The time in your child’s life when she is most likely to stutter is precisely when she is developing language skills and growing her vocabulary. So, how then, do you know if you’re dealing with a routine stumbling over words, which will pass, or genuine, lasting stuttering?
A preschooler, aged three to six years, who’s occasionally repeating words and sounds is most certainly not a cause for concern. “It can simply mean they’re stalling for time as they search for the right words,” says Arina Coetzee, a Cape Town-based speech therapist. This is a regular part of language development and one that’s generally outgrown by the age of seven. Also, stressful changes, such as the arrival of a new sibling, a change in school or a parent returning to work, could temporarily affect speech.
However, if your child’s stuttering has been severe and constant for at least a month, it might be time to visit a speech therapist. In addition to your child repeating, blocking and omitting words and sounds, signs to look out for include tension in his shoulders, jaw or cheeks. Does she look away or clench her fists, blink repeatedly, or stamp her feet with frustration related to trying to get out the words? These signs of stress can be additional indicators that your child’s stuttering is something that needs addressing – if you are unsure, chat to your child’s paediatrician or teacher.
Facts and Findings
Developmental stuttering is the most common form of stuttering in young children. This happens when a child’s developing speech and language abilities aren’t able to meet their verbal demands. According to The National Institute on Deafness and other Communication Disorders (NIDCD), developmental stuttering runs in families, and recently confirmed this link by isolating three genes said to be responsible for stuttering.
Stuttering has also been thought to be associated with higher levels of the neurotransmitter dopamine. Dr Gerald Maguire, the director of the Kirkup Centre for the Medical Treatment of Stuttering at the University of California, recently completed a nine-year study that conclusively made the connection.
Whether due to genetics, dopamine or other factors, 10 percent of South African preschoolers will stutter. Of these, 60 percent will be boys and 40 percent girls, and one percent will be chronic, with the pathology persisting into the teenage years or even adulthood. However, early intervention (before stuttering becomes established) is effective in helping many children achieve normal fluency. Research shows that the prognosis for recovery from chronic stuttering is good with 65 percent of preschoolers who stutter recovering in the first two years of stuttering and about 74 percent recovering by their early teens. In particular, girls seem to recover well.
Case in Point
Shortly after three-year-old Cole Ryan started stuttering, his parents Clare and Linsley started taking him to a weekly one-hour speech therapy session. “At these sessions, which lasted six months, the therapist did not interact with Cole. She observed the interaction between Cole and me, and at the end of each session she would give us an evaluation. We were given tasks to do with him at home. I also came up with my own tasks to help him,” says Clare. Within a year he had fully recovered from his stuttering.
This style of therapy might seem strange and a little too hands-off on the part of the therapist, for some, but it’s commonly used in assisting stutterers. This indirect approach teaches parents about normal language and fluency development, stuttering, and the conditions that may worsen a child’s speech disfluencies. The parent is also taught how to make communication changes at home. The direct approach, on the other hand, teaches the child to produce more fluent speech, either through modelling easier speaking styles, or through feedback from the parent or speech therapist to your child about her fluency. Most therapists use a combination of the two techniques.
“Family knowledge, involvement and input are critical factors for successful therapy,” says Dina Lillian, a Johannesburg-based speech therapist affiliated with the organisation, Speak Easy, a stuttering support group. She says Cole’s recovery is a case of a job well done by both parent and therapist, and sees treatment as a 50:50 partnership between the two. The strength in Cole’s treatment lay in the ability of the therapist to equip and empower his parents to help him improve.
An Overwhelming World
But it’s not just the obvious speech-related issues that need addressing. “Children who stutter become embarrassed, frustrated and angry at themselves and others,” says Johannesburg-based child psychologist Cristine Scolari. This often comes with despondency, sadness, a sense of unfairness and an overwhelming feeling that something is wrong with them and won’t get better. Stuttering worsens when others tease stutterers about their speech impediment. As a result, says Cristine, children will often withdraw and become self-conscious so that social interactions – such as meeting new people, asking or answering questions or talking on the telephone – exacerbate their stuttering.
Building self-confidence is thus an essential tool in the stuttering child’s recovery, which is why play therapy or psychotherapy can be beneficial. During psychotherapy, children are taught ways to express their feelings other than through verbalising. This also helps with peripheral issues such as developing social skills, learning how to deal with teasing, and working through their anger and frustration.
Some also recommend adjusting a child’s diet. Try “cutting foods containing sugar, caffeine, colourants and preservatives,” says pharmacist Felicia Rubin, as stimulants can exacerbate stuttering.
Recovery Begins At Home
The experts put you, the parent, in charge of your child’s recovery. There are a number of easy-to-implement things you can do to help your child improve.
- Don’t make a big issue out of the stuttering, unless your child broaches the subject. If she does bring it up, speak in a casual and matter-of-fact way to avoid making her feel self-conscious.
- If your child brings up his stuttering in conversation, avoid using big words. These include “stuttering”, “stammering” or “speech therapist”, which may frighten him and make him feel there’s something wrong with him. Instead, use words that are part of his vocabulary such as “stuck words”.
- Don’t instruct; lead by example. Children tend to mimic their parents, so speak slowly, use short sentences and pause before answering their questions. Keep your voice soft and relaxed.
- When your child speaks to you, make sure you look at her and give her your full attention. If you are impatient, your preschooler will feel pressure to “get it out”, making her stuttering worse.
- Do not interrupt your child when he’s speaking. A child is more relaxed and less likely to stutter if he knows he won’t be interrupted.
- Don’t pressure with questions. Let your child speak about what she wants to talk about.
- Praise your child each time something is done well. This will increase his confidence.
- Allow your child to express her frustration or embarrassment. Acknowledge her feelings by saying “I understand how frustrating that must be for you”.
- Provide an atmosphere of acceptance of all types of speech, this includes stuttered speech so your child will learn that she is okay.