What One Speech Therapist Wishes You Knew About Stuttering

Many young children develop a stutter as they learn to speak—as their brains are processing thousands of new words and sounds in the first few years of their lives. For the majority of these children, the stutter will go away on its own. But for others, the right treatment with a speech-language pathologist can make a big difference.

Kristin McKee, speech-language pathologist at Stanford Medicine Children’s Health, explains things parents can be on the lookout for and ways treatment can help.

What causes stuttering?

We know there is a genetic component to stuttering. We believe the origins of a stutter are related to the way a child’s brain develops neural pathways for speech and language. During the preschool years, children undergo rapid development that we call the “language explosion,” when stuttering can start to occur. Throughout this short period of time, a child’s vocabulary increases at a rapid rate, and the brain’s neural networks that are involved in speech—those that process emotion, cognition and language—can have difficulty coordinating.

Stuttering can also present with other issues, including difficulties with articulation and speech sound production as well as ADHD.

How can parents differentiate between typical language development and a stutter that may warrant treatment by a speech-language pathologist?

For about 75 percent of preschool-age children who have a stutter, it will go away without treatment. However, if parents notice their child’s stutter lasts longer than six months, if the stutter began after age 3½, or if they have a family history with the condition, I usually recommend they see a specialist.

It is also a good idea to come in if your child demonstrates tension or develops a negative attitude about the way he or she sounds when speaking. Some parents may notice secondary characteristics that are reactions to the stuttering itself, including escape behaviors such as purposeful eye blinking, head nodding, excessive use of filler words like “um,” or avoidance behaviors like abandoning a thought or changing the words they’re going to use in the middle of a sentence.

Is it important to seek treatment for stuttering in children?

Yes. It is best to treat fluency disorders early. One of the reasons is that when children are still stuttering later in childhood, they can experience negative reactions from peers, teachers or unknowledgeable adults. When that happens, the child might learn to use behaviors to escape the stuttering: holding back from saying what they really want to say, avoiding speaking situations at school, avoiding words they want to use. If left untreated, adults who stutter may end up avoiding jobs or personal commitments that have speaking demands.

What can parents expect when they bring their child in for an evaluation?

The first thing we do is listen closely to how the patient speaks. Kids who occasionally repeat words without tension and hurry, or who pause and revise what they’re saying, are usually experiencing typical disfluencies and don’t require treatment. However, frequent repetitions of sounds, syllables or words—especially three or more repetitions—as well as prolongations (extending a sound out) or blocks (inaudible/silent fixations or inability to initiate sounds) are all signs that treatment could help.

What does a typical treatment for stuttering include?

In general, our goal is twofold: (1) to encourage a healthy attitude about speaking, and (2) to reduce the severity and frequency of the stutter.

Specific treatments are individualized based on the patient’s age. For instance, among preschoolers we often use the Lidcombe Program, an approach in which the speech-language pathologist and parents praise the child for smooth talking, helping to encourage the formation of new neural pathways that diminish stuttering. With school-aged children and teenagers, treatment focuses on techniques to help ease into the sound of words, speak at an appropriate speed and reduce tension in speech production. Treatment is also tailored to the individual’s needs.

What are some things that parents can do at home to help with treatment?

We always point out the child’s communication strengths, but also other strengths outside of speech and language. It is important for adults to demonstrate acceptance and minimize reactions to the disfluencies. Children pick up on our thoughts and emotions, and if parents feel anxious or worried about the stutter, it can create a vicious cycle where the child begins stuttering more because they feel increased pressure.

Other tips to keep in mind:

1. Avoid finishing a child’s thoughts, even when they stutter.

2. Model an easy, relaxed way of talking.

3. Maintain openness and honesty. If a child mentions their stutter, it’s OK to acknowledge that you noticed it too.

4. Listen attentively, and in general, focus on the content of what the child says rather than how it’s said.