Listen to this episode on Apple Podcasts, Spotify, Google Podcasts, or your favorite podcast platform. You can also watch the interview on YouTube.

BIO:

Joseph Donaher, Ph.D., 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.  

EPISODE HIGHLIGHTS

0:00-02:55 Intro
02:55-9:31 Darren Sproles’ stuttering and NFL journey
9:31- 13:46 Stuttering and Avoidance
13:46- 16:47 Joe Donaher’s career path
16:47-20:44 Behavioral vs. Holistic Approach.
20:44- 22:15 NSA experience
22:15 - 25:55 Getting a sense of the client as an individual.
25:55-29:16 Defining severity in stuttering
29:16 - 30:38 Podcast info
30:38 - 36:10 Iceberg analogy on people who stutter
36:10 - 39:52 Stuttering and Concomitant conditions (ADHD)
39:52- 41:20 Changes in the field.
41:20 - 46:31 ADHD and reasons for stuttering
46:31 -51:26 On medicating kids with ADHD/Stuttering.
51:26 - 55:47 Outro

RESOURCE LIST

• Joe Donaher on Children’s Hospital of Philadelphia

• ADHD and Children Who Stutter

MORE QUOTES

"We avoid things all the time. And so as clinicians, we have to remember if we tell someone who stutters stop avoiding, that's not in line with what we do in every other way. So what we have to do is start discussing why you're avoiding, or what's behind the avoidance and how can we do less of it?" - Dr. Joe Donaher

"When we're talking about avoidance and getting someone to do more, instead of avoiding more, go back to the very beginning of the intervention and you have to build that trust." -Dr. John Donaher

TRANSCRIPTION:

Uri Schneider: Good morning, everybody. What a special day and what a special guest. so my name is Uri Schneider from Schneider speech.

Today is a day that, as I said before, if you haven't been living under a rock, today is October 22nd. It's international stuttering awareness day. The hashtag on social media, as Isad, ISAD 2020, around the world and in countries around the world, a global community of people who stutter and people who care for people who stutter kind of use today to add knowledge and understanding and advocacy, for people who are living with stuttering to really feel the.

The comradery, the community around them, not to feel alone that no one should feel alone. And for those of us seeking to understand whether we're parents, clinicians, people who stutter teachers, psychologists, whatever today, the internet is filled with mostly good stuff. But like all the time you got to filter what you read, but there's going to be more posts.

If you're wondering what's going on. Why is the stutter verse taken over the internet? That's why. And so it's all the more extraordinary. To have, with us today, someone who is truly a living legend among the giants in the field. when you go to the stuttering foundation of America, Jane Frazier, the organization that she leads for decades, and I describe her affectionately as an Energizer bunny.

She has the energy of someone younger than me. And the experience and the insight and wisdom of someone far beyond me in years. That's for sure. And, what she's done, what you'll notice is if you go to the new catalog of the stuttering foundation of America, you'll notice that the man whose face you're looking at to my left above me to my right.

I'm not sure how it appears on your screen. This man appears on a lot of the material. So Joey Donaher is someone who's been around and continues to contribute to the field in incredible ways. He is active at the children's hospital of Philadelphia. I'm gonna make it informal. He also is on faculty at university of Pennsylvania.

and he is an editor. And, on the reviewing board and just on every important place that you need to be contributing to the literature, calling the literature and really bringing the best knowledge out to the world. He's been doing it for decades, and it's a great privilege to take the time and have a conversation.

So thanks for coming on, Joe.

Joseph Donaher: Thank you. And happy international stuttering awareness day.

Uri Schneider: I was wondering like, yeah, we got to come up with a good greeting, it's a mouthful. Yeah.

Joseph Donaher: I think I have been known and I've been here at the hospital for 23 years and I think for every international stuttering awareness day, I send the same message out, which is happy.

ISA D please celebrate responsibly. So I'll say the same thing to all of you.

Do you have Irish

Uri Schneider: blood?

I have Irish blood in me.

My dad explained why, you should celebrate responsibly.

Yeah,

Joseph Donaher: maybe a little bit,

Uri Schneider: but.

I'm looking over your shoulder. And I wonder if that might be a good opening. Yeah, it seems to be a Philadelphia Eagle.

Darren Sproles. is there any reason besides the fact that you're in Philadelphia, that Darren Sproles is significant to you?

Sure.

Joseph Donaher: And, it's a perfect day to say that because not only is it ISAD but tonight thought that the eagles will be defeating the New York giants to take first place in the division.

Uri Schneider: I told you no politics and no rivalries. And that we're not going to put down New York or Philadelphia. Yeah. Okay. But you're expecting the Eagles to put down the giants.

Joseph Donaher: Sure, but it's the team that wins we'll have two wins for the season. So it's not really bragging about much when I'm bragging about the Eagles

Uri Schneider: and beating the giants is not to brag much either.

Exactly.

Joseph Donaher: Yeah. Our division is a little weak this year, to say the least, but I get Darren Sproles the person who stutters and, he was a communication sciences and disorders major at Kansas state. He, has talked about his stuttering. He has been open about it. he's worked with stuttering foundation of America.

being in Philadelphia, we brought about 45 kids who stuttered and their families with them a few years ago. We had dinner with him and, he knows I'm a very good sports fan. I after meeting him and he, as a thank you, he gave me that poster. So I keep it in my office as an inspiration for all the kids.

I work with who stutter.

Uri Schneider: The other thing I love to say about Darren Sproles is most people don't necessarily know if you're a sports fan. You don't know of his, outstanding characteristic of stuttering as much as another feature, which I believe correct me if I'm wrong.

Was he not at the time, the shortest player in the NFL?

Yes, I believe so. I believe

so. I think I'm thinking of Tom Scharfstein had a beautiful post on the ISAD conference about, crushing it in life and stuttering. And on the one hand, people who stutter and parents of kids who stutter and teachers need to understand the difference of growing up and speaking with a stutter and where it's appropriate, make accommodations.

And at the same time, there should be no free lunch, No one's entitled to get an a without earning it. No one's entitled to the job without earning it. So sometimes when someone has one challenge, they deserve the accommodation and understanding, but it still means they got to work hard. And I think Darren Sproles is a great example.

He had two things. So to speak strikes against him, but on the football field, certainly being of short stature, was something that made people think less of him. And what he did about that was he showed them with his work ethic and with his hard play. And I think for all of us, whether we stutter or not the idea of earning our stripes and earning the opportunities and the favor of people, one of the things I love to do this is a quick riff, but.

When people say, how will I get that girl to say yes to me? Or how will I get that guy to say yes to me? Or how do I get that job? My father would often say, what do you think they're looking for? What are the top five things in their hiring process or in what are they looking for? A boyfriend or girlfriend stuttering or being fluent?

Probably ain't in the top five. they want someone who's courteous, someone who's thoughtful, someone who's generous, someone who's fun. So if a person is so consumed with the one thing, they feel bad about whatever it might be. and they don't think about what assets do I have, what characteristics do I bring to bear?

What value do I bring to this relationship? And they don't put that on a table. It might be doomed, not because of the reason they think it is, but because they didn't put their assets and their value on the table. So I think Darren Sproles, I just love that poster and. Even though

I like your comparison

Joseph Donaher: with the size thing for him too, because, if he was, if he listened to everybody else, if he listened to that, the wisdom of the day , if he listened to his coaches and everybody else, he probably would've said I'm too small to play in the NFL I am too small to play state

state. but he didn't. And is that because he refused to listen to it? Or it's because he wanted more or it's because he was just dedicated and, and really motivated. And I don't know the answer to that, but I think it's interesting to look at, how he talks about his stuttering in the same vein.

So the first time I ever. heard him speak was I was actually in a hotel room giving a talk in California for the stuttering foundation. And I was, just watching sports center, like I normally do at the end of the day. And he was being interviewed because he set the record for the most yards in a single game between punch and kick off returns and all this right.

And it was, I guess it was his first year in the NFL. He was in, he was playing for, I believe San Diego back then in the beginning. And, so he was there and he was interviewed and they were talking about this amazing game and he started to stutter and he announced when ESPN said to him, Oh, relax, don't worry.

We have time. And he said, Oh no, I'm not nervous. I stutter. And the announcer said something like, Everybody stutters when they're nervous. And he goes, no, you're not listening to me. I'm a person who stutters. And then he went on and said the rest of his interview. And so just if he had listened to all those naysayers for football, he wouldn't be playing in the NFL.

And if you'd listened to all those folks about his speech, he might've been avoiding his speech. And what I think is really interesting about him is he rises to that challenge.

Uri Schneider: Totally. And it makes me think of also Alan Rabinowitz. have less memory. and in the film, transcending stuttering, the inside story, which is a free documentary produced by my father and myself and the team. in that film, he says the hitting rock bottom was when people said things about him because of his stuttering, and he kind of didn't have the courage to own that he was not what they made him out to, but he actually played and famed.

The kind of things that they were accusing him of someone said he was retarded, please, excuse him. He's retarded. Give him a few moments. And he actually would act the part, but Darren Sproles, for example, Alan later in his life, certainly they stopped selling out. Didn't just accept that, but chose to speak up for their dignity.

And I think that's such an important message that you brought from Darren. We see it in Allen and I think it's an important piece, whether it's a parent. Advocating for a kid, an ally, a teacher, a kid, a young person learning to speak up for yourself and don't let other people's ignorance or just misunderstandings, put you down.

And I think an important point with

Joseph Donaher: that. And you brought it up brilliantly with our Minowitz. but also Darren Sproles, it's very easy for us to hold these celebrities up. As people who stutter and say, look, they're doing whatever they want. We can look at guys on television, announcers, political commentators, sports guys.

And it's very easy to say, look, they're not letting it hold them back. But if you back up the track a little bit, if you back up their storyline, even Darren will talk about, how he wasn't doing television interviews. To the extent he could have, he wasn't doing guest appearances and things, and it took him a while to do that.

I was fortunate to work on a show with him called NFL players, United television show. It was one of his first times really talking about his stuttering and he helped a person who stutters in that show. so I think it's important as we talk about people, not letting their stuttering hold them back.

We talk about that as a progression, because it isn't an all or nothing. It's not you avoid, or you don't avoid. And I think avoidance is such a big thing in stuttering and the way I talk about it, both the individuals who stutter and to clinicians is that avoidance is a normal part of life. I avoided traffic today.

So I left a little bit earlier and took a different route. I avoided having argument with my son last night, so I didn't yell at him for something. We avoid things all the time. And so as clinicians, we have to remember if we tell someone who stutters stop avoiding, that's not in line with what we do in every other way.

So what we have to do is start discussing why you're avoiding or what's behind the avoidance and how can we do less of

Uri Schneider: it?

What would you say would be some legitimate ways for parents, for clinicians teachers? I think that's such an important point that it's a continuum and it's not linear.

It can have ups and downs. So one day someone has no qualms about the presentation in front of class and another day it's not feeling so strong could be their stuttering feels different that day. It could be their spirit, their state is different. You have any tips on how to gage that and what are, one of the places that always comes up for me is a bar mitzvah or confirmation or some lifecycle event.

The parent has a conundrum. If I give them a pass, if I respect their resistance, their desire to avoid will I teach them to avoid for life. On the other end, if I push them up to the podium, am I going to create a trauma that they're going to forever blame me for and navigating that is so nuanced.

any tips from your experience?

Joseph Donaher: Yeah, it will be, it's a giant topic, which I love getting into that

. But, 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 has to be a 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, before we do anything, we have to develop a relationship with the individual and with their families. Okay. I often say that a speech language pathologists that 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 is being honest and open with me.

Here's kids that come to us, who 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 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. Okay. I'm not, I'm sure everyone has thought about this at times, but you have certain therapy sessions that you're like, Oh good. They're coming here today. I'll see them at three. And you're all excited and really motivated, but we all also have to be honest, there's also those other ones that you don't click with necessarily that you're not, your goals aren't, in line with each other and it's just a harder time.

And those times you think, Oh no, maybe we'll cancel this week, and that's really difficult and we have to be honest with that. And so if we have a client that we're working with, a family that we're working with, and something's not there, we have to be honest about repairing the relationship before we're going to change anything that we're doing moving forward.

Uri Schneider: Beautiful. And I just want to give attention to and share with you, Joe, as I did before, there were so many people that poured out so much, warmth and regard. You got a hello from Brandon parish. We've got Elizabeth coming in from England. We've got Lucy ward sending you regards. You guys were classmates.

I won't say when. but, your impact in the professional community. And as you said, with the people that send you Christmas gifts is. Is legendary. so we talked beforehand a little bit, we could dive into any number of things and both of us are it's beyond just a job, but maybe you want to talk about a little bit.

How did you get into this? How did you're not one of the people who stutter. So how did you find your way. Into this niche into this focus. What got you

Joseph Donaher: hooked?

it was a, it was a long, strange trip and then I think about how I get into it.

And, first of all, by having you invite me to this, I was very honored that you invited me in. It was funny. It was right during the pandemic and I'm at a hospital. So the pandemic has been a little rough on us to say the least. And I was talking to my wife and I told her that I got invited to do this.

And I said, it's really nice. He wants me to talk about the field and what's. What has happened and what's going on. And as I'm sure describing this, I said, I really think all he's doing is telling me I'm old. And that I've been around too long and I started realizing this and she goes, did you know him really well?

And I said, I know him. Fair enough. I go, actually I knew his father. And then as soon as I start saying, I know your dad for years and years, I'm like, yep, I'm old. This is tough.

Uri Schneider: I just want to be clear on my intention is I think there are a lot of, there are a lot of young people, some wonderful up and coming people in the field, in the research, in the PhD track clinicians on the front lines.

More and more people who stutter, who are also entering the field, which has enriched everything on every level. and at the same time, I think there are people like yourself and someone else that I've lined up. Barry yeoman and, Michael Sugarman and many of your colleagues, as well as the young guns and the young bloods up and coming.

Eric Raj is my next, conversation, from New Jersey. And, I'll be speaking with, Ruben cheof. As well. So we've got a great lineup, but what you bring, and I think what's so important. We'll get to this at the end, perhaps, is the, what Lee Reeves talked about, the importance of bringing the communities together and what's been accomplished in that regard and that we cherish that and protect that because I think that's an accomplishment from the past several decades and it didn't just happen.

It would be a big loss to see. To see it not be sustained for those that understand this for those that don't, that's fine. But as in any community, there's always a certain tribalism and certain feelings of safety and are my interests being met and so on, but we can get to that. But I think you're not here because you're old, you're here because you're still relevant.

You are still relevant. And you're sitting there at the hospital on the front line as you have been, and, you're as relevant as ever. And that's, that was my

Joseph Donaher: intention,

I was kidding you, but, so let's think about this a little, right? Yeah. you said I went to grad school a long time ago, right? I was fortunate in graduate school.

I took my first stuttering class from a professor who wasn't the main stuttering professor, cause the main starting professor was on sabbatical. So I didn't get to meet him yet. So I took a course and I believe the first thing that the professor said to me after the first paper was I should never work with anyone who stutters, ever.

Okay. being a little bit bull-headed that annoyed me. And then the next semester, I'm thinking I'm not gonna, I'm gonna hate this second stuttering course. I'm not going to like it at all. Whatever the professor comes in, it was Woody Starkweather. And so from the beginning, Woody and I hit it off, I learned so much he is one of my mentors in the field.

So I was really lucky that when I started learning about stuttering, I was learning from Starkweather. And at that point in the field, this would have been about 26 years ago. Okay. so at least 26 years ago. so when you think about it back then in the field, there was really two islands at the time.

And on one Island, there was a very strong, behavioral emphasis, which changed the behaviors of stuttering. And there were a lot of folks in that, on that Island. Then there was a second Island, which was a more holistic Island that was not just looking at the behaviors of stuttering, but talking about the experience of stuttering, talking about, what it's like the impact of stuttering and what does it mean to be a person who stutters rather than just the behavioral approach?

We know all the cool people were on the one Island. And this Island wasn't as cool, but it really was

Uri Schneider: a dichotomy.

Those people got voted off at the first Island

Joseph Donaher: Exactly yeah it really was that kind of dichotomy. And I can remember when I was really young going to conferences and you would see presenters and you almost knew what were they a shark or were they a jet?

like you knew the side they were on. And then what I really think is nice is. What was at the same time coming up was the self-help movement. And, I remember Woody S. Started by the telling me, I would be better off going to an NSA meeting than an Asher meeting. So I went to national NSA meetings before I ever went to a national ASHA meeting.

And so what was interesting was you had this field kind of developing an area, developing. And at the same time, people who stuttered were making their own community because they needed a voice. They needed to say what. What's best for them instead of a profession telling them that. So at that point, we started to see the NSA really get strong.

And I can remember the first time I went to the NSA, I was giving a talk and he asked all the speech language pathologists to stand up. And there were like 15 speech pathologist in a room of 200 people. And I was say, that's not a great, really big number. And he talked about five years before the number was three.

At the NSA. And now when you look at the NSA, you really see a great deal of speech language pathologists coming in because it's such a great place to learn about stuttering. So it was really interesting back there. You had the self-help community and then you had the professional community. And, for me, in my journey, I was very fortunate early in my career to hookup with the stuttering foundation of America.

And in my CFY I did their two week course, at Northwestern back there, if you go Gregory. And his team and that changed so much of what I had learned about

Uri Schneider: stuttering.

It was, Kristen was Kristin Chmela in your cohort or just.

Yeah,

Joseph Donaher: she had already graduated from Northeastern, but she wasn't in my group yet.

And she, I think she came in, I think that's the first time I met Kristin. That was one of my good friends. But I think that was the first time she came in as a guest speaker to my talk or to my group. My group though had Lisa Scott and I met each other. That's where we met in that group. And Alex Johnson was in that group as well.

it's just interesting how those. courses develop,

But what could

Uri Schneider: be is that Woody knew that if you went to ASHA you wouldn't be learning much because you'd be sitting at the booth in the, in the hall there in the booth for the stuttering foundation America, you would man, that booth.

I know Steph is really missing doing that with you. And she said she was going to rearrange our whole, pulmonary care around trying to tune in for this. And I just wanted to make a plug. I will post a comment. Our good friend colleague needs some help. She's going through a really, Valiant and unbelievable fight with, some pulmonary stuff, unrelated to COVID preexisting stuff.

And she and her family could use some help. There's a go fund me. So I just wanted to make a plug for that to support a friend and a colleague. but she's just tremendous. And she sends her warmest. yeah. So what you're saying is that Woody Starkweather and Brandon parish wants you to know that before he saw you, he saw Woody.

before he retired. and my father also had a very close relationship there and Woody's work had a big influence on the work that we do as well. so So Woody Starkweather said to you more than ASHA you'll learn more if you go to this NSA.

Correct.

and that's the message I've also received from some people, for many people, not just, the illustrious dr.

Phil Schneider, my father, but I would just share one anecdote. it was, in Scottsdale, Arizona. It was ed contour was just about to retire. One of the greats. And if he wanted to, he could have gone back to the spa. He wasn't slated to speak, but there was a session for parents. And in the back of the room, there were two legends sitting there and it was ed contour and my father and they were the only two professionals that said, there's a CEU professional continuing education, but the real learning, where it's at.

Listening to these real parents. And it sounds like Woody was transmitting that, and you're amplifying that listening to the people who stutter the community of people who stutter has as much, if not more value in certain ways than, than just perusing the literature or in the absence of connecting to the people who live with this.

Yeah. And if

Joseph Donaher: you don't look at, if you look at stuttering as a static, one thing, you might be okay to just go in and do the same thing with every person. But when people, I get calls all the time and emails, I'm seeing a child who stutters today at 10. What do I do? And just to be a little snarky and a jerk a little bit, I always say, which person who stutters?

And some people get it right from that comment, but I have no idea what you're supposed to do with a person who stutters. I have no idea what I'm going to do with the family, with a child who stutters who comes to me until we really start seeing what's going on.

What are the first, what

Uri Schneider: are the first three?

So I'm with you 200% My father and I often say I'm comfortable saying it because I've heard him say it. And it sounds like you as well, I'm always a little nervous, cause as much experience as I have, clocking, sitting with. Hundreds of people. It's still a little tenuous. You don't know what's walking in and what they need and where they've been and what are, what's the holistic picture of this human being and what they're looking for.

But I think what I go to, or what are the things I want to know, we're on the phone, what are the questions I might ask? What would you say would be like three questions, a clinician or a parent might want to tune into to get a sense of what are some of those important variables aside from the isolated fact that they have interruptions in the flow of speech?

Joseph Donaher: Yeah, great question. I'll tell you the way I start almost every therapy session. So I'll tell you that, because that kind of leads into this a bit. I say the parents would come in the room and I almost always had the parents there for decent let's talk evaluation. The first time I meet them. almost every time I say the parents, 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 later a bunch, 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 is I've met a friend that meets on a regular relationship. So what we're doing is just, I want to listen.

I don't want to talk if I'm doing the talking, then they, 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. And I look at my goal for the, an interaction like that is truthful. I want to see the real life impact of the stuttering. And then I want to see the choices that they make when they communicate. And I really want to look at their ability.

And desire to communicate. Everyone looks at ability to communicate. They talk about the types of disfluencies all that junk, But more so than just, are you able to express your wants and needs? Are they able to give me longer stories can tell me all the cool stuff you want to report? I want to know about their desire to communicate.

Cause I'm more interested in the desire. Then the ability, if it's just that we can work on that. But what often happens as we know is individuals start listening to those messages. Messages in their own head messages from other people. and so they start limiting what they're doing. So I want to have a general conversation just about regular stuff to see how

Uri Schneider: they communicate

well, before we talked and I did make reference to your Irish, Blood.

So I think it would only be fair to bring on the Jewish blood. we said, how much do we need to prepare? We said, we'll just schmooze. it'll just go. Are you familiar with the word (translated) 'dairy meat'? Do you know that one?

I'm not familiar with that

It's a mouthful.

I won't ask you to say it, but it's even harder than my name, but, ? Is dairy and ? Is meat. So in a, we don't have right. The, The chicken parm. We don't mix the meat poultry and meat with the dairy. So the reason I bring that up is I think of what you were saying when someone comes in, so they stutter, but you don't know if that person is a pescatarian or if you know vegetarian, what do you serve them?

and what you're going to serve them is going to be informed by things far more than bean counting. How many stutters per syllable spoken? So I think a very well said I would suggest clinicians, parents, I think in addition to finding out what's their junk, what do they do when they relax? Joe's wisdom.

I think looking at the parameter of what's their social satisfaction, like socially, how satisfied are they're in their social arena? Are they bright enough to keep up with class or are they struggling academically or cognitively? And then, just motorically physically is everything seemed to be in check and they seem to be athletic enough and coordinated enough, especially with the younger ones, but, the, what you hit on the communicative spirit, To desire the way they communicate is so important. Can you just talk about that? Because I think a lot of people feel. Unfortunately, and maybe today's the day to highlight still making predictions about outcomes and therapy plans based on the type of disfluency or the frequency. Can you like, bring it together a little bit and just share a little wisdom on that?

Yeah.

Joseph Donaher: great point though. really when I think that gets to is how do you define severity in stuttering? And really, I would say, how do you define stuttering? Because if you look at stuttering is 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 to automaticity, to make movements, motor movements easy, and automatic is tough for many people who stutter. So right there's an issue right there.

If we're trying to get it motor things. And yet we know from the research, there's 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, you were talking about severity, how much stuttering equals an impact basically.

But if we look at the research, we know that. Adolescents who stutter, regardless of severity, tend to doubt themselves as communicators tend to be more isolated, tend to be more ripe for bullying and teasing tend to be 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.

Okay. So again, the way you define stuttering is going to. Really dictate how you intervene with people who stutter. And I really look at severity as the degree to which the stuttering impacts the individual's life. How much of a roadblock is it in other words? And so when we start looking at it that way, that, how is it impacting your life?

We start thinking things, thinking about things in a larger kind of context. So then we're talking about, social relations with your friends. Do you have a lot of interactions with your friends? Can you. do you have folks you go out with at night? Do you go out on the weekends? Do you feel comfortable interacting with them?

Do you feel comfortable introducing yourself to new people when it comes in? how are you doing at school? Are you participating and interacting? Do you feel safe? How has your role in your family? Are they supporting you as a communicator? all of these things, we have to start looking at there.

So again, I think when we look at severity, Types frequency. All of that does one thing for us. It helps us with diagnosing stuttering and things like that. But we have to think about what is the stuttering problem because to me, the starting problem, very rarely is the frequency of stuttering or the type of stutter to me very frequently.

The stuttering problem is that people are talking for the child. People are teasing the child, making fun of them doing things. That's the problem we have to work with. Not necessarily just the course that are in behaviors.

Uri Schneider: A lot of brilliance packed in there. And for some people listening that have to go, yes, playback available on Facebook playback.

Also all these conversations with all these sages and up and coming stars are all available on our website. And I'll also share it with Joe if in any way that he wants to share it. But on our website, Schneider speech.com/our blog. Okay. That's where we have a repository of all the past stuff and the upcoming stuff on Schneider speech.com/.

Events. If you have questions, just pop them in here, Joe, a couple of hellos from Jim Fortunato and from, John Gomez, who says he enjoyed spending last year, ISAD with you.

Congratulations on

Joseph Donaher: getting married.

Jimmy. Jimmy just got married two weeks ago.

Uri Schneider: Yay. All right. You want to make a toast? It's too early.

Mazeltov .

You'd be surprised. I'll just mention, I connected with some of our colleagues. I posted a picture of somebody and if you saw it on Facebook and I wanted to see who could identify the picture, did you know who that was? I did not Bayla Fleck. He didn't use to have a beard. He's like David Letterman, right?

He's morphed into an outdoors, living in a shack and creating great music, but Bayla Fleck has a Gaelic set that he does with banjo and bluegrass fused with some Gaelic stuff. I love it. I get up and people start wondering why I'm doing river dance and they, yeah. It's I can't contain myself.

So I've got that in me.

excellent.

Joe, you shared it so much right there. and you want to bring it back to the research and then you went back to talking about what might be called a lot of soft stuff. Yeah. how are they doing here? How are they doing there?

Number one, do you have any assessment measures that you like to include or recommend. in engaging those things or do you navigate that in a dynamic way? And number two, maybe, we can get into everything you were talking about the stuff that can accompany stuttering. You might have a young person who stutters.

Who's also got something else going on. Think about that for one second. I actually just remembered, I wanted to reflect on something you said for people that don't know, this is like an advanced. workshop here with Joe Donaher. So for anyone that is not able to unpack all that wisdom, I just want to share there's a concept from Joseph Sheehan of the iceberg, right?

And there was an experience of stuttering that can be seen and can be heard by people on the outside. And that's on the top of the iceberg. That's what sticking out. There's also a mass that exists beneath the surface that you don't see. And I often point out that's probably what the Titanic hit.

They didn't run into something they saw, it was probably a mass that's spread out beneath the surface. And oops, didn't notice that the radius around that was that wide without getting into that. What Joe mentioned severity. If we only measure severity by what we see in what we hear, there are many people who stuttered, whose stuttering is quite pronounced, quite strong, quite observable, and they would score very high on behavioral metrics.

But frankly, it doesn't bother them that much. They've gotten for some, they've gotten accustomed to it for others. They're quite disturbed, quite bothered and holding back a ton. But the surface behavior is not the be-all and end-all because you've got people on the other side, whose experience is it's a more mild physical trait.

They've learned how to hide it, to stuff it in and their significance of their experience and the impact on their communication life. is V can be very significant can be while at the surface, they would score very low, mild, or even told they don't stutter, based on what people would see. So I think what Joe was alluding to is the importance of looking at, the whole person above and beneath at the surface.

And that severity is much greater than just a, one factor being count of stuttered moments, which is what. Some measures like the SSI, which was used as the gold standard for a long time, is limited in that way. And some of the new metrics are much more helpful. So things like the kitty cat or the Oasis for clinicians that are looking for tools like that can give you a full picture if you're not able to do it.

But what do you use? What's your,

I've used all of them

Joseph Donaher: for different purposes and different times, but it's interesting because. So we want to branch out from just looking at behaviors in stuttering this isn't new. This has been around for many years. the question always is how to do it and there's been different packages too.

Charlie feely, at least, Scott, two of my mentors in the field and Mike Saska have the Coms's model. And so they were really trying to get you to look at more than the motor behavior. They want you to look at, the cognitive piece, the affective piece, and everything else.

And I would say that's a great way to expand it out, but there's even further distancing. We have to do. If we look at how someone handles their stuttering or the impact of the stuttering on their life. We have to look at how they handle other things in their lives. So there's going to be congruence between how they handle their stuttering and how they handle other things.

And some of the things we know that impact the way you approach things or your level of reactivity and regulation, for example. And so you talked about some of the other issues that come in with people who stutter and people who stutter or have other problems too. So if 5%

Uri Schneider: of the population,

some of them like Darren Sproles are short, some of them are tall.

So I'm going to have red hair. Some of them were Irish.

Joseph Donaher: If you think that the regular population, let's say 5% struggles with ADHD, the scenario i do a lot of work with why wouldn't we think 5% of people stutter are going to have concomitant ADHD. So what we look at is we look at how reactive kids are, how they regulate their emotions.

We look at their temperament. We know certain kids get excited and are going zero to 90 miles an hour in a second. Some kids you say to them, today's Thursday. They tell my gosh, I love Thursday. And then other kids you said today, Thursday, and they say, yup. And they're slow to interact or slow to move.

Your intervention is going to be so different depending on what the individual brings to the table. So if I have someone who's aggressive. I'm going to have to work probably a ways to get them to hit the brakes a little bit. At times, if I'm working with someone who's really struggles to share their emotions, struggles, to feel comfortable, getting anything out, Then I'm going to have to work in a different area with them. So I want to know a little bit, so I've used temperament scales over the years. I tend to do more of it just informally. And if I think there's an issue, I'll pull something. I've done a lot of different types of scales. We look at locus of control.

We look at comfort. We look at self-confidence and self-confidence were my favorite variables. It doesn't mean that you're going to be perfect. It just means that you believe you have a shot of being successful. And that's very different than thinking you have to be

Uri Schneider: perfect. I like this.

I like to remind people, kids are born with self confidence.

You don't see a baby born. Who's scared to crawl. It's more a factor of, do you have experiences along the way that protect, that nurture, that gives you the feeling like you can test the boundaries and go a little bit further or you get the message from the world that, to be extra careful.

And sometimes that's a innate part of their temperament. And then sometimes it's something that can be. facilitated or inhibited by, by different things that parents and teachers and families can do. Why don't we get into the ADHD thing? And I think, cause I think, that's your, I don't know what to call it, but your passion, the thing that people love to hear the most from you.

And I hear about it all the time and you're the guru. So when it comes to the kid, First of all. I'll just say my piece. I don't, I've worked with kids with all types of issues. I worked in a school for kids with, all kinds of intelligence, but specific scattered profiles that have had such a significant learning disability in reading difficulty or language difficulty, but otherwise mathematical geniuses or kids who had social difficulty, pragmatic difficulty, but otherwise language, masters, and Nobel laureates with their poetry.

When you're dealing with this, I don't like labels, but are they're helpful to get a sense of what we're dealing with. So I go phenomenological. So if you've got a kid, like you said, Oh, it's Thursday

Joseph Donaher: is my favorite day on Thursdays. We get this for lunch. And then we do this after school.

Uri Schneider: And they're revved up and they're talking like what I often say, whatever the S the speed of the family is like, they're like 10 miles an hour, 15 miles an hour above that, they're in the left lane and then going into the margins, passing everybody.

Yup.

What's your consideration in terms of, what do you bring to the table in terms of how you think about, okay, this is a kid with a lot of rev, a lot of, maybe a bit of impulsivity, difficulty with inhibition, difficulty with self-regulation maybe. And he also, when he starts going like that, he's not maybe bothered by it.

But it starts to be like a bucking Bronco with the stuttering because it's like hitting the gas and the brakes at the same time. And the system starts to show those hiccups of fluency, but the kid is so spirited and the concern is we don't want to hurt the spirit. We don't want to hurt the self-image of the kid.

And at the same time, how do we help a kid who's like revving like a Bugatti

Joseph Donaher: You have to think about, it sounds simple when you just say reeving like that. And I used to wear tubing all the time. I love that we have a similar vernacular, but, it, it sounds so easy. Are the kids just zooming or he's gone like this, but that's in every area of his life.

And so we have to think about this. When we think about ADHD. When we think about any of these areas, talk about a learning disability or any really all those labels 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, 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, all these things that often we think of it as negative. But if we think of like energy level, I coach a lot right on my team. I want a kid that is like the Energizer bunny that can just go go, not worry about failing or anything like that. He'll just go, I want

Uri Schneider: that on my team. Like Jane

Joseph Donaher: Frazier. Yeah, I would like Jane, if you want to play point guard on my team, Jane, you can play point guard.

but if you think about that same kid, the next day, you go to church, those characteristics that were great on the field are not great

Uri Schneider: there.

You don't like you don't like when he's sitting right behind you and kicking the back of your seats.

Exactly. So we really

Joseph Donaher: have to think about goodness of fit. So I agree with you.

There's no characteristic, that we have to say that it's bad or whatever. But what we look at for individuals, let's start with the family unit because we learn our rate and rhythm of speech and communication styles. So much of what we do in our home communication. If that's fit between the child's temperament and the parents' temperament, isn't a good fit.

So let's say the child's a go. And the parents are slow that it's going to cause a lot of friction.

Uri Schneider: So

there you go again,

Joe, there you go with the vernacular. We're saying the same thing, friction and traction, right? So like rightness of fit could be thought of how much traction, how much are we clicking?

How much is it creating either communication breakdown or negative feedback or frustration on either side, whether it's for the teacher, for the church fellows or for the family? Yeah.

Joseph Donaher: Yeah. And what's interesting too. And we talked a lot earlier about the field when I started in it but one of the biggest changes in our field right now, Is I talked about how we had the professional community and then the self-help community.

And they were emerging a little bit, but not a whole lot. It's still dictated. We worked so many years on awareness and acceptance, and we work with individuals on being accepting of your own stuttering and put it out there and don't avoid do all of this, but at the same time, The community, the real community and the world that they're living wasn't necessarily as open and as accepting of stuttering.

And I think what I see as the most exciting part of our field, that's changing right now, and it started a little bit with the King's speech, but it started before that, but that kind of pushed it up is all of a sudden people understand stuttering a little bit more, and they're able to talk about it a little bit more.

And now what we're seeing is. For many people who stutter the support organizations or what gave them a sense of community, but that community was supposed to be a microcosm of the larger community. And it wasn't always,

Uri Schneider: it was like a bubble. It was like a bubble. It was like the, like the NBA, and Disneyland.

And now it feels like right more campfires in a good way. More campfires are catching fire. And this today is so special for anyone that wants to know. Without getting into politics, zero politics, but Joe Biden, putting the topic of stuttering in the media, putting the topic of stuttering on the table.

and discussing it. Our colleague, Craig Coleman did a really nice breakdown of how to look at that. and what is maybe a moment of cognitive, linguistic, block or hiccup and what is a stutter and what does that mean and how should that be regarded? And what's legitimately a way to relate to that.

Obviously, if a student doesn't know the answer and they're hesitating, there's one type of response, but if the student is hesitating because they know the answer, but they. They just can't fire it out on the response time schedule that the class expected needs to be responded to differently, which is, so rightness of fit.

So how do you problem solve that? What do you, what are you go

Joseph Donaher: to?

One of the big things we'll do is talk about it. So the more child realizes. And when we go back to ADHD, for example, we know that most kids that have ADHD, have some kind of social impact of it, negative social impact to it. So when they see that they're interacting with peers is being impacted by their impulsiveness or by their distractability.

You can talk about that. You can talk about, I'll use a lot of, especially kids who stutter. in ADHD, I see three patterns. Typically we see those young kids who are just. Excessively disfluent typical disfluencies but a lot of them, and that typically has to do with the increased use of more words for kids,

they use more words to describe the same thing. They're hyper vocalists. So those typical disfluencies at high levels expected. The second thing we see is for kids who stutter and have ADHD, the ADHD makes it much harder to handle their stuttering. for example, if we're expecting them to monitor their speech, it took to look at times that they avoid or times that they backed up or times they want to do something different.

That monitoring for someone, with ADHD is extremely difficult.

Uri Schneider: Okay.

I like to talk about that as you don't know that you need to change the oil or pull over cause you're overheating the engine, unless you have a dashboard. And kids with ADHD don't have as crisp the ability to take all those metrics and have a sense.

And we're asking them to adapt and modulate all kinds of things, but you can't change what you don't know.

Yeah. And

Joseph Donaher: I'll give you I'll change that analogy a little bit. You have your dashboard in your car, And you're driving in your car and you see your different meters that you have.

someone with ADHD has countless meters that they have. So it's not that they're distracted and can't focus on the meter right in front of them. It's that they have so many meters that they can't figure out which one to focus on. And so what we do is we have to talk to them about, what does this mean?

How do you monitor your speech? How do you do whatever? I'm working with a child right now, who's working on these spurts of speech that it's like, the gun goes off and he just zooms. It goes, and we're talking a lot about that, but we're working really hard on awareness of what his communication pattern is now.

Because why would he change? Why would he take the risk? Why would he try and put all that effort into doing something different? If he didn't see the rationale for why he should do

Uri Schneider: something different?

For a kid with ADHD, it's so important to make explicit the motivational value, because the things we ask people to do, as you said, Avoidance natural thing, unless there's a benefit that outweighs the cost, we're all going to pull back.

None of us, we see an expensive car. We like it, but the cost hurts more than the value that it seems to offer. We're going to avoid it. We're going to step back, being invited to a holiday party. That's more stressful and has more people and more time commitment and more time sucked than we're interested in investing.

We're going to avoid it. But for the kid with ADHD, I think as you said, they're going to be less compliant. Not because they're oppositional. But they don't necessarily notice the things that other people might notice. And sometimes that's a blessing, right? Because they might not be bothered themselves by some of the interruptions that someone else would be intrinsically interpersonally bothered by.

And they might steamroll over other people. Not because they're inconsiderate, but that is the social pragmatic side effect of. Of the experience of ADD

Joseph Donaher: the other thing with that is I said two patterns that I see, there's also a third pattern. We see a great deal of for older kids who stutter for older kids, but with ADHD, we'll see a disfluency pattern that looks almost identical to cluttering.

and I would say it is cluttering. And so if you think about the same areas of the brain, everything that's going on right there, there. Very repetitive, limited awareness, limited kind of ability to monitor it

Uri Schneider: you're often going to see what the kids with ADHD also language markers or narrative structure.

Now,

Joseph Donaher: the problem with that though is so I get a lot of kids with ADHD who come in, who are in speech therapy and they have ADHD and they're highly disfluent, but their disfluencies don't look like stuttering behaviors. They're not avoiding speech. as someone who stutters and yet the therapist are working on easy onsets with them.

I see this all the time. And so that's again, when we go back to, when we're talking about what do you do with someone who stutters in the beginning? And I said, yeah, I have no idea. We've got to learn. What's going on a little bit. That's a perfect example because if you have this person stuttering, so you teach them the one stuttering, technique, and then guess what, they're not successful and you blame the individual because they're not doing it.

Whereas what we want to look about is what's going on first before we know what we need to adjust. And so for kids with ADHD, especially those kids who have more cluttering behaviors, monitoring, rate reduction, things like that were typically used for cluttering are going to be much more helpful than a stuttering technique because the child's not really stuttering

Uri Schneider: that's a huge, four hour workshop right there. But I was going to say, let's, I want it to get real push against the wall, just as an expression, do you medicate these kids? Do you avoid medication? Because it's going to whack out their fluency and besides medication, I'm a big student of of Rady and Halliwell and that whole camp and all kinds of different holistic ways of looking at things.

Anyone interested in this topic, the best conference, as Joe said, it's not always in your field. Only. I love learning in the brain. Have you ever gone to their conferences, learning in the brain? Oh, my gosh. And that's where I met. That's where I met, John Rady and a bunch of these guys and ed Hallowell.

We worked together in New York a little bit. These guys talk about, several things, there's medication, but there's also other things I was wondering if you had any insights on what you like to recommend. We're talking about how you get stuttering therapy to fit that kid, but then there's also the thought like, If there's anything we can do to help the kid be more settled, be more grounded, be more available, the same way you want them to be more available for learning while not stifling or taking them away from their, I call it.

it's a super power and a kryptonite. As you said, it's a superpower on the field and it's a kryptonite for sitting still in church. in different situations. So what are your thoughts and how do you advise those parents? Maybe we'll wrap on that.

Yeah.

Joseph Donaher: if I wanted to be, snarky again, I would say to you, which child with ADHD instead of being, but here's what I want you to.

And I truly mean that though, that this is so individualized because every person reacts to the medications completely different. And there's no guidance on the medication for ADHD and stutter. there's little guidance for ADHD. There's so many different medications. It really depends on what your doctor, what trend he's getting into and stuff like that, or she's getting into.

so as far as the medications go, there's not a single medication that we would recommend or not recommend. I will point out a study that Charlie H. And myself, years back, and we took a child who was stuttering, fairly severely. And, was on ADHD, stimulant medications. And we know that stimulant medications can increase tick like behaviors and increase some stuttering like behaviors in some individuals.

So yeah, some kids. so what we looked at is this child's family took them off the stimulant medication. The stuttering had gotten so bad when they took him off the stimulant medication, his grades bounce down. His participation school was literally disruptive because of impulsivity and things like that.

Yeah. And the standard went down a little bit, but not that much. So it really was the first time I had a look at quality of life and really look at what's the best. Thing here to impact this child's functioning. So in that family, they tried a different medication for ADHD and non-stimulant different class.

It doesn't have the excitability piece there. They tried that and they said it helped a lot with the attention and focusing not as much as the stimulant meds. But they were willing to do that and get some improvement because it didn't impact the stuttering or other areas as much. And didn't have the side effects that they didn't want.

So the other problem with this though, is medications for ADHD. There's no consistency. The only consistency is inconsistency and what works for a while stops working. And you always have to be problem solving and keeping on top of that. So the big push for that is to really keep on top of it with a team we've talked about the relationships before, but in management or things like this that are so complex, you need a real good team of neurologists and speech pathologists.

Often counselors and psychologists are involved and that family has to be actively involved.

Uri Schneider: Wow. would it be fair to say, as you said, it's predictably unpredictable and, and reliably unreliable and all that, but it, if it takes time to task, It's a dynamic thing. And similar to stuttering it's not linear, but one thing is for sure.

I think what I find helpful would you agree is that, like you said, problem solving and if you're not experienced in this figuring out, what are the metrics? What are the KPIs? What are the indicators? What's that dashboard as a professional or as a parent or as a teacher? Besides just the Conner scales or whatever, like how they functioning in class.

How many times are they, are you having to reprimand them for their behavior? How many times are they forgetting things that they legitimately did, but they were just too. Energized to remember to pack that homework when those things are coming up, that's when you might be motivated to do something more.

And if things are coasting and doing well, whether it was indicated or thought to be, or they just stop meds on their own, no one told them to, but things are going well. It's more about figuring out what to look for, I think is the real wisdom there when you say

yeah. It's problem solving, not solving problems.

Oh man. That's so good. Or you could also say, Problem solving starts with figuring out the problem.

Yeah, sure.

You can't start on the backend.

I'll say

Joseph Donaher: that my father said, years and yesterday it was his birthday. So I'll be very happy to quote him. He said, can't make rabbits still until you catch a rabbit.

And so if you don't know right, what the problem is, what you need to address

Uri Schneider: you can't move forward and do it.

You know what rabbits are not (translation) and they're not (translation) they're just not on the kosher menu. So I haven't made rabbit stew, but clearly I wouldn't even known that. So I'm grateful for your dad's wisdom.

So that the next time I'm thinking about it, I know what to do. This has been a pleasure. I wanted to just give you a chance. If anyone wanted to contact you, if you want to share any contact info or any exciting ways that you've got stuff coming up. And then if you have any parting wisdom,

Joseph Donaher: Yeah, my email is always the best way to contact me.

I read it again every day. I try to answer as many as I can. So feel free to do that. and, closing wisdom. I think this is a really exciting time in our field. you're serious with talk with these folks. I really enjoyed that to see different people's takes on it. And I think you've done a very nice job at putting the eclectic mix together.

So it's not all right. Professionals. It's not just, teens, not just the parents really have a nice mix there. And I think we should all be encouraged because stuttering is being talked about in the political arena this year. It's being talked about a great deal in, social networks is being talked about a great deal.

And I understand that it's hard sometimes to talk about this, but the more we talk about it, the more we normalize it. And the more that other people who have no connection to stuttering. Start learning what they need to do. And we think about stuttering. We think about someone who stutters, we can't put all the responsibility on them to change public opinion and change perceptions.

So we have to start thinking about why is it acceptable to make fun of stuttering? Why is it acceptable to make fun that someone who stutters has a cognitive impairment? Why is that okay. in our society right now. And what's really interesting is. Those discussions are being had, not just by geeks, like us who are really involved in this, those conversations are coming out from other people now.

So

I

Uri Schneider: think good.

I've never been so flattered to be called a geek.

Joseph Donaher: Yeah. But it's really interesting to me that, last year it asked you, this was pretty funny. That big article came out in the Atlantic rate during Ashleigh last year, from

Uri Schneider: judge John Hendrickson today.

Just a quick plug later today. Part of, I said they, Cody packer from New Zealand and John Hendrickson are going to do a Facebook live conversation. So John is the author of the article you're talking about.

Yeah, John and I are

Joseph Donaher: close, so I'm excited to listen to them. I have to listen to, but when we think about like that article came out and it, I remember at ASHA leaving the convention, I'm in my room.

I just want to decompress a few minutes and I put on cable news. And they're talking about stuttering and I'm like, where am I? What's going on here? This is odd, you're already in that ASHA bubble there, but, I think we're really in a great space where we're really talking about it.

It's an acceptable conversation and people are talking about it all over the world. and I

Uri Schneider: think that's exciting.

Yeah. Just to piggyback on that. I think the excitement. Of someone like you taking the time out of your schedule to share your wisdom so freely without any incentive, just full disclosure, there are no monetary incentives is totally voluntary.

Two of us taking the time to share conversations for the public. Good. we care about this topic. we care to learn more about it. We learn from each other. I certainly from you and, I really appreciate you doing that. And I just want everyone else here to know that this is totally on, Joe's time and his family's time.

So appreciate that. And I think for ISAD day, I think to take away from it, you said people can think whether you stutter or not. If you're listening right now, international stuttering awareness day, this is the most exciting time because it's now, and we can take all the wisdom and experience we have from the past and create a better tomorrow for all of us.

And the idea of making stuttering a more acceptable topic to talk about, to address, to put on the table. It can be uncomfortable and awkward, but similar to other conversations that are happening in our country and need to happen. We need to have these uncomfortable conversations. And by doing that, they.

Become less uncomfortable. And the people that have been on the short end of the stick are given a more of a fair chance to play. And I think I really liked what you said about the onus is not all on the person who stutters, right? They depend on a good diet, a good environment, a good partnership, a good family, a good school teacher that can make the difference.

There's plenty of research that shows that one caring adults can make the difference between someone turning out to be a statistic. of suicide or incarceration or going into all kinds of drug and other trouble, one caring, adult, one, understanding, supportive adults, whoever you may be can make the difference in a person's life.

Understanding. 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. Check out the replay on Schneider speech.com/our blog and big thanks to Joe Donaher

and we've got lots of great things coming up the rest of the day. Thank you, Joe. Thanks.