Q&A: Help for Stuttering Children

Even parents of stuttering children don't understand what's happening. Nine out of 10 parents would tell a child who stutters to slow down and relax, said a survey by the Stuttering Foundation of America (SFA). But that might not be the best therapy for your child, says Lisa Scott Trautman, Ph.D., assistant professor of communication disorders at Florida State University and a spokeswoman for SFA. Learn about what stuttering is and how to help your child.

What is stuttering?

Lisa Scott Trautman: Stuttering is repetitions of words or holding onto sounds - what we call prolongation of certain sounds or words - that causes a disruption in the forward flow of speech.

Stuttering varies from person to person. When the child is younger, they may repeat words like "because," "and" and "so." They are learning grammar at this age. By the time they get to school, they may be having trouble with nouns and verbs.

At what age does it start?

Trautman: It generally starts between the ages of 2 and 5. The most common age is later, usually around 4 or 5 years old. But it can occur as late as third grade.

Stuttering usually starts when a child is in rapid growth in language development with using full sentences and grammar becoming more complex.

What causes stuttering?

Trautman: We don't know. Current research shows that half of children who stutter have some sort of genetic link predisposing them to stutter. With the other half, our best educated guess is a combination of biological factors including temperament, overall communication skills such as a delay in developing language, how they learn, their cognitive skills and the environment.

For example, some children are very sensitive and can be shy. They tend not to like change such as moving to a new home or changing babysitters. This is a totally normal personality. But we do find that kids who stutter seem more likely to have this sort of personality. These are considered inborn, or biological traits.

These inborn factors, combined with environmental factors such as parents who have very high expectations of their children, may help trigger stuttering.

One sort of environmental trigger could be what we call "speech on demand." For example, all parents expect their child to say "please" and "thank you." This is normal. But for a child who is very sensitive, if parents push for this too much or when a child is not quite ready to learn "please" and "thank you," it may cause the child to become anxious about speaking. They may ask the child to repeat a phrase like "Thank you for the nice gift." That can be too much for the child, and the child might hesitate and say, "Th-th-thank you for the present." In this situation, parents can reduce speaking pressure on the child by just modeling what the child should say instead of forcing the child to say it: "Oh, how nice, Grandma gave you such a nice present! Thank you, Grandma!"

Also, stuttering might be triggered at a time when a child's speech and language development is a bit out of sync. When learning a new skill like walking, most toddlers will slow down temporarily in other areas of development until that new skill is mastered. Once the child has mastered that, development will rapidly begin again. In communication skills, we often see stuttering begin when the child is learning new vocabulary and grammar, so some researchers think that stuttering may be triggered at a time when there is a mismatch in the child's development of those skills.

Do parents cause stuttering?

Trautman: There has never been any research that says a parent does anything to cause it. In spite of this, parents tend to feel a lot of guilt when their child begins to stutter, thinking, "Oh, gosh, what did I do?" They try to attribute the beginning of stuttering to a specific event and they can put a lot of guilt on themselves. It's very important for parents to know that it is not their fault.

Although parents don't cause stuttering, they might be doing things that contribute to the problem. Recently, I talked with a mom who had a 3-year-old who had just started to stutter. This child was learning three languages. The mom spoke English, the father Portuguese, and they had a woman from Thailand who was helping around the house. At the same time, they changed his daycare. This little boy was very smart and the parents were excited he was being exposed to three languages, so they were teaching him all kinds of words in each of them. But it was too much for him, and he began to stutter.

In this case, the parents didn't cause stuttering. Maybe it was an example of a mismatch between his environment and his own language skills. But they may have contributed to his problem by having such high expectations of him, even though he was a very smart little boy and liked learning new words. We decided the best thing to do in this case was to reduce expectations and simplify. They all began speaking to him in only one language and the stuttering soon went away. When he gets a little older, they can start teaching him again, but for now, it might have just been too much.

Do children grow out of it?

Trautman: Research tells us that 75 to 80 percent of all children will probably outgrow it without getting any speech treatment. But if parents are concerned, they should have it checked out with a speech pathologist.

Many pediatricians say, "Don't worry. They'll grow out of it." But you need to get the opinion of someone who has specific knowledge about stuttering. Most pediatricians have a very basic understanding.

One of the biggest misconceptions is to just ignore it and wait it out. But children don't always grow out of it or it may take a while. Parents should get informed about the problem so they can make better decisions about waiting versus getting help right away.

How successful is treatment?

Trautman: We have a very high success rate with young children. By using speech therapy, we help the child learn an easier way to talk and we help the parents manage their own concerns.

We can help children and families deal with stuttering in a healthy way, by learning to talk more easily, being more assertive in conversations, and more confident about talking. We have been highly successful in helping children and adults make positive changes in their communication skills. We want to decrease the amount of impact stuttering has on a person's life.

Do medications work?

Trautman: Some medications like Zoloft® and Risperdone® have been tried on adults but they really don't have consistent results. Part of the problem is that we really don't know what causes stuttering in the first place. So it's hard to prescribe a medication that will treat it. There's no one drug to fix it right now.

Are there medications that could make it worse?

Trautman: Some medications may make stuttering worse. In my experience, some ADHD medications may make it worse, but also sometimes it makes stuttering better. It really depends on the child, and it's definitely not something you can predict.

I've also noticed that some kids will stutter more when taking an asthma medication and then parents will wonder if they should stop the asthma medication. Asthma is a life-threatening illness, so it's very important to give children the medicine they need. Parents should talk with the speech therapist about any changes they see in stuttering that seem to be related to medications.

Does it get worse as a child gets older?

Trautman: The longer kids stutter, the more likely that kids will have negative experiences like being teased or stuttering when called on in class. These negative experiences are going to influence whether they raise their hand in class, talk freely with their friends, or give speeches. I worked with a 17-year-old girl who purposely flunked a chemistry course, because part of the grade was classroom participation and she didn't want people to think she was stupid and didn't know the answer when in fact, she just couldn't say the answer quickly.

It's not uncommon for a child who stutters to be quiet, even though I've had many children tell me, "It's not my personality to be quiet, but I don't want other people to hear me stutter." If children have this attitude, their stuttering can be inhibiting their social interactions.

Are there misconceptions about stuttering?

Trautman: People assume that these children are shy or more anxious than other children, or that they have learning problems or are dumb. Nothing could be farther from the truth.

Which gender is more susceptible to stuttering?

Trautman: Boys are five times as likely to stutter as girls. We don't know why. It's like that for most disorders like learning disorders and genetic syndromes - males are affected more often than females.

Are there specific warning signs parents should be concerned about?

Trautman: When trying to help families decide whether to seek help, there are a few key questions we ask.

Is there a family history of stuttering? If yes, is that person still stuttering? We're more concerned about children who have a family history of stuttering, especially if that family member is still stuttering.

Is the child a boy? Boys are more likely to stutter than girls.

Has the stuttering been going on longer than three months? If the child has been stuttering longer than three months, we get a bit more concerned. If the child has been stuttering longer than six months, we're even more concerned.

How old was the child when he or she began to stutter? Research shows that children who begin stuttering BEFORE age 3 are more likely to outgrow it with no treatment. If a child starts stuttering after age 3-and-a-half, we're much more concerned because these children are less likely to grow out of it.

Does the child have a hard time with certain words or syllables? Children who are in the early stages of stuttering will often repeat the first syllable of the word, usually more than three repetitions such as muh-muh-muh-muh-mommy. If the child is repeating a syllable three or more times, we're more concerned.

Do they follow commands well and use lots of vocabulary words? We're more concerned about children who are delayed in other areas of communication skills. If the child has a limited vocabulary and doesn't seem to understand as well as other children his or her age, we're more concerned.

How do you know when to get help?

Trautman: Almost all children go through a period of disfluency, where words or sounds are a bit harder to say. We usually see this during preschool years, especially at times when vocabulary and grammar are really growing. If you notice lots of syllable repetitions and it's been going on for three months or more, parents should definitely get more information about the problem. But if there is a family history of stuttering, or the child is older than age 3-and-a-half, parents might want to call if the stuttering has been going on only for a month or so. It's better to get information and decide that it's not really something to worry about, than to worry and wait too long.

What can parents do?

Trautman: The first thing parents should do is get more information about the problem. This is one of the best ways to help the child.

Parents can also help by thinking about what they are asking of their child. Is there a lot of pressure and demands on the child to talk or to use certain words or speech sounds?

For example, asking your child to say "please" and "thank you" is normal. If a child is not saying these things and using good manners, parents might get a little anxious and put added pressure on the child to use those terms. This can be hard on a sensitive child. Instead, parents can model it for the child such as saying, "Oh, wow, this is such a neat present that Grandma got for you! Thank you for such a cool present, Grandma!" So the child gets the idea that he or she is to say thank you, but it's not forcing the child to say it.

Another way parents will often put extra communication demands on their children is by giving way too much information. For example, a parent might tell a 2-year-old who sees a dog, "That's a poodle and poodles can be lots of different colors and like to have their hair fluffed and you have to give them baths." That's too much information for them to process. Just saying, "Hey, that dog is called a poodle," is enough for a 2-year-old.

Finally, one thing I always recommend to parents is to try to keep the environment and schedule as consistent as you can. Preschoolers really need lots of structure and routine, so being consistent with the same bedtime, same daily schedule and so on is helpful.

How should parents behave with a child who stutters?

Trautman: You should treat that child just as you would any other child. If you treat the child as special by not disciplining him or her in the same way, by giving that child special favors, in the long run you can create all sorts of problems not related to the stuttering. The kid might learn, "All I have to do is stutter to get my way."

Where can parents get help?

Trautman: Getting information is one of the most important things parents can do to help parents their child. The Stuttering Foundation has lots of materials that are available to parents for free. You can reach the SFA at 1-800-992-9392.

External Source The Stuttering Foundation of America

This article was reviewed and updated June 2007.

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