first part of every good clinical relationship is to have trust there. And we think about trust. We think about faith in the other person and belief that change is possible. So I would say before we change people's behavior, we have to develop a relationship with the individuals and with their families. I often say that speech-language pathologists who work with people who stutter get more Christmas presents. And the reason I say that is because we have a different type of relationship with the families we work with. We know more about them. We're closer to them. We have to get in there a little bit more. I always think the biggest gift someone could give me is working with me in therapy and being honest and open with me. Here, kids come to us and we say to them: “I want to talk to you about the most difficult thing in your life that you're struggling with. Go ahead and tell me about it.” You can't do that unless there's some trust already built there. So when we're talking about avoidance and getting someone to do more, instead of avoiding more, I really think that you need to go back to the very beginning of the intervention and you have to build that trust. And if you don't have that relationship, therapy doesn't work as well. 

24:30 US: What would you say would be three questions that a clinician or a parent might want to tune into in order to gain a sense of what are some of those important variables, aside from the isolated fact that the patient has interruptions in the flow of speech?

24:40 JD: I'll tell you the way I start almost every therapy session. I ask the parents to come into the room and I almost always have the parents there for a decent amount of time to talk evaluation. The first time I meet them almost every time I tell them where to sit and I say: “Thank you very much. I'm going to ignore you now; don't take it personally. I'll bother you a bunch later, but I just want to get to know your son or daughter more.” And then when I start talking to the son or daughter, I say, “I got all of this stuff from your parents. I know where you go to school. I know how old you are. I know your favorite color. I know all this stuff, but they don't have any good stuff in there. I want to know the real junk. I want to know what you like to do for fun. What you like to play with.”  And that again is just what I would do if I've met a friend on a regular relationship. So what we're doing is just listening. I want to listen;  I don't want to talk. If I'm doing the talking, it goes back to that medical model that they come to me to listen to me to get the answer. And I don't think there's a single answer. And I don't know what the question is yet. So really what I want to do is I just want to communicate with them. And then I want to see what's going on a little bit. When I look at my goal I see it’s twofold. I want to see the real-life impact of stuttering. And then I want to see the choices that they make when they communicate. I really want to look at their ability and desire to communicate.

28:17 US: The way they communicate is so important. Can you just talk about that? 

28:46 JD: I would say, how do you define stuttering? Because if you look at stuttering as a behavioral issue, a motor behavior, let's say you're going to treat it with a motor intervention. But we know from a lot of motor research that individuals who stutter have a harder time habituating techniques or habituating behaviors---from automaticity, to make motor movements easy, and automatic is tough for many people who started. So right there is an issue. We’re trying to teach motor things and yet we know from the research that there are some motor complications there as well. Let's think about the research because I don't want this just to be a discussion of what we think, and if we look at the research---we are talking about severity, how much stuttering equals an impact basically. We know that adolescents who stutter, regardless of severity, tend to doubt themselves as communicators and tend to be more isolated. They are more likely to be bullied. They are looked at by their peers in more negative ways. So the research shows us that the impact of stuttering goes much deeper than just a set of behaviors. Again, the way you define stuttering is going to dictate how you intervene with people who stutter. I really look at severity as the degree to which the stuttering impacts the individual's life.  In other words, how much of a roadblock is it? When we start looking at it that way, we start thinking about things in a larger kind of context. 

39:50 US: What do you bring to the table with a kid who has a bit of impulsivity,  difficulty with inhibition, and difficulty with self-regulation without hurting the self-image of the kid?

40:28 JD: We have to think about this. When we think about any of these areas (like ADHD) or  talk about a learning disability or really any of those labels, all they are is a set of characteristics that are pushed together because they commonly come together. And I understand there's a ton of problems with labels. I'm not going to get into that, but it also helps us some, because we see some of these characteristics and it gives you a place to think about. One thing I want to really stress though is, there are no good or bad traits, right? Impulsivity, for example,  all these things that we often think of  as negative. So we really have to think about the goodness of fit. But what we look at for individuals is the family unit where we learn our rate and rhythm of speech and communication styles. Much of what we do is in our home communication. If the fit between the child's temperament and the parents' temperament isn't a good fit, it’s going to cause a lot of friction. 

58:45 US: There's plenty of research that shows that one caring adult can make the difference between someone turning out to be a statistic of suicide or incarceration or going into all kinds of drugs and other trouble.  So one caring adult, one understanding, supportive adult, whoever you may be, can make the difference in a person's life. Do your part, tell someone else what you've learned today so that they know a little bit better, how to understand and treat a child or a young person or an adult, whether it's in personal or professional contexts. Thanks for taking the time. Hope everyone enjoys it. Check out the replay on Schneider speech.com/our blog