• Information for Parents of Young Children Who Stutter

    What Is Stuttering?
    Stuttering is a communication disorder characterized by disruptions in the forward flow of speech
    (“speech disfluencies”), such as repetitions of 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 speak
    fluently. Factors influencing the likelihood that stuttering will occur differ from one child to the next,
    but might include:
    The child’s conversational partners or the topic of the child’s conversation
    What the child is doing while talking and where the child is when talking
    What is going on in the child’s life at the time of the conversation
    The child’s emotional or physical state (e.g., excitement, fatigue, illness)
    The length and complexity of the message the child is trying to convey
    Other factors that are more difficult to identify

    Many times, children experience fear or embarrassment because of their stuttering. This is not
    surprising, because stuttering “stands out” in the child’s speech. As a result, children may try to
    hide their stuttering so it does not show as much. They may do this by avoiding speaking in certain
    situations or to certain people. They may also avoid saying words they think they might stutter on
    or refrain from talking altogether. If a child begins to avoid speaking to prevent 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 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 a significant feeling of
    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.
    What Causes Stuttering?
    There is no single cause of stuttering. Current research indicates that many different factors play a
    role in the development of stuttering, 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.
    Copyright © 2009. All Rights Reserved. The Stuttering Center of Western Pennsylvania.

    How Do We Treat Stuttering
    For very young children (age 2½ 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 experience 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 their
    speech, even if they still stuttering. Parents play a 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.
    How Can Parents Help?
    It is important to remember that parents do not cause stuttering. Still, there are several things
    parents can do to help their child 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 as he tries to keep up. Family members (particularly
    parents and primary caregivers) should be aware of their speaking rate and make a conscious
    effort to reduce the overall pace of their interactions with the child.
    Beyond reducing their own communication pace, parents can model 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
    slightly slower speaking rate, then expanding on the child’s utterance when responding to a
    question. For example, if the child says “I want to play outside now,” parents can respond using a
    slightly slower rate, saying “You want to play outside now? (pause) That would be fine.” This gives
    the child an 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 breath, and think about what they want to say.” Although this might
    sound like good advice, it may make the child more self-conscious about his stuttering. (Keep in
    mind that advice to slow down is typically given only when the child is having difficult with fluency,
    and not when the child speaks rapidly but is able to maintain fluency.) 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 may seem positive, children may interpret
    them as corrections since they may not know what they did differently to make their speech fluent.
    In general, it is best to avoid any such corrections or demands for 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 they may
    ask their children to give performances for friends or family. Although some children enjoy these
    activities, this “demand speech” places can make it hard for the child to maintain fluency. Although
    it is important to show pride in children’s accomplishments, particularly those related to speech, it
    may be helpful to also find ways for the child to demonstrate his skills that will be less demanding
    on fluency (e.g., physical activities, math games, or coloring and painting – in addition to talking).

    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 particularly disfluent, therefore,
    it may be helpful for parents to limit their use of open-ended questions requiring long, complex
    answers (e.g., “what did you do at school today?”). Instead, parents can 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?”). Parents can also encourage the child to talk without asking questions
    at all, for example, by simply commenting on the child’s activities (e.g., “I wonder if it’s going to rain
    while you’re at school”) and giving him an opportunity to respond. The key is to manage the child’s
    speaking situations carefully – at times when he is speaking more fluently, parents can feel
    comfortable stimulating his language by using more open-ended questions; at other times, parents
    can help him communicate successfully without requiring long, complicated sentences.
    Minimizing Time Pressure. One way parents can reduce time pressures a child may feel is to
    model and use a slower speaking pace. Another technique is to pause briefly before answering the
    child’s questions. This gives the child the time he needs to ask and answer questions, and it teach
    him not to rush into responding during his own speaking turns. This technique shows the child how
    to take enough time before speaking to formulate his answers more fully.
    Another benefit of using pauses is that it helps children learn to take turns when speaking. The
    normal flow of conversation involves turn-taking. That is, only one person speaks at a time. If two
    people are competing for talking time, or if one person interrupts another, there is a tendency for
    their rate of speech to increase and for the speakers to feel pressure to get their message out
    quickly. This time pressure is particularly challenging for children who stutter, so it is best to take
    turns when talking. Each person gets an opportunity to talk without fear of being interrupted and
    without the need to hurry. Parents can demonstrate this in their own speech by not interrupting the
    child (a part of pausing between speaker turns) and by managing the talking turns of other children
    so each child gets his or her turn to talk.
    Finally, parents can reduce time pressures by reviewing daily routines to make sure the 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 enjoying fewer activities at a slightly slower pace.
    Finally, 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 may be more likely to hear the stuttering, rather than the message the child is
    trying to convey. Children quickly become aware of this, and this can increase their sense of
    shame or embarrassment about stuttering. 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.”
    Parents can help themselves focus on the child’s content (rather than the manner in which the
    child’s speaks) by developing a “talking log,” in which they keep track of the topics the child raises
    in conversation during the day.
    Respond to Stuttering in an Accepting Manner. No parent would want their child to stuttering;
    however, it is important for parents to convey complete acceptance of the child, including
    acceptance of stuttering. Children’s self-esteem and self-acceptance are highly dependent upon
    the acceptance of others, particularly their parents. If parents convey the message that stuttering is
    bad, or something to be ashamed of, then it is more likely that the child will believe this, too. This
    can cause his shame to increase. Importantly, it is the child’s negative reactions to stuttering that
    determines whether he will be negatively affected by his speech, not the number of disfluencies he
    produces. In treatment, children will learn to be more fluent; however, they will not be as successful
    if they have already developed negative attitudes about themselves and their speech.

    Some Helpful Tips
    Speaking More Slowly. Learning to speak slowly can be quite challenging, both for children and for
    parents. Many parents are accustomed to a fast rate of speech, and they initially feel that slower
    speech feels unnatural. The best way for parents to learn how to reduce their pace is to start just 5
    minutes a day, during a simple activity such as reading a child’s book (Dr. Seuss books are great
    for this). The key to reducing pace is to use pauses between words and between phrases. For
    example (the spaces indicate pauses a little less than one second long):
    “ One fish, two fish, red fish, blue fish. ”
    “ This is a story about a little girl named Goldilocks. ”
    After practicing when reading, parents can begin to use this strategy in conversation. The best
    example of how to talk to young children is Fred Rogers of Mr. Rogers’ Neighborhood. Watching
    Mr. Rogers can also help parents become more comfortable with a slower speaking rate.
    Managing Turn-Taking. Another challenging strategy is learning to follow turn-taking rules. This is
    especially true for parents who have more than one child. You help all of your 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, parents can gently direct their 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 the 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, parents do not refrain from commenting for fear that he will become self-conscious
    about his bicycle-riding skills. Instead, they 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. Parents can use their own parenting style to encourage their child
    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 training about 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
    severity is increasing 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 parents notice any of these behaviors, they should discuss them with a licensed and certified
    speech-language pathologist who specializes in childhood stuttering.