By Jessica Safer MS, CCC-SLP 
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As children grow and develop language, many may display “typical disfluencies” in their speech. These disfluencies are natural as the young child’s language is emerging, and his or her speech system is working hard to put together new words in a variety of ways. 
 
Typical disfluencies occur between the ages of 2 ½ and 5. They can include:

• Multisyllabic whole word repetitions (e.g.  “Gimmie gimmie the cookie”)
• Interjections (e.g. “I um, went to the kitchen”)
• Phrase repetitions (e.g. “I want I want I want a cookie”)
• Phrase revisions or abandoned utterances (“I want.. Can I have a cookie?”)

 
Typical disfluencies are common among young children and are not cause for concern.
 
The disfluencies characteristic of Childhood Onset Stuttering are different than typical disfluencies.
Some examples of the disfluencies seen in Childhood Onset Stuttering include:

• Monosyllabic whole word repetitions (e.g. “I-I-I-I- want the cookie”)
• Sound / syllable repetitions (e.g. “be-be-be-because I’m hungry”)
• Prolongation of sounds (e.g. “IIIIIIIIIIIIII want a cookie”)
• Blocks (when no sound comes out)

 
These disfluencies may be accompanied by:

• Signs of physical tension or struggle, such as eye blinks, facial grimaces, head or body movements, and/or distracting sounds
• Negative reactions towards talking
• Avoidance of certain sounds, words, or situations

In addition to the types of disfluencies demonstrated, the following are considered risk factors for persisting stuttering:

• Being male
• Having a family history of persistent stuttering
• Having a later onset of stuttering
• Demonstrating stuttering for a longer period of time (6 months to a year or more)
• Having delayed or advanced language skills
• Another speech/language disorder

 
Knowing the differences between typical disfluencies and Childhood Onset Stuttering can help identify those children that would benefit from therapy. If you’re not sure if your child is demonstrating Childhood Onset stuttering, contact a speech language pathologist with experience in stuttering. Your speech language pathologist can help determine if therapy is recommended, and if so, assist you in finding the therapy approach that would be the best fit for your child and family.

Stuttering is a fluency disorder that is defined as a disruption in the forward flow of speech.  It is commonly characterized by repetitions (ex. ba-ba-baseball), sound prolongations (ex. mmmommy), or blocks (i.e. no sound).  Disfluencies may also be accompanied by negative thoughts and feelings about stuttering, avoidance of sounds, words or situations and physical tension or struggle behaviors (ex. eye blinking, lip tension, head nodding, etc.).   Stuttering is NOT an emotional disorder, but stuttering can certainly have an emotional impact.  As children get older, they may develop “tricks” for hiding their stuttering by swapping out words or planning and rehearsing what they are going to say before speaking.  Other children may avoid speaking in certain situations altogether.  These “tricks” may make it look like the child is stuttering less or has eliminated stuttering altogether, however this fluency comes at a significant cost to their emotional and social wellbeing as well as their ability to thrive in an educational setting. 
 
There are many young children who demonstrate disfluencies in their speech as they go through the natural process of developing language, however these disfluencies look and sound different than stuttering. Consult a speech/language pathologist if you are unsure if what you’re seeing is “true stuttering.”  If a differential diagnosis is made early on, the family can make use of the critical window of time that therapy is most effective.  

HOW CAN TEACHERS HELP?
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• Saying things like “slow down”, “think about what you want to say” or “take a deep breath” may help fluent speakers when they are stumbling on their words.  However, children who stutter are disfluent for different reasons and these remarks often add more pressure and thus trigger more disfluencies. Instead slow your own rate of speech by adding pauses within your sentences at natural breaks, between your sentences and after the student finishes their thought​ to reduce pressure. 

The following are tips for enhancing your child’s fluency and promoting healthy communication attitudes and enjoyment for speaking:

• Reduce the overall pace of your interaction with your child.  Do this by slowing your rate of speech and adding pauses within your sentences at natural breaks within a sentence, between your sentences and after your child finishes their thought.  

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• Follow your child’s lead in play in order to match the pace of their interaction, reduce language demands and promote creativity and development of problem-solving skills.

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In 1988 Ronald Reagan declared the 2nd week of May as National Stuttering Awareness Week (NSAW)- a week dedicated to educating our communities about stuttering and its impact on peoples' lives.  Members of the National Stuttering Association (NSA) played a huge role in establishing this week so what better way to celebrate it than to hear from current NSA members? The following excerpts come from the social media accounts of 4 NSA members (with permission).  

Speech Pathology Australia (SPA), Australia's professional organization for speech-language pathologists (SLPs), recently submitted a proposal that suggests that SLPs working in clinics run by the Australian government must be trained in the Lidcombe Program in order to treat pre-school aged children who stutter.  SPA is also supporting legislation that would extend this mandate to private practitioners and require them to provide the Lidcombe Program in order to be reimbursed by Medicare.  Although the SPA’s intentions may be to increase access to treatment for young children who stutter, we must not overlook the ramifications of having the government and private insurance companies intervene with clinical decision-making.  

The first thing to consider is that there are multiple factors that are known to contribute to the onset of stuttering.  Each child has a unique set of abilities and vulnerabilities that determine if and how stuttering is going to persist. Those different circumstances demand different approaches to treatment.  A speech pathologist cannot be expected to develop a treatment plan that is specifically tailored to the client when the SPA is using Medicare reimbursement to limit them to one approach. Speech pathologists could be faced with the unfortunate dilemma of deciding whether to use an approach that best fits the child and families’ needs or to use the approach that will get reimbursed. 

Question: Do you have a sequence in which you like to introduce techniques to students who stutter?  

I do not believe there is a "right" sequence. Each child and family experiences stuttering in a different way due to their temperament, home environment, communities, etc. and their treatment plan has to reflect that.  However for new clinicians or clinicians who have little experience with treating a child who stutters, it is understandable that you may want a blueprint of what therapy should look like. 

There are more than 3 million people in the United States who stutter. Pediatricians and teachers are often the first professionals that a parent will go to for advice. In order to determine when to refer to a speech/language pathologist, these professionals are faced with the challenge of differentiating between typical disfluencies and true stuttering.

Research suggests that anywhere between 75 to 80 percent of children who go through a period of disfluency will outgrow stuttering. This statistic can often lead teachers and pediatricians to suggest that the family “wait and see” before consulting a speech/language pathologist.

However, one must also consider the risk of missing a critical window in which treatment is optimal. Early intervention plays a vital role in reducing the likelihood that a child will continue to stutter and can minimize the impact of stuttering on a child’s life--both socially and academically. There are certain risk factors that professionals, as well as families, should consider when deciding what’s best for the child.

Read the rest of this article at:  www.expertbeacon.com

Very excited to be helping to facilitate a FRIENDS workshop on March 28, 2015 in Washington, D.C.  There will be sessions for children, teens, siblings, parents and speech-language pathologists .  You can learn more about this wonderful organization by visiting their website at http://www.friendswhostutter.org/.  

When a child who stutters is demonstrating the ability to make changes to their speech in the therapy room, it seems obvious that they’d want to use the same strategies to improve their speech outside of the therapy room as well.  Children, especially teenagers, rarely want to stand out in a way that can stigmatize them, provoke questions or increase the chances of teasing.   The question then arises, “Why aren’t they using their tools?!”

Speech and stuttering modification techniques are often learned quickly and easily within the therapy setting.  However, speech/language pathologists and parents often feel discouraged when knowledge of these techniques seem to disappear as fast as it takes for the child to get to their car in the clinic’s parking lot.  Is it laziness on the part of the child?  Is it the fault of the family for not following through with home assignments?  Is the speech/language pathologist not teaching the correct strategies?  Instead of pointing fingers at each other, let’s uncover why speech/stuttering strategies can be difficult and determine how we can best navigate these challenges. 

A careful diagnosis, thorough evaluation and an individualized care plan, are the keys to successfully treating the fluency disorder cluttering. The disorder is characterized by perceived rapid and/or irregular rate of speech, which results in reduced clarity and fluency. 

"To the listener, the speech rate of a person with cluttering sounds rapid, or sounds rapid sometimes, then other times more typical," explained Kathleen Scaler Scott, PhD, CCC-SLP, BCS-F, assistant professor, Department of Speech-Language Pathology at Misericordia University in Dallas, Pa. 

In the past, experts thought the rate of speech in this patient population was faster than average, but that is no longer the case, said Scaler Scott, who recently co-authored Managing Cluttering: A Comprehensive Guidebook of Activities, with David Ward, PhD, of the University of Reading, England. 

While the person's speech might sound rapid or irregular to the listener, research now shows the rate of speech is often measured within normal limits, Scaler Scott told ADVANCE. "The current thinking is that a person with cluttering speaks at a rate that is too fast for their system to handle," she qualified. 

According to Brooke Leiman, MA, CCC-SLP, people who clutter often demonstrate missed or collapsed syllables (e.g., "I went to the zoo," becomes "I went the zoo."), abnormal pauses or speech that contains abnormal rhythm or syllable stress. Leiman is director of the Stuttering Clinic at the National Speech/Language Therapy Center in Bethesda, Md., and host of www.stutteringsource.com. 

People who clutter also demonstrate excessive "typical" or "non-stuttering-like" disfluencies, according to Leiman. A few examples of typical disfluencies include: phrase repetitions ("can I can I have a cookie?"); phrase revisions ("I want the-can I have the cookie?"); and interjections ("um").

Read the rest of this article at ADVANCE for speech and hearing