All children fumble for words sometimes, especially when acquiring early language skills. In fact, many children go through a temporary period of "disfluency" that lasts several days, weeks, or months — a normal occurrence when growth in vocabulary and grammar proceed at a faster rate than motor skills. In most cases, children outgrow stuttering without intervention in three to six months. Still, stuttering that requires therapy affects as many as 20 percent of children between ages 2 and 4 (after age 5, the number drops to about 10 percent). If stuttering lasts longer than three months and begins after age 3, it is likely a child will need therapy to correct it.
To help you understand the signs and subtleties, we spoke with the Stuttering Foundation's Lisa Scott Trautman, Ph.D., CCC-SLP (Certificate of Clinical Competence in Speech-Language Pathology). Trautman, a professor at the department of communication disorders at Florida State University and co-author of several books on fluency disorders, stresses that well-intentioned guidance to "slow down" or "relax" can make matters worse. Instead, patient listening is the best medicine.
What causes stuttering?
Dr. Trautman: There are four factors most likely to contribute to stuttering:
- Genetics: Approximately 50% of all people who stutter have family members who stutter.
- Child development: Children with speech, language, or cognitive development delays are more likely to stutter.
- Neurophysiology: Research has shown that some people who stutter process speech and language in different areas of the brain than non-stutterers.
- Family dynamics: Fast-paced lifestyles and high expectations can contribute to stuttering.
You mentioned that age is a factor in determining if a child has a stuttering problem. How so?
Dr. Trautman: Most children who begin to stutter do so between the ages of 2 and 4 years. However, it is not uncommon for stuttering to start later than age 4. I have known several children who did not start stuttering until sometime in early elementary school, but this is the exception rather than the rule. The child's age is a factor we consider when trying to decide whether a child is truly stuttering or is in a temporary period of disfluency. We are inclined to consider it actual stuttering if the problems begin after age 3 and/or the child has been stuttering longer than three to six months.
How can a parent differentiate normal hesitation from a more serious stuttering problem?
Dr. Trautman: First, parents need to identify the type of stuttering they are hearing. One of the hallmark signs of early stuttering is a "part-word" repetition — repeating a sound or a single syllable, like b-b-b-ball or buh-buh-buh-baby. If you hear a part-word repetition, listen for how many times the sound or syllable is repeated. If there are three or more repetitions (like in the examples), I would be more concerned than if a child repeats only once or twice. You also need to consider your child's overall development: Is he able to understand your conversations? Can he follow through with requests and answer your questions? Is his speech understandable to others? If he has many speech sound errors or is struggling to use and understand language, you should be concerned.
One thing to note, though, is that even children who are experiencing the temporary disfluency that is a normal part of development may show some of these same types of stutterings. If you're not sure, listen over the course of several days and see if you can pick out what types of stutterings you are hearing. Then write them down. Keeping a record will help you form a better picture.
So careful observation is really the key.
Dr. Trautman: As parents consider these factors, they should also go with their gut instinct. I am constantly surprised and respectful of how well parents know their own child and how concerned they need to be about a problem a child is having. If a child has been stuttering for only a few days or weeks, it's alarming to parents, but if they can wait to see how the stuttering changes, they might be surprised at how quickly it goes away. However, if it's getting worse instead of better, or went away and is back again, I usually recommend that parents begin helping their child by talking to their pediatrician about the early signs of stuttering.
What should parents do if they suspect a problem?
Dr. Trautman: If your child has many speech-sound errors or is struggling to understand and use language, it's a good idea to have his speech and language skills evaluated by a speech therapist. When parents consult me, even if we decide that therapy isn't needed at the time, we have a baseline example of the child's communication skills that we could look back on later. If a child is still stuttering a year later, I recommend therapy.
What can parents do at home to help a child who does stutter?
Dr. Trautman: I recommend that parents make a daily rating of their child's stuttering, on a scale of 1 to 10, with 1 being no stuttering that day and 10 being the worst stuttering they have heard. I suggest that this rating be made on the family calendar or in a planner if Mom or Dad keeps one. That way, they can see over time whether the stuttering is getting any better and if there are any circumstances (stuttering is worse on the weekends or when the child is out of a normal daily routine) that will help parents understand what factors might be contributing to changes in stuttering. Pool your information with the observations of your child's teacher. The more informed you all are, the better able you will be to make decisions about your child's needs.
If your child shows signs of frustration or of being aware of the stuttering, it's perfectly okay to say, "Man, some words are hard to say, aren't they? Sometimes my words are hard to say, too." It's fine to acknowledge if the child is struggling, and it's important to let kids know that it's normal to face challenges when learning new skills.
Are there things you should avoid saying or doing when your child stutters?
Dr. Trautman: Try not to say things like "Stop" or "Slow down and think about what you're going to say." This often frustrates children and might even trigger more stuttering. Instead, it's best to simply repeat back what he is saying so that he knows he is being understood. Remind him that it's okay to take time to talk because Mom and Dad have plenty of time to listen.
How does stuttering affect children in a classroom environment?
Dr. Trautman: For many children, stuttering is not a big deal, especially in the early grades. For other children, though, stuttering may mean that they are less likely to raise their hand to answer a question, or to say, "I don't know" even though they do know. Children can also have difficulty forming friendships for fear that others will make fun of them because of the way they talk.
How should teachers work with children who stutter?
Dr. Trautman: A teacher should focus on being a good communicator herself. Use eye contact, give the child enough time to finish speaking, and stay focused on what the child is saying rather than how he is saying it. In addition, if a teacher believes that the child is not participating because of his stuttering, she can check with the child about things she can do to help him feel more comfortable communicating in the classroom. It's always best to check with the child.
What does professional therapy for stuttering involve?
Dr. Trautman: It involves helping a child learn an easier way to talk, and then learning to use these skills in many different places (at home, at school). It should also involve helping the child become the best communicator possible, including being a good listener and not interrupting. There is no known "cure" for stuttering, but we have our best success with children who come to therapy while they are still young and have not learned that talking can be a hard or a negative experience. We can always help a child learn to manage his stuttering in a way that will make him feel confident and willing to share his ideas — whenever and wherever he wants to share them.