The Child Who Stutters: Parent's Guide

The following Parents' Guide was written by Julie Mazzuca-Peter, a Speech-Language Pathologist for the Metropolitan Separate School Board, and published in 1989 as one of a series of guides for the Special Programs Department in Toronto, Ontaria, CA. A hard copy is available at cost by contacting Susan Menary at menarys@mssb.edu.on.ca. The entire guide is reproduced below with the permission of the author and the Catholic School Boards.

THE CHILD WHO STUTTERS - PARENTS' GUIDE

INTRODUCTION

Stuttering is an age old problem. As long as people have been talking some have been afflicted with this disorder. Throughout history, a number of famous people including, Moses, St. Paul, Sir Isaac Newton, Winston Churchill, king George VI and country and western singer Mel Tillis stuttered. Stuttering does not seem to have interfered with the accomplishments of these individuals. There are more than fifteen million stutterers in the world today, and the majority are children.

Children who stutter present puzzling problems to parents and teachers. Parents wonder what can be causing the breaks in fluency. They wonder too, why the difficulty varies so much. On some days, and sometimes for weeks, little or no trouble is apparent. Then, suddenly, the speech of some youngsters is filled with long series of repeated words or syllables, noticeable facial contortions or even more unusual evidences of strain and effort. They are unable to understand why a child at times becomes shy and may even refuse to talk to some individuals while with others he converses freely. And, occasionally, parents understandably are puzzled by the report of a teacher that their child, seldom if ever observed having trouble at home, has a stuttering problem in school.

A child who stutters should be assessed by a registered Speech-Language Pathologist either at school, in a local hospital or health centre, or at a private practitioner's office. These professionals are qualified to manage stuttering in children and adults. They can help the child deal with his stuttering and assist teachers, parents and all those involved with the child to understand and deal most effectively with the problem.

This booklet is written especially for the parents and caregivers of the child who stutters. Parents can do a great deal to help the child who stutters. Unfortunately, they can also contribute to the problem if they do not learn about the nature of stuttering and effective management techniques. Before trying to help your child, it is important to learn as much as you can about stuttering - to be forewarned about common superstitions, to learn how speech develops normally, and to learn about how true stuttering develops. You should become aware of the types of conditions in the home, school and/or neighbourhood that promote stuttering, and understand the types of conditions in your child's environment that promote fluent speech. With this kind of information in hand, parents and care-givers can make a more informed decision about the kind of corrective measures they should use and most importantly, the kind of attitude they should develop toward their child and his speech problem.

Further information on stuttering and treatment options for the child who stutters can be obtained from the school's Speech-Language Pathologist by contacting the Metropolitan Separate School Board, Speech and Language Department, at 222-8282, ext. 2261.

FACTS ABOUT STUTTERING

Stuttering (or stammering) is defined as any disturbance in the flow and time patterning of speech. These disturbances may include one or more of the following behaviours:

audible or silent blocking
part or whole-word repetitions (e.g. pa-pa-paper)
phrase repetitions (e.g. what is-what is- your name?)
sound prolongations (e.g. f-f-f-flower)
broken words (e.g. ha-ppy)
interjections (e.g. um, uh, like, you know)
words produced with too much tension
circumlocutions (i.e. talking around a certain idea)
any form of struggling behaviour associated with speech production

Stuttering can be viewed as a developmental problem that often begins during the early years of speech and language development (2-7 yrs.). Onset is often subtle and most stutterers are first identified during their preschool or primary school years.

Occasionally, stuttering arises in an older child or even an adult. It may follow an illness or an emotional event. It may also occur following brain injury due to stroke or a head injury, however, these instances are rare. For the majority of children, the cause of stuttering is not known.

Although stuttering can begin quite suddenly, it usually develops over a period of time and it follows an unpredictable pattern. The child's speech difficulties can disappear for weeks or months only to return in full force.

All stutterers can speak fluently some of the time. Most can also whisper smoothly, speak in unison and sing with no hesitation. Most stutterers can also speak easily when they are prevented from hearing their own voices, when talking to pets or small children, and when addressing themselves in front of a mirror. All these instances of fluency suggest that nothing is basically wrong with the stutterer's speech machinery.

Stutterers generally experience their worst moments under conditions of stress or emotional tension. Situations that are generally associated with increased stuttering include speaking in front of a group, answering questions in class, and speaking on the telephone.

Stuttering does not occur equally among the sexes. Boys are four times as likely as girls to be stutterers. The reason for this is not known. Hereditary factors play some role in stuttering even though genetic transmission from one generation to another has not been proven. Stuttering has been found to run in families and children with a first degree relative who is either an active or recovered stutterer have a slightly greater likelihood of stuttering than the normal population. Nonetheless, environmental influences also play an important role in some if not all onsets of stuttering.

Stuttering does not come from imitating other stutterers. Although children often imitate differences they notice, imitation alone does not cause stuttering. If a family member or friend stutters, a child may - for a time - imitate the unusual speech pattern. In time the child will stop imitating the stutter and her speech will again become fluent as long as no one displays anxiety or discomfort or draws attention to it. If others become anxious for fear that the child will become a stutterer, the child may also become anxious and self-conscious about her own speech. True stuttering might then result - not because of imitation - but because of the anxiety and tension around communication created between the child and family members.

The intelligence of stutterers is in no way inferior to that of non-stutterers.

Emotional problems do not cause stuttering; however, stuttering may cause emotional problems.

It is estimated that 3-4% of preschool children and 1-2% of school-aged children stutter. Of these, approximately one half will outgrow their stuttering by early adulthood.

Unfortunately, it is not possible to determine who will recover and who will continue to stutter into adulthood, therefore, it is recommended that all children who stutter be assessed by a Speech-Language Pathologist. In Ontario, Speech-Language Pathologists should be registered by the provincial organization O.S.L.A. (Ontario Association of Speech-Language Pathologists and Audiologists). These professionals are employed by the Metropolitan Separate School Board. They also work in hospitals, public health and community programs and in private practice.

NORMAL DYSFLUENCY

What parents call stuttering is sometimes normal nonfluency. A young child who repeats a s-s-s-sound or syl-syl-syllable or a word like-like-like this is not necessarily a stutterer. The repeating, pausing, backing up, holding on to sounds and general confusion of "thinking and talking" are very normal. During their preschool years, children have new experiences they want to tell you about without knowing how to put enough words together to express themselves smoothly. Although some or all of the characteristics of stuttering may be present, this is not true stuttering.

Normal nonfluency is considered to be a normal stage in speech and language development which eventually disappears if handled wisely. It is often thought to be a "true" stuttering problem by parents, family doctors and teachers. A Speech-Language Pathologist can differentiate between normal nonfluency and true stuttering and make appropriate recommendations.

The following suggestions are positive ways to react to a child's normal nonfluencies in order to reduce communication stress during this phase of his speech and language development.

Keep in mind that approximately 85% of children show hesitations and repetitions at times when talking. Don't over-react!

Pay attention to your child when he talks to you. Let him know you're listening. Give him your time and attention if he has something urgent to say. Remember that your child wants to share his feelings, experiences and ideas with you. Let him know that you are interested and don't rush him.

Don't demand speech if your child is crying, injured or obviously upset. These situations will almost always disrupt fluency.

Don't put your child on exhibition for relatives and friends by having him recite stories or little jingles and don't coax him to say "hello" or "say good-bye to the nice lady".

Keep your own speech slow and deliberate when talking to your child. Let him hear talking that is easy to copy.

When your child is having a particularly difficult day, keep your own speech concise and simple in style and vocabulary so that he will hear a speaking pattern that is easier to copy. Don't interrupt your child or complete her sentences. All she wants is an attentive listener and she should not have to worry whether she will be allowed to finish without interruption.

Don't make suggestions to your child about talking in a better way. Comments like: "slow down", "think about what you are going to say", "stop and take a deep breath", "count to ten", or "start over" should be eliminated completely. This type of advice only calls attention to the false idea that something is wrong with the way she talks. Your child may begin to think that her speech is not good enough to please you and this uncertainty and anxiety around talking may contribute to a true stuttering problem.

Keep your child from failing whenever possible. Encourage her to play games and do things that she does well.

If your child becomes frustrated and complains that "I can't say that word" or "I can't talk right", then reassure her by explaining how some words give everyone trouble. Convince your child that even adults have trouble talking sometimes as indeed they do.

If your child becomes startled by words she has said nonfluently, calmly try to reuse the words in a natural, easy manner and state what your child is trying to say. For example, if your child says "Billy broke my t-t-t-toy", you might say, "Did he break your toy? Where is it? Let's go see how it is, maybe we can fix your toy".

Take advantage of the days and weeks when your child is much more fluent by increasing the opportunities for her to talk. Decrease her need to talk on days when she is more nonfluent than usual. Try to casually accept the nonfluencies, then change the subject or shift your child's attention elsewhere.

Tell others not to joke or imitate your child's nonfluent speech. This includes brothers, sisters, friends, relatives and baby-sitters. Be very frank about how you want others to react to her nonfluency.

Never discuss your child's nonfluency when she can overhear you. There is no need for your child to assume that the way she talks is a general topic for alarm.

Changing a child's preferred handedness will not cause stuttering. However, your insistence in trying to make a change may create emotional problems which will likely affect her speech negatively.

POSSIBLE CAUSES OF STUTTERING

It is impossible to identify any single factor as the cause of stuttering. In fact, it is felt that the difficulties in talking from which a severe stuttering problem can develop are caused by several conditions or circumstances. Depending on their individual personalities, children cope with these obstacles to their normal speech development with different degrees of success.

Although stuttering sometimes begins quite suddenly, it usually develops over a period of time. The usual onset is between the ages of two and seven - ages at which all children hesitate and repeat in their speech, even as adults do.

In homes and classrooms where no concern is shown about these repetitions, the likelihood is that the child's speech will develop normally. If unusual attention is given to these natural nonfluencies, the child may also become concerned about his speech and stumble over sounds and words even more. This in turn increases the parents' and teacher's anxiety, and a vicious cycle is begun.

Even though a certain amount of hesitation and repetition is normal in children's speech, some experts believe that this normal dysfluency may be aggravated by fear, unattainable standards of performance, and emotional pressures.

Some children are expected to perform on a level above their ability. Perhaps it is from the desire to acquire adult speech, to talk in phrases and sentences before the skill of talking has had time to mature, that most stuttering starts. Fluent speech is very important in our society and the struggle to obtain fluency may be too great for some children in an environment complicated by radio, television, busy parents, talkative brothers and sisters, and the new experience of school.

A home environment may be disturbing to the normal development of speech in other ways. Homes in which parents quarrel and living is a constant battle, or homes in which discipline is too strict, too lax, or inconsistent are homes which make for basic insecurity that may well be reflected in the child's speech.

Because of their particular personalities, some children are less able to handle the ordinary problems associated with growing up. For them, hesitant nonfluent speech may be the result of their trying too hard to be perfect. Such children may feel the pressure from within themselves rather than from their environment.

Stuttering is a complex problem. Despite extensive research in this area, a definitive cause of stuttering has not been identified.

SITUATIONS WHICH PROMOTE DYSFLUENCY

There are certain pressures which tend to make all of us more dysfluent and your child may be especially vulnerable to them. The following list includes a number of these. Elimination or reduction of these pressures may minimize the occurrence of dysfluent episodes in your child's speech and increase the likelihood of fluency.

Listener Loss: When a child loses audience attention, she will often keep repeating a word until she is being listened to again. Therefore, when your child is talking, listen carefully to what she is saying.
Interruptions: We all feel annoyed and frustrated when we are interrupted before we have finished what we are saying. To reduce this pressure, as far as possible, allow your child to finish what she has to say without being interrupted.
Competition: Many people become more dysfluent when they have to compete for speaking time. Don't let the most vocal family member do all the talking; give everyone a chance to speak.
Time Pressure:People tend to become more and more dysfluent as they have to talk increasingly faster. Therefore, when possible, try to avoid making the child feel hurried. Arrange your schedule so that you are not rushing your child from one activity to another. Try to keep your own speech as calm and unhurried as you can. Your child needs a good speech model.
Display Speech: Most people become nervous when asked to speak before an audience. Don't urge your child to recite or say big words to demonstrate her verbal ability to your friends or relatives. If given time to become used to them, she may be willing to talk to them about topics of interest.
Demand Speech: Sudden, unexpected questions often cause individuals to hesitate or falter in their speech. Avoid asking your child unnecessary questions such as: "Why did you get your shoes muddy?", "Just what do you think you're doing?" etc. Also, avoid asking your child to report an unpleasant experience or to confess a wrong-doing of which you are already aware.
Natural Emotions: Fear, anger, grief, humiliation and frustration can cause speech disruption. When possible, don't encourage your child to talk while experiencing these emotions. You can show that you understand by verbalizing your child's feelings for him/her (e.g. "That loud noise scared you.", "You were angry when you couldn't keep that toy." etc.). This will minimize the disruptive influence of these natural emotions on your child's speech.
Excitement: A child's speech is more broken when she is excited or overwrought. Therefore, try to limit unnecessary over-stimulation such as tickling, teasing and wrestling. A calm living environment helps a young child in adjusting to a demanding and complex world.

The following is a list of practical suggestions to help parents and care-givers manage a child's stuttering. These have been shown to minimize the occurrence of dysfluent episodes in other children's speech. Some have already been mentioned in previous sections of this booklet, however they are worth re-iterating because although easy to learn, these corrective measures are not easy to carry out. They demand real effort, understanding, persistence, and patience over a long period of time. These measures may even require serious consideration of your family's lifestyle and the ways that you relate to one another.

Help your child in every way possible to feel that he is a normal and adequate person.
Be ready to make reasonable changes in the environment to facilitate verbal communication. Your child cannot make these changes alone.
Be a good listener.

Look at your child when he is talking to you.

Show interest in what your child is saying not how he is saying it.

Don't interrupt, constantly criticize, supply words or complete what your child is saying.

Accept a certain amount of dysfluency in your child's speech.
Reduce communication stress.

We all speak more easily in an atmosphere which is cool, calm and collected.

Be a good speech model by speaking slowly and calmly and by using simple, unhurried words.

Reduce competition in speaking and encourage turn-taking. Part of being a communicator implies being a good listener as well.

Minimize situations and environments which trigger stuttering.

Try to eliminate rapid speech, loud commands and overly strict discipline on your part.
Lower your standards of fluency, remembering that everyone is occasionally dysfluent when tired, nervous, angry or excited.
If your child is having a good day with very little stuttering, give him many opportunities to talk and point out that he/she is very fluent at times. For example:
- engage in puppet play
- play verbal pretend games
- look at picture books and take turns telling the story
- take him shopping or visiting where he can talk to others
- join in activities involving speech, rhymes and songs.
If your child is having a bad day with a great deal of stuttering, casually accept the stuttering and do not demand a lot of speech from him. Instead concentrate on non-verbal activities that he enjoys such as playing sports, watching TV, going for a walk together, etc.
Allow time for your child to speak without giving special favours which may encourage manipulative behaviour.
Be consistent in your discipline. It doesn't so much matter what specific rules you feel you should set down as long as the same rules are in effect day after day so that your child knows where the boundaries are.
When you take your child somewhere new, tell him about it ahead of time. Explain the types of things he will see and hear and what he will be expected to do.
Don't protect a child who is conscious of stuttering by pretending not to notice it.
Call as little attention as possible to the stuttering of a young child who has developed no secondary symptoms. Don't make your child more aware of his stuttering by having him repeat the stuttered words.
If your child asks about his stuttering, be open, calm and accepting. Tell him that you have noticed his speech, but that everyone finds it difficult to talk at times. Help an older child develop an objective attitude.
Don't allow others to tease, ridicule, interrupt, imitate or joke about your child's speech. Encourage a favourable attitude and try to foster understanding attitudes from others by explaining the nature of stuttering to them.
Don't reprimand your child for stuttering. He is not doing it purposely to call attention to himself or to annoy you.
Don't refer to your child as a stutterer, especially in her presence. Think of her as a normal child who is presently having difficulty talking.
Don't react emotionally to your child's way of talking. Do not show embarrassment, impatience, anxiety or pity. She may see stuttering as something that is "wrong". Your fear will become her fear.
Don't insist that your child try not to stutter. This may lead to greater attempts to force the words out and may increase secondary struggle behaviour.
Don't make your child different by discouraging her from taking part in plays or speaking activities that she is interested in.
Don't have your child compete verbally with other children who may be more fluent. Allow her to have equal speaking time without interruptions from others.
Don't teach your child any tricks or devices which you have heard may help her to speak with less difficulty (e.g. slowing down, repeating, relaxing, stopping, thinking before speaking, taking a deep breath, speaking to a beat etc.). These will only make your child's speech more abnormal and reinforce stuttering-like behaviour.
Don't put undue pressure on your child to speak by demanding that she recite in front of visitors or by demanding a verbal explanation when he/she is being punished.
Don't ask your child to talk when she is very emotional, especially when crying. Sobbing is repetitive enough to trigger a stuttering response.
Don't insist that your child use her right hand if she prefers the left.

added with permission May 11, 1998