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Maria is almost three years old. Three weeks ago he started repeating, sometimes, the first syllable of the word, as well as the monosyllabic short words of the phrase: “ma-ma-ma-mama shall we go to-ya-ya bath?” Maria was slow to speak, but lately she has made leaps and bounds in her speech. He uses new words, complex sentences and talks non-stop. The parents temporally associate the appearance of the repetitions with the rapid development of her speech. They worry about the repetitions, but they notice that while at first they were frequent and many, in the last week they are less frequent and only one repetition of a syllable at a time, “di-ie”, something like that. Maria exhibits “dysflows” (repetitions of syllables) in her speech, similar to those that many preschoolers experience transiently during speech development. They are, probably, symptoms of what is called “transient dysflow” (transient dysfluency or normal dysfluency), a difficulty that lasts a few days or weeks and then stops.
Nikos is also almost three years old. He started stuttering about 6 months ago, with stutters like Maria’s. His parents are deeply concerned, both by the intensity of the problems, and by Nikos’s reaction to them. He started talking less, covering his mouth with his hand when he stutters, pointing instead of saying the words, and lowering his gaze when he speaks. Unlike Maria, Nikos’s dysflows became more frequent and more intense over time, added blockages, “k/k/k/k/stucks” that is, and lengthenings – “traaaaaavegmata” of the phthongs. The anxiety of the parents intensified, due to the concern that the child shows when he stutters and the presence of dysfluencies for more than six months. They are afraid that Nikos will continue to stutter, just like his father. Nikos’s profile creates more concern for a speech therapist than Maria’s. The possibility that Nikos belongs to the percentage of children who will show chronic “developmental stuttering”, stuttering that appears in preschool age and develops into a chronic difficulty, is greater and needs to be investigated.
Which children are at risk of continuing to stutter?
One in twenty preschool children experience dysfluency, usually at the age of 2-2.5 years, period during which the discourse is rapidly evolving. One in a hundred children will continue to stutter through school age and into adulthood. From research we know which groups of children are most vulnerable to chronic stuttering:
- The boys and children with a family history of stuttering, like Nikos are more vulnerable. Stuttering is 3 times more common in families with a history of stuttering and 5 times more common in boys than girls.
- Children with an awareness that they stutter and a temperament characterized by high emotional arousal which is not easily “regulated” we are most concerned about. Nikos has hints of these traits in his temperament. He reacts to the stuttering (covers his mouth with his hand, speaks less or not at all, his behavior has changed) and becomes agitated, having difficulty releasing the tension created by the stuttering.
- Children with phonological difficulties in speech, i.e. children who do not speak clearly, replace consonants or have difficult to understand speech and children with language abilities ahead or behind the abilities of peers, are at greater risk. Also, children who stutter, as a group, have more difficulties in coordinating articulatory movements compared to children who do not stutter or more general difficulties in motor coordination.
- THE duration of presence of the symptoms and the way they develop appears to be related to possible chronicity. Nikos’ stuttering, which has been present for more than 6 months and is getting worse, is more problematic than Maria’s stuttering, which, over time, stutters less strongly and less frequently and shows longer periods of good speech flow than periods of severe dysfluency .
Does stuttering go away on its own?
Stuttering is a neurodevelopmental disorder with a strong organic basis. It is not a product of stress, psychological causes or poor parenting. Stuttering does not go away on its own. What passes is the “temporary dysfluency” that some children like Maria experience. The instruction “don’t pay attention, it will pass” is outdated, it can be identified with the desire of the parents but not necessarily with the particular needs of the particular child who shows dysflows. Early, direct and appropriate treatment of developmental stuttering in preschool age by a specialized speech therapist can lead to the recovery of the difficulty and reduce the likelihood of recurrence.
Interventions in preschool age
Although restoration of fluency is a key goal of early intervention, we know that a number of children will continue to stutter. This is also why most modern interventions for preschool stuttering are positioned holistically against the disorder. In other words, their goal is not just the flow but the restoration of the child’s communicative functionality, the development of communication skills that facilitate the flow, the increase of the child’s self-confidence and mental resilience, the desensitisation of stuttering, the empowerment of parents and the strengthening of their helping behaviors in stuttering management. The aim is for the child to have “confidence in their communication skills, comfortable, effective and functional communication, with or without stuttering”.
The stuttering of school age
By school age, stuttering has developed into a complex disorder. The mouth sticks with fluctuations, but consistently. The child perceives and probably anticipates episodes of stuttering. He may think negative thoughts (they will make fun of me) before, after or during the stuttering and activate emotions (anger, frustration, fear). In trying to manage the speech or the feelings it evokes, he may activate coping mechanisms such as taking a breath, changing the words, or avoiding speaking.
These mechanisms are most often dysfunctional, either because they fail to restore the flow of speech, or because they lead to behaviors with negative consequences. An example of such behavior is the child who knows how to answer the question and does not raise his hand in class because he is afraid he will get stuck, causing the teacher to think that he does not know the lesson. Therefore, at school age, stuttering has a verbal dimension, but at the same time it also has psychological, cognitive and functional dimensions. Treatment fails when it is aimed solely at the removal of verbal symptoms and does not respond to the overall needs of the child. Instead, treatment is effective if it addresses the total experience of stuttering, educates parents and significant others, and removes stereotypes. There are specialized treatment programs that are suitable for school age.
Three tips for parents
Parents know their child better than anyone and how to support them. If we were to give three tips from clinical experience, they would be the following:
- Refer to a specialized speech therapist. Specialized, appropriate and timely speech therapy intervention can make a significant difference to the child and the family. The European Fluency Specialists organization defines and certifies the clinical skills of specialist stuttering speech therapists
- Talk openly about stuttering to the child, in your family and surroundings. The desensitized, open attitude is liberating. It creates cracks in stereotypes and an environment of equal treatment and acceptance for the child
- The child who stutters is no different than other children, it is not incomplete because it stutters. He has weaknesses and abilities like all of us. Move your magnifying glass from the dysfunctional to the functional view of the child, their abilities and strengths. The child who stutters can have functional communication and a normal life like all children.
The text was published in issue n.10 of the magazine ygeiamou which was released with THE THEME on Saturday 28/10