Getting the Word Out

How to help children who stutter

Health column, December 2001

Sometimes it’s the sounds you don’t hear that break your heart.

“M-m-m-m-m-m-m-m…” stuttered two-year-old Max, as his father tried to dress him for bed. In another room of the house, his mother heard him and knew he was stuck, though this instance was the worst she’d heard. “He was really tired, and Daddy wasn’t going to do,” remembers Cindy Harasen, a Thunder Bay, Ontario, mother who had recently had another baby. “He was trying to say ‘Mommy do, Mommy do.’ But it was ‘M-m-m-m-m,’ over and over.”

If you’ve heard your child stumble or get stuck on a word, you know how it feels. It’s the polar opposite of that moment of elation when she utters her first “Dada.” It jangles in your ears, it pulls at your heartstrings. And if the stumbling persists, it’s not long before you get that sinking feeling and wonder whether it’s more than a developmental blip.

It’s reassuring to know that a speech bump — speech-language specialists also call it “disfluency”— is a normal part of speaking. For young children learning to talk, disfluency is even more common. As they work on the puzzle of language, sometimes it’s difficult to deal with so many pieces at the same time.

According to Hamilton, Ontario, speech-language pathologist Carla Di Domenicantonio, kids’ speech can stumble over the following and still be considered normal:

  • pauses;
  • interjections (um, like, you know);
  • revision of phrases or sentences (“the baby, the baby ate the soup,” or “the baby eated, the baby ate the soup”);
  • word and phrase repetition (“Can, can I,” or “Can I, can I”) — as long as there are only two repetitions, and no accompanying frustration.

Although the dividing line between what’s typical and what’s stuttering (frequent and persistent periods of disfluency) isn’t always clear, experts use a few guiding principles. Certain types of disfluency suggest a more serious problem:

  • more than two short-unit or whole-word repetitions (s-s-s-s-song, ba-ba-ba-ba-ball, but-but-but-but);
  • prolongation of sounds (“liiiiike”);
  • blocks, in which the child is completely stuck and can’t get the word out at all;
  • avoidance or delay in saying certain words or sounds.
  • Duration — longer than six months — is another red flag. Increased tension, leading to a rise in pitch, loudness or facial grimacing, can go hand in hand with episodes of more serious disfluency, says Di Domenicantonio. “The child is having to work at getting the words out,” she explains. Any obvious stress associated with speaking — crying, facial contortions, a look of panic or fear — signals a more serious problem that needs professional attention.

Kids who stutter usually show first signs of it between the ages of two and five. Though it affects roughly one percent of the general population, Deborah Kully, executive director at the Institute for Stuttering Treatment and Research (ISTAR) in Edmonton, believes that its incidence is higher among children. Boys are four times more likely to stutter.

For five-year-old Erin McLaughlin, stuttering is especially frustrating when she’s with her friends. Her mother, Chris, watches Erin’s pals ask for a toy easily, while her daughter sometimes struggles. “It takes her a lot longer. The other kids get frustrated too, and they’ve gone off [before she finishes],” reports McLaughlin, who recently got speech help for Erin. “She’s still standing there saying, ‘Uh Rachel, uh Rachel, uh Rachel.’” One time, the Burlington, Ontario, mother remembers Erin giving up and dissolving into tears.

Other children don’t seem to notice speech bumps at all. My son, who stuttered for nearly two years starting at age two, seemed oblivious to the word repetitions that characterized his speech when he was excited. For Liam, excitement was such a predictable cause that I was able to produce the stutter on demand for the speech-language pathologist at his assessment. All I had to do was ask him to talk about his favourite toy.

Liam’s stutter wasn’t always predictable, however, and keeping a diary helped me note when it seemed worse. Kully recommends that parents concerned about their child’s speech keep such a record. “Then they can modify those factors as much as they are able to. For instance, if it’s fatigue that’s contributing, they can make sure the child has more rest.”

Di Domenicantonio and Kully both stress that variance is a hallmark of stuttering: it does come and go. “Sometimes parents get fooled by that,” says Di Domenicantonio. “They think it’s gone only to find that it’s back three months later with a vengeance.”

That’s why, says Kully, the wait-and-see approach may not make the most sense. In some cases, the stutter actually goes underground. “Sometimes prolongations or blocks or go undetected,” she says. “Parents notice the repetitions but not the other behaviours. And yet it’s those blocks and prolongations that show the problem is actually advancing further.”

Kids do, of course, spontaneously outgrow stuttering. If you’ve ever asked friends or relatives about their child’s stutter, you’ve probably heard, “Oh, Tracey stuttered, but she outgrew it.” Kully reports that the percentage of kids who outgrow stuttering without assistance is anywhere from 50 to 80 percent, a wide range because it’s difficult to keep track of cases that aren’t treated. “The problem is, you can’t predict which child will outgrow it and which child won’t,” she cautions.

Treating a preschooler who stutters is preferable to waiting until she is school-aged for two reasons. First, speech-language development is intense during these years; it’s easier to correct a new problem than one that’s become entrenched. Second, Canada’s health system gives priority to preschool speech and language problems, perhaps because of reason one. “Children under five are seen in the hospital setting, and school-aged children are seen in the school setting, where there is sometimes a long waiting list,” says Di Domenicantonio.

Although the word “treatment” may conjure up stark images for parents, Kully assures parents that a speech-language pathologist trained in childhood stuttering makes speech-smoothing a positive experience. “It’s done in a gradual way to ensure the child is responding positively and having lots of successful experiences,” she reports. “It’s really about creating the conditions that build further on the fluency the child already has.”

Many programs, such as the one Liam attended at the Hospital for Sick Children in Toronto, begin with the parents, who are taught how to work with their child in daily sessions at home. (We spent several five- to ten-minute periods one-on-one with Liam, during which we’d saying words more slowly and increase the number of pauses between sentences. Speech therapists believe that slower speech helps reduce the demands on a stuttering child.) Treatment in the hospital is available if the problem persists.

As Liam approached his fifth birthday, the stuttering we thought was gone returned, probably in response to a new stress: a change in daycare. We headed back to Sick Kids’ and were relieved to find that the stutter was still mild. Still, the speech-language pathologist encouraged us to resume our slow-talking sessions and diary keeping.

As for what causes stuttering, the answer is still largely unknown. Kully says it’s thought to involve a number of factors — genetic, physiological, environmental and personal — interacting together. “Parents should know that they don’t cause stuttering,” she says, “but there are things they can do to help it.”

McLauglin agrees. “You’ve got to listen, you’ve got to be patient,” she muses. “What they’re saying is important.”

Sidebar

Do’s and Don’ts
Speech-language pathologists are careful to point out that parents don’t cause stuttering, yet you can create conditions to help your child’s speech come more easily.

Do:

  • Slow down. Decrease your own rate of speech to help your child relax, and pause after your child finishes a sentence to create a little breathing space.
  • Set aside one-on-one time every day (15 minutes or so) in which your child has your undivided attention and lots of room to talk.
  • Arrange to spend more time together when your child isn’t having difficulty speaking. (Keep a diary to find out when those times are.) Times of fluency build confidence.
  • Encourage taking turns talking around the kitchen table (especially if there are other kids in the family).
  • Be sympathetic if your child expresses frustration, but don’t make a big deal about it. Offer comments such as, “I get stuck, too” or “Yes, sometimes words are hard.”

Don’t:

  • Say “slow down,” “take your time,” or “think about what you’re trying to say.” All of these add pressure to an already tense situation.
  • Interrupt or finish a word or sentence for a child who’s stuck.
  • Pepper your child with questions (How was nursery school? What did you do? Who was there?) or otherwise put your child in a command-performance situation (Tell Daddy what you did today, sing that song for Grandma). Some kids tend to stutter more in these situations.

Sidebar 2: When to get help

Deborah Kully, executive director at the Institute for Stuttering Treatment and Research in Edmonton, recommends that parents seek professional help if:

  • stuttering has persisted for longer than six months;
  • your child is showing distress while trying to speak;
  • you are distressed about your child’s speech and would like guidance.

Resources:
Canadian Association of People Who Stutter
1-888-STUTTER (1-888-788-8837)

Stuttering Foundation of America
1-800-992-9392

Stuttering and Your Child: Questions and Answers, Richard F Curlee et al. If Your Child Stutters: A Guide for Parents, Stanley Ainsworth et al. Institute for Stuttering Treatment and Research (ISTAR)
(780) 492-2619