Stuttering Treatment in Italy
by Donatella Tomaiuoli
Italy has 24 universities that offer diplomas in speech-language pathology. The country has
approximately 8,000 speech-language pathologists, 2,500 of whom are members of the Italian
Association of Speech-Language Clinicians (Federazione Logopedisti Italiani), which consists of 21
smaller associations, representing every region in Italy.
Many approaches to stuttering treatment are employed in Italy. These include the psychotherapeutic
approach, the pharmaceutical approach (both with or without logopedic treatment), or just
logopedic treatment. Our overall impression, however, is that the best results are obtained by
employing a global approach, using logopedic treatment associated with a psychological-cognitivebehavioral treatment. The logopedic treatment for adults and school-age children, suited to age and
individual characteristics, commonly aims at controlling the stuttering symptom by the patient
through verbal facilitation and relaxation techniques as well as counseling. For preschool-age
children, the treatment is uniquely based on parental counseling without the child’s involvement.
My experience in treating stuttering led me to realize the importance of a center that would
specialize in its diagnosis and treatment. The Clinic for Research and Treatment of Stuttering (CRC
Balbuzie) is the only one in Italy that is completely free of charge. It also serves as an internship site
for university students specializing in speech-language pathology. Each year, we treat more than 60
clients who stutter—about 70% of our overall caseload.
Together with four clinicians (pictured on page #) who are part of a much larger clinical staff, we
have developed a multimodal intervention program for adults and school-age children that typically
requires 12 months to complete. The team includes doctors (a neuropsychiatrist and a neurologist),
a speech clinician, and a psychomotor therapist, who work in individual and group sessions with the
patient, paying attention not just to the symptoms but to the totality of the person in regard to
communication.
This approach allows patients to use different verbal facilitation techniques as well as to concretely
experience their potentialities by dealing with other group members (patients) in different verbal
activities. The most important verbal activities are: telephone therapy, to overcome the patient’s
most dreaded experiences through specific training; dubbing of a movie or commercials to
overcome the time pressure, especially when the patient is involved in a conversation or is telling a
joke; humor therapy to succeed in laughing off defects; mental training, a particular relaxation
technique used mainly by athletes to control anxiety and face the situation without thinking about
the result; and theater therapy to experiment with different roles in various situations.
A unique part of the CRC Balbuzie Center is that patients attend a theater class with a real director
who leads them to a full play production at the end of the year. The cast is made up entirely of
children and adults who stutter, and the play is produced several times in a real theater for a large
audience of friends, family members, and others. This year, Moliere’s The Miser was staged by
three different casts of people who stutter: children up to age 10, children ages 10 to 15, and young
adults. Of course, some modifications were made to accommodate the different ages. It is amazing
to see the excellent participation, without exception, of all children and adults. None has refused to
be on stage in front of a large audience. The satisfaction and confidence that all participants drew
from the experience has been enormous.
Tomaiuoli et al. (2001) have developed another unique six-month program for preschool children.
Involving parents, it uses known children’s stories as a preventive instrument. Every story has a
precise objective and colorful settings (e.g., The Jungle Book or Winnie the Pooh). Using the tale, it
is possible to “insert” people and problems that reflect the real world. Every scene also has a precise
title and objective and includes examples. Complicated issues can be simplified by imposing them
on clear and popular characters.
For example, Jack Panther and the Woodland Friends are employed to work on interpersonal
relationships or assertiveness training. In the first scene, Jack, who lives in the forest, loses his
friends. All, including him, escaped the big fire and move to different forests. Jack, now alone in a
new forest, must make new friends and be accepted into a new group. He must experiment with
various approaches, including performing roles he does not like, to finally succeed. Skittle, the baby
elephant, is used to work on reducing fear of others’ judgment. In the last scene, Skittle experiences
difficulties with precise movement because of his size and is often clumsy in the presence of
friends. Negative judgments by others make him shy and produce inferiority feeling. To change the
situation, he will try to show other aspects of his personality, as well as overcome his handicap,
transforming it to a point of strength.
In this way the child finds himself in a near-real world that is less intimidating than his real world.
The child is instructed to act in different roles within the same tale. The clinician also actively
participates, playing a role that either facilitates or hinders communication. Additionally, family
members become involved. Whereas early in the program they serve primarily as spectators, later
they become active participants, taking several roles that allow assertiveness training. In this phase,
the clinician becomes an important verbal and behavioral model for the parents.
In my view, the different tales allow children to play and interact with different personalities, and
through these they realize what the optimal behavior is, including assertiveness, to achieve the
objective. The child also realizes the importance of non-verbal communication, learns to identify
basic elements of the verbal communication (voice tone, accentuation, rhythm, and pauses), and
experiences the reinforcement of communication (handshakes, cheers, embraces). Thus, although
the program does not attempt to deal directly with stuttered speech, it is aimed at helping the child
cope better with the stuttering problem, improve self-awareness, adjust, and function well in school
and society. Such gains eventually also result in a significant reduction in dysfluency. Some results
have been reported by us (Tomaiuoli et al., 2001; also summarized in Yairi & Ambrose, 2005).
Finally, in the past seven years two international conferences on stuttering were organized in Rome.
The CRC Balbuzie, in cooperation with “La Sapienza” University, is now planning another
conference to be held in Rome in May of 2007.
Donatella Tomaiuoli is a psychopedagogist and SLP specializing in stuttering. She is the director
of the Clinic for Research and Treatment of Stuttering (CRC Balbuzie), Rome, and a professor in
the Department of Speech Therapy, La Sapienza University, Rome. She developed a multimodal
intervention program for adults and school-age children who stutter and a preventive “play”
program for pre-school-age children. Contact her at crc.balbuzie@tiscali.it.
Sidebar
References
Tomaiuoli, D., Del Gado, A, Lucchini, E., Lattuca, S., Spinetti, M. (2001). The fantastic world
of the tales. Presented at the Second International Symposium on Stuttering. Rome, Italy.
Yairi, E. & Ambrose, N. (2005). Early childhood stuttering. Austin, TX: Pro Ed.