To the Parents of the Nonfluent Child

Peter R. Ramig, Ph.D.
Dept. of Communication Disorders and Speech Science
University of Colorado
Box 409
Boulder, Colorado 80309 (303) 492-3049

The following pages contain guidelines, suggestions, and general information for parents or other significant adults (e.g. day care providers) who have or know a young child who repeats, blocks, or hesitates when he/she speaks. It is important to realize that learning to speak is a complex task and repetitions and hesitations occur frequently during the developmental stage of speech (2 - 7 years). For most children, those "errors" are only normal nonfluencies. For some children, however, they can be the beginning signs of stuttering. Below is a list of danger or warning signs to look for in any child's speech. These signs can occur randomly; however, frequent and consistent appearance of one or more of them should be brought to the attention of a speech-language pathologist.

STUTTERING DANGER OR WARNING SIGNS

Multiple part-word repetitions -- Repeating the first letter or syllable of a word, such as t-t-t-table or ta-ta-ta-table.
Prolongation -- Stretching out a sound, such as r------abbit.
'Schwa vowel' -- Use of the weak (schwa in German) vowel. For example, instead of saying bay-bay-bay-baby, the child substitutes buh-buh-buh-baby.
Struggle and tension -- The child struggles and forces in his attempt to say a word. For example, the child may exhibit eye blinks or facial grimaces when having difficulty speaking.
Pitch and loudness rise -- As the child repeats and prolongs, the pitch and loudness of his voice increase.
Tremors -- Uncontrolled quivering of the lips or tongue may occur as the child repeats or prolongs sounds or syllables.
Avoidance -- An unusual number of pauses; substitutions of words; interjection of extraneous sounds, words, or phrases; avoidance of talking.
Fear -- As the child approaches a word that gives him/her trouble, he/she may display an expression of fear.
Difficulty in starting and/or sustaining airflow or voicing for speech This is heard most often when the child begins sentences or phrases. Breathing may be irregular and speech may occur in spurts as the child struggles to keep his/her airflow and voice flowing.

The following ideas are suggested to help parents better understand the disorder of stuttering.

There are many fallacies we hear regarding the cause(s) of stuttering in children. The fact is, experts on stuttering openly acknowledge that the cause(s) of stuttering are unknown and are probably multidimensional in nature. Much of the recent research, however, supports a possible weakness of some kind in the neurophysical or neuromuscular systems. Few specialists of stuttering support or prescribe to a psychological cause or base for stuttering. However, there is little doubt that stress created from feelings of embarrassment, inadequacy, shame, and frustration caused by stuttering increase and maintain it. There is no respected research evidence that targets parents as the cause of stuttering.
Stuttering can become an embarrassing and frustrating problem for the child and may influence his/her behavior, academic performance, and self-esteem and confidence.
Stuttering can be changed and possibly eliminated in younger children if professional help is sought before excessive struggle and tension develop.

OTHER CHARACTERISTICS SOMETIMES EVIDENT IN NONFLUENT CHILDREN

The child may have inadequate attending behaviors that may include hyperactivity, distractibility, and difficulty attending to tasks.
The child may have oral motor difficulties evidenced by misarticulation of sounds and/or inability to rapidly coordinate tongue and/or lips.
The child may have perfectionistic tendencies and he/she may appear to be exceptionally sensitive.

CHARACTERISTICS OF THE ONSET OF STUTTERING

Some children may display nonfluencies or stuttering as soon as they begin combining words, but most do not start until approximately one year later.
Stuttering often begins gradually and its progression can be episodic, containing oscillations in severity across communicative tasks and time.
Repetitions of syllables which occur on the initial words of an utterance are the most frequent type of nonfluency occurring in beginning stuttering.

HOW TO TALK TO CHILDREN

The following guidelines are appropriate when talking and/or listening to any child, but are especially important when a child is exhibiting some of the danger signs of stuttering.

Speak clearly so that each sound is pronounced clearly and words do not run into one another. Use the appropriate names or words for objects and events. Use sentences and vocabulary appropriate for the child's age. This is important so that the child is not frustrated because he/she may be unable to repeat or imitate more complex words, phrases, or sentences.
Beginning at a very young age, associate talking with pleasant activities. Use a pleasant voice when speaking to the child. For example, while rocking or holding the child, talk about pleasant daily activities or events.
Talk about people, objects and events that are meaningful to the child.
Promote spontaneous conversation on the part of the child by waiting silently for the child to initiate the conversation during free play. Reinforce the child's responses with smiles and praise and by touching.
Provide a variety of entertaining language experiences, such as trips to the zoo, amusement park, museum, circus, etc. Talk about each experience with the child.
Read to the child in a relaxed manner that is slightly slower than normal and has a natural rhythm. After you have read a story, discuss what happened with the child. Let him/her finish sentences in familiar stories or tell them in his/her own words. Let him/her do as much talking as he/she wants; again, calmly allow the child to complete statements. Tell stories about events in your own life and when he/she was smaller; use familiar pictures. Avoid frightening stories because they may be disturbing to the child even if he/she appears to enjoy them.
Help the child express his/her feelings, both verbally and nonverbally, by doing so yourself. Tell him you love him/her and like him/her, with words as well as by caressing him/her, smiling at him/her, etc.
Listen to the child when he/she is expressing rage, anger, or frustration. Discuss what caused these feelings.
Pay attention to his/her nonverbal communication: Is he/she asking you something because he/she really wants to know the answer, or is he/she really asking for attention and/or physical contact?
Consider the child's feelings. Adults do not like to be ridiculed for speaking poorly, or to frequently be told "no," or to be reprimanded for something that is insignificant, or to seldom receive praise. Neither do children.

The Following are suggestions which will help your child deal with their feelings:
1. You can listen quietly and attentively.
2. You can acknowledge their feelings with a word. "Oh".."Mmm".."I see."
3. You can give the feelings a name. "That sounds frustrating."
4. You can give your child his wishes in fantasy. "I wish I could make the banana ripe for you right now!
(Taken from How to Talk so Kids will Listen and Listen so Kids will Talk, Adele Faber and Elaine Mazlish, 1980, Avon Books, New York, New York.)
When the child is nonfluent, any of the following behaviors may only make him/her feel that you are dissatisfied with him/her and with him/her way of communicating. They may make him/her feel that nonfluencies are "bad", resulting in his/her attempt to avoid being nonfluent. When avoidance develops, the problem of stuttering often worsens.

IT IS NOT RECOMMENDED TO:
1. Hit him/her.
2. Tell him/her to stop stuttering.
3. Threaten to punish him/her for stuttering.
4. Help him/her with the word.
5. Tell him/her to think about what he/she is going to say.
6. Answer or "fill in" for him/her.
7. Look concerned or pained.
8. Appear angry or impatient.
9. Tell him/her to take a deep breath before speaking.
10. Ask him/her to stop and start over.
11. Suggest changing pitch.
12. Suggest avoiding or substituting words.
13. Reinforce nonfluency by attending more to it than to fluency.
14. Express pity.
INSTEAD:
We suggest the following when the child is nonfluent:
1. Try to act the same as you do when he/she is fluent.
2. Remain calm and listen to what he/she is saying.
3. Try to show that you enjoy talking to him/her.
4. Seem interested in what he/she is saying (even if you are not).
5. If he/she seems especially excited or in a hurry, say: "Take it easy" or "No need to get excited," and then, "I have the time and I want to hear what you have to say." This is different from telling him /her to speak more slowly. Instead you are telling him/her to slow down everything -- not just speech.
6. Calmly acknowledge the occurrence of any long, effortful or forceful awareness of these obvious disruptions. A simple statement like "That was hard for you, wasn't it?" can defuse some of the child's concern and show him/her that the same lapses do not upset you. If the child explains "I can't say it," or "I can't talk," assure him/her that talking will be easier if he/she talks softly and says the word with you, in unison, 2 - 3 times.
CAUTION: This approach ("e" above) should be used only on those occasions when the child exhibits real distress over his speech failures.

For more assistance, refer to Stuttering and Your Child: Ouestions and Answers. Stuttering Foundation of America, 1989.

When you ask the child a question, use "close-ended" queries like "Did you have a good time at school today? What did you do that you liked best?" These sorts of questions are far more likely to elicit short, simple responses as compared to a directive such as "Tell me about school today." Short, simple responses are more desirable on days the child is especially nonfluent because they are more likely to be produced fluently.
When the child wants to talk to you and you are busy doing something, if you can, stop and give him/her your full attention. If you cannot do this immediately:
1. Tell him/her you will listen soon, after you have finished what you are doing.
2. Try to find a convenient stopping place in whatever you are doing soon so the child does not have to wait longer that 1 - 2 minutes.
3. Give your full attention to the child when you do listen.
4. Ignore any crying, nagging, or temper tantrums after you explain that you will listen in a minute or two, but do not continually repeat this or engage in an argument.
5. Try not to pay more attention to your child when he/she is nonfluent than when he/she is fluent. The amount of time he/she must wait for you should depend on what you are doing, not on his/her fluency.
6. When you are ready to listen to the child, sit down with him/her so that you are at the same level.
7. If he/she wants to talk to you for more than a few minutes, tell him/her that you have to finish whatever you were doing. Tell him/her you will see him later, when you are through, and go back to your task, ignoring any crying, etc., and without arguing.
(These suggestions about how to react to nonfluencies are from Zwitman, The Disfluent Child, A Management Program, 1978.
Everyone should take turns talking.
- If a child interrupts someone who is talking, he/she can be told: "When ______ is finished, it will be your turn, and no one will interrupt you." This should be applied to everyone (children and adults) in the family. b. Do not allow a child to interrupt just because he/she is nonfluent. c. You can role play interrupting and turn taking; the one who interrupts is told to wait. d. If one person's turn is lasting for an unusually long time, tell him/her it is someone else's turn now and he/she will have time to talk again later. If he/she continues to talk, ignore him/her and let someone else have a turn.
If possible avoid using the word "stuttering" to describe the child's speech when talking to him/her. Instead, use descriptive words -- "gets stuck," "bumpy speech," "hard talking," etc.; however, if the child is well aware of his/her nonfluencies and refers to them as stuttering, it would be unnatural for everyone else to avoid using the word.
Do not place demands on the child to perform in front of people (asking him to say the alphabet, recite nursery rhymes, etc.). If he/she wants to and initiates this type of activity, then it is okay.
Avoid extensive questioning of the child, especially about details or about the past.
Do not request the child to speak excessively on days when he/she is extremely nonfluent.
After a nonfluent utterance you might repeat back the content of what the child said. This will help you make sure you are attending to the content of what is said, and help to reduce his memory of the nonfluency. In addition, you are showing the child that you are listening to him/her. (Child: "I went I went shopping." Parent: "So you went shopping.")
Be careful not to convey a sense of time pressure on talking. Behaviors can purposely be modeled to reduce this sense of time pressure by speaking more slowly. Speech should be evenly paced and not contain fast rushes followed by long pauses. "Brisk" turn taking and frequent interruptions also convey a sense of time pressure and should be minimized.
Talk openly with the child about stuttering, if he/she expresses a desire to do so, but do not make a big issue out of it.
A child usually develops his attitudes about talking by observing his parents' behaviors. Take advantage of everyday opportunities to see that the child experiences some form of success and praise.

THE NONFLUENT CHILD'S HOME AND SCHOOL ENVIRONMENT

In addition to how you talk and listen to the child, the child's home and school environment can have an impact on his/her speech. The following suggestions pertain to the home and school environment.

Define rules so the child knows what is expected of him/her. Consistency in the home and school every day is important.
1. The child should feel sure that when he/she begins talking he/she will not be interrupted. He/she should also know that he/she will not be allowed to interrupt others who are talking.
2. The child should know that he/she will receive specific, predictable, and noninjurious punishment when he/she seriously misbehaves.
3. The child should know that he will be consistently rewarded for doing his assigned chores.
4. Praise the child for everything he/she does well.
5. Try to reduce the use of the words "no," "can't," "don't" and "stop it." Instead, make an attempt to tolerate his/her activity if it is not harmful, or try to redirect his/her interest.
Examine the child's schedule. Does he/she have enough free time? Does he/she have enough quiet time?
- Allow some time every day to spend alone with the child. Fifteen to twenty minutes a day is probably sufficient. During this time you might walk with him/her, play with him/her, or read to him/her.
- Before he/she goes to bed is a good time to be alone with him/her for a few minutes.
- During this time together, ask the child "how" his/her day went. This will enable you to find out about his/her feelings, rather than just asking, "what did you do today?"
Physical fitness is important to good speech. The child should have adequate rest and overfatigued should be kept at a minimum.
Do not reward the child with sweets. Keep his/her intake of refined sugar at a minimum. This includes closely monitoring his consumption of candy, soft drinks, bakery goods, etc.
Traumatic events, such as illness, accidents, and emotional conflicts, cannot be avoided. However, be aware that such events may be accompanied by more nonfluency in the child's speech.
1. Accept this as normal and do not give the child more to worry about by reacting to his/her nonfluencies.
2. Try to counteract the traumatic event by providing pleasant experiences and making him/her feel secure in his relationship with you.
Avoid discussing the child's speech in his/her presence. If, however, he/she inquires about it, be empathic and reassure him/her that everyone finds it difficult to talk at times.
Holidays and events, such as Christmas, Chanukah, out-of-town guests, or starting school, can also result in increased nonfluency in the child's speech. Do what you can to reduce the intensity of those events.
Be alert not only for events but also people and places that result in increased nonfluency in the child's speech. When possible, change what you can to enhance his fluency.
Attempt to alter communicative stress both at home and at school so that more chances for fluency are provided. You should try to remove any stigma attached to stuttering which the child may be experiencing. One way to do this is by occasionally modeling easy, unforced stuttering behaviors so that the child begins to realize everyone is nonfluent sometimes, and that it can be done easily and without tension.
Be aware that the child may become very frustrated if he/she experiences a great deal of severe nonfluencies. Provide a way to cope with this frustration, such as:
1. outdoor exercise;
2. allowing him to express his/her feelings without anyone displaying displeasure.
Parental intervention is recommended if brothers and/or sisters tease the nonfluent child.
1. Explain patiently and clearly that teasing is impolite and unkind.
2. Discuss the fact that all people have their weaknesses and strengths. Explain that the nonfluent child sometimes makes mistakes when he/she talks, and that this is no reason to make fun of him/her.
3. This may need to be repeated several times before the idea gets across. If the teasing still continues, it may be necessary to ask the speech-language pathologist to talk to the siblings.
4. Chances are that if the child's siblings are non-critical, the neighbors, friends and other relatives will treat the child's nonfluencies the same way.
5. If the child attends preschool or school, the teacher may need to carry on this discussion with the entire class, or a few members-- when the nonfluent child is not present.
When the child is experiencing a period of increased nonfluency, try to provide him/her with successful speaking experiences. Encourage choral speaking, singing, recitation of nursery rhymes, rhythmic speaking, using puppets, etc.
Remember the power of positive suggestion! You can use it to motivate children by helping them realize they can change.
Do not set unrealistic goals for the child. Try to keep your expectations appropriate for his age and level of maturity.

For more information, the following brochures are available:

The Child who Stutters at School: Notes to the Teacher, The Stuttering Foundation of America, Memphis TN.
Stuttering and Your Child: Questions and Answers, The Stuttering Foundation of America, Memphis TN.

CHARACTERISTICS OF SOME PARENTS OF NONFLUFNT CHILDREN

Research indicates that some parents of nonfluent children do not cause stuttering but unrealistic expectations can maintain or increase existing or developing stuttering. For example, the parents may expect their child to:

pronounce words perfectly;
use an unusually large vocabulary;
perform difficult motor tasks;
succeed in advanced academic activities;
be involved in too many activities outside of the home.

Some parents of nonfluent children speak rapidly or hurriedly. In turn, their children may speak quickly. Because speech and language is a very complex motor and cognitive act, rapid speech may cause the child to make mistakes such as hesitating, repeating, prolonging or mispronouncing sounds or words. Such mistakes may lead to even more mistakes because the child becomes frustrated, tense, self-conscious, etc.

If parents speak rapidly or act rushed, the home environment may become more stressful. Hurrying becomes a way of life. An environment such as this may not be conducive to good speech development, normal parent-child interaction, or normal parent-parent interaction. The parents should provide a good model by speaking calmly and reducing their rate. This is more effective than telling the child to slow down. If any of the above examples are characteristic of you or your home environment, it is suggested changes be made.

Putting this information practice is difficult. Lena Rustin describes a task called "Talking Time" in which the parents complete a home assignment involving a commitment to spend three, four or five minutes; four, five or six times per week playing with their child. "Talking Time" is structured accordingly:

Parents are to solicit help from their child with this assignment.
Parents should negotiate with their child for a mutually convenient time.
The parent asks the child to choose a toy to play with.
The parent and child then go into a room, close the door so that they cannot be interrupted by others.
During this interaction, the parent should not make any demands on or comments about the child's speech but should listen carefully to what is being said, not how it is said.
When the time is completed, the parent should thank the child for helping with their homework and record in a notebook that the task was completed and make some comments about how they felt doing it. Time limits should be adhered to when participating in "Talking Time" activities.

(Rustin, Lena, 1991. Parent, Families and The Stuttering Child, Singular Publishing Group, Inc., San Diego, CA, pg. 63-64.)

IDEAS FOR DISCIPLINING

The following suggestions (1-5) regarding discipline are taken from Zwitman (1978) and are appropriate for any child, whether or not he/she is nonfluent:

Establish a noninjurious discipline system for the child's misbehaviors. This system should be consistent from day to day and from child to child.
When the child unintentionally annoys you:
1. Try to be tolerant, if his behavior is unintentional, is not harmful to people or objects, and occurs infrequently.
2. Try to remain calm and collected.
3. Do not attack the child; (refer to his behavior, not to him).
  - describe the wrong act, (e.g., "You spilled your milk.")
  - state your feeling, (e.g., "That makes me angry.")
  - present a solution, (e.g., "Help me clean it up.")
4. If the same behavior occurs often and apparently carelessly, and if he refuses to correct it, then reasonable, noninjurious punishment may be warranted.
When the child intentionally annoys you, and you are sure that he/she knows his behavior is wrong, we suggest the following:
1. Tell the child how you feel about what he/she has done.
2. Be specific about what he/she has done that is wrong.
3. Send him/her to his/her room for five minutes.
4. Do not argue with him/her.
5. Ignore any crying, temper tantrums, or nonfluencies.
6. Ignore any negative behavior when he/she is in his/her room.
When the child wants to do something he/she is not allowed to do:
1. Explain to him/her why he/she is not allowed to do the activity. For example, "It's too dark to play outside."
2. After you explain why, do not argue with him/her.
3. Tell the child you realize he/she is upset.
4. Tell him/her that you will be upset if he/she does this activity.
Discipline must be consistent from day to day and from parent to parent. Spanking may stop his/her behavior, but it can also create mistrust and fear in the child.

PARENTS AND TEACHERS AS MODELS

When considering the effects the general environment has on his speech, it is important to realize that the parents themselves serve as models to the child. Many of the child's behaviors, feelings, and attitudes are directly influenced by the behaviors, feelings, and attitudes of the parent.

Some behaviors are modeled directly; however, indirect influences of the parents and other adults important to the child are very powerful.
The nonfluent child may adopt the parent's feelings about stuttering. As a result, parents might ask themselves the following:
1. Do I feel guilty about my child's stuttering?
2. Do I blame myself for his/her stuttering?
3. Do I feel stuttering is shameful, embarrassing, or bad?
4. Am I angry at the child because he/she stutters?

Stuttering is one problem for which there is help and a great deal of hope. It can be overcome if dealt with at an early age, before the development of struggle, tension, and the self-concept of a person who stutters.

IF YOU ARE INTERESTED IN LEARNING ABOUT SERVICES AVAILABLE FOR THE NONFLUENT CHILD (OR ADULT) CONTACT DR. PETER RAMIG AT THE UNIVERSITY OF COLORADO, BOULDER, DFPARTMENT OF COMMUNICATION DISORDERS AND SPEECH SCIENCE (303) 492-3049.

{document revised 9/10/93}

REFERENCES

The Child Who Stutters at School: Notes to the Teacher, Stuttering Foundation of America, P.O Box 11749, Memphis, TN, 38111-0749.

Conture, Edward G., Stuttering. Prentice-Hall, Englewood Cliffs, New Jersey, 1990.

Faber, Adele and Elaine Mazlish, How to Talk So Kids will Listen and Listen So Kids will Talk, Avon Books, New York, New York, 1980.

Ramig, Peter, "Parent-Clinician-Child Partnership in the Therapeutic Process of the Preschool-and Elementary-Aged Child who Stutters". Seminars in Speech and Language, vol. 14, #3, 1993.

Rustin, Lena, Parents, Families and the Stuttering Child, Singular Publishing Group, Inc., San Diego, CA 1991. Stuttering and Your Child: Questions and Answers, Stuttering Foundation of America, P.O. Box 11749, Memphis, TN, 38111-0749.

Zwitman, Daniel H., The Disfluent Child, A Management Program, 1978, University Park Press, Baltimore, MD.

added December 15, 1995, with permission