A Guide for Parents of Children Who Stutter

Families of children who stutter have a number of common questions and concerns. This brochure has been put together to answer these as best we can.

WHAT IS STUTTERING?

Stuttering occurs when the natural flow of speech is interrupted. When the child involuntarily prolongs sounds, is unable to produce certain sounds, or repeats a sound, we can say he or she is at risk for stuttering. Stuttering will usually begin between the ages of three and six. Onset is usually gradual but may be quite sudden.
At the time most children are developing complex speech and language skills, a lot is happening. It is a difficult process. They may repeat words and phrases and use many "ands" while they are formulating a sentence. This type of behavior is normal.
If the majority of your child's "stutterings" are part-word repetitions (Mo-mo-mommy), if many of them consist of three or more repetitions per sound, (e.g., b-b-b-ball), if you child prolongs sounds for more than a second or so (ssssssoup), or shows signs of struggling to "get his words out," we can start thinking in terms of the child's "stuttering," and begin to formulate what to do about it.

WHAT CAUSES STUTTERING?

The first thing you should do is not blame yourself for your child's stuttering. It is not your fault.
While the popular view of the cause of stuttering is that it is due to an emotional problem, research has shown that there are many factors that are more likely to lead to stuttering. Many children first begin to experience difficulty in speech fluency when they are learning complex grammatical forms. Some children, especially those who come from a family where stuttering is common, may inherit a tendency to stutter. Our guess is that many of you can point to someone else on one side of the family or the other who stutters or, perhaps, did as a child. Stuttering occurs in a consistent four percent of children throughout the Western world.
Although we do not know the exact cause of stuttering, it appears to be the result of a general tendency to have difficulty in coordinating the speech muscles in the presence of certain external demands. The coordination problem is probably neurological. It is very significant that we find the exact same gender ratio (five males to every female) in stuttering as we find in learning disorders such as dyslexia and disgraphia and other "neurological" disorders. A neurological and developmental perspective may also best explain why more than half of children who exhibit some stuttering seem to "outgrow" it before puberty. Physical maturation takes care of the problem.
The emotional problems your child may be experiencing are usually the result of living with the stuttering problem rather than being the cause of the problem. It is natural for children who experience difficulty in talking - especially if they have been embarrassed by their inability to say what they want, when they want - to become hesitant and afraid when talking.
But there is rarely ONE single contributing factor to the amount of stuttering your child is exhibiting. We do know, however, that how you relate to your children's stuttering, and what kind of environment surrounds them once the stuttering begins, may have a great deal to do with the severity and development of your child's stuttering problem.

WHAT CAN BE DONE ABOUT IT?

Being a parent is a phenomenal task. Being the parent of a child with special needs makes the job even harder. Children who stutter can experience a range of negative emotions. They may feel terribly frustrated at the loss of control over their speech, and they do not understand why it is happening or to what degree they will stutter on any given day. Later on, they may feel guilty or ashamed about not being able to speak like normal children and may go to great lengths to hide their difficulty. They may develop a fear of being teased and laughed at by their peers. And they may feel the loneliness of being different. (So many children we have come to know in the NSP express the feeling of being "the only one in the world who stutters".)
You also have to deal with your own feelings when this is going on:anxiety, guilt, irritation, wanting to pretend this isn't happening or that it will go away soon, embarrassment, sadness, anger, or frustration at the child's inability to perform what may seem to you like a simple task. These are feelings that most parents experience at one time or another. It is very hard to watch someone we care about having difficulty. You may also be experiencing pressure from other family members, neighbors, and teachers about what to do. You may be feeling confused and alone.

GETTING HELP

First of all, you don't have to feel alone. There are people out there who can help you. Call our office to talk. We will be glad to put you in touch with professionals we know in your area who can guide you. We may be able to put you in touch with other parents, too.
If your child exhibits the kind of behavior we outlined in the first part of this brochure, your first step should be to seek a qualified and experienced speech pathologist with expertise in treating children who stutter.
We cannot urge you more strongly to seek this guidance EARLY ON. There is much evidence that early therapeutic intervention is the most effective. For preschool children there is every hope that, with early intervention and guidance, the child will recover from stuttering. On the other hand, stuttering in school age children can be much more resistant to change. It may be that the difficulty is one your child will outgrow, but it would be wrong to take a chance on that. The experienced professional can only help you and your child.
Many pediatricians will tell you, "Ignore it, it will go away." At one time, this was thought to be good advice. We know now it is very bad advice in cases where there is embarrassment or definite struggle behavior on the part of the child. Err on the side of caution and seek professional help if you have any doubts about your child being at risk for stuttering.
A professional can work with your child, and/or (especially if they are under 5 years of age) they can work with you, helping you create a constructive, fluency-enhancing environment for your child.
Under Public Law 94-142, stuttering is considered a disorder for which public schools are required to provide competent assistance to the child in the school setting or to pay for appropriate treatment elsewhere.
The NSP can possibly put you in touch with other parents who know what you are experiencing. And you can become a member of Aaron's Associates, an organization especially designed for children 11 and under and their loved ones. (See their address at the end of this brochure.)

INTERACTING WITH YOUR CHILD

Examine what is going on when you interact with your child to determine if something you are doing may be contributing to his or her anxiety.
Here's an example. Your child is speaking and begins to stutter. In an attempt to be helpful, you respond with a comment like, "Slow down and take your time, Bobby. " First of all, the child is incapable of slowing his or her own speech down for more than a few moments. You are asking them to do something they cannot. Secondly, and more importantly, two children may react very differently to this simple comment. One may hear it as a helpful suggestion for expressing himself more freely. However, another child may feel personally rejected, as though the form of his speech was all that counted; as if the stuttering was something he should not be doing.
You may have said "Slow down" because you wanted to suggest ways he could talk more easily. You may have been truly concerned about what your child was saying and yet finding it hard to follow him/her.. Or it may have been a reaction to the unpleasantness of his stuttering. You will have to examine your own feelings to know which is true for you. Maybe you have never said this particular phrase to your child, but there may be other phrases, ways in which you use your body, facial gestures, or other non-verbal ways which perhaps made your child feel that he was doing something wrong when he stuttered.
Keep in mind that slowing the child's manner of speech down is a very valid goal, but you can achieve this more effectively by modeling a relaxed, unhurried manner of speech yourself. If you are telling the child to slow down, but talking rapidly yourself, the child is more likely to follow your example than your instructions. Please seek the guidance of a speech-language professional to guide you in just how to model this kind of speech.

"IT COMES AND GOES"

You have undoubtedly noticed that the amount of stuttering will fluctuate, sometimes very dramatically. It will disappear or be better one day and worse another. It may disappear for days or weeks at a time and then come back suddenly.
You may be tempted to think that all increases in your child's stuttering are related to what is happening emotionally. Speech is a motor skill and tends to break down more when the child is under stress, but there may be other reasons. For example, increases in severity may be related to what is happening to your child's physical makeup. Your child's neurological system is not stagnant (neither is yours for that matter), but can go "in and out of sync" due to conditions like illness, fatigue, excitement, or simple biorhythms.
Please remember, however, that each child is unique and nothing will be true for all children who stutter. You may want to keep track of the severity of the stuttering in a journal along with any unusual events in the child's environment. The patterns that show up here may give you some insights into the individual patterns of your child's stuttering, and help you and your clinician find ways to reduce the problem.

REALISTIC EXPECTATIONS

Many parents are tempted to think, especially when they have obtained speech therapy for their child, that the stuttering should be amenable to treatment or is a problem the child should learn to control on his or her own. They believe that the child should be able to learn what they "are doing wrong" and then start talking like all the other kids. They notice that the child is fluent much or at least some of the time, and think, "If they can do it some of the time, they should be able to do it all the time." In light of what we stated above, we know that these assumptions are not appropriate for children who stutter.
Have realistic expectations of your child. It is true that early therapeutic invention, before the child goes to school, can often alleviate the stuttering altogether. However, despite heroic efforts on the parents' or the therapist's part and total love and acceptance from all, the stuttering may still persist in some children into their teenage years and beyond. You must consider the fact that stuttering can be a chronic disorder.
Have realistic expectations of speech therapy also, especially with the school-age child. You may witness your child being very fluent in a clinical setting, for example, especially if they respond well to the therapist, and still have a lot difficulty outside the clinic or therapy room. This is natural. The stuttering will naturally fluctuate according to the kinds of communication the child is asked to perform, as well as where he or she is asked to perform them.

CREATING A "SAFE" HOME ENVIRONMENT

Just as you try to make your home environment safe in other areas, you must make it a safe place in which to speak. Many of the Suggestions later on in this brochure speak to this point. You want to make your child feel comfortable talking to you and others even if he stutters. You want your child to find enjoyment in talking. Frequent reminders that he is stuttering or that he should try hard to be fluent may make him feel less comfortable talking.
In general, encourage a lot of talking; model gentle, slow and comfortable speech; design fun speaking experiences (reading stories or poems aloud, choral reading - the child will probably experience more fluency in these activities); make sure time pressure is not put on the child when their turn comes to speak; build on your child's confidence in all areas by constantly reinforcing them for what they do well; and make sure that his or her siblings react in a positive way to the stuttering.
An experienced speech-language pathologist can aid you in the proper way to facilitate these constructive activities and attitudes.

TALKING ABOUT IT

Having a home environment in which open, caring communication goes on between you and your child is very important. We encourage you to sit down with your child and talk about his or her stuttering and the way you both experience it. Beware of the Green Hippopotamus Syndrome. In many homes the stuttering becomes like a green hippopotamus standing in the living room. It definitely stands out, everyone notices it, but no one talks about. DO NOT MAKE STUTTERING A TABOO SUBJECT. Not talking about the child's difficulty can be interpreted by him or her to mean that stuttering is something wrong and shameful.
Use your instincts here. Many children will just stutter away very naturally, unaware that there is anything different about them. This does not mean that they are totally unaware of the stuttering however. You might still talk to them casually about it, to reassure him or her that it will be all right. If the child is definitely aware of it, if it becomes a visible struggle for them, acknowledging it openly is very important. Your child is not too young to understand. We sometimes underestimate what children can understand; they know and can accept a lot! Even if the child cannot express directly what he or she is needing, your concern will have been communicated. It is this kind of communication that is so important in getting the child to feel free about talking.

SUGGESTIONS FROM TWO EXPERTS

Dorvan Breitenfeldt, Ph.D., Eastern Washington University

The goal is to keep the child's stuttering at its present level, prevent its further development, and keep the child talking.
Don't let the child know you are upset about his speech.
Keep your child healthy, getting adequate sleep and proper nutrition, and follow a general routine schedule.
Look at your child when s/he speaks and show by your expression that you are interested in what s/he is saying, not how s/he is saying it.
Refrain from teaching tricks (deep breaths, finger snapping, arm waving).
Don't force the child to speak or recite to strangers. However, encourage the child to speak as often as s/he wants.
Accept your child as s/he is; don't reject him/her or give him/her the impression of rejection.
Don't let your child avoid normal responsibilities. Use the same discipline as with any other child.
Don't supply words. Let your child get his/her words out himself. Don't interrupt.
Look for emotional tension at home or school when stuttering is very bad.
Praise your child when s/he speaks well; but this should not be taken as praise for not stuttering; praise what s/he says, not how s/he says it.
Help your child develop constructive work and hobby activities. Give positive feedback and reinforcement.
The child should not be required to hurry with speaking nor should you develop the attitude that s/he should.
Model a relaxed manner of speech when talking to the child. Maintain a calm, reassuring, unhurried manner with slow speech.
Avoid suggestions as: "Think before you speak." "Talk slower (or faster)." "Wait until you can say it." etc.
Don't ask the child to substitute an easy word for a hard one as this will only increase the fear of certain words and phrases.
Encourage speaking at home and in school.
Nothing can ever take the place of love, understanding and patience when dealing with children, any children.

Peter Ramig, Ph.D., of the University of Colorado in Boulder.

Beginning at a very young age, associate talking with pleasant activities. Use a pleasant manner when speaking to the child. For example, while rocking or holding the child, talk about daily activities or events.
Prompt spontaneous conversation on the part of the child by waiting silently for the child to initiate the conversation during free play.
Help your child express his/her feelings both verbally and non-verbally by doing so yourself.
Read to your child in a relaxed manner that is slightly slower than normal and has a natural rhythm.
Don't ask your child to stop and start over when s/he stutters.
Try to act the same way when your child stutters as when s/he is speaking fluently.
Calmly acknowledge the occurrence of any long effortful or forceful disfluencies especially if your child indicates concern and/or 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.
Avoid using the word "stuttering" to describe your child's speech when talking to him/her or to someone else. Instead, use descriptive words-"gets stuck," "hard talking," "bumpy speech," etc. However, if the child is well aware of the disfluencies and refers to them as stuttering, it would be unnatural for everyone else to avoid using the word.
Do not push your child to speak on days when s/he is extremely disfluent.
After a disfluent 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/her memory of the disfluency. In addition, you are telling the child you are listening to him/her.
Talk openly with your child about stuttering, if s/he expresses a desire to do so, but do not make a big issue out of it.
Remember, a child develops his attitude about talking by observing his parents' behaviors. Take advantage of every opportunity to see that the child experiences some form of success and praise.
Do not reward the child with sweets. Keep his/her intake of refined sugar at an absolute minimum. This includes closely monitoring his/her 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 disfluency in your child's speech.
Parents should intervene if brothers and/or sisters tease the disfluent child. Take the sibling(s) out of sight and sound of the disfluent child, and talk to them. Chances are that if the child's siblings are non-critical, the neighbors, friends and other relatives will treat the child's disfluencies the same way.
When your child is experiencing a period of increased disfluency, try to provide him/her with successful speaking experiences. Encourage choral speaking, singing, recitation of nursery rhymes, etc.
The parents should provide a good model by speaking calmly and reducing their rates. This is more effective than telling the child to slow down.
Give your full attention to the child when you listen to him or her.
Be careful not to convey a sense of time pressure. Modeling good slow speech will help here. "Brisk" turn taking and frequent interruptions can convey a sense of time pressure and should be minimized.
When the child is experiencing a period of increases nonfluency, try to provide him/her with successful speaking experiences. Encourage choral speaking, singing, recitation of nursery rhymes, rhythmic speaking using puppets, etc.
Promote spontaneous conversation on the part 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 by touching.
Provide a variety of entertaining language experiences, such as trips to the zoo, amusement park, museums, etc. Talk about each experience with the child.
Parents should 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 begins to realize everyone is disfluent sometimes, and that it can be done easily and without tension.
Nonfluencies are the result of many factors over which children and adults have little or no control. Therefore, no one is to blame for the disfluencies.
Children who stutter are no different from other children except that they have trouble getting words out. Your child is not to be considered maladjusted or traumatized in some way just because s/he stutters.
There is nothing "wrong" or "bad" about stuttering.
Stuttering is a complex problem that usually requires help to solve it. We encourage seeking the help of a certified speech-language pathologist with expertise in stuttering.
Stuttering is one problem which there is help and a great deal of hope for. It can be overcome.

Things to Do

For more advice and for a possible referral to an experienced speech-language pathologist contact the National Stuttering Project.

Become a member of the NSP, a non-profit organization in need of your financial support. You'll love the monthly newsletter, Letting Go.

The Stuttering Foundation of America also has a number of great books at very reasonable prices. Among these are: "If Your Child Stutters: A Guide for Parents ; "Treating the School-Age Stutterer ; "Do You Stutter: A Guide for Teens". Order from the Stuttering Foundation of America: P.O. Box 11749, Memphis, TN 38111 (or call 1-800-992-9392).

EXAMPLES OF BOOKS AND TAPES FROM THE NATIONAL STUTTERING PROJECT "ADVICE TO PARENTS BY SEVEN EXPERTS ON STUTTERING" -- 90 minute cassette tape. -- Seven experts on childhood stuttering offer practical advice to parents. Includes practical tips on when a child should be brought in to therapy and provides insights on what such a program entails.

"STUTTERING PREVENTION: A CLINICAL MANUAL" -- This excellent pamphlet is written by Woody Starkweather, Ph.D., of Temple University. The pamphlet further develops ideas contained in the guide you are now reading.

"A PERSONAL MESSAGE FOR TEENAGERS" -- National Stuttering Project Executive Director John Ahlbach talks heart-to-heart in this 50-minute videotape designed for teenage viewers. .

"LOST BOYS NEVER SAY DIE" -- Readers age 10 and up will enjoy this wonderful story about the troubles and ultimate triumph of an 11-year- old boy who stutters.

Additional information and order forms available at the NSP Bookstore