Information for Families: Stuttering - What can be done about it?
A family affair
The realisation that a child is struggling to speak fluently is an alarming and unexpected experience for many parents. But for parents who remember stuttering themselves as children (and those for whom the problem persists) recognising that their own child is stuttering is something that they have probably anticipated having to deal with one day. Similarly, parents with older children who stutter probably get that awful "here we go again" feeling when their toddler or preschooler starts to be dysfluent.
People who stutter, and who are well-informed about the problem, are aware that stuttering tends to run in families.
What they may not know is that many of the 'stuttering myths' that prevailed in earlier times have been exposed, through international scientific research, as so much superstition and folklore. Nowadays there is a range of successful treatments available for children who stutter. Most of these treatments were unavailable to their parents.
If you are the parent of a child who stutters, you will be relieved to know that it is a speech problem, and not an emotional or psychological one. And you will also be reassured to know that stuttering can be treated successfully by Speech-Language Pathologists / Speech and Language Therapists (SLPs/SLTs).
What are the characteristics of stuttering?
Stuttering (called 'stammering' in the UK and parts of the US) disrupts the fluency of speech. Hence, "stutters" are often referred to as "dysfluencies" or "nonfluencies". They may be in the form of prolongations, blocks or repetitions. One or any combination of these features may be present, consistently or variably.
Prolongations do not occur in the speech of all little children who stutter. When they do, a vowel or a consonant, somewhere in a word, is lengthened, for example:
"Aaaaaaask her if I can come."
"Pu-------put it back!"
"Is that y------yours?"
Blocks are periods of silence or silent struggle, and are common in young children who stutter. The child seems unable to make a sound, attempting to force words out, with her mouth open, or her lips firmly closed. Her speech mechanism appears to be "blocked":
"Do my b----utton up."
"R---ub it out."
Repetitions are the most common feature of stuttering, and may include repetitions of vowels, consonants, syllables, words or phrases.
"B-b-b-b-but not now."
"B-u-u-u-u-ut not now."
"Bu-bu-bu-bu-but not now."
"But-but-but-but but not now."
"But not - but not - but not - but not now."
Some children are unaware that they are stuttering, but others, probably most, are very aware. They may become exasperated or upset and say things like:
"My words won't come out."
"I can't say it."
"I can't talk properly."
Some get frustrated and angry, and others refuse to talk, or limit the talking they will do, especially outside of home.
If I ignore the stuttering, will it go away?
Not so very long ago it was believed that stuttering was "psychological". It was commonly thought that if parents noticed that their child was stuttering and commented on it, the stutter was there to stay.
This was called the "diagnosogenic theory" and its powerful legacy remains. Parents are still advised (but not by SLTs/SLPs), in many instances, against dealing directly with stuttering.
The diagnosogenic school said that if you drew attention to the stutter it would not only make it worse, but also make it "stick". Modern research demonstrates how wrong this viewpoint is!
Pretending to ignore the stutter (supposedly, to make it go away) or pretending that stuttering is a normal phase in speech and language development is completely the wrong thing to do, and may leave the child confused and wondering why her struggle to speak fluently is an unmentionable subject.
Parents do not cause stuttering
Stuttering has a strong genetic link. Children who stutter are likely to have inherited their "stuttering potential" or "stuttering predisposition" from their mother, father, grandmother or grandfather, with 50 to 75 per cent of people who stutter having at least one relative who also stutters (or stuttered).
Treatment during childhood is preferable
Stuttering in children is more amenable to treatment than stuttering in adults.
Early intervention is best
University studies show that early intervention, as soon as parents are concerned about their child's fluency, is highly desirable.
Stuttering should not be ignored
"Ignore it and it will go away" is bad advice.
Stuttering usually starts, if it is going to, when children are two or three years old, with four boys for every girl affected. It might suddenly appear one day, or it might develop gradually over days or weeks.
It usually fluctuates, and the child has good days and bad days (even including completely stutter-free days). Parents often report that their child's stutter is worse when the child is tired or out of sorts.
Stuttering has a strong tendency to "remit" - that is, it may get better on its own. Unfortunately, we cannot yet tell which children have stutters that will resolve without treatment. This means that if another child in your family grew out of stuttering, the next child in the family to stutter may or may not follow the same developmental pathway. There is never any guarantee that children will grow out of it.
A number of well-researched, scientifically valid approaches to treating childhood stuttering exist, and none of them stands out as being "the best". The following information is about one highly respected approach: the Lidcombe Program.
The Lidcombe Program
Thanks to Professor Mark Onslow for help with this section.
The Lidcombe Program, first developed in Sydney in the 1980s, and now being used and further evaluated throughout the English-speaking world, has proved most successful with preschoolers, though it has been applied effectively with some school-aged children too.
There is extensive information about the Lidcombe Program on the University of Sydney's ASRC (Lidcombe Program) website.
What happens in treatment?
The Lidcombe treatment, or adaptations of it, is readily available from speech pathologists throughout Australia and around the world.
- The therapy focuses directly on the child's speech.
- Parents become actively involved in therapy.
- Parents learn methods of recognising stutters, measuring the severity of moments of stuttering, praising stutter-free speech, gently requesting that the child self-correct stuttered utterances, and providing support for the child.
- During regular once-weekly consultations, the speech pathologist guides the parents and child through a therapy process that is comparatively short-term, and usually effective.
According to the Lidcombe researchers, the advantages of the program are:
- That it is administered by parents, at home, where young children do most of their talking.
- It is cost-effective; and, once children have become fluent in the program, they stay fluent, provided an appropriate maintenance program is completed.
The Lidcombe team also stresses that the program must be conducted under a speech-language pathologist's supervision.
Individual Assessment Is Necessary
Not every child who stutters will be a candidate for the Lidcombe Program. It has been developed (and evaluated) specifically for children under six years of age. A speech-language pathologist / speech and language therapist will assess your child's speech and his or her suitability for this approach, or for another approach to fluency control.