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Developmental Stuttering / Developmental Disfluency




When we say that someone speaks "fluently,” we mean that the person's speech flows easily. Sounds blend into syllables, syllables blend into words, and words blend into sentences with little conscious effort. Speaking is a creative, decision making process happening extremely quickly, so everyone has occasional trouble speaking fluently.


Producing many breaks in fluency by repeating sounds, prolonging sounds, or producing silent blocks, are called disfluencies, because they break up the smooth flow of speech. Many people refer to this as “stuttering.”


There are many different types of disfluencies:

  1. Repetitions of sounds, syllables, and monosyllabic words, usually at the beginning of an utterance (e.g., “Look at the b-b-baby,” “Let’s go out-out-out”)

  2. Prolongations of consonants when it isn’t for emphasis (e.g., “Ssssssssometimes we stay home”)

  3. Blocks (e.g. inaudible or silent fixation or inability to initiate sounds)

  4. Interjections are extra sounds, syllables, or words that add no meaning to the message. Probably the most common interjections are "uh" and "um" ("The uh baby ate the soup" or "The baby um ate the soup"). Words or phrases such as “well,” "like,” and "you know" are considered to be interjections.

  5. Revisions occur when people stop mid-sentence and start over in a new direction. Revisions may be in pronunciation ("The bady-baby ate the soup."); grammar ("The baby eated-ate the soup"); or word choice ("The daddy-The baby ate the soup"). A child also may go back to add a word ("The baby-The hungry baby ate the soup").

  6. Mis-timing of words occurs when sounds or syllables are slightly prolonged, enough to throw off the typical rhythm of what is being spoken ("The baby ate the s-s-soup" or "The baaaby ate the soup"). There could also be a break in the word ("The ba-by ate the soup"). Varying amounts of tension in the speech muscles (lips, tongue, vocal cords, etc.) may accompany these mis-timed words. Sometimes, the voice sounds strained or the coordination of breathing and speaking breaks down.


What is “Normal Nonfluency” or "Developmental Stuttering," or “Developmental Disfluency”?


Many children between 3 and 4 years of age go through a period of “nonfluency” where they demonstrate disruptions in the flow of speech, but then grow out of it. 85% of all children who are 2 to 6 years in age show hesitations and repetitions at times when talking. There are some important differences between children who demonstrate Developmental Disfluency versus those who will continue to stutter.


Children who are more likely demonstrating Developmental Disfluency and therefore at a lower risk for continuing to stutter, have the following characteristics:

  • Phrase repetitions (for example, “I like, I like, I like…”)

  • Sound interjections (for example, adding “uh” or “um”)

  • Revisions (for example, “You should, we should go there”)

  • Multi-syllabic Whole Word Repetitions (for example, “giraffes giraffes are my favorite”)

  • No tension or struggle

  • No secondary behaviors

  • No negative reaction or frustration

  • No family history of stuttering

  • Girls

  • Shorter amount of time since the beginning of the stuttering

  • Children who are younger than 3 ½

  • Typical overall speech sound production and language skills

Children who are more likely demonstrating persistent stuttering, and therefore at a higher risk for continuing to stutter, have the following characteristics:

  • Syllable repetitions (for example, “Be-be-be-because”)

  • Prolongations (for example, “ssssssssometimes”)

  • Blocks (inaudible fixation or inability to make sound)

  • Tension/Struggle

  • Changes in pitch/loudness

  • Secondary behaviors (physical struggling behaviors, such as aversion of eye gaze, facial grimace, lip tremor, jaw tension, excessive hand or body movements, audible gasps of air)

  • Negative reaction/frustration leading to avoidance of certain words, sounds, or speaking situations

  • Family History of stuttering

  • Boys

  • Longer amount of time since the beginning of the stuttering

  • Children who are older than 3 ½

  • Other delays in speech sound production and language skills


What causes stuttering?


The specific cause or causes of stuttering are unknown. For any individual child, there are probably several factors that come together to result in a breakdown in fluency. These contributors include delayed speech and language development, an immature nervous system, an event in the home that upset the child, or a personality that is highly sensitive, excitable, or impulsive.


The most popular theory for the cause of Developmental Disfluency is rapid growth in language during the early preschool years. Preschool children begin to talk about more complicated ideas. Since there are several different ways to express those ideas, decisions about what to say and how to say it become more difficult.



Why does stuttering vary so much?

One of the most frustrating characteristics of stuttering in young children is the way it comes and goes. There is no scientific explanation for this variability. However, it is important to remember and to assure other communication partners that they are not "the" cause of a sudden increase in disfluency.



What can caregivers do when their child is demonstrating the characteristics of persistent stuttering?


It is important to work closely with a Speech-Language Pathologist if you are concerned about your child's fluency, especially if they are demonstrating the characteristics of a persistent stutterer.


Contact your local Speech-Language Pathologist. www.asha.org/profind/



What can caregivers do at home and in the community when their child is demonstrating Developmental Disfluency?


Please realize that you are not causing your child to stutter, but there are many changes you can make in your manner of talking with your child, in your daily schedule, and in your environment that have a positive effect on a child's fluency.


  1. Slow your own speech just slightly and try to model calm, fluent speaking.

  2. Insert pauses in your speech, especially after your child has spoken and you are about to speak. This will allow your child to continue to speak and allows them time to think about what they want to say.

  3. Keep eye contact as much as possible to let them know you are listening. If you look away when the child is disfluent, it may signal that you are uncomfortable.

  4. Be an attentive listener, pay attention to them and let them know you are listening. Do not interrupt them while they are talking or try to finish what they are trying to say. This lets them know that they have time to finish their thought and there is no pressure on them.

  5. Try to reduce questions, directives, and commands, and use a more positive, accepting form of comments and statements. Instead, begin statements or comments with "Let's . . ," "How about. . . ," or "What do you think. . . ?"

  6. Do not demand that they speak when they are upset or hurt. These situations are more likely to disrupt fluency.

  7. Do not force them to speak in front of others. If you are concerned about them developing good manners, use yourself as a model.

  8. Do not make suggestions to them about talking in a different or better way. Do not tell them “slow down,” “stop and take a deep breath,” “think about what you are going to say,” or “start over.” These comments draw attention to the disfluent speech, contribute to the false idea that there is something wrong with the way they are talking, and will not help make the speech more fluent.

  9. Casually accept non-fluencies and also acknowledge when speech is difficult in a reassuring way, especially when they are frustrated by their speech. Explain that some words are hard for you to say too. You can show your acceptance of your child and that you are not upset or angry by casually commenting, "That was hard for you to say," or "That was a tough word." Use statements like these only when the child is visibly upset about her speech or expresses fear or distress. Other times, when the child is disfluent, maintain eye contact and wait (however long it may take) for the child to finish.

  10. Do not discuss non-fluency when they can overhear you. We do not want children thinking there is any cause for alarm with the way they talk.

  11. It is not beneficial to complete words or sentences when a stutterer is having difficulty. By completing words or anticipating what the person is going to say, you are actually putting the speaker under time pressure, making them feel like they need to finish quicker, and adding anxiety to speaking. They will eventually be less likely to try to communicate with you. No one likes to be interrupted. Sometimes it is helpful to echo back fluently what the child has just said. Then the child knows that you heard the meaning, not just the stuttering.

  12. Create a special time when you can devote your full attention to your child to play and talk. This should be at least 30 minutes per day. Use this time to practice the above strategies. Let your child decide what activity you do and let them initiate and take the lead in conversation.


What can caregivers say to others about their child’s Developmental Disfluency (including teachers, siblings, relatives and friends)?


Remind others to model slower, more fluent speech, to not call attention to the disfluency, to make sure the child has the attention when speaking as much as possible, and to NOT offer suggestions to the child for how to speak more fluently.


Peers and Siblings

Explain to peers and siblings that speaking is like any other skill you have to learn, for example playing basketball, reading, or cooking. Explain that some people learn these skills quickly and easily while others find them more difficult and acquire them more slowly. Remind them that everyone makes mistakes when learning a new skills and no one likes to be teased when they are trying hard to learn. Households with several children may want to establish certain rules for turn-taking in conversations. For example, at the dinner table, one person at a time gets to talk without interruption from others. This reduces the time pressure placed on your child and makes conversation more fun.


Teachers

Let teachers know it would be helpful if they could have your child speak in less time sensitive situations, when the question is more open (i.e. does not have a specific correct answer), or when they notice the child is more fluent. If teachers are doing an activity where they call on all children in the class, request that they call on your child sooner to try to avoid the anxiety they will feel waiting for their turn to be called on.




As always, please reach out to us with any questions or concerns.





Resources:

The American Speech-Language-Hearing Association


National Stuttering Association


The Stuttering Foundation





 

Written by:


Rachel Troccoli, M.A., CCC-SLP.

Speech-Language Pathologist and Founder of Skyrocket Pediatric Therapy Foundation.



Skyrocket Pediatric Therapy Foundation (Skyrocket) does not provide medical or legal advice or services. Skyrocket provides general information about developmental disabilities and developmental therapies as a service to the community. The information provided on our website is not a recommendation, referral or endorsement of any resource, therapeutic method, or service provider and does not replace the advice of medical, legal or educational professionals. Skyrocket has not validated and is not responsible for any information, events, or services provided by third parties. The views and opinions expressed in blogs on our website do not necessarily reflect the views of Skyrocket.







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