While young children may not even notice that they stutter, as they get older, living with this speech fluency disorder becomes increasingly stressful for many.
"Stuttering is a disorder that comprises many elements, some that are very specific to the individual, so it’s critical that it’s accurately diagnosed and managed through treatment," says pediatric speech and language pathologist Amy Sindelar, a specialist in stuttering as well as language delays and disorders.
Speaking in front of the class, meeting new teachers or classmates, eating at restaurants and socializing at events have been reported to Sindelar as difficult speaking situations by some of the young people who have been in treatment for stuttering with her.
Distinguishing normal disfluencies from stuttering
The most commonly known symptom of this fluency disorder is the uncontrolled repetition of initial sounds (c-c-c-cat), syllables in a word (to-to-to-today) or complete one-syllable words. In addition to repetitions, disfluencies associated with stuttering encompass prolongations, such as the extension of a sound as in "coooooookie" or long, silent pauses called blocks.
Interestingly, these disfluencies and others not considered stuttering, such as repeating short phrases, are also part of the normal speech development. A helpful outline of which speech patterns do and don’t fall into the realm of stuttering are listed on the American Speech, Language and Hearing Association (ASHA) website.
"A child may be learning a lot of words or new speech sounds," note ASHA site authors. "This can cause her to repeat sounds or phrases, which is normal."
Given that normal periods of disfluency lasting less than six months aren’t unusual, they recommend getting a professional diagnosis when stuttering persists for over six months. At the same time, six additional signposts that warrant assessing a child prior to that are listed include when a child has another speech or language disorder, struggles or tenses up when talking, starts stuttering after 3.5 years of age or has a family history of stuttering.
With the multitude of factors that come into play with language and speech disorders, Sindelar advises erring on the side of caution if a parent or caregiver has concerns about stuttering. In 10 years working as a clinician, she reports very few cases where parents have brought their child for an evaluation based upon their concerns in which treatment was not recommended given findings from testing.
She reports that parents are often the first ones to note early difficulties with fluent speech and initiating treatment early is important in supporting fluent speech as a child grows older.
The complicated nature of fluency disorders
Stuttering has different levels as it progresses and can be present with other issues. It may be addressed simultaneously with other fluency disorders such as cluttering, a less-commonly known disorder introduced in a previous MultiBriefs article.
There are different ways to go about treating stuttering, explains Sindelar. Depending on the specifics of the case, the SLP adjusts therapy to fit the needs of the child using either indirect approaches that focus on parent education to adjust their manner of communication or direct therapy that focuses on modifications to how the child speaks using strategies.
Sindelar’s specialization in language delays and disorders has given her a unique perspective in working with stuttering, which is a speech deficit. She has found that it is essential to thoroughly assess language development when looking at fluency cases, especially potential word retrieval deficits or language formulation difficulties. She reported that addressing these language deficits that may coexist in addition to disfluencies in a child’s speech are essential.
Do’s and don’ts when communicating with children who stutter
When teaching a child who stutters, there are best practices that go a long way in supporting and valuing that individual.
"Some the best things parents and teachers can do are the same things they do to communicate with and listen to children who don’t have speech difficulties," recommends Sindelar. "Like maintaining eye contact and giving them time to get their ideas out. A child with a significant stutter can take a very long time to get their ideas out but they do know the message they want to convey."
While her advice may sound obvious, many children who Sindelar has worked with report that siblings, classmates and even adults do things like cut them off or talk over them.
"Some of my older kids will say, ‘It’s really is hard for me when my sister doesn’t let me finish my words, it makes me really mad,’" shares Sindelar. "The younger ones may not verbalize it quite the same way, which is why parent reporting can tell you a lot about how a child interprets communication exchanges."
Whether due to impatience or trying to be helpful, peers, family members, and teachers can do things that unwittingly discourage children already experiencing communication challenges. These include assuming that the child nothing more to add and putting pressure on him/her to hurry up.
"Adults serve as excellent models for children when we think about supporting communication within social exchanges," explains Sindelar. "Children watch adults and, often times, when adults model and demonstrate how to be an active listener, peers and/or other siblings can pick up on these acts and subsequently use them in their own communication exchanges. For example, turn-taking and maintaining eye contact while a child who stutters is speaking can be watched and imitated by children who do not have fluency difficulties."
In addition, some speakers simplify their language, use fewer words or slow the pace of their speech when talking to someone with a language or speech disorder. While usually not intentional, the message that comes across is that they’re perceived as less intelligent and less capable of understanding what’s being said.
"It’s important to remember that children with fluency disorders have great ideas, are smart and have important things to share — just there’s a disorder that at times makes it difficult to share their ideas," says Sindelar.
