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Stuttering

stutter; stammer; talk; talking; speech; speak; fluent; fluency ;

Stuttering is a problem with the rhythm of speech (fluency) where the person knows exactly what he or she wants to say, but is unable to say it because of involuntary (they cannot control it) repeating of sounds or stopping of sounds. It is fairly common; about 5% of all children stutter at some time in their life and stuttering will last into adult life in about 1% of people. It happens less often as people get older but it can continue into adult life. There are about 3 times more boys and men who stutter than girls and women.

Contents


What causes stuttering?

  • The cause of stuttering is not clear, but at least some of the reason is genetic.
    • Children whose mother or father stutter or stuttered are much more likely to stutter than other children.
    • Children who have a sister or brother who stutters are also more likely to stutter.
  • Brain damage around the time of birth is the only known environmental factor which makes it more likely that a child will stutter, but most children who stutter have not had this brain damage, and most who have this brain damage do not stutter.
  • Deafness is the only known factor that makes it less likely someone will stutter.
  • Stuttering occurs in all communities and in all languages, and also in all historical groups.

Because these factors are present (eg, running in families, occurring in all language groups), it is clear that there is some physical reason involved. Parents do not cause their children to stutter.

What is happening when someone stutters?

  • When someone is stuttering there is a subtle (very small) neurophysical (brain/nerve/muscle) dysfunction (it does not work normally).
  • People who stutter have difficulty coordinating airflow, articulation and resonance (articulation and resonance are how they move the small muscles in the mouth to shape the sounds and control how loud they are).
  • Many people who stutter are able to speak more fluently in some situations (perhaps at home), and less fluently when they are anxious or tired.
  • Feeling stressed, perhaps because they have to speak in front of the class, can make it harder to speak fluently, which increases the stress. Talking on the phone can be very hard.
  • Even though stress can make it harder to talk fluently, stress does not cause stuttering.

People almost never stutter when singing, whispering, speaking in unison with other people or when they cannot hear their own voice.

Recognising stuttering

Most children who stutter will start to have speech that is not fluent between the ages of 2 and 5 years, but almost all children will have some time when they repeat sounds, words and do not talk fluently (normal dysfluency).

Having other people in the family who stutter makes it more likely that this is the sort of stuttering which will persist.

The pattern of stuttering is:

  • repeating parts of words, such as the first consonant of a word (eg t-t-t-table)
  • prolonging the sound of the beginning of the word (ssssun)
  • having silences before words, in words or after the word
  • the 'break' almost always happening at the beginning of a sentence or near the beginning.

A child with 'normal dysfluency' (also called 'developmental stuttering'):

  • often repeats whole words or phrases (I-I-I-want to want to go out and play)
  • usually does not repeat the part of a word more than 1 or 2 times
  • keeps speech going after it has been started.

Other movements and behaviours can happen, such as having tense muscles in the lips, jaw and neck, tremor of the lips, jaw and tongue during attempts to talk, blinking and head turning.

Other findings

  • Children and adults who stutter know what word or words they are trying to say (it is not because they are trying to find the right word).
  • They do not have trouble hearing or listening.
  • People talking to them do not have to slow down their own speech.
  • There is some disagreement about whether people who stutter have the same or lower 'intelligence' compared to other people. Most research suggests there is not a difference.
  • Some children who stutter may have similar fine motor control problems with other muscle groups and may be a bit clumsier than some other children.
  • Children who stutter have been said to have trouble with 'social adjustment' (making friends, feeling confident in groups, etc). This would have to be caused by the stuttering, not a cause of stuttering.

Children who stutter need to have their own skills assessed individually, without assumptions that they are 'clumsy',  'less intelligent' or 'lack social skills' being made.

The impact of stuttering on daily life

The impact of stuttering varies.

  • Some people with mild stuttering can be very frustrated and anxious, while other children with more severe stuttering may be less distressed.
  • Stuttering interferes with communication as soon as stuttering starts.
  • School-aged children report embarrassment about stuttering when they answer a question or read aloud.
  • Children often try to avoid speaking, making it even harder when they have to speak.
  • Stuttering can restrict work opportunities for adults.

Assessment

  • Children who have speech that is not fluent should be assessed when they are young.
  • Developmental stuttering only lasts for a short time.
  • Seek advice immediately if a child is stuttering.
  • Other reasons for having a speech pathology assessment include stuttering much of the time, showing tension or struggling when trying to talk, avoiding speaking, or family history.
  • If a parent is concerned, the child is becoming anxious and distressed, or there are many 'breaks', the child needs an assessment.
  • Note: some organisations recommend later times for assessment, such as 12 months after stuttering starts, or when a child is 5 or older. However, most research strongly emphasises that therapy works best when it is started early.

There are often long waiting lists for speech pathology assessment, so get onto the waiting list early. Then, if the problem has gone away, cancel the appointment (please give a week or more notice, so that someone else can have the session time).

Some speech therapists will be able to talk to parents of young children on the phone and send out information as soon as the child's name goes onto the waiting list. If the parents are able to use the information the stuttering may be gone by the time of the appointment.

Therapy

  • Speech pathologists work in many settings including community health centres, hospitals and private practice. Check with your local community health centre or in the telephone book ('Speech Pathologists').
  • While some children will recover from stuttering naturally, it is not possible to work out which children will recover without therapy.
  • Starting therapy early seems very important for future fluent speech.
  • Early therapy, even if the stuttering is 'mild', can make a difference, and probably means therapy can be for a much shorter time.
  • There are several different treatment methods that can make a difference. Some work better for young children, and others are recommended for adolescents and adults.
  • The 'Lidcombe' approach is used by most therapists in Australia for young children. Pre-school and child care staff often know the program and are able to continue working with the child.
  • Parents are asked to let the child know when they are pleased that the child has been speaking fluently, notice some 'bumpiness' and suggest the child slow down, relax and try again. It is a behaviour change program. (There is more about the Lidcombe program and other programs in the references below.)
  • Adult-oriented programs include prolonged speech, precision fluency shaping, rhythmic speech, biofeedback and attitude change.

What parents can do

  • Arrange for your child to be assessed by a speech pathologist if you have concerns, especially if others in the family also stuttered.
  • For several of the ways of assisting a child who stutters, a parent will be 'trained' by a speech pathologist about how to do this at home, and this can include saying things like 'slow down', 'relax', 'bumpy', 'try again', 'slowly'.
  • Listen very patiently and show that you are listening and that you will listen until the child has been able to say what he or she wants to say. Make good eye contact.
  • Don't interrupt or say the words you think they were trying to say. You may not say the correct words, and they will become even more frustrated.
  • Do not talk more slowly or with an exaggerated voice - they can hear and understand well.
  • If you have tried hard, but not understood, say something like 'sorry, I did not understand that'. Don't pretend to understand when you did not.
  • Make sure that your child is not being teased or bullied because he or she stutters, especially by other people in your family or at school.
  • Ask your speech therapist about how to help your child talk in front of others (such as in class), then share this with the teacher.
  • If others in your family have 'good stories' about how they 'beat' stuttering, ask them to share this with your child. Knowing that someone else has been successful can help children, especially if they are having difficult times. Be certain that the child does not get told all the 'bad' stories, especially when he or she is young.
  • Become well informed!

Resources and references

The Australian Stuttering Research Centre, at the University of Sydney 
http://sydney.edu.au/health_sciences/asrc/
Information about several different therapy programs such as the Lidcombe Program and the Camperdown Program are also on this site.

American Speech, Language, Hearing Association, (ASHA) 'Stuttering'
http://www.asha.org/public/speech/disorders/stuttering.htm

Australian Speak Easy Association (a self help organization)
http://www.speakeasy.org.au

DeLisle DM 'Stuttering' in Garfunkel, Kaczorowski, Christy 'Pediatric Clinical Advisor' Mosby 2007

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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