Educators

• For children who are being ridiculed by their peers about their stuttering, it is helpful to problem solve a solution with the child’s speech therapist, if possible. If not, the following are some solutions that may work in your classroom.
• It is best to deal with each instance quickly and to reassure the child that the teasing was not kind or appropriate. Talk to the child directly about what was said and how that made the child feel. Validate the child’s feelings.
• If possible, talk with the perpetrators as quickly as possible. Explain how their comments were hurtful and un-supportive. Explore why the teasing occurred. Many times children tease when they don’t understand something they are seeing or hearing.
• Discuss teasing with the entire class in a general fashion. Talk about individual differences and strengths and weaknesses of the class in general. Explain the need for tolerance of these differences and set up a “zero tolerance” policy for teasing. In addition, explore suggestions for handling teasing and providing support for peers who are being teased. Many times children need to role play hurtful situations in order to be able to handle them better and to understand the negative impact teasing can have. It is recommended that the discussion not be specific to the stuttering, but rather general in nature.
• Talk with the parents of children who are being teased and who are teasing. Children do not always share information with their parents and it is important that this happen in a timely manner. Excessive teasing about stuttering can result in behavior issues and increased difficulty with stuttering. The child who stutters may begin to limit their participation in classroom activities in order to avoid being teased.

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.

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.

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.

Please click here to see our Developmental Levels of Disfluency chart.

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 non stutterers. 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 (Mairi and colleagues, 1996).
• Concomitant Speech-Language Difficulties: Research has found that stutterers have 2 ½ times the incidence of articulation disorders as non stutterers (Andrew and Harris, 1964; Berry, 1938; Bloodstain, 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.

The following is a checklist to help you determine if the child should be evaluated by a fluency specialist.

Instructions: Parents/teachers check any area that applies to the child:

I. Risk Factors

II. Speech Behavior

If two or more questions are checked, the child needs to be seen for consultation or evaluation.

Please contact the Center of Stuttering Therapy to schedule a consultation or evaluation.

When parents have concerns about their child’s persistent stuttering, it is highly recommended that they contact a speech-language pathologist who has expertise in stuttering. The American Speech-Language Hearing Association’s (ASHA) Division 4-Fluency, suggests parents look for a Board Recognized Fluency Specialist. Speech pathologists with this distinction have received extensive training and experience in the diagnosis and treatment of stuttering disorders.

Individuals looking for referrals in their area for fluency specialists can contact the Stuttering Foundation of America (SFA) for a referral list. You may call the SFA at 1-800-992-9392, or visit their website at www.stuttersfa.org.

Differential diagnosis is the key to effective early intervention. It is critical to have your child evaluated by a speech-language pathologist with fluency expertise in order to accurately determine whether your child’s disfluencies are normal or abnormal.