10 Dos and Don’ts For When Your Pre-School Child Starts to Stutter

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My little girl started to stutter when she was 2 & ½ years old. And although I knew the theory, it didn’t stop me from filling up with anxiety about it. This post is for you if your young child has started to stutter. (Stuttering and stammering are basically the same thing) The kind of speech I’m talking about here  is called normal non-fluency. It’s also called developmental fluency. It’s most common between ages 1 & ½ and 5 years of age. Or 2 and 4 depending on where you read. The American Speech Language Hearing Association say that about 95% of people who stutter, start stuttering before age 5.

About 5% of young children start to stutter and about 70-80% of these children do grow out of it naturally without formal treatment. BUT- it’s not yet possible to predict if a particular child will recover without treatment. At the same time, early intervention (before age 6 years) is considered to be best practice.

 

What does stuttering sound like? We’re talking about pre-school children here and situations where they don’t have a persistent stutter. In this situation your child’s speech can sound like this:

#1 Repeating syllables once or twice (parts of words) li-li-like this

#2 Repeating whole words once or twice but but I want to stay

#3 Hesitations or pauses

#4 Fillers like uh and er and um The dog is uh black.

 

These kinds of disfluencies as they’re called, tend to come and go. So you might notice them for a few weeks. Then they go away and then after several weeks, they come back again. With my little girl, it seemed to me that the stuttering came back when she was going through a growth spurt. She’d grow a bit, stutter for a few weeks, and then it would go away again. She’s 7 years and 9 months now now and it’s gone for at least two years. Young children are more likely to stutter on grammar words such as the, a, an, and, because, she, he, him, her and so on. And stuttering tends to increase as sentences get longer and more complex.

 

In young children, these disfluencies tend to be effortless- no tension as your child is not aware of them. I know with my little girl, they were effortless and she never seemed to notice them. But then we never remarked on it. One day, my mother did say to her I think you have so much to say that you have a stutter. (I nearly died!)  I just held my breath and noticed my little girl looking at my mother with a kind of What the bleep are you talking about? expression and then moving on- phew!! I didn’t know what to say to my mother so  I said nothing. Later, I asked a colleague who specializes in working with children who stutter what to say when people comment. She suggested saying, lightly, ‘Oh that’s normal for her age’. These disfluencies often happen alongside spurts of speech and language development.

The other thing to remember is that everybody hums and haws when they talk, to varying degrees. We start a sentence and then change our minds and pause and start again. We use those fillers like uhm and ah while we try to put our thoughts in order. I noticed after a while that she sounded like my husband! (Hope he’s not reading this!) So she was learning from the model she was exposed to.

 

How many people are affected by stuttering in general?

About 5% of the population is thought to stutter at any one time in their lives- this is from childhood to adulthood. But it’s a bit of a head-wreck trying to find a definite number because studies tend to vary in how they carry out the research. A recent article that I read reported that by age 3, approximately 8.5% children can be diagnosed with stuttering. When stuttering first starts, the ratio of boys to girls tends to be equal. By the time they start school the ratio is 3 boys to every 1 girl. There’s a higher likelihood of stuttering in an identical twin if one of them stutters. But for non-identical or fraternal twins, the chances are the same as for anyone else.

Do children grow out of it?

The 24 months between age 2 & 4 is considered to be the time window for both the peak numbers in terms of it starting and children recovering naturally. And rates of growing out of it range from 68%- 96%.

Girls may be more likely to grow out of it than boys.  And so are children from families who have a history of someone in the family who grew out of a stutter.  Again, there’s the issue of variety in how studies are conducted….it’s not black and white. And it’s not yet possible to predict if a particular child will recover without treatment. So there are no guarantees that being a girl or having a family member who grew out of will mean that your child will grow out of it naturally.

 

Is your child at risk of developing a stutter?

The most straightforward information I could find comes from The American Stuttering Foundation who have a useful checklist of risk factors.

Having a parent, sibling, or other family member who still stutters is considered a risk factor. Other risk factors are starting to stutter after 3 ½ years of age, the stuttering lasting 6-12 months or longer, being a boy, having delayed language, (I’ll be posting about this soon so be sure and sign up to Talk Nua) and having speech that is difficult to understand. I have a post about that which you can read here.

What can you do about it?

If you’re worried about your child’s speech, then you need to contact your local services and get an appointment to see a speech and language therapist. The SLT can assess your child’s speech in terms of the types of speech behaviours. She’ll want to know things like when you first noticed it, how long it’s been going on for, and any changes you’ve noticed in terms of it increasing or decreasing, and your child’s awareness or attitude to it. In terms of intervention, there are two well-known approaches for pre-schoolers. One is a direct approach called the Lidcombe Program which is a works directly on your child’s speech in order to reward fluent speech and correct stuttered utterances. Numerous studies have shown that it’s effective for treating stuttering in preschool children especially when it’s carried out correctly and when parents continue to keep an eye on their child’s fluency when they’ve finished the programme. You can find out more about it here.

 

The other well-known approach is the Demands and Capacities Model which targets your child’s environment, making it less demanding on your child’s speech while also building their capacity for fluent speech. Some of the approaches within this model work directly on speech. It’s important to remember that there is a lot of variability in how children respond to the treatments and it’s possible that neither approach actually yields meaningful results. There’s no universally accepted intervention for all children who stutter. There’s a lot of work still to be done in the research.

While you’re waiting for your appointment, here are 10 ways to support your child’s fluency, drawn from indirect approaches to working on children’s speech.

#1 Slowly, Slowly

I speak fast and I realised that when my daughter started to stutter, she was trying to keep up with me! So I focused on slowing down- still sounding natural, just not at full tilt. Keep it slow and relaxed. This sets the scene for relaxed communication in general. And when we talk too fast, it makes it harder for our child to organise their thoughts, and express themselves. Make sure your body language is relaxed too- that you’re not leaking impatience in your facial expression or tapping fingers.

# 2 Pause

Pause before you speak- maybe count to 3 before responding- all part of creating an environment that will support fluent speech. This is also good for giving your child the space to start a conversation if they feel like it. The Stuttering Foundation of America recommend waiting 2 seconds before answering your child. The idea is that not only will it create an environment for relaxed talking but children learn by imitation and may well adopt a slower rate which helps fluency.

# 3 Respond to the message not the speech
Think about the content of what your child is trying to tell you and don’t focus on how it sounds.  What’s more important? For you to really get what they’re trying to tell you so they feel understood? Or saying it according to expectations that it should be a particular way? This is important because showing your anxiety to your child isn’t helpful. After a lot of reflection, I realised that I was the only one who was anxious about my little girl’s speech. I realised also that I had anxiety that was just looking for a home and it happened to be her speech! Let them know by giving them your full attention (listening and looking at them) that you’re interested in what they are trying to tell you rather than whether their speech sounds smooth or bumpy.

#4 Ditch the questions
How was your day? What happened in school? What are you doing? Do you want to watch a movie? Questions are a pressure on speech because there’s an expectation of a response. And they’re not the best way to get a conversation going. So reduce your questions and use statements instead. When you do ask a question, wait for your child to answer before asking another one.

I have two other posts with more tips on getting rid of questions here: here and here.

 #5 Don’t give them advice
It’s not helpful to tell your child to slow down, take their time, start again, take a deep breath and so on- the kinds of advice we might instinctively give.  Instead, focus on other general ways to create a calm environment like not rushing in general or putting time pressure on like Oh there’s the bell. We’re late. What ways can you think of that will help your child not tire themselves out and get more rest?

#6 Undivided attention
This means 5 minutes undivided attention where there’s no rush. This isn’t time reading a book or playing a lively outdoor game. You let the child choose the activity and you play with them for 5 minutes giving your undivided attention focusing on what your child is saying rather than how he says it.

#7 Don’t finish their word or sentence for them

Your child is most likely not aware that their speech sounds different and you want to keep it that way at this stage. The British Stammering Association suggest that as long your child isn’t upset by the struggle, it’s better to leave them finish what they’re saying in their own good time. Keep normal eye contact so don’t look away. Accept your child’s speech without commenting but do keep an eye out for any signs of anxiety about speech.

#8 Keep it simple

We talk a lot in our house and once I paid attention to how I was communicating with my little girl, I realised that I was using very complicated language. Long sentences.  I’d fallen into the habit of expanding everything she said to make it even more complex! I had to work at actually saying less and keeping my own contributions shorter and simpler until her speech had settled.

(There is some concern in the literature about the effect of using shorter sentences with children who were late talkers.)

#9 Take turns

Make sure everyone gets a turn to speak and try to minimize interruptions. This isn’t easy! But everyone talking at once is another pressure on speech.

I have a blog post about how to work on turn taking here.

#10 Let them know you love them just the way they are

When I was worried that my little girl’s speech, I found myself thinking about the future and what would I want for her if she did have a stutter? The conclusion I came to was that I wanted her to love herself the way she was and the only way I could think of doing that was by loving her the way she was. I never commented on her speech or drew her attention to it because I knew that was actually my problem and not hers. I didn’t want to infect her with my anxiety so I talked to a trusted colleague who specialises in working with children who stutter and that really helped too.

One of my favourite books about this is Ann Irwin’s Stammering in Young Children: A Practical Self-Help Programme for Parents– you can get it on Amazon.

If you’re worried that your child is stuttering, it’s best to contact your local services and talk to a speech and language pathologist and ideally one who has experience of working with young children who stutter.

The tips I’ve given you are part of what’s called the Demands and Capacities Model where the focus is on the environment. There are other treatment options for pre-schoolers that involve working directly on their speech. So far one approach has not been identified as being superior to another approach. Each child and family’s situation is unique so this is something to discuss with your local speech and language pathologist.

 If you like this post, please pass it on to your friends! 

Let’s get talking!

MP

Inspired by:

BergϷórsdottir, Í., Ingham. R. (2016). Putting the cart before the horse: a cost effectiveness analysis of treatments for stuttering in young children requires evidence that the treatments analysed were effective. Journal of Communication Disorders 65: 65-67.

Byrd, C. and Donaher, J. (2018). Best practice for developmental stuttering: balancing evidence and expertise.  Language Speech and Hearing Services in Schools 49:1-3.

Imeson, J., Lowe, R., Onslow, M., Munro, N., Heard, R., O’ Brian’, S., and Arnott, S. (2018). The Lidcombe Program and child language development: long-term assessment. Clinical Linguistics and Phonetics

Nippold, M. (2018). Stuttering in pre-school children: direct versus indirect treatment. Language Speech and Hearing Services in Schools 49: 4-12.

Yairi, E. & Ambrose, N. (2013) Epidemiology of stuttering: 21st century advances. Journal of Fluency Disorders 38(2): 66-87.

 

 

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