What is Normal Nonfluency?
Normal nonfluency
of speech typically occurs in children between ages two
and seven, with a heightened occurrence between 2 ½
and 4 years.
In young children,
typical nonfluent speech is initially episodic, then becomes
more cyclical in nature, coming and going without apparent
cause or pattern. The following are characteristics of normal
nonfluencies (Guitar 1998):
- No more than
ten disfluencies per one hundred words.
- Most repetitions
are only one or two repetitions in length.
- Repetitions
are easy, loose and relaxed with no apparent sign of tension
or struggle.
- The most
common normal disfluencies are interjections (um, uh),
revisions and whole word repetitions. As children mature
past three, they will show a decline in part-word (sound
or syllable) repetitions.
- When the
disfluencies occur, the child’s body is in motion
and they will appear relaxed. Most of the time they will
appear as if they are unaware of the disfluencies and
will continue talking without interruptions.
In 1997, the
Stuttering Foundation of America reported that 25% of all
pre-school aged children go through a stage where their
disfluencies are severe enough to concern parents. Of that
25%, only 5% developed true stuttering.
Most children
will begin to spontaneously recover from normal disfluencies
after only 6 months, though they may continue to evidence
disfluencies for up to 2 years post onset. The important
thing to remember is that they should be getting better
over time, not worse, as they spontaneously recover.
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Is Your Child Stuttering?
Most
children between the ages of 2 ½ and 7 years of age
experience nonfluencies and disruptions in their speech.
In most children, this period of nonfluency is normal. However,
some children may be exhibiting early warning signs or danger
signs of a potential stuttering problem. Timely and appropriate
identification of these danger signs is critical to the
prevention of a confirmed stuttering problem.
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Warning and Danger Signs
Listed below
are the warning or danger signs frequently observed in the
speech of young children who are at risk for developing
a chronic stuttering problem. The frequent and consistent
occurrence of any of these behaviors in a young child’s
speech would identify a child at serious risk.
- Multiple
part-word repetitions: The child repeats
the first sound or syllable of a word, such as t-t-t-table
or ta-ta-ta-table.
- Prolongations:
The child stretches out a sound, such as rrrrrrrrabbit.
- “Schwa”
vowel:
Use of the weak (schwa in German) vowel. For example,
instead of saying bay-bay-bay-baby, the child substitutes
b^b^b^baby.
- Struggle
and tension: The child shows struggle
and force in an attempt to say a word. Parents may observe
tension around the child’s mouth, eyes or in the
child’s body posture.
- Pitch
and loudness rise: As the child repeats
and prolongs, the pitch and loudness of the voice increase.
- Tremors:
Uncontrolled quivering of the lips or tongue may occur
as the child repeats or prolongs sounds or syllables.
- Avoidance:
The child shows an unusual number of pauses; substitutions
of words; interjections of extraneous sounds (um, uh),
words (like, well) or phrases; avoidance of talking; or
talking in funny voices.
- Fear:
The child recognizes that certain words are likely to
be troublesome, and may display an expression of fear
when about to say those words.
- Difficulty
in starting or sustaining airflow or voicing for speech:
This is heard most often when the child begins sentences
or phrases. Breathing may be irregular and speech may
come in spurts as the child struggles to keep the voicing
continuous.
Source: If Your
Child Stutters: A Guide for Parents, Stuttering Foundation
of America, Memphis, TN, 1-800-992-9392.
Anytime a child
exhibits heightened negativity, negative awareness or struggle
and tension during speaking, there is cause for concern.
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What are the Risk Factors for Chronic Stuttering?
Many factors
are believed to signal that a child is at high risk for
chronic stuttering.
Important risk
factors to consider include:
- Time
Post Onset: The longer the child continues
to stutter, the greater the risk. Spontaneous recovery
begins at approximately six months post onset and can
continue up to a year post onset. The likelihood of chronicity
increases approximately fifteen months after onset.
- Family
History of Stuttering: Research has indicated
that relatives of stutterers are at greater risk for developing
stuttering than relatives of nonstutterers. Both genetic
transmission and social inheritance theories have been
proposed to explain the tendency for stuttering to occur
in families. To date, the cause of this familial link
has not been explained. It is estimated that 25% of chronic
stuttering has this familial link.
- Persistent
Prolongations: The presence of prolongation
behaviors in a child’s speech appears to be an important
indicator of chronicity of stuttering (Yairi and colleagues,
1996).
- Concomitant
Speech-Language Difficulties:
Research has found that stutterers have 2 ½ times
the incidence of articulation disorders as nonstutterers
(Andrew and Harris, 1964; Berry, 1938; Bloodstein, 1958;
Kent and Williams, 1963). Evidence also exists that children
who stutter lag behind fluent children in language development.
Significant deficiencies in syntax and word finding may
directly affect a child’s ability to string together
words in a smooth, fluent manner.
- High
Self-Expectations: Perfectionistic tendencies
in young children who stutter may lead them to have less
tolerance of the disfluencies in their speech and more
at risk to develop chronic stuttering.
-
Heightened Negative Awareness:
Guitar (1998) notes that the child’s response to
the awareness of their stuttering is the underlying factor
in the progression of stuttering.
The more risk
factors a child has, the greater the chance that the child
will develop chronic stuttering.
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I Think My Child Is Stuttering.
What Should I Do?
Many children
between the ages of two and four years go through a stage
when they seem to stutter. This disfluent speech can be
very disturbing to parents.
When your child
is experiencing disfluencies in their speech, the following
suggestions may be helpful when communicating with your
child:
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What to do when your child is disfluent:
- Take care
not to draw negative attention to the speech difficulties.
Instead:
- Listen
patiently until the child is finished speaking, while
maintaining consistent, appropriate eye contact.
- Try to
avoid showing concern, pain, or pity on your face.
- Respond
the same to disfluent speech as you would to fluent
speech.
- Repeat
back to the child what they said in a slow, relaxed
manner. This will tell the child you were listening
to what was said rather than how it was said.
- Try to use
slower, more relaxed speech (easy speech) whenever you
are communicating/talking with your child. This is difficult
to do at first, but will become easier over time. Begin
slowly, gradually increasing the use of “easy speech”
during all daily activities. It is not advisable to draw
attention to the child’s rate of speech. Instead
simple provide this “easy speech” model whenever
possible.
- Speak to your
child in short, simple sentences using vocabulary appropriate
for his age. Disfluencies will increase with longer, more
complex utterances. Children frequently attempt to match
adult language models.
- Try not to
convey a sense of time pressure. Give your child adequate
time to respond. Try to avoid rushing or asking him to
hurry. Inserting adequate pauses in your speech will help
reduce time pressure.
- Suggestions
such as “slow down”, “think about what
you are saying”, “start over”, and “take
a deep breath” are not helpful and will only serve
to frustrate your child during moments of speech difficulty.
- Protect your
child’s talk time by limiting interruptions. Appropriate
turn taking skills should be used by the entire family.
- If your child
appears unaware of his disfluencies, avoid talking about
the “stuttering” in his presence. In addition,
do not label the disfluencies as “stuttering”.
- Avoid extensive
open-ended questioning. Instead ask yes-no questions or
short answers questions whenever possible.
- When your
child is experiencing increased disfluencies, encourage
more nonverbal or physical activities, such as coloring,
outdoor recreation, and movies, etc. On more fluent days,
encourage talking as appropriate.
- In all daily
activities, attempt to make talking a positive and fun
experience for your child. We suggest:
- Positive
verbal praise for talking (i.e., “you are a
good talker”, or “I like the way you said
that”.)
- Talk
about things that are important and of interest to
your child.
- Allow
your child to initiate conversations.
- Read
frequently to your child in a slow and relaxed manner.
Below is our
“REST” acronym. Posting copies of these in strategic
places in the home (i.e., refrigerator, play area, car etc.)
will serve to reinforce important information to help you
make positive changes in your communication patterns with
your child:
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Childhood
Stuttering 
