Stuttering: Fumbling With the Normal Flow of Speech

One of the great joys of parenting is listening to your child learn to speak. However for some, this process causes concern, frustration, and social isolation.

"I couldn't wait until Cooper could talk. Now, every time he speaks I'm a nervous wreck," admits Susan, a mother of a 7 year old child that stutters. "Everyone kept telling me he would outgrow it (stuttering), but he didn't. Soon after his 5th birthday, I knew I had to get help."

Speech: A Complex Process

Learning to speak isn't easy. Speech requires understanding of language, converting thoughts to words, and rapid and intricate movements of the tongue, lips, jaw, vocal cords, and teeth. In addition, precise timing of the muscles for breathing and sound production is necessary to a child's ability to speak. Many factors can interrupt these processes.

Most children will speak normally by the time they enter kindergarten, but some will continue to have a speech or language disorder. A speech disorder occurs when a child has difficulty putting sounds together to form words. Stuttering is one of several speech disorders that cause disfluency in a person's ability to speak.

What Does Stuttering Sound Like?

Stuttering is characterized by a repetition of sounds or syllables, usually at the beginning of words. For example, "Mommy went to the s-s-store", or "That ba-ba-baby is crying." These repetitions and prolongations are often accompanied by tightness in the speech muscles, changes in the pitch or volume of the voice, and facial expressions of fear. Frequent occurrence of such behaviors is considered stuttering.

This type of disruption in the flow of speech most often develops between age 2-5 years, when a child's vocabulary is developing at a rapid rate. However as a child begins to reach school age, stuttering becomes less evident.

The following criteria have been identified as warning signs of disfluency associated with stuttering:

• Frequent sound and syllable repetition
• Syllable repetition in which an "uh" vowel replaces the correct vowel in the word ("puh-puh-peach rather than "pe-pe-peach")
• Frequent prolongations of sounds that become longer in duration
• Trembling of muscles around the mouth and jaw during speech
• Rises in the pitch or loudness of the voice during the prolongation of sounds
• Tension and struggling while saying certain words
• A look of fear or frustration on the child's face while saying a word
• Avoidance of or delay in saying certain words

What Causes Stuttering?

There are multiple reasons a child will stutter and several practices that may worsen an existing stuttering problem.

• Development—As mentioned earlier, rapid development of language during the preschool years is a common cause. The child has many thoughts to express and is quickly making decisions about the appropriate words needed to correctly communicate. This is often referred to as developmental stuttering, which is often outgrown.
• Coordination—Another reason is a lack of coordination in the movement of the lips, tongue, jaw, and vocal cords, causing them to miss the rapid movements required for speech. This can be due to a lack of maturity and can also be outgrown, or can be caused by a neurogenic disorder.
• Genetics—There is some speculation that a predisposition to stuttering is genetic. Some research indicates that stuttering tends to be more prominent within certain families.
• Parenting—A common misconception is that poor parenting or a negative home environment causes stuttering. There is no evidence that the way a child is raised is the cause. However, stuttering can be affected by the way people respond to the stutterer and the child's anxiety concerning his stuttering.
• Stress—Although stress does not cause stuttering, existing stuttering can be aggravated by stressful circumstances. When a child feels pressure to perform, find the correct words, construct appropriate sentences, and coordinate their speech muscles to form words, they are likely to be disfluent in their speech.

Treatment

As a parent, if you are concerned about your child's speech, ask your pediatrician for advice and a referral to a speech-language pathologist—a professional trained to test and treat individuals with speech, language, and voice disorders. This is especially appropriate if your child's stuttering persists for more than 6 months.

Early identification and treatment of speech and language disorders is important to improving communication skills. The goal of early intervention therapy is to build a foundation for fluent speech by helping the child to view speaking as easy and enjoyable instead of difficult and dreadful.

Many children outgrow stuttering without therapy. However, it is difficult to determine who will and who will not. If the nature of the problem is associated with a physical tension of the speech muscles, it is less likely to be outgrown.

At this time there is no cure for stuttering. However, early intervention and continued therapy can control the stuttering, resulting in a more normal flow of speech. Most therapy programs will focus on specific speech techniques as well as the psychological issues associated with stuttering.

Your Role

As a parent, you play a significant role in your child's speech and language development. The way you communicate with your child is important. A child who stutters needs extra patience and encouragement. But the results are worth it!

Here are a few tips to keep in mind when having a conversation with your child:

• Provide a relaxed environment for communication.
• Speak slowly and easily, without tension.
• Use consistent and direct eye contact when your child is speaking.
• Do not discuss your child's stuttering with others when your conversation can be overheard.
• Pause for a short time before responding to your child's comments. This provides time to say something else without feeling rushed.
• Avoid interruptions and do not complete your child's sentence.
• Set aside at least a few minutes each day to talk one-on-one with your child.
• Avoid criticism or direction when your child speaks, such as "Slow down and think about what you want to say."
• Avoid having them speak to perform, such as "Tell grandma what you are learning in school." Allow the child to initiate the conversation.

Share these tips with the child's siblings, teachers, and caregiver.

The more you understand your child's stuttering, the more you can help. With patience and understanding, you can help eliminate much of the frustration and anger associated with stuttering, and encourage your child's communication.

Revision Information

• Reviewer: EBSCO Medical Review Board Michael Woods, MD, FAAP
• Review Date: 08/2017
• Update Date: 10/14/2015