The Child Who Stutters to the Pediatrician

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the child who stutters:to the pediatrician

stuttering foundation of america

publication no. 0023

revised 4th edition

www.stutteringhelp.org

www.tartamudez.org

Copyright 2001-2007 by the Stuttering Foundation of America


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The Child Who Stutters:To the Pediatrician

Barry Guitar, Ph.D.Professor,Department of Communication Sciences,University of Vermont

Edward G. Conture, Ph.D.Professor and Director, Graduate Studies,Department of Hearing and Speech Sciences,Vanderbilt University

Editorial assistance:

Stephen Contompasis, M.D.,Associate Professor of Pediatrics,University of Vermont Medical SchoolUniversity of Vermont

Jane Fraser,President,Stuttering Foundation of America

Michael B. Grizzard, M.D.,Medical DirectorThe World Bank, Washington, D.C.

Diane G. Hill, M.A., CCC-SLPSenior Lecturer in Speech and Language Pathology,Communication Sciences and Disorders Department,Northwestern University

James McKay, M.D.,Professor Emeritus of Pediatrics,College of Medicine,University of Vermont

Peter Ramig, Ph.D.,Professor,Department of Speech, Language, and Hearing SciencesUniversity of ColoradoBoulder

Patricia M. Zebrowski, Ph.D.,Associate Professor,Department of Speech Pathology and Audiology,University of Iowa

Stuttering Foundation of America

Publication No. 0023

revised 4th edition

www.stutteringhelp.org www.tartamudez.org



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the child who stutters:to the pediatrician

Publication No. 0023

First Edition1991Second Edition2001

Third Edition2004Fourth Edition2006Revised Fourth Edition2007

Published by

Stuttering Foundation of AmericaP. O. Box 11749Memphis, Tennessee 38111-0749

ISBN-0-933388-47-0

Copyright 2007, 2006, 2004, 2001 by StutteringFoundation of America

The Stuttering Foundation of America is a nonprofitcharitable organization dedicated to the preventionand improved treatment of stuttering.



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Although the etiology of stutter-ing is not fully understood,there is strong evidence tosuggest that it emerges from acombination of constitutionaland environmental factors.

Geneticists have found indica-tions that a susceptibility tostuttering may be inherited andthat it is most likely tooccur in boys.1,2,3 Further sup-port for inheritance comes fromtwin studies that have demon-strated a higher concordancefor stuttering among bothmembers of identical twin pairsthan fraternal twin pairs.4,5

Congenital brain damage is alsosuspected to be a predisposingfactor in some cases.1 For alarge number of children whostutter, however, there isneither family history of thedisorder nor clear evidence ofbrain damage.

Brain imaging studies con-ducted in many laboratoriesthroughout the world indicate

that adults who stutter showdistinct anomalies in brainfunction.6,7,8 In contrast withnormal speakers, individualswho stutter show deactivationof left-hemisphere sensorimotor

centers and over-activation ofhomologous right-hemispherestructures during both stut-tered and nonstuttered speech.The essential defect is hypothe-sized to be a lack of sensori-motor integration necessary toregulate the rapid movementsof fluent speech. Both tempo-rary fluency (induced throughsinging or choral reading) andmore permanent fluency (as aresult of behavioral treatments)appear to normalize the activa-tion patterns.9

The onset of stuttering istypically during the period ofintense speech and languagedevelopment as the child isprogressing from 2-word utter-ances to the use of complexsentences, generally between

the ages of 2 to 5 but sometimesas early as 18 months. Thechilds efforts at learning to talkand the normal stresses ofgrowing up may be the imme-diate precipitants of the brief

repetitions, hesitations, andsound prolongations that char-acterize early stuttering as wellas normal disfluency*. Thesefirst signs of stuttering grad-ually diminish and then disap-pear in most children, but somechildren continue to stutter. Infact, they may begin to exhibitlonger and more physicallytense speech behaviors as theyrespond to their speaking diffi-culties with embarrassment,fear, or frustration. If referral toa speech-language pathologistfor parent counseling and treat-ment is made before the child

The Child Who Stutters:To the Pediatrician

Most children go through periods of disfluency as they learn to speak.Some will experience mild stuttering, and for others the difficulty will

become severe. Early intervention by the pediatrician can help parentsunderstand and thus minimize the problem.

ETIOLOGY

*The term disfluency means a hesitation,interruption, or disruption in speech. It maybe normal or, as in the case of stuttering,it may be abnormal.



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Risk Factor More likely in

beginning stutteringTrue for Child

Family history

of stuttering

A parent, sibling,

or other family

member who still stutters

Time since onset Stuttering 612 months

or longer

Age at onset After age 31/2

Gender Male

Other speech-language

concerns

Speech sound errors,

trouble being understood,

difficulty following

directions

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has developed a serious socialand emotional response tostuttering, prognosis for recov-ery is good.10,11,12

PREVALENCE, INCIDENCE,AND RISK FACTORS FORCHRONICITY

About 5% of all children gothrough a period of stutteringthat lasts six months or more.Three-quarters of those whobegin to stutter will recover bylate childhood, leaving about1% of the population with a

long-term problem. The sexratio for stuttering appears tobe equal at the onset of the dis-order, but studies indicate thatamong those children who con-tinue to stutter, that is, school-age children, there are three tofour times as many boys whostutter as there are girls.4

Risk factors that predict achronic problem rather thanspontaneous recovery include:*

Family history

There is now strong evidencethat almost half of all childrenwho stutter have a family mem-

ber who stutters. The risk thatthe child is actually stutteringinstead of just having normaldisfluencies increases if thatfamily member is still stutter-ing. There is less risk if the fam-ily member outgrew stutteringas a child.

Age at onset

Children who begin stuttering

before age 3 1/2 are more likelyto outgrow stuttering; if thechild begins stuttering beforeage 3, there is a much betterchance she will outgrow it with-in 6 months.

Time since onset

Between 75% and 80% of allchildren who begin stutteringwill stop within 12 to 24 monthswithout speech therapy. If thechild has been stuttering longer

than 6 months, he may be lesslikely to outgrow it on his own. Ifhe has been stuttering longerthan 12 months, there is an evensmaller likelihood he will out-grow it on his own.

Gender

Girls are more likely than boysto outgrow stuttering. In fact,three to four boys continue tostutter for every girl who stut-ters. Why this difference? First,

it appears that during earlychildhood, there are innate dif-ferences between boys' and girls'speech and language abilities.Second, during this same period,parents, family members, andothers often react to boys some-what differently than girls.Therefore, it may be that more

Risk Factor Chart

Place a check next to each that is true for the child




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boys stutter than girls becauseof basic differences in boys'speech and language abilitiesand differences in their interac-tions with others.

Other speech and languagefactors

A child who speaks clearlywith few, if any, speech errorswould be more likely to outgrow

stuttering than a child whosespeech errors make him difficultto understand. If the childmakes frequent speech errorssuch as substituting one soundfor another or leaving soundsout of words, or has trouble fol-lowing directions, there shouldbe more concern. The most re-cent findings dispel previous re-ports that children who beginstuttering have, as a group, low-er language skills. On the con-trary, there are indications that

they are well within the normsor above. Advanced languageskills appear to be even more ofa risk factor for children whosestuttering persists.

At present, none of these riskfactors appears, by itself, suffi-cient to indicate a chronic

problem; rather it is the cumu-lative or additive nature ofsuch factors that appears todifferentiate children for whomstuttering comes and goesversus those for whom stutter-ing comes and stays.

THE PHYSICIANS ROLE

The physician is often the firstprofessional to whom a parent

turns for help. Knowing thedifference between normal devel-opmental speech disfluency andpotentially chronic stutteringenables the physician to adviseparents and refer when appro-priate. Early intervention forstutteringwhich may rangefrom parent counseling and indi-rect treatment to direct instruc-tioncan be a major factor inpreventing a life-long problem.

Data from several different

treatment programs indicatesubstantial recovery if treat-ment is initiated in thepreschool years.7,8,9

DIFFERENTIAL DIAGNOSIS

Normal developmental dis-fluency and early signs of

stuttering are often difficult todifferentiate. Thus, diagnosis of astuttering problem is madetentatively. It is based upon bothdirect observation of the childand information from parentsabout the childs speech in differ-ent situations and at differenttimes. The following section andTables 1 and 2 at the end of thisbooklet should help the physiciandistinguish between normaldisfluency, mild stuttering, andsevere stuttering, so that appro-priate referral can be made.

Normal Disfluency

Between the ages of 18 monthsand 7 years, many children passthrough stages of speech dis-fluency associated with theirattempts to learn how to talk.Children with normal disfluenciesbetween 18 months and 3 years

will exhibit repetitions of sounds,syllables, and words, especially atthe beginning of sentences. Theseoccur usually about once in everyten sentences.

After 3 years of age, childrenwith normal disfluencies are lesslikely to repeat sounds or sylla-bles but will instead repeat wholewords (I-I-I cant) and phrases(I wantI wantI want to go).They will also commonly usefillers such as uh or um andsometimes switch topics inthe middle of a sentence,revising and leaving sentencesunfinished.

Normal children may bedisfluent at any time but arelikely to increase their disfluen-cies when they are tired,excited, upset, or being rushed

*Longitudinal research studies by Drs. Ehud Yairi and Nicoline G. Ambrose and colleaguesat the University of Illinois provide excellent new information about the development of stut-

tering in early childhood. Their findings are helping speech-language pathologists determinewho is most likely to outgrow stuttering versus who is most likely to develop a lifelong stutter-ing problem. Research reports include:

Yairi, E. & Ambrose, N. (1992). A longitudinal study of stuttering in children: A preliminaryreport. Journal of Speech, Language, and Hearing Research, 35, 755-760.

Ambrose, N. & Yairi, E. (1999). Normative disfluency data for early childhood stuttering.Journal of Speech, Language, and Hearing Research, 42, 895-909.

Yairi, E. & Ambrose, N. (1999). Early childhood stuttering I: Persistence and recovery rates.Journal of Speech, Language, and Hearing Research, 42, 1097-1112.

Yairi, E. & Ambrose, N. (2005). Early Childhood Stuttering: For Clinicians by Clinicians,ProEd, Austin, TX.



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to speak. They also may bemore disfluent when they askquestions or when someoneasks them questions.

Their disfluencies may in-crease in frequency for severaldays or weeks and then behardly noticeable for weeks ormonths, only to return again.

Typically, children with nor-mal disfluencies appear to beunaware of them, showing nosigns of surprise or frustration.Parents reactions to normaldisfluencies show a wider rangeof reactions than their childrendo. Most parents will not noticetheir childs disfluencies or willtreat them as normal.

Some parents, however, may

be extremely sensitive to speechdevelopment and will becomeunnecessarily concerned aboutnormal disfluencies. Theseoverly concerned parents oftenbenefit from referral to a speechclinician for an evaluation andcontinued reassurance.

Mild Stuttering

Mild stuttering may begin at any

time between the ages of 18months and 7 years, but mostfrequently begins between 3 and5 years, when language develop-ment is particularly rapid. Somechildrens stuttering first ap-pears under conditions of normalstress, such as when a new sib-ling is born or when the familymoves to a new home.

Children who stutter mildlymay show the same sound, sylla-ble, and word repetitions as chil-

dren with normal disfluenciesbut may have a higher frequencyof repetitions overall as well asmore repetitions each time.

For example, instead of one ortwo repetitions of a syllable, theymay repeat it four or five times,as in Ca-ca-ca-ca-can I havethat?

They may also occasionallyprolong sounds, as in MMMM-MMMommy, its mmmmmyball. In addition to these speechbehaviors, children with mildstuttering may show signs ofreacting to their disfluency.

For example, they may blink orclose their eyes, look to the side,or tense their mouths when theystutter.

Another sign of mild stutteringis the increasing persistence of

disfluencies. As suggested earlier,normal disfluencies will appearfor a few days and then disap-pear. Mild stuttering, on theother hand, tends to appear moreregularly. It may occur only inspecific situations, but it is morelikely to occur in these situations,day after day. A third sign associ-ated with mild stuttering is thatthe child may not be deeply con-cerned about the problem, butmay be temporarily embarrassedor frustrated by it. Children atthis stage of the disorder mayeven ask their parents why theyhave trouble talking.

Parents responses to mildstuttering will vary.10 Most willbe at least mildly concernedabout it, and wonder what theyshould do and whether theyhave caused the problem. A fewwill truly not notice it; stillothers may be quite concerned,

but deny their concern at first.

Severe Stuttering

Children with severe stutteringusually show signs of physicalstruggle, increased physical ten-sion, and attempts to hide theirstuttering and avoid speaking.

Although severe stuttering ismore common in older children,it can begin anytime betweenages 11/2 and 7 years. In somecases, it appears after childrenhave been stuttering mildly formonths or years. In other cases,severe stuttering may appearsuddenly, without a period ofmild stuttering preceding it.

Severe stuttering is charac-terized by speech disfluencies inpractically every phrase or



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Case Example: Sally, a child withMild Stuttering

Sallys mother and father were concerned because Sally, age3, was beginning to avoid speaking. The problem had begunseveral months earlier when Sally was repeating parts ofwords, like, Ca-ca-ca-can I ha-ha-ha-have some? Then afew weeks ago she had difficulty getting started making thefirst sound of a word. She would open her mouth, quite wideat times, but nothing would come out. Once she asked hermom, Why cant I talk?

Sallys speech and language development had beennormal. She began using single words at an early age9monthsand was speaking in 23 word sentences by 13months. She talked fluently and enjoyed the familys fast-paced conversations and word games.

When Sallys father discussed her speech with Sallyspediatrician, she referred Sally to a speech-languagepathologist in private practice who was known to haveexpertise in stuttering. Once-a-week treatment sessionsconsisted of parent counseling and play-oriented interactionsbetween Sally and herspeech clinician. Over aperiod of six months theclinicians model of arelaxed, accepting styleof interacting, combinedwith Sallys parentschanges in the intensityof speech and languagestimulation at home,eliminated Sallysavoidance of speakingand her inability to getsounds started. Shecontinued to show a

slightly greater thannormal amount of wordrepetition and phraserepetition for severalmore years and graduallydeveloped normal speech.



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Case Example: Barbara, a child withMild Stuttering

When Barbara was 3, her pediatrician noticed shewas repeating and prolonging sounds when hetalked to her. He discussed this with her mother andfather and found them to be aware of it. In fact, theyhad been instructing her to stop and start over againwhen she repeated sounds. He gave them guidanceabout slowing their own speech rates and refrainingfrom criticism.

When her parents brought Barbara to his office sixmonths later for a minor illness the pediatricianinquired about her speech. Barbaras parents werefrustrated by the lack of change in her speech and hadbegun to correct her again. Barbara herself seemedreluctant to talk to him. The pediatrician referred Barbarato a speech-language pathologist and continued tocounsel the parents to ease conversational pressureson Barbara and refrain from direct correction.

A month later, the pediatrician received a copy ofthe speech-language pathologists written evaluationof Barbara. This indicated that her stuttering hadprogressed from mild to severe, and that the parentsseemed willing to change some key variables in thehome speaking environment. The plan for treatmentincluded some direct treatment of Barbarasstuttering in the speech clinic.

Several months later, Barbaras parents brought herto the pediatrician for treatment of an infected insect bite.The pediatrician noticed that Barbaras speech seemedto be the same as before. The parents indicated that theydidnt see the sense in using slower speech ratesthemselves and have continued to try to correct Barbarasstuttering by instructions. They had discontinued speechtherapy because they were unable to afford it. At present

the pediatrician has given them a copy of If Your ChildStutters: A Guide for Parents, and Stuttering and YourChild: Questions and Answers, and is counseling them tocontinue changes at home.



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sentence; often moments ofstuttering are one second orlonger in duration. Prolon-gations of sounds and silentblockages of speech are common.

The severely stuttering childmay, like the milder stutterer,have behaviors associated withstuttering: eye blinks, eye clos-ing, looking away, or physicaltension around the mouth andother parts of the face. More-over, some of the struggle andtension may be heard in a risingpitch of the voice during repeti-tions and prolongations. Thechild with severe stuttering mayalso use extra sounds like um,uh, or well to begin a wordon which he expects to stutter.

Severe stuttering is morelikely to persist, especially inchildren who have been stutter-ing for 18 months or longer,although even some of these

children will recover sponta-neously. The frustration andembarrassment associated withreal difficulty in talking maycreate a fear of speaking. Chil-dren with severe stuttering of-ten appear anxious or guardedin situations in which they ex-pect to be asked to talk. Whilethe childs stuttering will proba-bly occur every day, it will prob-ably be more apparent on somedays than others.

Parents of children who stut-ter severely inevitably havesome degree of concern aboutwhether their child will alwaysstutter and about how they canbest help. Many parents alsobelieve, mistakenly, that theyhave done something to causethe stuttering. In almost all

TAKE-HOME MESSAGE

A child who stutters often feels that he is theonly one to have the problem. He willappreciate hearing from his pediatrician thatother children stutter, too.

cases, parents have not doneanything to cause the stutter-ing. They have treated the childwho stutters just like they treattheir other children, yet theymay still feel responsible forthe problem.

They will benefit from reassur-ance that their childs stutteringis a result of many causes andnot simply the effect of some-thing they did or didnt do.

The distinctions among nor-mal disfluency, mild stuttering,

and severe stuttering are sum-marized in Table 1: Checklist forReferral.

COUNSELING PARENTSCounseling Parents of aChild with NormalDisfluencies

If a child appears to be normallydisfluent, parents should bereassured that these disfluen-cies are like the mistakes

every child makes when he orshe is learning any new skill,like walking, writing, or bicy-cling. Parents should be advisedto accept the disfluencies with-out any discernable reactionor comment.

Particularly concerned par-ents may find it helpful to slow

their own speech rates, useshorter, simpler sentences, andreduce the number of questionsthey ask.

They may also want to arrangetimes the child can talk to themin a quiet, relaxed environment.They should not instruct thechild to talk more slowly or to saya disfluent word over again.Instead, they should concentrateon calmly listening to what theirchild is saying.

Counseling Parents of aChild with Mild Stuttering

Parents of the child who has amild stuttering problem shouldbe advised not to show concernor alarm to the child, butinstead be as patient listenersas they can. Their goal is to pro-vide a comfortable speakingenvironment and to minimizethe childs frustration andembarrassment. Parents are

usually upset when their childrepeats sounds or words, butthey should be reassured thatthese are just slips and tumblesas the child is learning to matchhis ability to speak with themany ideas he wants to express.If the parents let the childknow that repetitive stuttering



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is acceptable to them, this canhelp the childs speech and lan-guage develop without increasedphysical tension and struggle.

Parents should also be advisedto slow their own speech rates toa moderate and calm pace, espe-

Case Example: Jeremy, a child withSevere Stuttering

Jeremys speech and language developed more slowlythan that of his older sister. He didnt start to speak untilhe was two; until then, he would point to what hewanted. When he started to speak, he was difficult tounderstand. Jeremys parents often had to ask him torepeat what he said. His speech became a little clearer

at age 3, when he was using 23 word sentences. But atabout that time he began to repeat initial sounds ofwords and soon he was prolonging sounds and openinghis mouth extra wide when he couldnt get soundsstarted. Jeremys cousin had also been late indeveloping speech, but never stuttered, so Jeremysparents assumed he would just outgrow it in time.Unfortunately, the stuttering worsened. Soon Jeremywas saying um several times just before a word to get itstarted, in addition to using facial grimaces and widemouth postures when he got stuck. When he madeseveral attempts to get a word started without success,Jeremy would say Oh, never mind and give up. He wasgradually becoming more and more reluctant to talk.

By this time, Jeremys parents became concernedenough to ask their family physician for advice. After talkingto Jeremy, the physician referred them to a speech-language pathologist in a local pre-school program. Thespeech clinician soon determined that immediate treatmentwas needed and worked with Jeremy and his family in theirhome for a year with good initial success. Following this,Jeremy entered first grade and was seen twice a week bythe school speech clinician and continues to make goodprogress. Although he still gets hung up on a wordoccasionally, his language development is normal and heparticipates fully in class and in social situations.

cially when the child is goingthrough a period of increasedstuttering.

It is often difficult for busy, con-cerned parents to provide modelsof slow speech for the child to em-ulate. Therefore they are likely to

need encouragement for continu-ing this practice after an initialtrial. Most children, whether theystutter or not, will benefit fromadults speech that is close totheir own natural rate. Childrenwho stutter may feel less need tohurry their speech if their par-ents speak slowly.

While parents may providemodels of a slower, more relaxedway of speaking, they should re-

frain from criticizing, showing an-noyance, or telling the child toslow down. This may create apower struggle that makes itmore difficult for the child to slowhis rate.

It is also important for parentsto provide daily opportunities forone-on-one conversations withthe child in a quiet setting, asfrequently as possible.

These are times when the childhas chosen the activity and can

experience the feeling its a timeto talk about anything he or shewants.

If the child asks about the prob-lem, parents should talk about itmatter of factly: Everyone hasdifficulty learning to talk. It takestime, and lots of people get stuck.Its okay; its a lot like learning toride a bike. Its a little bit tricky atfirst.

The parent may mentioncasually that going slow can

sometimes help or that the childneed not hurry, if the child seemsto be asking for help.

If the childs stuttering persistsfor four to six weeks or more de-spite these efforts on the parentspart, or if the parents are unableto follow these suggestions, thechild should be referred to a



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speech-language pathologist (seelater section on referral).

Treatment of the child withmild stuttering may be indirectand focused on creating anenvironment in which the childfeels fairly relaxed about speak-ing, both at home and in thetreatment setting.

If more direct treatment isneeded, the speech-languagepathologist may show the child

how to produce speech more easi-ly, without increased physicaltension and struggle, so that stut-tering gradually diminishes intosomething more like normalspeech.10,11 Some speech-languagepathologists may choose to trainthe parents to work more directlywith the child.10

Counseling Parents of a Childwith Severe Stuttering

The child with severe stutteringshould be referred immediately toa qualified speech-languagepathologist for an evaluation, fur-ther counseling, and direct treat-ment of the child if appropriate.Because severe stuttering fre-quently seems to develop when achild struggles or becomes afraidof or concerned with speaking inresponse to his milder stuttering,anything that helps the child re-lax and take his or her disfluen-

cies in stride will be of benefit.Parents should model a slowerrate of speaking. They should tryto convey acceptance of the childregardless of the stuttering, bypaying attention to what thechild is saying rather than to thestuttering. The speech-languagepathologist working with the

child might also encourage theparents to nod or comment on thechilds courage for hanging inthere, when the child has a par-

ticularly hard time on a word. Inaddition, the child with severestuttering would probably benefitfrom being able to share his orher frustration with his or herparents. This may be difficult inmany families, and may be besthandled with the help of aspeech-language pathologist ex-perienced with the managementof stuttering.

Professional treatment of severestuttering often consists of help-

ing the child overcome the fear ofstuttering and, at the same time,teaching the child to speak, re-gardless of stuttering, in a slower,more relaxed fashion. In addition,treatment is focused on helpingthe childs family create an atmo-sphere of acceptance of stutteringand conducive to ease in speaking.7,10

As mentioned earlier, somespeech-language pathologistsmay choose to train the parents toprovide some aspects of therapyin the home. The clinician willask the parents to keep carefulrecords of the childs responses totreatment and will closely moni-tor the therapy.7

During a period of a year ormore, the childs stuttering willoften gradually decrease in fre-

quency and duration. In somecases, the child may recover com-pletely. Treatment results dependon the nature of the childsproblem, the presence of otherstrengths, the skills of the thera-pist, and the ability of the familyto provide support.

WHEN TO REFER TO ASPEECH-LANGUAGEPATHOLOGIST

Children with severe stutteringproblems should be referred im-mediately. Children who havemild stuttering problems thathave not shown marked improve-ment within six to eight weeks,depending on the child, should al-so be referred. These childrenshould be given direct treatmentif it is warranted, and theirparents will receive support andguidance, and they will befollowed carefully.

Some children with mild prob-lems may receive direct treat-ment, but it should be carefullyplanned so as not to make thechild feel apprehensive or self-conscious about the problem. AsTable 1 suggests, children withnormal disfluency do not need tobe referred unless the parents are



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so concerned that they need reas-surance about the normalcy oftheir childs speech. They may al-so be followed by the speech clini-cian to provide additional guid-ance if needed.

The speech-language patholo-gist should have a Certificate ofClinical Competence (CCC-SP)from the American Speech-Language-Hearing Association,and should also be licensed by the

state in which he or she practices.Certification requires a mastersdegree from an accredited univer-sity, a national examination, anda year of supervised internship.In addition, the speech-languagepathologist to whom a child is re-ferred for stuttering should be ex-perienced with the disorder.Many hospital and universityspeech and language clinics willhave such persons on their staffor can suggest one. Most school

systems also employ speech-language pathologists. TheStuttering Foundation of Amer-ica provides referrals to qualifiedtherapists in most areas of thecountry. Their toll-free telephonenumber is 800-992-9392, andtheir web site is www.stutter-inghelp.org. They also providebooks and DVDs for parents:Stuttering and Your Child: Help

for Parents, a 30 minute DVD;Stuttering and Your Child:Questions and Answers, a 64 pagebook; If Your Child Stutters: AGuide for Parents, 7th edition, a64 page book; Stuttering: For

Kids By Kids, a 12 minute DVDfor children; and for teenagers DoYou Stutter: A Guide for Teens, allfor a nominal cost.

The charts on the following threepages may be photocopiedand distributed withoutpermission of the publisher.

CONCLUSIONPediatricians, family physi-

cians, and other healthcareproviders are often the first pro-fessionals to whom parents turnfor advice about their childs dis-fluencies.

These professionals can help inthe prevention of stuttering.Early identification of children atrisk for chronic stuttering and ap-propriate referral is critical.

Moreover, effective parent coun-seling can often create an envi-ronment conducive for children tooutgrow their disfluencies.

The authors of this booklet toooften meet severe adult stuttererswhose parents were told Dontworry, hell outgrow it so that theopportunity for therapy when thedisorder is most treatable hasbeen missed. We have repeatedlyfound that when children are re-ferred early, treatment is most ef-

fective, even in cases of severestuttering. Early interventionprevents the development of life-long habits that interfere with so-cial, academic, and occupationalsuccess.

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ings and theories circa 1982. Journal ofSpeech and Hearing Disorders, 48, 226 246.

2. Bloodstein, O. (1995). A Handbook OnStuttering(5th ed.). San Diego, CA: SingularPublishing Group, Inc.

3. Drayna, D. (2004) Results of a Genome-Wide Linkage Scan for Stuttering. InAmerican Journal of Medical Genetics124A:133-135.

4. Felsenfeld, S. (1996). Epidemiology andgenetics of stuttering. Chapter in R. Curleeand G. Siegel (Eds.), Nature and Treatment ofStuttering: New Directions. Boston: Allyn &Bacon.

5. Howie, P. M. (1981). Concordance for stut-tering in monozygotic and dizygotic twin pairs.Journal of Speech and Hearing Research, 24,317 321.

6. Fox, P.T., Ingham, R., Ingham, J.C., Hirsch,T.B., Downs, J.H., Martin, C. et al. (1996).A PET study of the neural systems of stutter-ing. Nature, 382:158-162.

7. Fox, P.T., Ingham, R.J., Ingham, J.C.,

Zamarripa, F., Xiong, J.-H., and Lancaster,J.L. (2000). Brain correlates of stuttering andsyllable production: A PET performance-correlation analysis. Brain, 123:1985-2004.

8. Sommer, M., Koch, M.A., Paulus, W.,Wei ller, C. and Buchel, C. (2002).Disconnection of speech-relevant brain areasin persistent developmental stuttering. Lancet,360: 380-383.

9. Ingham, R.J. (2003). Brain Imaging &Stuttering [Special Issue]. Journal of FluencyDisorders, 28 (4).

10.. Harrison, E. and Onslow, M. (1998), EarlyIntervention for Stuttering: The LidcombeProgram. In R. F. Curlee (Ed.), Stuttering andRelated Disorders of Fluency, (2nd ed.). NY,NY.: Thieme.

11. Pellowski, M., Conture, E., Roos, J.,Adkins, C. & Ask, J. (2000, November).A parent-child group approach to treating stut-tering in young children: treatment outcomedata. Paper presented to Annual Conferenceof American Speech-Language- HearingAssociation, Washington, DC.

12. Starkweather, W., Gottwald, S., andHalfond, M. (1990). Stuttering PreventionA Clinical Method. Englewood Cliffs, N.J.:Prentice-Hall.

13. Yairi, E. (1997). Home environment andparent-child interaction in childhood stuttering.In R. Curlee and G. Siegel, Nature and

Treatment of Stuttering: New Directions.Boston: Allyn & Bacon.

14. Yairi, E. & Ambrose, N. (2005). EarlyChildhood Stuttering: For Clinicians ByClinicians, ProEd, Austin, TX.



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Table1:

PHYSICIANSCHECKLISTFO

RREFERRAL

The

ChildWith

NORMALDISFLUE

NCIES

AgeofOnset:11/2

to7ye

arsofage

The

ChildWith

MILDSTUTTERING

AgeofOnset:11/2

to7yearsofage

The

ChildWith

SEVERESTU

TTERING

AgeofOnset:11/2to7yearsofage

Speechbehavioryou

mayseeorhear:

Occasional(notmorethan

onceinevery10se

ntences),

brief,(typical1/2secondor

shorter)repetitionsofsounds,

syllablesorshortwords,e.g.,

li-li-likethis.

Frequent(3%or

moreof

speech),long(1/2

to1second)

repetitionsofsounds,syllables,

orshortwords,e

.g.,

li-li-li-like

this.

Occasional

prolongations

ofsounds.

Veryfrequen

t(10%

ormoreof

speech),and

oftenverylong

(1secondor

longer)repetitions

ofsounds,sy

llablesorshort

words.

Frequ

entsound

prolongations

andblockages.

Otherbehavioryo

u

mayseeorhear:

Occasionalpauses,

hesitations

inspeechorfillerss

uchas

uh,

er,orum,c

hangingof

wordsorthoughts.

Repetitionsand

prolongations

begintobeasso

ciatedwith

eyelidclosingan

dblinking,

lookingtotheside,andsome

physicaltension

inandaround

thelips.

Similartomildstutterersonly

morefrequen

tandnoticeable;

someriseinpitchofvoice

duringstutter

ing.

Extrasounds

orwordsuse

dasstarters.

Whenproblemsm

ost

noticeable:

Tendstocomeand

gowhen

childis:tired,excite

d,talking

aboutcomplex/new

topics,

askingoranswering

questions

ortalkingtounresponsive

listeners.

Tendstocomea

ndgoin

similarsituations

,butismore

oftenpresenttha

nabsent.

Tendstobepresentinmost

speakingsitu

ations;farmore

consistentan

dnon-fluctuating.

Childreaction:

Noneapparent

Someshowlittle

concern,

somewillbefrustratedand

embarrassed.

Mostareembarrassedand

someareals

ofearfulof

speaking.

Parentreaction:

Nonetoagreatdea

l

Mostconcerned,

butconcern

maybeminimal.

Allhavesom

edegreeof

concern.

Referraldecision:

Referonlyifparents

moderatelytooverly

concerned.

Referifcontinue

sfor6to8

weeksorifparentalconcern

justifiesit.

Referassoonaspossible.

Thischartmaybephoto

copiedanddistributed


www.s

tutteringhelp.org

www.tartamudez.org

T H E S T U T T E R I N G

F O U N D A T I O N



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14

SUGGESTIONS FOR PARENTS OFCHILDREN WHO STUTTER

1. Speak with your child in an unhurriedway, pausing frequently. Wait a fewseconds after your child finishes speakingbefore you begin to speak.

Your own slow, relaxed speech will be farmore effective than any criticism or advicesuch as slow down or try it again slowly.

2. Reduce the number of questions youask your child.

Children speak more freely if they areexpressing their own ideas rather thananswering an adults questions. Instead ofasking questions, simply comment on whatyour child has said, thereby letting him knowyou heard him.

3. Use your facial expressions and otherbody language to convey to your child,when she stutters, that you are listening to thecontent of her message and not to how shestalking.

4. Set aside a few minutes at a regulartime each day when you can give yourundivided attention to your child.

During this time, let the child choose whathe would like to do. Let him direct you inactivities and decide himself whether to talk ornot. When you talk during this special time,use slow, calm, and relaxed speech, withplenty of pauses. This quiet, calm time can bea confidence-builder for younger children,serving to let them know that a parent enjoystheir company. As the child gets older, it canserve as a time when the child feelscomfortable talking about his feelings andexperiences with a parent.

5. Help all members of the family learn totake turns talking and listening.

Children, especially those who stutter, find itmuch easier to talk when there are fewinterruptions and they have the listenersattention.

6. Observe the way you interact with yourchild.

Try to increase those times that give yourchild the message that you are listening to herand she has plenty of time to talk. Try todecrease criticisms, rapid speech patterns,interruptions, and questions..

7. Above all, convey that you accept yourchild as he is.

Your own slower, more relaxed speech andthe things you do to help build his confidenceas a speaker are likely to increase his fluencyand diminish his stuttering. The most powerfulforce, however, will be your support of himwhether he stutters or not.

For more information on stuttering and ways to helpyour child, write or call the nonprofit

Stuttering Foundation of America3100 Walnut Grove Rd. Ste. 603P.O. Box 11749, Memphis, TN 38111-0749(800) 992-9392 www.stutteringhelp.org

The following books are available from them fora nominal cost:

If Your Child Stutters: A Guide for Parents, 7thedition, Publication No. 0011, 64 pages,Stuttering and Your Child: Questions and Answers,3rd edition, Publication No. 0022, 64 pages,Do You Stutter: A Guide for Teens, 4th edition,Publication No. 0021, 72 pages.

The following DVDs are available at www.stutteringhelp.org:Stuttering and Your Child: Help for Parents,

DVD 0073, 30 minutesStuttering: For Kids, By Kids,

DVD 0172, 12 minutesStuttering: Straight Talk for Teens,

DVD 1076, 30 minutes

Please see the Stuttering Foundations catalog at

www.stutteringhelp.org for these and other resources.

This list may be copied and distributed withoutpermission of the publisher provided you acknowledgethe Stuttering Foundation of America as the source.

800-992-9392


THE STUTTERINGFOUNDATION




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15

TABLE 2. QUESTIONS THAT MIGHTBE ASKED OF PARENTS

Note: These questions are listed in order of the seriousness of the problem. If a parent answersyes to any question other than number 1, it suggests the possibility of stuttering rather thannormal disfluency.

1. Does the child repeat parts of words rather than whole words or entire phrases?(For example, a-a-a-apple)

2. Does the child repeat sounds more than once every 8 to 10 sentences?

3. Does the child have more than two repetitions? (a-a-a-a-apple instead of a-a-apple)

4. Does the child seem frustrated or embarrassed when he has trouble with a word?

5. Has the child been stuttering more than six months?

6. Does the child raise the pitch of his voice, blink his eyes, look to the side, or showphysical tension in his face when he stutters?

7. Does the child use extra words or sounds like uh or um or well to get a wordstarted?

8. Does the child sometimes get stuck so badly that no sound at all comes out forseveral seconds when hes trying to talk?

9. Does the child sometimes use extra body movements, like tapping his finger, to getsounds out?

10. Does the child avoid talking or use substitute words or quit talking in the middleof a sentence because he might stutter?

800-992-9392


THE STUTTERING FOUNDATION



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16

The Stuttering Foundation of America is a

tax-exempt organization under section

501(c)(3) of the Internal Revenue Code

and is classified as a private operating

foundation as defined in section 4942(j)(3).

Charitable contributions and bequests

to the Foundation are tax-deductible,

subject to limitations under the Code.

A Nonprofit OrganizationSince 1947Helping Those Who Stutter

3100 Walnut Grove Road, Suite 603P.O. Box 11749 Memphis, TN 38111-0749

800-992-9392 [email protected]

THE

STUTTERINGFOUNDATION

If you wish to help this worthwhile

cause, please send a donation to




18/18

STUTTERINGFOUNDATION

ISBN 0-933388-47-0

1-800-992-9392

www.stutteringhelp.org

www.tartamudez.org

THE

3100 Walnut Grove, Suite 603Memphis, Tennessee 38111-0749

A Nonprofit OrganizationSince 1947 Helping Those Who Stutter

ISBN 0-933388-47-0

7 8 0 9 3 3 3 8 8 4 7 5

The Child Who Stutters to the Pediatrician

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Transcript of The Child Who Stutters to the Pediatrician