How Speech and Language Can Affect You Socially

How you speak in public and to others, and the qualify of your language, can determine if you fail or succeed in life. Speaking properly in a social setting is so important to your future. If people don’t want to be around you, because of how you speak, then succeeding in life will be difficult. Hanna and Cari, hosts of the College Talks & More podcast, interviewed Timothy Kowalski, who is a speech and language pathologist, and owner of Professional Communication Services, INC. Timothy is a licensed speech-language pathologist, specializing in social pragmatic communication deficits, and an internationally known expert on Asperger’s syndrome. His Orlando practice has seen clients from Europe, South America, and throughout the USA. He is also a renowned author of eight books. He is discussing with us the topic of speech and language pathology.

Timothy started off with a brief overview of his professional and educational background:

Our guest Timothy

As you mentioned, I’m a speech language pathologist and I did my undergraduate at Southern Connecticut State College in New Haven. Then, I went on for my masters at Case Western Reserve University in Cleveland. To be a speech and language pathologist, a full bonafide speech path, almost all states require you to have a master’s degree and pass the Certificate of Clinical Competence through the American Speech-Language-Hearing Association. It’s sort of like the bar exam, and you’ll see those three C’s at the end of someone’s name. Then you apply for state licensure. If everything goes well, you are allowed to practice in that particular state. 

So you studied near us.

Where are you located? I hear your accent.

We’re located in Connecticut along the shoreline, about 30 minutes from New Haven.

I grew up in Trumbull.

What is a speech language pathologist and what do they do?

A speech language pathologist is someone who is specially trained to work with any form of communication disorders. It could be from birth to death. It’s a wide ranging profession. Some people specialize in neonatology difficulties with preterm babies that are having difficulty suckling, some specialize in geriatrics and nursing homes and hospitals, and others are in acute care settings. I’m in private practice. The bulk of our profession is working in the public schools. We see a whole gamut of difficulties, in terms of neurological, developmental, and trauma induced difficulties. My area of specialization is in psychiatric, and then I specialized more in the high functioning autism. People will have areas of niches like mine, or they can be broad ranging where they’ll see all of the types of cases that are out there.

I didn’t realize there were so many different types of speech and language pathologists. How would one choose a reputable speech and language pathologist?

Well, there’s many sources that you can look at. One of the things that I would strongly recommend is check and see if the person has what they call the three C’s. That would be the Certificate of Clinical Competence. That means you have passed a rigorous examination that is nationwide. I would also look around with word of mouth comments, but be aware that there’s some people that are always going to be dissatisfied with something. They didn’t feel like they got the right thing. If you’re seeing a lot of those, then perhaps that should be your red flag. But if it’s one or two, everybody has something that they can find, even with me unfortunately. So looking for the three C’s is a big one.

So when should parents seek out the help of a speech and language pathologist?

What I typically recommend is as soon as you start to notice something, call and ask. One of the problems is if you rely on your pediatrician, sometimes they will wait for parents to ask, and then they would feel comfortable saying something. Parents, when polled, were saying, “If there was a problem, my pediatrician would tell me.” It’s like two ships passing in the night. What I typically told parents when I was working with typical preschool problems and early education problems, is, “Take a good look.” Most of our kids are in some form of a daycare or preschool program. Do a vast, quick overview of the kids in the classroom. How does your child compare? Invariably, you might choose the one kid who’s the genius that’s talking three years advanced for what they should be, or you’ll find the one kid who is talking poorer than your child. Look for the general. If your child isn’t speaking like everybody else, that should probably be your red flag. It’s much easier to correct problems when they’re early on, rather than let them become habituated.

What communication disorders do you most commonly work with?

As I said before, my practice is very specialized. I work only with social pragmatic communication problems. An example of that would be Sheldon from The Big Bang Theory. Sheldon would be your quintessential Asperger person that’s taken all of these Diagnostic and Statistical Manuals of Mental Health Disorders and the International Classification of Diseases, known as the DSM and the ICD. They’ve amalgamated them into a full blown everything case. I’ve never seen somebody as intense as him, but basically we all know somebody who we would prefer not to sit next to at the Thanksgiving dinner table, because they make us feel uncomfortable. That’s my particular caseload. I take people who are having difficulties with interaction, communication, and emotional regulation, and try to help them assimilate into what’s more socially acceptable for the standards of the community that you’re in at that given point in time.

I find that to be very interesting, because I am a big fan of The Big Bang Theory. I found your website, social pragmatics to be a wealth of information. Can you explain to our listeners what the differences are between an articulation disorder and a phonological disorder?

Articulation is the process of producing speech sounds. A phonological disorder is the sounds necessary to produce a language. The easiest way to look at that is an artic disorder would be the classic TH for the S, the lisp, the W for the R, those types of things. A phonological disorder is going to be a much broader type, where the child doesn’t have all these sounds. Another way to think of it is for me, a speaker of English as my first language, learning Spanish is going to be a lot easier than it is for a Spanish speaker to learn English, because English has more sounds in it than Spanish does. Spanish people have a harder time producing what we call the short vowels, that “eh”, because the A is always ab, E is always A, those types of things. It’s very consistent. There’s 27 vowel sounds with only five letters. It really throws some people off. Certain other languages, like some of the African languages use cliques and the trilled R in carro in Spanish. Those are sounds that are not found in English. Individuals trying to learn another language may have a hard time saying certain sounds. Hebrew is especially difficult for me, because of those guttural sounds that are made way in the back of your throat. I just don’t find them in my capacity to do it. That would be a phonological type of problem.

That’s very interesting, because English was actually my second language. I was an American living abroad and my first language was actually Swedish. My stuttering only occurred when I tried to speak English as a young child. So I don’t know if maybe that has any correlation to what you just said, but I find what you said to be very interesting.

Well, I know that Swedish has some interesting things and sounds, so sometimes I joke around with those sounds. The intonation is different between Swedish and American English. That’s one of the big problems as far as a lot of Spanish speakers, because of the glides that we use. A classic word that really throws a lot of Spanish speaking people trying to learn English is the linens that you put on your bed. We use a glide and to produce the word, “sheet,” your voice goes up and down, whereas in Spanish it’s more flat. It comes out as an interesting word. Typically it’s not used in social communications. It sounds more like an “eh”. 

I do not speak another language, unless you consider a Boston accent another language.

Well, for some people it could be.

My children were both born and raised in Connecticut, and they have a Boston accent just like me. So it’s kind of funny when people ask them, “Where were you born? Boston?” And they’re like, “No, Connecticut.”

Yes, I can relate. When I went back home, I couldn’t easily drop my R’s. An interesting story is my first job was in Gary, Indiana. The kid I was working with had an artic disorder. I got him fixed with everything, except for his R’s and what we call the vocalic R, which would be that “pak” instead of “radio” that would be a continental R. Everything was perfect except for that R sound. I said to his parents, “He’s fine. He’s fixed.” The parents just looked at one another and looked at me. They didn’t know how to answer it. They said, “Well, he sounds like he comes from New England.” I said, “What’s wrong with that?” Then, I said, “I’ll work on that for you.”

What are the realistic goals for therapy now and in the future?

A speech and language pathologist can help you become less noticeable in the crowd.

It depends on each particular situation. Certain people with dementia could be concerned. Obviously, we’re not going to make that person be just like they were before they came down with dementia. We’re going to look at certain things that would be for immediate needs. My father passed away from a horrible disease called progressive supranuclear palsy. What we were trying to do was develop some form of a communication system so at least we could get to a yes and no from him. He ended up with what was called a lock down syndrome, where no voluntary muscles were moving at all. I can’t imagine, because technically he still knew what was going on, but we couldn’t access any system. In my population, I try to make you become less noticeable in the crowd, so that people become more willing to be around your presence. When it comes to social stuff, it doesn’t matter what you think about yourself. It matters what everybody thinks about you, because if I think I’m great and you don’t like me, we’re never going to have lunch together. You’re just not going to want to be with me. The goals for that might be very different than they would be for a kid with an R or an artic problem. It’s a wishy washy answer. 

What formal assessment tools have you used to treat patients?

I’ve used a variety of formal assessment tools that are out there. There are certain ones that assess components of language. Speech and language is composed of speech, which would be your articulation and the sounds. There’s tests that look at how you produce sounds, and there’s tests that look at phonology, your language component. The speech component is articulation fluency or stuttering, and also voice. The voice has to be appropriate. That could be a cleft palate child who might have a hyper nasal problem, so they are not closing off the port that opens into the nasal passages. It could also be a dysarthria type of thing, where you have a neuromuscular type of problem where you’re paralyzed and certain muscles aren’t moving the way they should. That’s going to be the speech component. The language component is comprised of that sound system. The phonology consists of the vocabulary known as the semantics, the syntax (the grammar), and the pragmatics (the social aspect of how you use your language). In each one of those components, there’s going to be specialized testing. There’s going to be things that are called standardized testing, where they have these norms that are referenced. They can say, “Well, your child is performing at the 30th percentile, which isn’t very good. He should be more at this particular percentile.” The 50th percentile is what half of the population is, when doing the sound or the skill. Depending on which one it is, there will be different ways to assess that.

How do you assess success in a patient?

If they walk away and say, “Mr. Tim was a great therapist.” Actually I tell everybody, The Great and Powerful Mr. Tim. But in my profession, if you can start making friends, I feel that’s the big thing. If I have a choice between academic success or social success, I will choose the social success over the academic any day, because you need the social skills to go through the interview, to get the job and things of this nature. You can always get the academics. They have GRE’s, they have all sorts of things. You don’t have to get it at the time that everybody else is typically getting it. But there’s a critical time for acquiring social skills. If it’s not achieved prior to high school, it makes it so much more difficult for you. Because now you’re going out, and you’re out in the community, and no one’s really liking you and you’re having a hard time with this type of stuff. In terms of the language aspects, if you’re talking and people understand you, then that’s going to be self satisfying for you as well.

Yes, and you become very self conscious. So speaking in public, or speaking and trying to make new friends can be very difficult. How would you respond to a parent who believes that speech therapy is not helping their child?

We have to try to always look at, are they accurate with their statement? How do they define helping? What are they looking at in terms of successful situations? When we’re talking speech and language, as you knew, I’m not certain how long it took for you to improve your speaking skills so that your fluency aspect of the stutter was less noticeable, but I’m sure to this day, you might still have a few words that you stumble over. 

Yes, I do.

We all do. I mean, nobody is completely fluent a hundred percent. We always have little stumbles that we do, but at what point in time do we consider an individual a stutterer? It’s when it passes that quasi area. So does the parent really have an accurate view of what they’re expecting? It might take a long time. A child who has a neurological problem, like a down syndrome child, might take a long time. I have a hard time working with very young down syndrome children, because behaviorally, they frustrate me. They’re like limp spaghetti that just drop down on the floor. They’re not motivated to do things, because that’s part of the behavioral aspect. You have to work through all that type of stuff. It is an unrealistic expectation if a parent expects that their child will speak better in two weeks. So it takes time, and depending on what type of disability it is that you’re working with, some can be fixed relatively quickly, others might be years. I tell people, “We’re doing a dance for at least four to seven years when you come see me for your social difficulties.”

So it’s accurate to say that immediate gratification, in a parent’s eyes, is not the proper outlook when it comes to speech therapy.

I would say it’s unrealistic. What I try to paint to parents is that what we are trying to do is change behavior. For example, to get a child to say an R sound is fairly easy. To get you to say the L sound, we can teach you how to do that. Now comes the hard part, which is trying to remember to use that new sound every time you open up your mouth. That sounds really easy, but it’s a habit. It would be like me telling you, “Guess what? Some little gnome went outside and switched your gas and brake pedals.” Well, I don’t think that if I told you that, you’re going to drive home today and not have an accident. I think you’ll have an accident, but you’ll get to two blocks away, because you’re so used to slamming on the brake, that’s what you’ll end up doing. So it’s what we call unlearning habits, hence the reason why it’s easy to work with a kid when they’re younger, so that they don’t fixate on certain things and make the unlearning process easier.

How do you handle a group therapy session consisting of children with diverse needs?

When I was working in Gary, at the nation’s largest Easterseals facility, we had individual sessions and a large group, I had a variety of children sitting around me in a semicircle, and I would target a particular activity that we’re going to do. What I did was I remembered what each particular child was working on. Johnny might be working on certain sounds, so I would target certain things that I would expect for him to be doing and performing, using those target sounds. Susie might be having fluency problems while I’m trying to get her to use more fluent speech. Bobby might be having some situations where he can’t put his noun and verb together. So when  I’d ask questions, I would be looking at that. It takes a lot of flexibility and diversity to do this large group, but it can be done.

What is the age range that you treat? Can you develop a communication disorder later in life?

In my practice, I’d say from 4 to 94. Four years of age is really when you’re starting to become more social. I had one child come to me at age two and the doctor had diagnosed the kid as being Asperger. You have to have a large enough population of pro social skills to compare your child against. Can anybody tell me what are the pro social skills of a “terrible two”? They’re just not. So you have to have this large enough population. When I worked with traditional speech therapy, we would see kids who were two years old. I have friends that are in the neonatal type. So it depends on the type of problem that you’re looking at. Certain sounds like the R sound is a much more difficult and later developing sound versus a P,B, or M. Those sounds are much earlier in life. Language skills are also going to be dependent upon certain things. So you have to look at what would be expected for a given age, but then all the way down the line. Now, as far as how late you can start therapy, you can start at any given point in time. If you’re trying to work with the person who lisps, and they’re in their forties, we can still change that and help them with their lisp, but it’s going to be harder, because of all that pre-learned pattern of, “This is the way I always say my F sounds.” It’s going to be more difficult with that. In certain adults, there are certain types of things like strokes, neurological disorders, those are more adult onset, trauma induced, like car accidents and things of this nature. So it depends. Typically you’ll see more child language and that type of stuff is going to be obviously in the early developmental ages. But there’s a lot of things that we acquire as adults, progressive neurological diseases are a big one.

Does dyslexia affect speech?

It can, and in certain individuals, dyslexia might cause them to have difficulty in terms of trying to find that word where you have a groping and struggling type of situation. It’s on the tip of their tongue, and they just can’t get it. It’s usually very, very frustrating for a lot of people. You can get frustrated because you feel like you have to get that word out. It gets annoying for the person who’s trying to speak as well as the person who’s listening to you because it’s like, “Okay, let’s do something else.” One of the things that helps with that is the more you can gesture, then that gesturing will sometimes trigger the right word. So that word retrieval comes in.

I can see that being very frustrating for someone.

We’ve all experienced the, “It’s on the tip of my tongue.” I just say that I’m going to make a horrible stroke patient. I know that for a fact, because I’m going to be so furious at everything.

Is a speech impairment and a communication disorder considered the same thing?

Back to the whole aspect of how the communication part of the whole gamut of speech and language, is how you are presenting yourself. How are you communicating your ideas or messages to another individual? So the communication is going to look at the delivery style. One of the things I use in my practices is the “one, two, three speech production.” So the “one” would be how I’m talking right now. I’m using some gestures, I’m half Italian so my hands are flying away while I’m talking, and my facial expressions are changing. That would be what I call a number one. A number two is a person who just looks at a spot in the wall. Number two never deviates from the spot in the wall and number two talks in a monotone voice. I think most people would rather talk with person number one, rather than person number two. Person number three has that snarky tone of voice. He has that facial expression that looks gnarly the whole time, like you’re going to just slap my face. Most people would prefer not to be with that type of individual. So in my practice, those communication delivery styles are going to impact everything. So think of it, if you’re a parent, you say to your child, “Johnny, come on it’s dinner.” If he says, “Alright,” as a number three, you’re going to be a little upset with how he responded, but he might say, “Well, all I said was alright,” but delivery style is a big thing. When you’re looking at the speech impairment, I think most people would equate a speech impairment with that sound production type of thing where they’re looking at generalized in precise articulation. “Mush mouth” is what I would call that, where there’s not really one or two sounds, and it’s a gamut of everything. It’s inconsistent, versus the R or the S problems. That would be more of a speech problem. So I would say a speech disorder is probably going to be something a little more specific, whereas the communication disorders are a much broader type of area.

Would a speech or communication disorder affect reading or learning to read?

It can, but not necessarily. One of the things that you might really see is in terms of writing, because if you’re trying to sound the word out, and you’re sounding the word out incorrectly, you’re going to write that word incorrectly. On the flip side, sounding it out might help with the speech problem or also with the reading problem. Then you start to understand those things. So it’s sometimes yes, and sometimes no.

Now let’s get personal. What made you decide to be a speech and language pathologist?

Back when I graduated high school, along with Methuselah, my mother, a nice Italian lady, was trying to help me determine what I wanted to be. She hadn’t worked since, early on, my parents got married, and then my father was going to college, so she was working. Once he got his degree, he was employed. Then, she became a housewife, so she didn’t have much exposure in terms of types of jobs to help me. She said to me, “What about an accountant?” I started laughing, because I have an LD in math. I just can’t do math to save my soul. I was laughing, and she slapped me across the back of the head, like Italians typically do. She says, “It’s a perfectly acceptable and respectable job. Your father makes a decent salary.” I looked at her and said, “Would you come to me with your taxes?” That’s when she had a revelation and said, “Maybe we should look at something else.” So I decided I wanted to be in optometry, like eyeglasses and eye exams. That sounded kind of interesting, until I found out that it took a ton of physics and math to do this type of stuff. I remember my professor in college that said, “Tim, why are you taking my class?” He said, “I’ve never seen someone work so hard at math. You’re at every one of my extra classes. You have a math tutor, and you have only a 26th average in my entire class. What’s going on?” I said, “Isn’t college all about entering it, and thinking, ‘This sounds great.’ Then you open your eyes, and you say, ‘I don’t have the capacity to do this. This is not for me.’” I said, “That’s me. I don’t have this capacity to do math.” Or you decide, “I’m going to take this degree or this major. It sounds great.” Then, you find out you don’t like it. It’s just disgusting. It’s like everybody I know that takes an astronomy class. They think they’re just going to look through the telescope and see the beautiful rings of Saturn. Then, they find out that it’s all physics, and it’s not what they wanted. Another example is when you take another class by a professor of a subject that you had no idea what it was about. It opens your eyes and you say, “Wow, this is marvelous. I love it.” That was me with communication disorders. I also grew up with a deaf girl. When I was thumbing through the book, I flipped on communication disorders, and having a deaf girl next door to me, made it much more personal. I remember going into an interview with the department, because I knew I had to change. I changed from optometry to biology, and I didn’t want to do that, because I didn’t see what I could do with biology. Then, I made an appointment with the communication disorders department and they eventually said, “Why don’t you take the intro class and see if you like it.” That’s what I did, and I loved it. I even ended up graduating a year early.

That’s great. After all those struggles, you even graduated a year early.

Yes, and I changed my major three times.

In your opinion, should schools provide more assistance to students with communication disorders?

That’s a real fun one. The law in terms of what is ideal for Individuals with Disabilities Education Act says that the services are to be provided to help your child achieve adequate success. The word adequate is in there, and it doesn’t mean perfect. As long as he can benefit from classroom instructions, then that’s all they’re supposed to be able to provide. That’s all they have to provide. Now, the parent in me would not be satisfied with my kid getting C’s, and high D’s, but the law says that it’s not perfect. A lot of parents are expecting it to be the same as if they went outside and paid for it privately. It is not meant to be that way. So that’s one of the things I would definitely let parents know. What is the law? Now, the law is also specific to your state. What really happens is, certain states can be a little more “Lucy goosey” with their interpretation of what they will allow to be provided in the school systems. Then you go, and you move to a different state that’s more restrictive. The law also says that, every three years, your child has to have this big re-evaluation to determine if he’s eligible to receive services. That’s the whole situation in the school system. You have to be tested by the schools to find out if your child qualifies for one of the 13 handicapping criteria, as defined by the federal law. Each state defines the criteria to enter into the program for their state. That’s one of the things that’s really tricky for parents, because if they’ve moved, and now they’re getting this re-evaluation, and they find out that their child doesn’t qualify. Let’s say Michigan versus Massachusetts. One might be more restrictive (I don’t know what they really are, I’m just picking these states out.) So, you moved, it’s not fair. You had your services in Massachusetts, and now you’re in Michigan without your services. That’s how Michigan defines the program that your child is at, and that’s where it all boils down. The whole thing is if the child is achieving the goals and, then the IEP. That’s what you’re going to be working on, because the individual education plan is the IEP. It’s sort of like your contract between the school system and you, the parent, of what you’re going to be working on. These are the two things that you are really looking at: How realistic are my expectations? What am I asking for? You’ve probably heard the “no child left behind.” I think that the premise behind this was good, because it used to be, “Oh, poor Mary. Mary’s got these problems. We’ll just kind of help her along.” No, challenge Mary to do whatever she could do to the full capacity. But, the reality of the situation is, some of our students will not be at age expectations. Your profoundly, mentally handicapped, and profoundly autistic kids are very good examples. They’re not going to graduate in 12th grade with a 12th grade curriculum. It’s just impossible. The way that the law was written was that, by a certain year, all students, 100% of all students, in the school system will be graduating at their level of what is expected. That’s impossible. It’s just not going to happen.

You mentioned the IEP. Does the IEP follow you into college?

No. An IEP stops once you graduate. Now, the law says it can go up to age 21. That’s one of the things that I tell my parents to try to look at. Maybe your child should stay in the K through 12 program a little longer to access more of those services. Once you graduate high school, the IEP is completely null and void. The best you could hope for in college, is going to be the ADA, the Americans with Disabilities Act. That’s equal access. It has nothing to do with achieving these particular things. It’s just the school is going to provide you with certain things and is dependent upon the student to be able to say, “This is what is necessary for me to achieve success. Can I get the prof to provide me with these things here?” If you have a kid that is not willing to advocate for himself, that’s going to be the downfall for him, inside college, because you have to advocate for what you need to access the ADA. In K-12, the teacher is responsible for maintaining the IEP and achieving the IEP. The college professor doesn’t have to maintain anything.

That’s very useful information for today’s parents.

Yes, and I think a lot of parents are expecting that they’re going to get the same services. They’re not. It’s not going to be anything like that, whatsoever. That’s one of the big things. One thing I try to do is get K-12 schools to teach my kids, the ones that have social pragmatic difficulties, how to self advocate. It doesn’t seem to be happening. These kids aren’t able to say, “Could you repeat that? I didn’t understand what you said.” Hell can freeze over before a lot of my kids will ever say that. That’s a life strategy that we just take for granted. If you’re on the spectrum, you’re going to think, “Oh no, I’m not going to say that, because only losers don’t understand, and I’m not a loser.” So, there’s that whole self perception of how you’re going to be perceived by other people.

That’s very understandable. Do you work with occupational and physical therapists, also?

Indirectly, I might, but the way my practice works is I don’t have that much interfacing with them. When I was at the Easterseals Facility, yes, there were a lot of kids that were being seen through multiple disabilities. There are individuals that participate in co-treating. So there are certain types of body positioning that the PT or the OT might be working on will facilitate communication skills and vice versa. So you might have a team approach where two or three therapists are working simultaneously with the child. I know that a lot of times we want to know what everybody else is working on. So if your kid is a floppy kid, so he doesn’t have good muscle tone, and we want him to be positioned this way, the physical therapist is going to teach us how they want him to sit in this type of chair. So that would be wise for me to know, because that’s going to impact his ability to produce sounds, because you need to have a good power source. If you’re slouchy, you’re not going to be able to generate us as much air flow. A good exhalation is dependent upon how you’re sitting. So there’s a lot of interfacing that can happen depending upon the disability that you’re working with.

We see that COVID-19 is affecting the world right now. How is it affecting you with speech and language pathology? I can’t imagine it would be easy for you to do your job if you and the child are wearing a mask.

It can be hard to work with a speech and language pathologist, wearing a mask during the pandemic

I have only one or two kids that I see in my office right now, so I’m really debating whether or not I need to have an office. Most of my people are all online using some form of digital interfacing, so I don’t need to have a mask that way. One of the things that we do for arctic disorders is telling the kids to watch what I’m doing, and watch how I’m making my sounds. That’s really difficult when you have a mask on. There are some people that are using a clear plastic mask so you can see the person’s face and mouth. I know some individuals are using face shields along with plexiglass dividers, all that type of stuff. For me personally, COVID-19 is making my job more difficult because, by nature, my people don’t want to be around other people. So I’m taking a socially challenged individual, and trying to make him become more social in a quarantine situation, where you’re not supposed to be socializing. It’s so difficult for me. How do you become more friend worthy when you can’t have friends in your house? I just can’t wait for this to get over.

We’re all ready for this to be over. It’s one big oxymoron. What other advice can you offer our audience relating to communication disorders?

There are two things. If you’re a parent, and you are wondering as to whether or not your child is having a problem, my suggestion would be to contact a speech and language pathologist. A lot of times they’ll provide free screenings. They’ll provide you with some comments and discuss with you over the phone, that’s what I do. What you’re trying to do is decide whether or not you should bite the bullet, make the appointment, and pay. Nobody wants to do it if it’s an unnecessary concern. So the first part would be, if you suspect the problems, go ahead and do it. The second one is, as a person, when you go out grocery shopping. Publix is our grocery stores in Florida. One of things that Publix does is they hire individuals that have various forms of developmental disabilities. They usually are going to be your baggers and things of this nature. Sometimes these individuals might not get it the right way. They might have trouble expressing their thoughts to you. What I would say is try to be more willing to work with someone who’s having some difficulties. Sometimes what happens is adults, when they’re having communication difficulties, are drunks with slurred speech. Well maybe the person has a neurological problem. We don’t know. So have a little more compassion and be willing to work with that. Fluency. One of the things that happens with people who are listening to people that have stuttering problems is they might try to fill in the word for that person, trying to think that they’re helping, which is the worst thing you can do. You want to continue doing good eye contact, but what happens is when things make me feel uncomfortable, typically what we do is we shift our gaze, which you, as a stutterer, remember how people were treating you, then that reinforces more aggravation. So I guess more compassion with individuals that are having difficulties, trying to treat everybody with a little more dignity. I know that when I worked in the burn units, there were a lot of individuals that suffered head injuries after jumping out and they hit their head on the way down. What I always tried to do is look in the eyes of the person, and try to connect, especially if they have a disfigurement.

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