Stuttering And Fluency in Children
What is stuttering (or “disfluency”)?
Disfluency is an interruption within normal fluency of speech. Commonly, people associate stuttering with “getting stuck on a sound or a word.” All speakers demonstrate a natural level of disfluency in their speech, and children can display higher levels of “normal” disfluency as they are learning to talk and their language skills are emerging. The types of stuttering and frequency of the disfluencies dictate how “fluent” a person’s speech is perceived to be. Some types of disfluencies are typical in preschoolers as language emerges. Others, such as part-word repetitions (“Sat-sat-Saturday”) or prolongations (“sssssssssaturday”) are not.
Is my child “stuttering”?
It is important to pay attention to the “types of disfluencies” you are hearing. There are two general categories for disfluent speech. More-typical disfluencies refer to interruptions that are considered “normal” within speech. Less-typical disfluencies refer to stutter-like behaviors perceived by listeners as excessive interruption within speech or abnormal tension associated with speech production. Parents sometimes have difficulty hearing the difference, but a speech-language pathologist can help differentiate. As children develop speech and language, variations of disfluencies can appear and disappear. Paying attention to the time since onset and the types of stuttering can be helpful in deciding whether or not an evaluation is needed.
1. More typical disfluencies: A whole word or phrase being repeated three time or less, interjections (“filler words”) such as “um” and “like”, and/or revisions in speech.
2. Less-typical disfluencies: Any words that are repeated as part of a word or an initial sound, whole words or phrases repeated four or more times, prolonging one sound of a word, “blocking” (word is stuck without air moving), and any associated tension or effort observed in speech production
When parents should be concerned?
Developmental stuttering is stuttering that appears in early childhood and then naturally diminishes over time. Persistent stuttering is stuttering that continues past early childhood years.
Developmental stuttering typically emerges in early childhood years (2-6 years old) and lasts less than 6 months. If a child begins to stutter before age 3, there is a high probability (up to 75%) that he/ she will spontaneously stop stuttering. If stuttering emerges after age 3 or has persisted over 6 months since onset, an evaluation with a speech-language pathologist would be recommended. Important factors for determining a therapy recommendation include: family history, age of onset, sex of the child, length of time stuttering has persisted, types and frequency of disfluencies observed, reactions or emotions associated with stuttering, and other present speech-language and/or attentional, sensory, or neurological disorders.
Types of therapy for Stuttering or Dysfluency
Therapy approaches depend on the age of the child and the characteristics displayed during the speech-language evaluation, but general therapy options are outlines as:
Stuttering in Preschool:
The Lidcombe Program is an evidence-based therapy specifically for children ages 3-6. This program is a behavioral program to increase fluency within a child’s everyday speech and involves parent feedback outside the clinical setting. Traditional fluency therapy (involving modeling “easy, slow talking”) is less researched and is not structured to generalize fluency to everyday speaking. Incorporating speech-language goals or referring for an occupational therapy evaluation is sometimes necessary.
Stuttering in School-age, Teen, Adult:
A multidimensional approach to therapy is very important as stuttering continues to persist into the school-age years and early adulthood. Integrating strategies to increase fluency and decrease tension are one component. Addressing associated thoughts and feelings, language skills, and the social impact is also key in properly treating stuttering.