Introduction
Stuttering (a.k.a. Stammering) is a speech disorder in which a person involuntarily repeats and prolongs sounds, syllables or words; further, in stuttering, a person also pauses speech, which is usually known as blocks. A person who stutters knows what to say, but has trouble having a normal flow of speech
As secondary problems, a person with stuttering faces social issues such as anxiety, low self-esteem, problems in interpersonal relationship etc.; however, the good news is that all these issues can be fixed to a greater extent by attending speech therapy sessions and making some environmental modifications.
Five famous facts
Stuttering affects people of age groups.
About 1% of the world’s population suffers from stuttering; so, you are not alone.
Mostly starts between 2 to 6 years; the mean onset of stuttering is 30 months.
Almost 75% of children recover while 25% continue to stutter for lifelong; however, speech therapy can help them overcome stuttering significantly.
Treating before the age of 7 may prevent stuttering from becoming a lifelong issue.
Types of stuttering
Developmental stuttering: It is the most common form of stuttering that occurs in young children while they are learning speech and language skills.
Persistent stuttering: When stuttering persists after the age of seven.
Neurogenic stuttering: In this form, the brain has difficulty in coordinating structures involved in speaking; this usually happens due to stroke or brain injury.
Psychogenic stuttering: In this form, stuttering is related to psychological conditions or emotional trauma. However, in recent days, psychogenic stuttering is not considered a true form of stuttering.
Major risk factors
Family history: It is the most regarded risk factor in terms of stuttering.
Gender: Boys tend to stutter more than girls.
Age factor: Children who start stuttering at the age of 3.5 years or later are more likely to continue stuttering if not treated early.
Identifying stuttering (Ref. ASHA)
Stuttering is usually considered as a disfluency; however, all kinds of disfluencies can’t be considered as a sign of stuttering.
Disfluencies known as ‘typical disfluencies’ are normal and happen when a child starts learning a lot of words or new speech sounds; typical disfluencies are less likely to continue as stuttering and are not signs of stuttering.
However, on the other hand, few ‘other types of disfluencies’ are more likely to continue as stuttering and need to be considered as alarming signs of stuttering. Below is the table differentiating among these disfluencies (Ref. ASHA).
Typical disfluencies (Misunderstood signs of stuttering that less likely to continue as stuttering.)
Adding a sound or word, called an interjection – "I um need to go home."
Repeating the whole word – "Well well, I don’t agree with you."
Repeating phrases – "He is–he is 4 years old."
Not finishing a thought – "His name is . . . I can't remember." (Or) Changing the words in a sentence, called revision – "I had–I lost my tooth."
Noticed less frequently and doesn’t stay continuously for more than six months.
Other types of disfluencies (Alarming signs of stuttering that more likely to continue as stuttering.)
Prolonged sounds – "Ssssssssam is nice"/ "Ssssssometimes we stay home."
Repeating part of a word – "I w-w-w-want a drink."/ "Look at the b-b-baby"
Repeating One-syllable word – "Go-go-go away."
Completely pausing (a.k.a. blocks or stops – "I want a (pause) cookie."
Noticed more frequently and stays continuously for more than six months
Stuttering associated behaviours: Apart from the speech-related signs, a person who has stuttering will also show some physical struggles and associated behaviours, such as having a tense mouth, throat clearing, hand tapping, head nodding, eye blinking, avoiding eye contact, looking to the side, and avoiding conversations.
Influence of the environment: Symptoms of stuttering can vary significantly throughout a person’s day based on the situation; for instance, talking on the telephone, speaking in public, or speaking before a group may make a person stutter more whereas singing, reading or speaking in a familiar environment may reduce stuttering.
Influence of feelings: Feelings and attitudes can affect stuttering. For example, being frustrated, tensed, excited or feeling rushed can increase disfluencies. A person tends to stutter more if others tease them or bring attention to their speech.
Who needs treatment?
Any child or adult with any one of the three risk factors and/or any ‘alarming signs’ mentioned above in this article needs treatment. Remember, most of the times, stuttering can’t be cured, but certainly, it can be treated with intense speech therapy, hard work, and follow-up.
Who provides the treatment?
A certified and licensed Speech-Language Pathologist (SLP) is the ideal medical professional who will diagnose and treat stuttering. An SLP will first evaluate the stuttering issue by a formal assessment method. Thereafter, they will design the treatment plan based on a person’s age, communication goals, assessment outcomes and other factors. They will train you on scientific techniques, such as controlling the breath, speaking slowly, gradually progressing from single-syllable to longer words etc to help you consciously overcome stuttering.
The SLP’S don’t just focus on speech clarity, but they also guide a client to feel less tense and speak more freely in school, at work, and in different social settings and in situations that make them anxious. This might include speaking on the phone or ordering food at a restaurant, speaking publicly or handling a teasing scenario. The motto is to ensure that a person with stuttering participates fully in their daily activities without the fear of stuttering.
Two styles of treatment for children
There are two styles of treatment approach while treating pre-school children, i.e., indirect treatment and direct treatment.
The direct treatment method involves a child directly in the speech therapy sessions; this is done when the child is aware of his problem and exhibits stuttering associated behaviours.
Indirect treatment is to modify the environment of the child by guiding the parents and modifying their lifestyle; this is preferred when a child is frustrated or not aware of his/her stuttering. Below are a few dos and don’ts that a parent or caregiver can follow to help their child.
DOS and DON'TS as a parent (Concerning stammering)
Note: All the aspects discussed below are not only for children, but they are also relevant to any person who is suffering from stuttering.
Ideal Techniques:
Dos
A child usually attempts to match adult language models, so parents must learn and follow few techniques that will provide a good model for their child to imitate. Below are the three techniques that parents must incorporate when they speak (or read) to their child or others in the presence of their child:
Speak (or read) in a clear, slow and relaxed manner.
Take pauses and breaths between sentences while speaking (/reading).
Speak to your child in short, simple sentences using vocabulary appropriate for their age.
Don’ts
Don’t interrupt your child who is stuttering by telling them phrases such as ‘Start over,’ ‘Slow down,’ (or) ‘Relax’, (or) ‘Think before speaking’(or) ‘Think about what you want to say’, (or) ‘Take your time,’ (or) ‘Just breathe,’ (or) ‘Take a deep breath,’ etc. Such phrases make your child more self-conscious and frustrate, thereby exacerbating the stuttering rather than reducing it. This also shows that you are judging your child’s speech.
Appropriate Gesture:
Dos
Smile and always give eye contact during conversation; this helps your child to feel at ease.
Don’ts
Don’t be distracted or appear too busy to listen during a conversation.
Turn-Taking:
Dos
Allow your child to initiate conversations during a discussion and give enough opportunities and ample space for your child to speak, esp. when the child is excited and has a lot to say.
Appropriate turn-taking skills should be used by the entire family.
Don’ts
Don’t put your child in a kind of situation where he/she is competing for a turn to speak.
Time Factor:
Dos
Give your child adequate time to respond.
Don’ts
Don’t convey a sense of time pressure by rushing or interrupting your child.
Listening Etiquette:
Dos
Listen attentively, politely and patiently until your child has finished speaking and always focus on the content of the message.
Don’ts
Don’t finish sentences for your child who stutters. You may be trying to help your child by completing a sentence, but this further may cause anxiety, frustration and embarrassment.
Questioning Style:
Dos
Ask close-ended (Yes-No) questions or short answer questions whenever possible.
Don’ts
Avoid extensive open-ended questions.
Positive Approach:
Dos
Respond in the same manner to your child’s disfluent speech as you would respond to a fluent speech.
Share some positive vibes and verbal appreciations, such as ‘You are talking well.’ (or) ‘I like the way you said it.’ (or) ‘It’s okay to have some bumpy speech.’ etc.
Don’ts
Don’t draw negative attention to your child’s disfluent speech. Don’t try to look away or show signs of being upset, such as showing concern, pain or pity on your face.
Don’t let the siblings, family members or friends tease your child.
Handling Situations:
Dos
When your child is experiencing increased disfluencies, encourage more non-verbal or physical activities, such as colouring, outdoor recreation etc., and on days when your child has fluent speech, encourage them to talk more.
Don’ts
Don’t force your child to speak or read when he/she uncomfortable or the stuttering is severe; instead, during these time encourage activities that require less talking.
Ambience:
Dos
Provide a calm atmosphere in the home and try to slow down the pace of family life.
Don’ts
Avoid background noises and other distractions as much as possible.
Family Time:
Dos
Allocate exclusive time to talk to your child; talk more about things that are of interest to your child. This will help the child to gain more confidence in involving in conversations.
Don’ts
Don’t ignore your child if he/she hesitates to talk or engage in a conversation; we should understand that the hesitance is due to the inner-fear related to stammering.
Acceptance:
Dos
Expect your child to have some disfluency, disruptions in his/her speech.
Don’ts
Don’t expect your child to speak precisely or correctly at all times.
Self - Awareness:
Dos
When your child is aware of stuttering, it is best to talk openly, honestly and positively.
Don’ts
If your child appears to be unaware of the disfluencies, don’t talk about it in the child’s presence until you are seeing a speech-language pathologist (SLP).
Consultation & Treatment:
Dos
Follow up with a licensed speech therapist/ speech-language pathologist (SLP) for treatment.
Don’ts
Do not take guidance randomly from anyone and don’t follow home remedies that are not scientific to treat stuttering.
Remember:
1. The parents may find some difficulty in following the dos and don’ts at first, but it will become easier over time.
2. The dos and don’ts are just additional guidelines to be practised in a home setup and they are not a substitute to speech therapy sessions; hence, visit a licensed SLP for an early intervention to avoid missing the golden period of recovery.
Conclusion
Many famous actors, musician, athletes, and leaders have dealt with stuttering. Marilyn Monroe, Hrithik Roshan, James Earl Jones, Emily Blunt, Nicole Kidman, B.B. King, Elvis Presley, Shaquille O’Neal Tiger Woods, & Joe Biden are a few. So with a positive mindset, speech therapy, an attitude to practice the techniques daily, you can certainly conquer the fear of stuttering.