Stuttering

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Stuttering is a disorder characterized by disruptions in the production of speech sounds, also called “disfluencies”. These disfluencies affect the continuity, smoothness, rate, and effort of speech. All speakers experience moments of disfluency but individuals who stutter generally tend to have more disfluencies and different kinds of disfluencies than other speakers. These difficulties in speaking may lead to developing negative feelings about their speech and speaking difficulties; this may also cause an individual to become more self-conscious and lack confidence in speaking situations. It can also interfere with school, work, or social interactions. Children or adults who stutter may demonstrate or verbalize fear or anxiety about speaking and frustration or embarrassment with the time and effort required to speak.

Stuttering usually begins in early childhood, between the ages of 2 and 5, when speech and language skills are expanding and developmental learning is taking place. Most children will stutter during this time and about 75-80% of these children will recover at some point in their development, usually within 6 months or less after beginning to stutter.
There is a higher incidence rate in preschool children, reaching a rate of 8.5% by 3 years of age and 11% by age 4. The incidence in boys is almost twice the amount of girls.
Although it can occur independently, it can also occur at the same time as other disorders, such as speech sound disorders, intellectual disabilities, and language disorders.

For those children who continue to consistently demonstrate signs of stuttering, early and effective intervention may leave them with little or no stuttering.

Signs and symptoms

• Monosyllabic whole-word repetitions: “why-why-why did …”
• Part-word or sounds/syllable repetitions
• Prolongations of sounds
• Audible or silent blocking (filled or unfilled pauses in speech)
• Words produced with an excess of physical tension or struggle

Typical Disfluencies:

• Whole phrase repetitions: “Where is … where is the ball?”
• Single whole word repetitions: “Where … where is the ball?”
• Interjections: “Where … um is the ball?”
• Revisions: “What … where is the ball?”
• Hesitations: A long pause when thinking
Less Typical Disfluencies:
• Repetition of sounds: “sh-sh-shoe”
• Repetitions of syllables: “ba-ba-ball”
• Prolongation: stretching of sounds “Wh——-re is the ball?”
• Blocks: a tense stop in the flow of speech; child may open his mouth to speak but no sound comes out and/or there is a noticeable stoppage of airflow at some point in the upper airway (moth area).

Related Behaviors that may impact overall communication:

• Distracting sounds when speaking: throat clearing, insertion of unintended sound
• Facial grimaces: eye blinking, jaw tightening
• Head movements: head nodding
• Movements of the extremities: leg tapping, fist clenching
• Sound or word avoidances: word substitution, insertion of unnecessary words, circumlocution
• Reduced verbal output due to speaking avoidance
• Avoidance of social situations
• Fillers to mask moments of stuttering

Associated speech and language behaviors

• Speech sound disorders: articulation or phonological
• Language differences
o Tests of language ability are within or above average but lower performance on receptive and expressive language standardized tests compared to children who do not stutter
o Uses significantly fewer verbs overall
o Increased frequency of irregular past-tense forms (ex: ranned)
o Significantly more stutter-like disfluencies in narrative contexts versus conversational contexts

Causes

Most experts agree that stuttering has a neurological basis that affects the areas of the brain controlling speech and language production. There can also be genetic causes to stuttering although there are no definitive findings have indicated which transmission model, chromosomes, genes, or sex factors are involved. The factors vary from child to child and each develops stuttering as a result of his/her own unique factors.

In either situation, there are many environmental factors that can increase, but are not a cause of stuttering, the frequency and extent of stuttering in children who already exhibit signs. These factors can include family dynamics, fast paced lifestyle, stress and anxiety, the child’s temperament, and the pressure to speak when called up at home and in front of his/her peers.

Help

Speech therapy plays a central role in helping identify, assess and treat fluency disorders. A speech therapist can assess your child’s needs by conducting a thorough evaluation. The findings of the evaluation will allow the speech therapist to tailor an individualized treatment plan with goals sensitive to the unique values and preferences of each individual and family.

Treatment

Preschool children from an early age can be assisted with speech therapy. The treatment may assist to eliminate, greatly reduce, or help children manage their stuttering and avoid developing or decreasing negative emotional reactions related to their stuttering. Parent and family involvement is also essential in the treatment process.

A speech therapist will assist a family to make changes in their own speech and how to make changes in their child’s environment to facilitate speech fluency. The therapist will work directly with the child to help him/her change their speech to improve fluency. This may include speech modification and stuttering modification strategies. Direct assistance can also help target a child’s communication attitude.

School aged-children and adolescents can also be assisted to greatly reduce the frequency of disfluent speech. A speech therapist will help the child modify their speech with strategies associated with speech modification such as rate control, continuous phonation, prolonged syllables, easy onset, and light articulatory contact. This may also include strategies to not only increase the likelihood of fluent speech production but to improve overall communication skills.

Additional strategies used may include

• Identify behaviors that increase physical tension and struggle due to stuttering
• Increasing speech efficiency and reducing word avoidance
• Implement strategies for reducing negative reactions
• Desensitization to fears associated with speaking
• Cognitive restructuring to change thoughts or negative attitudes about themselves
• Support for improving attitudes, self-confidence, and reducing feelings of isolation
• Reducing activity limitations and participation restrictions

A speech therapist will assess and implement all appropriate strategies to assist you and your child achieve their maximum potential.

How do you know if and when you should contact a speech therapist for assistance?

• Stuttering persists longer than six months and occurs frequently during the day
• Child shows tension, a facial grimace, or struggle behavior during speech
• Avoids talking situations or expresses concerns about speech
• Avoids saying certain words or sounds
• You have concerns regarding your child’s speech
• Child shows signs of frustration or embarrassment during or after a stutter event

If one, many, or all of these signs are present, do not hesitate to contact us for a speech evaluation to determine if your child is in need of assistance or for more information on how you can help your child achieve their potential.

 

We look forward to assisting you and your child in reaching their maximal potential.

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