Producing speech is a complex process that does not always result in a fluent pattern. Understanding all of the components of speech helps identify what happens physically when this breakdown in fluency occurs — but this is only part of the information needed as we address stuttering.
Attitudes about stuttering can be a dominant force that influences choices children make and impact their view about themselves. Bullying has been an ongoing issue in our schools, creating negative effects on students’ academic and social endeavors, self-esteem and physical wellness. Much of the work in speech therapy is acknowledging how stuttering has played a role in a child’s life and addressing the inevitable feelings that coexist.
Views about stuttering are not only relevant from the child’s perspective, but also of their parents or caregivers. For many parents, expressions of guilt, confusion and worry seem to be consistent topics of discussion I encounter when working with children who stutter. These are best addressed by reviewing myths versus facts about stuttering, with the most powerful message that stuttering is not the parent’s fault.
Fact vs. fiction
Here is a list from The Stuttering Foundation website of myths about stuttering.
Myth: People who stutter are not smart.
Reality: There is no link whatsoever between stuttering and intelligence.
Myth: Nervousness causes stuttering.
Reality: Nervousness does not cause stuttering. Nor should we assume that people who stutter are prone to be nervous, fearful, anxious or shy. They have the same full range of personality traits as those who do not stutter.
Myth: Stuttering can be “caught” through imitation or by hearing another person stutter.
Reality: You can’t “catch” stuttering. No one knows the exact causes of stuttering, but recent research indicates that family history (genetics), neuromuscular development, and the child’s environment, including family dynamics, all play a role in the onset of stuttering.
Myth: Stress causes stuttering.
Reality: As mentioned above, many complex factors are involved. Stress is not the cause, but it certainly can aggravate stuttering.
What is stuttering?
Stuttering is a communication disorder in which there is disruption in the flow of speech. There are five primary types:
- Repetitions: Sounds, syllables, words or phrases such as c-c-c-cat
- Sound prolongations: Mmmmmore
- Blocks: The absence of a sound
- Interjections: Uh, um
- Revisions: Changing words in a sentence
Children can show evidence of stuttering between the ages of 18 months and 5 years as a typical part of learning words and forming them into sentences. The frequency of occurrence and severity may fluctuate based on the speaking situation. Most children — 50 to 80 percent— will outgrow stuttering by puberty. However, some will benefit from speech therapy intervention.
What causes stuttering?
Although there is not one definitive cause for stuttering, there are contributing risk factors.
Risk factors include:
- Genetics: Increased incidence occurs when having first degree relatives who stutter. Children with certain genetic syndromes such as Down syndrome or fragile X are at higher risk to stutter.
- Gender: Stuttering affects boys four times greater than girls.
- Other speech and language factors. A child who makes frequent speech errors such as substituting one sound for another or leaving sounds out of words may be at greater risk to stutter.
- Age of onset: Children that begin stuttering after the age of 3 ½ years are less likely to outgrow it.
- Duration of stuttering since onset: Children that have consistent episodes of stuttering for longer than 6 months are less likely to outgrow it.
- Neurophysiology: Recent neurological research has proven that people who stutter process speech and language slightly differently than those who do not stutter.
No magical cure can stop stuttering. However, there are effective ways to respond to stuttering when it occurs that can be learned through speech therapy.
Stuttering modification strategies increase awareness of stuttering events by identifying and reducing physical tension to ultimately stutter in a more relaxed way. For example, a child is not always aware that a stutter is occurring, so in therapy we do an exercise called “catching the stutter.” We have the child read passages and every time they stutter, they close their hand, as if they’re catching it. We want the child to squeeze their hand as tightly as the tension in their speech. This helps the child recognize when stuttering happens and the level of tension that occurs.
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Fluency-enhancing strategies are techniques that change breathing, rate of speech, voice production and articulation in ways that enhance more fluent speech. An example of a fluency-enhancing strategy is light articulatory contact. Articulatory contact is how the physical structures of the mouth come in contact with each other when making different sounds. Think of making an “F” sound — your lower lip briefly touches the top teeth. When a person stutters, they may use more force and tension than is needed, creating a hard articulatory contact. In speech therapy, we work with kids to help them be mindful of those contacts and practice using the least amount of contact to produce a sound. We often like to think of it as gently tip-toeing through each sound using soft steps.
In my practice, I have witnessed these and other techniques help countless kids. I’ve seen the transformation of a teenager from someone who avoided participation in school and social events, expressing his fear, shame and embarrassment with regard to how he spoke, into a confident young adult that talked openly about his stuttering and even asked someone to prom (she said yes!).
The key to this shift was his change in perspective of what he could control and his acceptance of the variability of stuttering. Rather than controlling his stuttering, the focus was shifted to how he would control his response to when stuttering occurred by using techniques he learned in speech therapy.
Knowledge and acceptance of stuttering along with a vision that it doesn’t need to hold anyone back from pursuing a dream, allows momentum to move forward.
What can parents do when their child stutters?
If you notice your child struggling with their speech, there are several simple things you can do at home to help them work through it.
- Maintain eye contact with your child, giving them enough time to finish speaking
- Try not to interrupt your child when speaking. Allow them to finish their thoughts without completing sentences or filling in words when they stutter.
- Focus on what your child is saying, not how it is said.
- Model slow, relaxed speech when talking to your child. Wait for a couple of seconds before you answer a child's question. Insert more pauses into your own speech to decrease your rate of speech.
- Set time aside each day when you can give your undivided attention to your child with no TV, iPad or phones. As little as five minutes a day can make a difference.
When is it time for speech therapy?
If you are concerned about your child’s speech based on the characteristics and risk factors listed, speak to your child’s primary care provider. They can assist with a referral to a speech-language pathologist if necessary for further assessment.
Some books I find helpful for parents and kids are Stuttering and Your Child: Questions and Answers, If Your Child Stutters: A Guide for Parents and Minimizing Bullying for Children Who Stutter: A Workbook for Parents. For additional resources, The Stuttering Foundation, The National Stuttering Association and Stuttering Therapy Resources are excellent websites that offer support for children and adults who stutter.
