May 2008

Signs of Stuttering
What It Means and How to Help Your Child

By Emily Kinsler, CCC/SLP.D.

At one time or another all children may stutter, especially during their preschool years. It is important for parents to know what is “normal” and what is not so they can make informed decisions about their child’s speech development.

Stuttering involves repeating, prolonging or blocking a word, a sound in a word or multiple words, according to the American Speech-Language-Hearing Association. Among young children, stuttering can be very inconsistent, starting and stopping unexpectedly. Stuttering often increases in times of excitement, when a child is very tired or when she feels rushed to talk. Some children begin to stutter during a burst of vocabulary growth and sentence development. Their motor development cannot keep up with their new, expanded vocabulary skills, and frequently this causes a temporary period of dysfluency. Other times, a child’s speech may be perfectly smooth. It is not always easy to determine if what you hear is typically developing speech for your child or something more.

Three factors often contribute to the development of stuttering in young children: language development, motor development and temperament, or personality. Any combination of these factors, in conjunction with environmental influences and a family history of stuttering, may lead to stuttering in young children.

Does My Child Stutter?

Stuttering usually begins between 2 and 4 years of age. It is often paired with a rapid increase in language skills. Many children will go through a normal, non-fluent period where speech is characterized by whole word repetition or sound repetition that appears smooth and effortless. Frequently, children do not seem to even notice their own non-fluent speech. This type of typical dysfluency may appear inconsistently and last for a few months. It may start and stop at various times during the preschool years as part of typical development. Generally, many typically developing children who begin to stutter usually stop within six months. Sometimes the non-fluent speech may be triggered by excitement or other strong emotions, but it will quickly disappear during calmer, less rushed moments.

Children who may be at risk for becoming stutterers frequently have some difficulty getting their words out. These children typically have more consistent dysfluent speech over a longer period of time, usually at least six months. They may get stuck on the first sound of a word or the first word in a sentence. Children who are beginning to stutter will repeat sounds, syllables or even whole words in an attempt to say a word or phrase. Sometimes, a child may work so hard to say a word that nothing comes out at all. This can be very frustrating and often may be accompanied by extraneous movements such as eye blinking, gesturing, grimacing or other nonverbal signs. For these children, speech may be effortful and create feelings of anxiety when they are communicating.

Examples of stuttering that you may hear your child make include:

• “W- W- W- When can we go?" (Part-word repetition)
• "SSSSing that song again! (Sound prolongation)
• "Can we – um you know, like, you know– go to the park." (interjections)
• I-I-I want want want to go to the park. (Whole word repetition)

If your child stutters or struggles with her speech, avoids talking in some situations, stutters on a more consistent basis each day or becomes frustrated, you should seek professional assistance from a speech-language pathologist.

What Can Parents Do?

There are many ways that parents can help their children to communicate more fluently.

• Try to position yourself at eye level with your child when speaking and maintain natural eye contact. This sends the message that you are ready to listen to your child.
• Avoid the temptation to fill in the words your child is having trouble producing, even if you know what she is going to say. Let your child use her own words and finish her own thoughts.
• Allow your child to finish a thought without interrupting. Although this can be difficult, wait patiently, even if your child is struggling.
• When responding to your child, pause before responding, take your time and model a relaxed, even rate of speech. Do not exaggerate or speak too slowly.
• It is okay to talk about your child’s speech with her. Children frequently are aware when they are dysfluent but will not say anything if a parent does not say anything. Use terms like “bumpy” or “smooth” to talk about different types of speech.
• The most important thing, according to the Stuttering Foundation of America, is for children not to “feel frustrated by their speech mistakes, hesitations and bobbles that speaking becomes a struggle.”

How Can I Find Help for My Child?

The first step in finding help for your child is to seek out the services of a speech-language pathologist (SLP) in your area who is trained to work with children who stutter. Parents can find specialists by consulting with pediatricians for referrals. Help can also be found by going online to the following websites:

• The American Speech-Language-Hearing Association at www.asha.org
• The Stuttering Foundation of America at www.stutteringhelp.org
• National Stuttering Association at www.nsastutter.org

In addition, universities and colleges with clinical training programs often have onsite speech and hearing clinics that may specialize in stuttering evaluation and treatment.

Once your child has been evaluated by an SLP, the next step is often therapy, which can take many forms depending on the age of the child and the severity of the problem. Sometimes therapy can consist of a few sessions with the parents or caregivers or more direct intervention with your child. Teaching parents how to model speech for their children is one of the main components of therapy when working with a preschool child. By learning an easier, more relaxed style of speech coupled with shorter sentences, parents can effectively transfer therapeutic techniques to the home environment.

With school-age children, an SLP can demonstrate and discuss different techniques directly with the child. The SLP will take the time to explain how speech is produced, teach skills to improve fluency and discuss any concerns a child might have about her speech. This can often help a child feel more in control of her speech.

The amount and intensity of therapy is different for each child and depends on the severity of the stuttering, the age of the child and the family situation. Some children who are just beginning to stutter may only be seen for a short time (2 to 3 months). For children with more consistent problems, long-term therapy may be needed (6 to 18 months or longer). Each child is different, and so is the degree and speed with which improvement is noted. However, success rates are high when therapy begins during the earliest years of stuttering, usually between 2 to 5 years of age. Regardless of the age, it is important to get professional help to assure your child’s communication success.

Emily Kinsler is director of Outpatient Speech-Language Services at TLC – The Treatment and Learning Centers, a local, private nonprofit agency based in Rockville that offers multiple services for children and adults with learning disabilities.