STUTTERING STUTTERING STUTTERING
TABLE OF CONTENTS
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What is a fluency disorder?
What is pragmatic language?
What are secondary characteristics?
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Why is your child stuttering?
What you should do
What you should expect Resources to learn more
Question: As a parent whose child is diagnosed with a fluency disorder, are their difficulties with eye contact or distracting body language behaviors a result of my parenting? How can I best support my child's communication skills in various settings?
WHAT IS A FLUENCY DISORDER?
Examples of typical disfluencies that occur during development
Around 2 years of age:
whole-word repetitions
I-I-I want a cookie.
interjection
Can we-uhm-go now?
syllable repetitions
I like ba-baseball.
Around 3 years of age:
revisions
She can't-She didn't do that.
CHILDHOOD STUTTER
NORMAL DISFLUENCY
The term "fluency" describes the smoothness, continuity, and rate of speech production.
There is a stage in typical development where all children are disfluent. It is important to understand the difference between typical disfluency in childhood development and stuttering disfluency.
All speakers will hesitate at times, use filler words, or repeat a word or phrase This does not mean the person has a stutter because the disfluencies don't affect the flow of speech continuously.
Examples of disfluencies that are consistent with a stuttering behavior
Stuttering is the most common fluency disorder, where there's an interruption in the forward flow of speaking.
Oftentimes, a person who stutters repeats sounds and syllables, prolongs the beginning of words, and pauses for long moments.
These disruptive speech behaviors are accompanied by negative emotions towards the stutter, avoidance and escape behaviors, and physical tension. Additionally, these behaviors are considered abnormal for the child's chronological age and cannot be attributed to another diagnosis (ex. motor issues, tumor, etc.)
(ASHA); (OWENS & FARINELLA , 2019)
Onset in early development and persisting over time:
sound repetitions
G-g-g-g-go away.
syllable repetitions
Yes, puh puh puh please sound prolongations
Ssssssssee me swing! blocks
Base-(pause)-ball.
monosyllable whole-word repetitions
It's my-my-my turn.
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WHAT IS PRAGMATIC LANGUAGE?
WHAT IS PRAGMATIC LANGUAGE?
Pragmatic language describes the use, function, or purpose of communication and involves a set of rules for successful conversation. These conversation rules vary across contexts, but some examples for the U S includes:
Only one person speaks at a time Speakers should not be interrupted Listeners should show body language that conveys their comprehension of the message
WHAT DOES POOR PRAGMATIC LANGUAGE LOOK LIKE?
In children, we look for competency in a variety of different pragmatic areas. A deficit in pragmatics could include:
Lack of entertaining, humorous, or sarcastic language
Inability to cater language towards communication partner (ex. speaking differently with friends vs. teachers)
Lack of conversational turn-taking
Lack of eye contact and other gestures that show active listening
Lack of conversation relevance or fixation on particular topics
Difficulty transitioning from one topic to another
Pragmatic language across contexts
Pragmatic rules vary across cultures and contexts. For example: in mainstream American culture, a child may be expected to speak formally with their principal and less formally with their family members.
However, in certain cultures, this expectation may not hold true. In Maidu culture, children are expected to speak formally with their grandparents in the same way they would a respected figure, like a principal.
It is important to consider these differences when evaluating the pragmatic capabilities of a child. Without consideration, children may be misdiagnosed as having a deficit.
(OWENS & FARINELLA , 2019); (WEISS, 2004)
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WHAT ARE SECONDARY CHARACTERISTICS?
Examples of secondary characteristics
eye blinking
facial grimacing
facial tension
exaggerated movements of the head, neck, and shoulders
These behaviors are not seen in typically disfluent children.
ARE SECONDARY CHARACTERISTICS INFLUENCED BY PARENTING STYLES?
Previous research in stuttering disorders has emphasized the role of parent-child interactions and parental influences, such as temperament, parental speech characteristics, communicative styles, attitudes, and knowledge regarding stuttering.
While parent styles can influence their child's perception of their stutter, parenting styles do not cause stuttering Additionally, they can not worsen the stuttering behaviors or secondary characteristics. However, encouraging your child
to use their stuttering modification and fluency shaping techniques may reduce the child's need for secondary or avoidance behaviors.
WHAT ARE SECONDARY CHARACTERISTICS
Secondary characteristics are behaviors that accompany instances of speech disfluency which are adopted in an effort to reduce instances of stuttering These actions momentarily distract from the act of speaking which can appear like they help stop the stutter.
Parenting styles and stuttering severity
In a study conducted by Lau and colleagues, researchers investigated the relationship between parental input and childhood stuttering behaviors and attitudes.
The investigators found no difference in the parenting styles of the parents of children who stuttered compared to parents of fluent children
While stuttering behaviors did not vary between parenting styles, children's confidence and comfortability with their parents varied widely. A significant number of children expressed frustration towards their parents. Further discussion can be found on page 5.
(LAU ET AL., 2012); (OWENS & FARINELLA , 2019)
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WHY IS YOUR CHILD STUTTERING?
HISTORICAL THEORIES OF STUTTERING
Organic Theory: there is some physical cause for stuttering
Behavioral Theory: stuttering is a learned response to environmental conditions
Psychological Theory: stuttering is a symptom of neurosis
Covert Repair Hypothesis: stuttering is a reaction to some flaw in the speech production plan
CURRENT UNDERSTANDING
While we do not know the full extent of the causes of stuttering, we do know that stuttering is influenced by genetic and environmental factors Most importantly, stuttering is highly neurological, and structural and functional brain differences have been observed.
Risk factors that may be associated with a stuttering diagnosis are biological sex, family history, co-occurring speech, and language impairments, or other comorbid disorders (ADHD, Autism, etc.)
Throughout history, many researchers have tried to reveal the underlying factors that cause stuttering. Here are some previous inaccurate theories: Myths of Stuttering
While we are still researching the direct causes of stuttering, it is important to recognize myths about the disorder. Some myths about stuttering include:
people stutter because they're nervous
stuttering is purely psychological
stuttering is caused by emotional trauma
stuttering is a bad habit that people can break if they try hard enough
changing a child's handedness from left to right causes stuttering
people who stutter are less intelligent
stuttering is caused by bad parenting
labeling a child with a stutter will only worsen the behavior
4 (ASHA); (OWENS & FARINELLA , 2019); (NSA)
WHAT YOU SHOULD DO
SUPPORTING YOUR CHILD'S FLUENCY
The most urgent thing to do to support your child's fluency is to seek the advice and guidance of a speech-language pathologist (SLP) who has a background in treating childhood stuttering. An SLP has knowledge of how to implement fluency shaping and stuttering modification techniques. Outside of therapy with a professional, parents can longitudinally support their child's confidence and emotions toward their stutter, as well as attitudes toward applying learned strategies
The Lidcombe Program is a parent-administered behavioral modification program that focuses on praising stutter-free speech and gently correcting stuttered speech.
While direct treatment can be utilized by parents, some children find it frustrating when their parents are consistently correcting them. To support a healthy relationship with your child while still impacting their stuttering in some way, the most important factor is encouraging confidence.
SUPPORTING YOUR CHILD'S PRAGMATICS
Learning the pragmatics of language allows a young child to participate successfully in conversations which contributes to greater academic, social, and linguistic success. These strategies may help your child use language across various contexts.
Model appropriate turn-taking and eye contact
Engage in social situations from a young age
Play simple turn-taking games
Model appropriate social skills
Explicitly explain the differences expected when communicating with peers versus respected adults
Remove time constraints to reduce stress in conversation
(ASHA); (BRIGNELL ET AL., 2021); (SINDELAR, 2023); (WEISS, 2004)
SUPPORTING YOUR CHILD'S OUTLOOK
As previously mentioned, children who stutter often have negative attitudes toward their stutter This is understandable because it can negatively impact their perceptions of self due to other's actions (bullying, exclusion, perceived cognitive deficits)
Positively talk about the child's communication strengths
Talk about stuttering openly and without negative connotations
Practice self-advocacy and positive self talk
Encourage open and honest conversations about anxiety, frustration, and sadness surrounding their stutter
Be flexible and listen to your child's feelings
Emphasize the fact that others reactions should not define their personal feelings towards their stutter
Introduce neutral feelings about the stutter
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Lidcombe Program
WHAT YOU SHOULD EXPECT
THE FUNCTIONAL, ACADEMIC, AND SOCIAL IMPACTS OF STUTTERING
As you can imagine, stuttering can impact virtually all areas of a child's life as they develop. Functionally, a child who stutters may experience difficulties with independence, communicating their wants and needs, and feeling comfortable in unfamiliar settings Socially, a child who stutters may have trouble having conversations or telling stories, forming friendships, regulating emotions, showing confidence, and feeling included. Academically, a child who stutters may have trouble reading aloud, answering questions in class, giving class presentations, and participating in class discussions. For these reasons, it is important that a child who stutters can self-advocate and disclose their stutter in order to set themselves up for success
While a stutter can seem limiting, there are several different ways that parents can support their child's fluency. It is important to remember that a child who stutters is just as intelligent, witty, and personable as any one of their typically developing peers. Plenty of people who stutter go on to be successful and your child's diagnosis will not change their ability to have a bright future
(ASHA); (SINDELAR, 2023)
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A bright future
"Those who stutter win, in the painful pauses of their demonstration that speech isn't entirely natural, a respectful attention, a tender alertness. Words are, we are reassured, precious."
– John Updike
RESOURCES
WEBSITES FOR ADDITIONAL INFORMATION
For additional information regarding your child's stuttering disorder, please check out the following resources:
ASHA Digital Toolkit: Stuttering 101 Cognitive Distortions and Fluency Examples
Characteristics of Typical Disfluency and Stuttering
Consumer Information: Stuttering
Early Identification of Speech, Language, and Hearing Disorders
How Can You Tell if Childhood Stuttering is the Real Deal?
Sources:
American Speech-Language-Hearing Association (n.d.). Fluency Disorders (Practice Portal). www.asha.org/practiceportal/clinical-topics/fluency-disorders/
Brignell, A , Krahe, M , Downes, M , Kefalianos, E , Reilly, S , & Morgan, A (2021, December) Interventions for children and adolescents who stutter: A systematic review, meta-analysis, and evidence map Journal of Fluency Disorders, 70 https://doi org/10 1016/j jfludis 2021 105843
Lau, S R , Beilby, J M , Byrnes, M L , & Hennessey, N W (2012) Parenting styles and attachment in school-aged children who stutter Journal of Communication Disorders, 45(2), 98-110 https://www.sciencedirect.com/science/article/pii/S002199241100092X?ref=pdf download&fr=RR2&rr=7cfa125e5acb8743
National Stuttering Association (2023, January 5) Myths about Stuttering https://westutter org/myths-aboutstuttering/?cmpn=NonBrand%7CUSA%7CDSA&device=c&kw=&adpos=&gclid=Cj0KCQjwmtGjBhDhARIsAEqfDEcxICYt07Sot d6WtvSy qn5cxqLdo6cW6XymrjDauKozaj-ydEPcDgaAiR3EALw wcB
Owens, R E , & Farinella, K A (2019) Introduction to Communication Disorders: A Lifespan Evidence-based Perspective (sixth ed ) Pearson
Sindelar, A. (2023, April 17). Fluency [Powerpoint Slides]. Northwestern University Intro to Speech, Language, Learning, & Their Disorders. https://canvas.northwestern.edu/courses/189528/files/folder/Lectures? preview=16289308
Weiss, A L (2004, January) Why We Should Consider Pragmatics When Planning Treatment for Children Who Stutter Language, Speech, and Hearing Services in Schools https://pubs asha org/doi/full/10 1044/01611461(2004/005)
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