Stuttering (stammering) disorder and how to handle it

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Lack of fluency is a stage many children go through in their journey to language acquisition; meaning that speech may be interrupted with stoppage or repetition of sounds or words. Most children overcome this stage, but if this stoppage or repetition persists or gets more severe and intense then that is a sign of a real problem that calls for consulting a speech & language therapist.

What is stuttering?

Stuttering is a speech fluency disorder, in which a range of behaviors interrupts the flow of speech.

This behavior includes:

  1. Repetition of words or syllables, e.g.: (fi-fi-fi-fish).
  2. Repetition of phrases, e.g.: (what’s-what’s your name).
  3. Audible or silent pauses.
  4. Prolongation of sounds, e.g.: (w ww watch).
  5. Division of words, e.g.: (ha-ppy).
  6. Use of interjections, e.g.: (um, ah, you know).
  7. Stressing certain words in speech.
  8. Inability to articulate an idea directly or say a certain word.

In addition to some secondary behaviors:

  • Trembling of the jaw
  • Jaw muscles tightening
  • Avoidance of eye contact
  • Nervousness
  • Movement of the leg, hand, torso
  • Tongue protrusion and lip biting
  • Frowning
  • Avoidance or lack of speech
  • Coughing or swallowing
  • Looking to the side

Facts about stuttering:

  • Stuttering might be similar between different people, but the underlying causes differ from one person to another.
  • It might start suddenly, but usually develops unpredictably over time.
  • It is not caused by mimicking other stutterers.
  • Emotional problems do not cause stuttering, but stuttering might cause emotional issues.
  • It is hard to tell who will get better and who will continue to have this disorder; so stuttering children must be evaluated by a speech and language therapist.
  • Forcing left-handed children to use their right hand does not cause stuttering per se, but could result in emotional problems, thus negatively affecting the speech.
  • Stuttering is usually accompanied with negative emotions that cause a problem for the person, while going unnoticeable for listeners. Stuttering is not consistent in all situations, as in some situations the child stammers a lot while he is fluent in other situations.

Factors affecting speech differ from one person to another, including:

  • Who the person is addressing
  • The subject of the speech
  • Where he’s talking
  • What time, day, or year he’s talking
  • The person’s emotional state (excitement, fatigue, illness, etc.)
  • The desired message’s length and complexity. People are often afraid or embarrassed of stuttering, making them try to cover their stutter from other people by avoiding talking to people in certain situations or avoiding words they believe they would stutter while pronouncing. However, if a child starts avoiding talking to avoid stuttering this will definitely affect his/her social, emotional, and educational progress.

Teenagers are more capable of hiding their stutter in a way that makes people go unaware of its existence. Although that might seem good, but it actually has its own shortcomings. Hiding this problem takes a lot of cognitive effort and emotions as a result of feeling ashamed.

This is reflected on the teenager’s ability to positively engage in school activities or social life. The best way to deal with a stutter is not by trying to hide it, but rather by directly facing it.

Role of the speech and language therapist

Speech and language therapists evaluate the stuttering person by taking the case history from either the patient or his/her parents and a sample of his/her speech, followed by testing to determine the problem’s severity. The speech and language therapist’s role is to help the patient modify the secondary behaviors to enhance his/her fluency (such as reducing the speed of talking, starting easily and pronouncing sounds gently),modify the stutter (such as using relaxation methods and reducing sensitivity to stuttering, etc.) or use a combined approach of fluency shaping and modification.

How stuttering is treated

The key treatment objective for children between two and a half to 6 years old is to help the child speak fluently, through teaching the child to change the timing and intensity of his/herwords, giving him/her a model to follow while they play or speak in the treatment room or at home. Treatment of this age group is highly effective, as many of them are completely healed by the age of six.

Stuttering could get worse with age, and is harder to treat for those older than teenagers. Enhancing fluency is still the main treatment objective, in addition to other objectives that help the child think positively about themselves and their speech, even as they continue to stutter. Parents also play a key role in this process through accepting the child’s speech abilities and providing a supportive environment for the child whether he/she stutters or is learning how to speak fluently.

What can parents do?

It’s important to know that parents don’t cause stuttering. There are things, however, that they can do to help their children speak fluently, for example:

  1. Give the child a role model

Disfluency increases when children find their surrounding people speaking too fast. This makes children attempt to mimic those theyare talking to (especially parents).

Parents, therefore, must pay attention to their speech rate and try hard to speak slower.

Parents should alsospeak less intensely and more comfortably. One way to achieve this is to repeat the sentence to the child but more slowly and with more information.

For example: If the child says “I want to play outside” you can answer slowly “you want to play outside” (pause) “that would be nice”.

This gives the child a direct example on how to speak more easily and fluently at a slower rate.

  1. Reduce requirements

People often feel uncomfortable when children stutter. This feeling creates an urge to help the child to speak slowly or stop to breathe and think about what he/she wants to say. It is best to avoid any correction or ask the child to speak more fluently. In treatment, people learn how to change their speech, and we learn how to respond to or support fluency more positively. Some parents are proud of how well their children can memorize stories and songs, and they often ask them to display this ability around their friends and family. Nevertheless, although some children enjoy these activities, this kind of requests that require verbal performance puts a lot of pressure on the child’s fluency.

Although it is very important to show admiration of your child’s performance and his/her fluency, what helps the most is actually finding a way to show their ability without putting a pressure on his/her speech or fluency, such as speaking in a group or singing.

Another form of requirements is using a complex language, as people who stutter are less fluent when they say long or complex sentences.

When  a person stutters, it is best to ask less questions that require long or complex answers, such as “what did you do at school today?” instead, try to use questions that require useful and easy  answers, such as “it’s nice that it was raining in your recess time.” Give him/her time to respond, the wise thing to do is to manage the patient’s verbal situation carefully when the child is speaking fluently

  1. Reduce time that creates pressure on the stutterer
  • This is one of the most useful approaches, in which the time factor that creates a pressure on the stutterercan be reduced, by providing an example of slower speech.
  • Another useful approach is pausing for a second or two before answering the child’s questions. By this, you give your child the time he/she needs to ask and answer questions, and helps teach him/her not to be impulsive in his speech. This approach makes it clear for the child that he/she should take his/her time before talking to answer correctly.
  • Another benefit of pauses is teaching the child how to take turns when talking, as a normal conversation requires only one person to speak at a time and the others to be listening, any interruption of speech is reflected as an increase of speed, whereas the speaker feels pressured to convey his message as quickly as possible.

 

  1. Pay more attention to the content than the way of speech

Stutterers draw attention to themselves as they speak, causing people to pay more attention to how they speak than to receiving the message the child is trying to convey.

The stutter soon realizes this, which in turn increases his/her shame or embarrassment of speaking.

To reduce negative feelings, people should focus on and respond to the message being said by the child.

  1. Deal with stuttering more acceptingly

No parents would like their children to stutter, but parents must accept their children and their stutter, as a stuttering person’s confidence comes from other people’s acceptance, especially their parents. Therefore, it is necessary to do away with any negative feelings resulting from other people’s lack of acceptance. Those receiving treatment learn to be more fluent, but would not make any successful progress if they have negative ideas about themselves or their speech.

  1. Consider stuttering modification like any other behavioral modification

Parents are often confused about what to say to their stuttering children, especially when stuttering is intense or prolonged. Some parents are advised not to draw the child’s attention to the stutter to prevent it from getting worse.

We believe that the best way to treat stuttering is through considering it like any other difficult behavior in the child’s life (such as riding a bike or skateboard). If a child falls while learning how to ride a bike, you wouldn’t hesitate to teach him/her, try to rid them of their fear, and increase their skills and competence.

This indeed is how we should proceed with stuttering.Using this approach of encouraging your stuttering child and building his confidence in his speck helps him/her speak freely and feel comfortable expressing his/her feelings and fears.

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