Information On Stuttering | A Million Things To Say

What is stuttering?

Stuttering, also known as stammering, is a speech disorder in which the rhythm and flow of speech is disrupted by repetitive speech or stoppages whilst talking. The cause is not known. However, it is believed to be a speech-motor processing difficulty. There is a genetic predisposition to stuttering. About 60% of people who stutter have a family history of stuttering. More boys than girls stutter at an approximate ratio of 4:1.

How do I know if my child or I am stuttering?
Children and adults who stutter often know what they want to say, but when they start to talk or in the midst of talking, they may experience the following involuntary symptoms:

Signs	Example
Repetition of sounds	m-m-m-m-m-mummy cho-cho-cho-cho-chocolate
Prolongations: Awkward stretching of sounds	mmmmmmmmore please caaaaaaaan I have wwwwwater?
Blockages: Uncontrolled hesitations/stoppages/pauses before talking: A sense of getting stuck : Long silences/delays before talking	My name is (silence……….) Beth

These symptoms could result in the person’s speech sounding effortful and reduce communication effectiveness. They may take a longer time to get the message across. The early signs of stuttering are repetitions. As stuttering advances, the repetitions, prolongations and blockages can be accompanied with effort and struggle. Physical characteristics such as face reddening, jaw tremors, blinking and grimacing may occur along with the stuttering.

When does stuttering first appear?
Stuttering is usually first seen in the preschool years (age 2-3 years old). The beginning of stuttering can be sudden or gradual. The first signs of stuttering usually occur when the child is beginning to put words together and is experiencing a burst in language development. It can be very distressing for parents when stuttering suddenly appears.

Stuttering is also variable. This means that in certain speaking situations (e.g. talking on the telephone or in a group), the stuttering might be more severe or less. Children and adults who stutter often find that their stuttering fluctuates and that they have “good” days, “bad” days and “stutter-free” times. The times in which their stuttering fluctuates can be random. Quite often people who stutter feel a “loss of control” over their speech.

What is the relationship between stuttering and anxiety?
It’s commonly thought that stuttering is caused by nervousness. This is a MYTH! Studies have shown that at the onset of stuttering, children who stutter do not experience higher levels of anxiety as compared to their peers. However, anxiety can develop as a consequence of stuttering.

It has been reported that about 80% of children who stutter may experience negative reactions/bullying/teasing at school. About 40-60% of adults who stutter experience higher levels of anxiety compared to their peers. While anxiety is not the cause of stuttering, anxiety can make the stuttering worse. Anxiety can manifest as a result of stuttering if it persists into school-age years and adulthood.

Should I get the stuttering treated?
For children, identifying stuttering early is important because treatment for stuttering is the most effective when a child is treated younger than 6 years of age. There are children who stutter who spontaneously recover without treatment. But it is also hard to predict who will and won’t recover without treatment. Generally, if the stutters persist beyond 1 year from the onset of stuttering, then spontaneous recovery is unlikely to happen.

Ignoring stuttering can be potentially harmful because if it persists into formal schooling years, stuttering can have an impact on their social interactions, self-esteem and communication in school, at home and even at work. Feelings of frustration and embarrassment may also arise. While preschoolers who stutter show no signs of social anxiety problems, we know that if stuttering continues into formal school years, social anxiety can develop as they may face bullying/teasing at school.

It is important to seek professional advice from a speech therapist as soon as stuttering is noticed. This is because outcomes for treatment are much better if treated before the child starts formal schooling. The speech therapist will assess and advise as to whether to start treatment or to monitor the stuttering closely.

What are the treatment options available?
There are various options and approaches to treating stuttering. The type of treatment can be categorised into 3 main age groups:

Stuttering treatment for the pre-schooler
Stuttering treatment for the school-aged child
Stuttering treatment for the adolescent and adult.

Stuttering treatment for the pre-schooler
The Lidcombe Program

It is important to treat stuttering as early as possible. Early intervention is crucial because studies have shown that as a child enters formal schooling, children can be bullied and teased in school because of their stuttering. The Lidcombe program is the gold standard and best practice for treating stuttering in the preschool years (3-6 year olds).

The Lidcombe program is a behavioural approach to treating stuttering. Treatment is highly effective and aims to reduce the child’s stuttering through praise (for fluent speech) and neutral correction (for stuttered speech).

The Lidcombe program is administered by the parents under the supervision of the speech therapist. Treatment is carried out by the parent in their home setting on a daily basis. The speech therapist will facilitate the parent’s/caregiver’s learning in carrying out the treatment sessions. In the Lidcombe program, parents learn to modify activities to draw out fluent speech from the child in a fun and enjoyable way. Parents are taught how to praise and acknowledge for speaking without stuttering and neutrally correct for stuttered speech. They also learn how to measure and monitor the child’s progress from day to day.

While the principles of the Lidcombe program remain the same, the program is individualised to suit the child’s interest and personality. The benefits of the Lidcombe program outweighs that of a wait-and-see approach. However, “when” to start treatment is best discussed with your speech therapist.

Syllable-Timed Speech (Westmead Program and Oakville Program)

Another approach to treating pre-schoolers who stutter is syllable-timed speech. This approach was developed by researchers at the Australian Stuttering Research Centre, Sydney. It is a parent-administered program where parents model for their child syllable-timed speech in their day to day setting. The speech therapist will facilitate the learning of syllable-timed speech in the clinic. The child then acquires the syllable-timed speech rhythm to his/her speech and is able to lower stuttering levels. Research is still ongoing but it has already shown promising results in the clinic.

Stuttering treatment for the school-aged child
Once stuttering persists past 7 years of age and into the formal schooling years, it becomes less tractable. The treatment aims for school-aged children to reduce their severity of stuttering. There are various treatment options for a school-aged child. However, which approach to take requires an experienced therapist to decide. Here are some of the reasons why school-aged children need to be carefully assessed and treated.

They may have experienced negative reactions at school such as bullying, teasing and mimicking from their peers/siblings
They may have developed unhelpful thoughts and reactions towards their stuttering. And hence their self-esteem may have been affected.
They may have developed high anxiety levels associated with certain speaking situations
They may have relapsed from previous therapy and have preconceived ideas of therapy
There are changing dynamics of the parent and child relationship as the child enters school-aged years
The maturity and motivation differs across each child and hence affects how he/she prioritise speech practice and his/her attainment of fluent speech amongst other school activities

There are different treatment approaches available for a school-aged child. While some younger school-aged children may benefit from the Lidcombe Program, more matured school-aged children may benefit from the Camperdown Program. The Lidcombe and Camperdown program may be modified to suit the child best. There are other approaches to treatments and these include: Extended Length Utterance, Syllable-timed speech, Self-imposed Time Out, Prolonged Speech and Speech Restructuring. For more information, please contact us.

Stuttering treatment for the adolescent and adult
Adolescents and adults who stutter often feel a loss of control over their speech. For this age group, the speech restructuring approach is recommended. This means that adults have to learn speech techniques to talk more fluently. Prolonged speech (PS) or smooth speech techniques (SST) are commonly used strategies to help control the stuttering. These strategies have been shown to reduce stuttering by approximately 80%-90% when applied.

Speech restructuring with PS and SST can be taught through the Camperdown Program. The Camperdown Program is facilitated by the speech therapist. It is well-researched and has been shown to give good speech outcomes in a shorter period of time compared to other service delivery models.

The Camperdown Program aims to help an individual control his/her stuttering while sounding natural. It also trains the individual to self-evaluate his/her speech while learning the strategies and in different speaking situations. The Camperdown Program gives adults the best chance of attaining controlled, natural sounding fluent speech. Studies have shown that 40-60% of people who stutter and have sought help have been diagnosed with social phobia. Hence, treatment for social anxiety may be necessary.