My child is having trouble talking. Is he stuttering, or is it just normal childhood disfluencies?

Danger signs include struggling to get words out, with an increase in vocal pitch, blocked airflow, or tongue protrusion. The child may show frustration at being unable to talk, and secondary behaviors such as eye blinking, nodding, or facial grimacing. Fear of talking or avoiding certain words or sounds is a danger sign.

Other danger signs include multiple repetitions, or part word repetitions. For example, "That my-my ball" is a normal disfluency. But "The-the-the-that's my ball," is stuttering. Note the part-word repetition, the multiple repetitions, and the substitution of the "schwa" or neutral vowel in "the", instead of using the vowel in "that."

Should parents take a child to a speech pathologist right away, or wait and see if the child outgrows stuttering?

If a child has stuttering symptoms, he or she should see a speech pathologist right away. Many parents report that their pre-school children outgrew stuttering without therapy, but some researchers now believe that these children had normal childhood disfluencies, not stuttering. They suspect that few, if any, children outgrow stuttering without therapy.

After the age of 4, the likelihood of outgrowing stuttering drops significantly. Children's stuttering becomes worse the longer they wait before treatment. Early intervention can head off a lifelong disability.

Where can parents find a qualified speech pathologist?

Post a topic in the discussion forum. You will be certainly guided to a reliable SLP in your vicinity.

How is childhood stuttering treated?

There are two ways of doing stuttering therapy with pre-school children: changing the parents' behavior, or changing the child's speech.

Indirect therapy changes the parents' behavior. Parents may be instructed not to talk too fast or use advanced vocabulary; be a good listener, such as not interrupting your child, or putting down what you're doing when the child wants to talk; reducing stress on the child, such as sticking to a predictable daily routine; and/or refrain from criticizing the child's speech, or correcting, helping, or reacting negatively to the child's speech.

But research shows that changing parents' behavior has little effect on children's stuttering. It can't hurt, but don't rely on this exclusively. Instead, speech pathologists increasingly advocate direct therapy.

Direct therapy begins by teaching the child to speak fluently. These skills include "easy speech" (also called "turtle talk") and stretching vowels. Therapy progresses from sounds to words and sentences, from a slow speaking rate to a normal speaking rate, and from the low-stress speech clinic to real-life conversations. If a child exhibits negative feelings or frustration in response to stuttering, the speech pathologist directly addresses these problems. For example, the speech pathologist may model the child's struggle behavior, and then discuss with the child whether the struggle behavior makes it easier or harder to talk.

What's the most effective treatment for school-age stuttering?

A study divided 98 children, 9 to 14 years old, into four groups:

1. The first group was treated by speech pathologists in a speech clinic.
2. In the second group, the parents were trained to administer the stuttering therapy to their children, but the children did not see a speech pathologist.
3. In the third group, the children used speech biofeedback computers designed for treating stuttering. They were not treated by speech pathologists, and their parents weren't involved.
4. The control group received no therapy.

All children were fluent at the end of their therapy. One year after the therapy programs ended:

1. 48% of the children treated by speech pathologists were fluent.
2. 63% of the children treated by their parents were fluent.
3. 71% of the children treated by computers were fluent.
4. The control group's speech didn't improve.

Too often children who stutter see to their school's speech pathologist once or twice a week, with no therapy outside the speech room, and no training for the parents. Even worse is group therapy where a stuttering child is treated with children who have articulation disorders (more common than stuttering) or are mentally-retarded (the stuttering child gets a message that he too is mentally-retarded).

Too many school speech pathologists have caseloads of 40 children or more, with little time for each child and even less time for in-service training.

Parents should ask their child's speech pathologist for therapy that can be done at home each day. Parents can also discuss with the speech pathologist whether a stuttering therapy computer would help.

My teenager has had stuttering therapy since kindergarten. He's fluent in the speech pathologist's office, but stutters elsewhere. He's not making progress and wants to discontinue therapy. He's withdrawing from his peers. What can we do?

Teenagers are adults, in terms of stuttering. Instead of relying on your school's speech pathologist, the teenager may be better off going to a university or other speech clinic. He could leave home for a stuttering therapy summer camp.

The teenager may want to join a teen stuttering support group, including the ones on the Internet.

The teenage years can be the worst for a stutterer, affecting the development of social skills such as dating. But teenagers are also able to develop focus, drive, and passion that adults may never again experience. Parents should help their stuttering teenager to find a fluency-enhancing activity that he or she feels passionate about. Examples include singing, acting, debating, or a foreign language.

Teenagers should also be encouraged to do school projects about stuttering. These can include science experiments, interviewing a successful adult who stutters, or writing a history paper about stuttering.