To the Teacher of the Nonfluent Child

By Peter Ramig
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 classroom teachers who have a child in their class who repeats, blocks, prolongs, 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 1/2 - 7 years). For most children, such "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 a young child's speech. These signs can occur randomly in any child's speech. However, frequent and consistent appearance of one or more should be brought to the attention of your school speech-language pathologist.

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.
• Pitch and loudness rise -- As the child repeats or 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; substitution of words; interjections 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 on.

CHARACTERISTICS OF THE ONSET OF STUTTERING

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

GENERAL GUIDELINES

1. The speech pathologist's time with the child is quite limited. Therefore, the teacher, who is with the child throughout most of the day, can be helpful in providing the clinician with a broader picture of the child's classroom speech behavior.
2. Try to treat the child's stuttering casually and matter-of-factly.
3. When the child is experiencing nonfluencies, PLEASE DO NOT:
   1. Tell him/her to stop stuttering
   2. Threaten to punish him/her for poor speech
   3. Help him/her with the word.
   4. Tell him/her to think about what he is going to say
   5. Answer or fill in for him/her
   6. Look concerned or pained
   7. Appear angry or impatient
   8. Tell him/her to take a deep breath before speaking
   9. Ask him/her to stop and start over
   10. Suggest changing pitch
   11. Suggest avoiding or substituting words
   12. Reinforce nonfluency by attending more to it than to fluency
   13. Pretend nonfluencies do not exist
   14. Express pity
   INSTEAD follow these suggestions 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 with 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, we suggest responding: "I have time and I want to hear what you have to say." This is different from telling him/her to speak more slowly or to take a deep breath. Instead, you are telling him/her in a supportive way to slow down everything, not just speech.
4. If you notice that the child has fluent speaking days and nonfluent speaking days, encourage his/her classroom participation on his/her more fluent days and let him/her participate less on nonfluent days.
5. If you are not sure if you should require the older elementary-age child who stutters to give oral reports, we suggest talking to him/her privately about it. Tell him/her that you realize he/she sometimes has trouble talking and tell him/her Its up to him/her to decide If he/she wants to give an oral report.
6. When the young child is experiencing a period of increased nonfluency, try to provide him/her with successful speaking experiences by encouraging fluency speaking situations such as choral speaking, singling, recitation of nursery rhymes, rhythmic speaking, using puppets, etc.
7. To increase the child's fluency during reading group activities, begin the reading passage speaking In unison with the child. If the stuttering child speaks or reads in unison with you, he/she usually will not stutter. This is called choral speaking or choral reading. Do this with every student 80 the nonfluent child will not be singled out as different.
8. Avoid intimidating questioning of the child.
9. Avoid discussing the child's speech differences in his presence. If, however, he/she asks particularly about it, be empathic and try to reassure him/her that everyone finds it difficult to talk at times.
10. Avoid using the word "Stuttering" to describe the child's speech when talking to him/her. Instead, use descriptive words such as: "gets stuck bumpy speech," "hard talking," etc. However, If the child is well aware of his nonfluencies and refers to them as stuttering, it would be unnatural for everyone else to avoid using the word.
11. 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 he/she said and help to reduce his/her memory of the nonfluency. In addition, you are showing the child you are listening to him/her.
12. Be careful not to convey a sense of time pressure while 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.
13. Talk openly with the child about stuttering If he/she expresses desire to do so, but do not make a big issue out of it.
14. A child develops his/her attitudes about talking by observing others. Take advantage of every opportunity to see that the child experiences some form of success and praise.
15. Try to remove the stigma attached to stuttering which the child may be experiencing. One way to do this is by occasionally modeling unforced stuttering behaviors so the child realizes everyone is nonfluent sometimes and that it can be done easily and without tension.
16. Be aware that the child may become very frustrated if he experiences a great deal of severe nonfluency. Try to provide a way for him/her to cope with this frustration.
17. Teachers should intervene if the nonfluent child is teased or harassed by other students. When the nonfluent child is absent, consider using the following discussion strategies with the class:
    1. Explain patiently and clearly that teasing is impolite and useless.
    2. Discuss the fact that everyone has his or her weaknesses and strengths. explain that the child sometimes makes mistakes when he/she talks and this is no reason to make fun of him/her.
    3. If the teasing continues, It may be necessary to ask the speech-language pathologist to also talk to the children.

IMPORTANT: There are many fallacies we hear regarding the causes of stuttering. The fact is, experts on stuttering openly acknowledge the causes of stuttering are unknown. Much of the recent research on stuttering, however, supports possible neuromotor influences. Few specialists on stuttering support a psychological cause or base for the problem. However, there is little doubt that once stuttering is present, stress created from feelings of embarrassment, inadequacy, shame, and frustration cause speaking to become more difficult.

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