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. 

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).  

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. 

If you had a chance to go back in time, would you do things differently?  Is there advice you might give your younger self, knowing what you know now? Why not put it in writing?  Simon Walsh, a person who stutters and the host of the blog "Diary of a Stutterer", did just that. After reading his post, I immediately knew I wanted to use this idea in my own therapy room.  The purpose of this assignment is not to dwell on "mistakes" of the past, but rather to help identify all the positive changes that have been made.  This is a fun way to get students talking about the consequences of previous unhelpful thoughts or habits so that if they were to reappear, which habits so often do, the student might be better equipped to identify and extinguish them.  For younger students and students that are new to therapy, this assignment can be adapted by having them write a letter to their future self. Instead of focusing on how things have changed and what they have learned, instead this assignment allows students to ask questions they may have about stuttering and identify things that they want to change. 

This is one of my favorite therapy activities!  With permission from the student, I have posted an example of one of these letters.  Do you have any similar activities you have done with your student, your child or something you did for yourself?  Post below!  

I have been getting a lot of questions from SLPs and parents that all seem to center around the question "Is this stuttering" or "Does this warrant speech services?"  


Question:  
I am a school based SLP. I just screened a 7 year old girl. Her teacher was concerned that she might be stuttering. She is repeating whole words and phrases quite often. She also used some interjections such as "um". Her teacher has never heard her repeat or prolong sounds. Is this really considered stuttering if a child is only repeating words and phrases? I have been looking on the internet, but most children either repeat syllables or sounds as well as words or else they don't repeat whole words as often as this student. 

In my time working in a private practice, I have had parent after parent come to me utterly frustrated with the lack of speech services being provided by their school district.  Too often these concerned parents are being told that their child does not qualify for services as stuttering does not have an "academic impact."  Unfortunately, this explanation is often being provided not because the child does not warrant services but rather because the therapist does not feel comfortable or competent in providing stuttering therapy.  Even worse, some children are being denied services as a direct result of therapists receiving pressure from their district to limit the students being added to the caseload.    Despite the challenges involved in providing stuttering therapy within the school setting, there are many dedicated therapists that demonstrate that it can be done! I want to take this time to spotlight the Kenosha Unified School District, of Kenosha, Wisconsin.  Thanks to a small group of devoted speech pathologists working in this district, KUSD has created a monthly therapy and support group, the Friends Stuttering Group (FSG).  I hope FSD can act as a model for how school districts around the country choose to serve their students who stutter.