Stuttering Center of Western Pennsylvania
Co-Directors: J. Scott Yaruss, Ph.D., CCC-SLP, and David W. Hammer, M.A., CCC-SLP
Stuttering is a speech/language impairment characterized by disruptions in the forward flow of speech (or "speech disfluencies"), such as repetitions of whole words or parts of words, prolongations of sounds, or complete blockages of sound. Speech disfluencies may be accompanied by physical tension or struggle, though many young children do not exhibit such tension in the early stages of the disorder.
Stuttering is highly variable – sometimes a child will stutter a lot and sometimes the child will be very fluent. Factors influencing the likelihood that stuttering will occur differ from one child to the next, but might include:
Who the child is talking to
What the child is talking about
Where the child is when talking
What time of day or year the child is talking
The child’s emotional or physical state (e.g., excitement, fatigue, illness) while talking
The length and complexity of the message the child wishes to convey
Other factors that are more difficult to identify
Many times, children experience fear or embarrassment because of their stuttering. As a result, they may learn to hide their stuttering so it does not show. They can do this by avoiding speaking in certain situations or to certain people. They might also avoid saying words they think they might stutter on or refrain from talking altogether. If a child begins to avoid speaking in order to avoid stuttering, the disorder can have a marked impact on his or her social, emotional, and educational development.
Sometimes, older children and adolescents become so adept at hiding their stuttering that other people may not even know that they stutter. Although this might sound like a good goal, it typically is not. Hiding stuttering takes a lot of emotional and cognitive effort and results in significant shame for the person who stutters. This, in turn, often limits the child’s ability to participate in life activities at school or in social settings. The best way to deal with stuttering is not to try to hide it, or to hide from it, but rather to face it directly.
There is no one cause of stuttering. Current research indicates that many different factors, including genetic inheritance, the child’s language skills, the child’s ability to move his or her mouth when speaking, the child’s temperament, and the reactions of those in the child’s environment play a role in the development of stuttering.
For very young children (age 2˝ to 5 or 6), the primary goal of treatment is to help the child learn to speak fluently. We do this by teaching the child to change the timing and the tension of speech production through modeling and play-based activities, both in the therapy room and at home. Treatment of children in this age range can be highly effective, with many children exhibiting complete recovery by approximately age 6.
For older children and adolescents, it is more difficult to eliminate stuttering, and the child is more likely to begin experiencing the shame and embarrassment that characterizes advanced stuttering in adults. Improving fluency is still a major focus of treatment; however, a necessary additional goal involves helping children to develop healthy, positive attitudes toward themselves and toward their speech, even if they are still stuttering. Parents play a very central role in this process by conveying acceptance of their child’s speaking abilities and by providing a supportive environment where the child can both stutter and learn to speak more fluently.
It is important to remember that parents do not cause stuttering. Still, there are several things you can do to help your child learn to speak more fluently. Parents of young children can help by: (i) providing a model of an easier, more fluent way of speaking, (ii) reducing demands on the child to speak, particularly demands to speak fluently, and (iii) minimizing the time pressures a child may feel when speaking.
Modeling. Children tend to be more disfluent when they or the people around them talk more quickly. This is due partly to the increased time pressures children may feel and also to the children’s own attempts to speak more quickly in order to keep up. Family members (particularly parents and primary caregivers) should be aware of their speaking rate and make a conscious effort to speak more slowly.
Beyond reducing your own speaking rate, you can model for your child an easier, more relaxed way of speaking. One way to do this is by reflecting the child’s sentences back to him or her, using a slower speaking rate, then expanding on the child’s utterance when responding to the child’s question. For example, if your child says "I want to play outside now," you can respond using a slower speaking rate, saying "You want to play outside now? (pause) Okay, that would be fine." This gives the child an immediate example of how to speak more easily and more fluently using a slower speaking rate.
Reducing Demands. Often, people in the child’s environment feel uncomfortable when a child stutters. There is sometimes an irresistible urge to try to help children by telling them to "speak more slowly" or to "stop, take a deep breath, and think about what they want to say." Although this might sound like good advice, it does not help, and only serves to make the child more self-conscious about his speech. The same is true about finishing a child’s words or making seemingly supportive comments about his or her fluency (e.g., "you said that so fluently"). Although such statements seem positive, children interpret them as corrections since they typically don’t know what they did differently to make their speech fluent. In general, it is best to avoid any such corrections or demands on the child to speak fluently. In treatment, children will be taught how to make these changes in their speech, and you will learn ways to respond to their children’s fluent and disfluent speech in a supportive manner.
Parents are naturally proud of their children’s ability to memorize stories and rhymes, and often ask children to give performances for friends or family. Although some children receive pleasure from these activities, this type of "performance speech" places great demands on children’s fluency. Although it is very important for you to demonstrate pride in your child’s accomplishments, particularly those related to speaking, it is probably more helpful to find other ways for your child to demonstrate his or her skills that will be less demanding on fluency (e.g., speaking together in a group or singing).
Still another form of demand involves the use of complicated language. Children are more disfluent when they use longer or more complex sentences. When a child is disfluent, therefore, it is helpful to limit your use of open-ended questions requiring long or complex answers (e.g., "what did you do at school today?"). Instead, try using closed-ended questions requiring shorter, simpler answers (e.g., "did you have fun at school today?" or "did you go outside during recess?"). You can also try to encourage your child to talk without asking any questions at all. Try simply commenting on your child’s activities (e.g., "I wonder if it’s going to rain while you’re at school today") and giving him an opportunity to response. The key is to manage the child’s speaking situations carefully – at times when he is speaking more fluently, you can feel comfortable stimulating his language development by using more open-ended questions.
Minimizing Time Pressure. One of the most helpful ways you can reduce the conversational time pressure your children may feel is to model and use a slower speaking rate as described above. Another useful technique is pausing, one to two seconds, before answering your child’s questions. This gives your child the time he or she needs to ask and answer questions, and it helps teach him not to rush into responding during his own speaking turns. Finally, this technique shows children how to take enough time before speaking to formulate their answers more fully.
Another important benefit of using pauses is that it helps children learn to take turns when speaking. The normal flow of conversation involves turn-taking – only one person speaks at a time. If two or more people are competing for talking time or if one person interrupts another, however, there is a tendency for the rate of speech to increase and for the speakers to feel pressure to get their message out quickly. This is particularly difficult for children who stutter, so it is best to take turns when talking—each person gets an opportunity to speak without fear of being interrupted and without the need to hurry. You can demonstrate this in your own speech by not interrupting your child (a part of pausing between speaker turns) and by managing the talking turns of other children so each child gets their turn to talk.
Finally, you can reduce overall time pressures by reviewing your daily routines to make sure your child’s schedule is not so busy that it does not leave time to talk about his or her experiences in a slow and unhurried manner. It is certainly good for children to have full and active lives; however, some children may benefit more from participating in fewer activities that are enjoyed at a slower pace.
For older children or for children who have exhibited concern about their speech, parents can supplement these strategies with other techniques to help children develop healthy, positive attitudes about their speaking abilities.
Listen to Content rather than Manner. Stuttering draws attention to itself, so it is not surprising that parents and others in the child’s environment might be more likely to hear the child’s stuttering, rather than the message the child is trying to convey. Children quickly become aware of this, and this can increases their sense of shame or embarrassment about their speech even further. To reduce these negative feelings, parents should be sure to focus on and respond to their child’s message and to "talk about what the child talks about." You can help yourself focus on your child’s content by developing a "talking log," in which you keep track of the topics your child raises in conversation during the day.
Respond to Stuttering in an Accepting Manner. No parent would want their child to have a stuttering problem; however, it is important for you to convey complete acceptance of your child, including acceptance of his or her stuttering. Children’s self-esteem and self-acceptance are highly dependent upon the acceptance of others, particularly their parents. If you convey the message that stuttering is bad, or something to be ashamed of, then it is more likely that your child will believe that he is bad. As a result, his shame will increase. Importantly, it is the child’s negative reactions to stuttering that determines whether he will be handicapped by his speech, not the number of disfluencies he produces. In treatment, children will learn to be more fluent; however, they will not be successful if they have already developed negative attitudes about themselves and their speech.
Speaking More Slowly. Learning to speak slowly can be quite challenging, both for children and for their parents. Many parents are accustomed to a fast rate of speech, and they initially feel that slower speech feels unnatural. The best way to practice slower speech is to begin just 5 minutes per day, during a simple structured activity such as reading a child’s book (Dr. Seuss books are great for this). The key to talking slowly is to use pauses, between words and between phrases. For example (the dots indicate pauses approximately 1 second long):
" One fish…….two fish………red fish…….blue fish."
" This is a story………about a little girl………named Goldilocks."
After practicing a slower rate and pausing when reading, you can begin to use this strategy in conversational speech. The best example of how to do this is Fred Rogers of Mr. Rogers’ Neighborhood. Watching Mr. Rogers on television can also help you become more comfortable with a slower speaking rate.
Managing Turn-Taking. Another challenging strategy is learning to use structured turn-taking. This is especially rents who have more than one child. You help all of you children learn to take turns when talking by playing simple and familiar games such as "Go Fish" or "Hi-ho Cherry-O." All of these games are based on turn-taking – to play the game, each child takes a turn, and the game cannot proceed until every child takes their turn. By highlighting the way that players are taking turns, you can gently direct you children’s attention to turn-taking rules that will facilitate their fluency in conversational speech.
Treat Stuttering Like Any Other Behavior. Parents are often confused about what to say when their children stutter, particularly following a tense or long disfluency. Many parents have been told not to draw attention to their children’s stuttering for fear that this will make the stuttering worse. We feel that a better approach is to treat stuttering just like any other difficulty your child may experience when learning a difficult task (e.g., learning to skip or ride a bicycle). If a child falls while learning to ride a bicycle, you probably do not refrain from commenting for fear that he will become self-conscious about his bicycle-riding skills. Instead, you might rush to him, pick him up and give him a hug, encourage him to try it again, and praise him for his courage in learning a new skill. The exact same approach should be taken with stuttering –use their own style to encourage your children and to build confidence about speaking. This also helps bring stuttering into the open so children will feel more comfortable talking about it and expressing their own feelings of fear and frustration.
Remember – These strategies take time to learn.
Do not feel discouraged if you find them difficult at first.
You will receive specific
how to make these changes during treatment.
Some Things to Watch For
Normal disfluencies can be hard to distinguish from stuttering. Also, the severity of stuttering can fluctuate over time, even if the child is in therapy. Some signs that might indicate that stuttering is getting worse include:
Increased iterations during repetitions (e.g., 5 iterations
of "I" in "I-I-I-I-I want that")
Increased proportion of prolongations rather than repetitions (e.g., "IIIIIIIII want that.")
Complete blockages of speech (e.g., child opens mouth to speak but no sound comes out)
Noticeable physical tension or struggle during disfluencies
Changes in pitch during prolongations or irregular rhythm during repetitions
Apparent signs of fear or frustration immediately prior to or following disfluencies
Indications that the child is substituting words to avoid stuttering
Indications that the child is avoiding talking in certain situations or to certain people
If you notice any of these behaviors, you should discuss them with a licensed and certified speech-language pathologist who is also a specialist in the diagnosis and treatment of childhood stuttering.