The Child Who Stutters: Guide for Pediatricians

the child who stutters:
to the pediatrician
revised 4th edition

stuttering foundation of america
publication no. 0023

www.stutteringhelp.org
www.tartamudez.org

Copyright 2001-2007 by the Stuttering Foundation of America

The Child Who Stutters:
To the Pediatrician
revised 4th edition

Barry Guitar, Ph.D.
Professor,
Department of Communication Sciences,

Edward G. Conture, Ph.D.
University of Vermont

Professor and Director, Graduate Studies,
Department of Hearing and Speech Sciences,
Vanderbilt University

Editorial assistance:
Stephen Contompasis, M.D.,
Associate Professor of Pediatrics,
University of Vermont Medical School
Jane Fraser,
President,
Stuttering Foundation of America
Michael B. Grizzard, M.D.,
Medical Director
The World Bank, Washington, D.C.
Diane G. Hill, M.A., CCC-SLP
Senior Lecturer in Speech and Language Pathology,
Communication Sciences and Disorders Department,
Northwestern University
James McKay, M.D.,
Professor Emeritus of Pediatrics,
College of Medicine,
Peter Ramig, Ph.D.,
Professor,
Department of Speech, Language, and Hearing Sciences
University of Colorado–Boulder
Patricia M. Zebrowski, Ph.D.,
Associate Professor,
Department of Speech Pathology and Audiology,
University of Iowa

Publication No. 0023

www.stutteringhelp.org • www.tartamudez.org


the child who stutters:
to the pediatrician
Publication No. 0023

First Edition—1991
Second Edition—2001
Third Edition—2004
Fourth Edition—2006
Revised Fourth Edition—2007

Published by
P. O. Box 11749
Memphis, Tennessee 38111-0749

ISBN-0-933388-47-0

Copyright © 2007, 2006, 2004, 2001 by Stuttering
Foundation of America

The Stuttering Foundation of America is a nonproﬁt
charitable organization dedicated to the prevention
and improved treatment of stuttering.

2


The Child Who Stutters:
To the Pediatrician
Most children go through periods of disfluency as they learn to speak.
Some will experience mild stuttering, and for others the difficulty will
become severe. Early intervention by the pediatrician can help parents
understand and thus minimize the problem.

ETIOLOGY
Although the etiology of stutter- that adults who stutter show the ages of 2 to 5 but sometimes
ing is not fully understood, distinct anomalies in brain as early as 18 months. The
there is strong evidence to function.6,7,8 In contrast with child’s efforts at learning to talk
suggest that it emerges from a normal speakers, individuals and the normal stresses of
combination of constitutional who stutter show deactivation growing up may be the imme-
and environmental factors. of left-hemisphere sensorimotor diate precipitants of the brief
Geneticists have found indica- centers and over-activation of repetitions, hesitations, and
tions that a susceptibility to homologous right-hemisphere sound prolongations that char-
stuttering may be inherited and structures during both stut- acterize early stuttering as well
that it is most likely to tered and nonstuttered speech. as normal disfluency*. These
occur in boys.1,2,3 Further sup- The essential defect is hypothe- first signs of stuttering grad-
port for inheritance comes from sized to be a lack of sensori- ually diminish and then disap-
twin studies that have demon- motor integration necessary to pear in most children, but some
strated a higher concordance regulate the rapid movements children continue to stutter. In
for stuttering among both of fluent speech. Both tempo- fact, they may begin to exhibit
members of identical twin pairs rary fluency (induced through longer and more physically
than fraternal twin pairs.4,5 singing or choral reading) and tense speech behaviors as they
Congenital brain damage is also more permanent fluency (as a respond to their speaking diffi-
suspected to be a predisposing result of behavioral treatments) culties with embarrassment,
factor in some cases.1 For a appear to normalize the activa- fear, or frustration. If referral to
large number of children who tion patterns.9 a speech-language pathologist
stutter, however, there is The onset of stuttering is for parent counseling and treat-
neither family history of the typically during the period of ment is made before the child
disorder nor clear evidence of intense speech and language

*The term “disfluency” means a hesitation,
brain damage. development as the child is
interruption, or disruption in speech. It may
Brain imaging studies con- progressing from 2-word utter-
be normal or, as in the case of stuttering,
ducted in many laboratories ances to the use of complex
throughout the world indicate sentences, generally between it may be abnormal.

3


STUTTERING

ber who stutters. The risk that
the child is actually stuttering
Risk Factor Chart instead of just having normal
Place a check next to each that is true for the child disﬂuencies increases if that
family member is still stutter-
ing. There is less risk if the fam-
Risk Factor More likely in True for Child ily member outgrew stuttering
beginning stuttering as a child.
Family history A parent, sibling,
of stuttering or other family
• Age at onset
member who still stutters Children who begin stuttering
before age 3 1/2 are more likely

Age at onset After age 31/2
to outgrow stuttering; if the
child begins stuttering before
age 3, there is a much better
Time since onset Stuttering 6–12 months
chance she will outgrow it with-
or longer
in 6 months.

Gender Male
• Time since onset
Between 75% and 80% of all
children who begin stuttering
Other speech-language Speech sound errors,
will stop within 12 to 24 months
concerns trouble being understood,
without speech therapy. If the
difﬁculty following
child has been stuttering longer
directions
than 6 months, he may be less
likely to outgrow it on his own. If
he has been stuttering longer
Copyright © 2001-2007 by the Stuttering Foundation of America
than 12 months, there is an even
smaller likelihood he will out-
has developed a serious social long-term problem. The sex grow it on his own.
and emotional response to ratio for stuttering appears to
stuttering, prognosis for recov- be equal at the onset of the dis- • Gender
ery is good.10,11,12 order, but studies indicate that Girls are more likely than boys
among those children who con- to outgrow stuttering. In fact,
tinue to stutter, that is, school- three to four boys continue to
PREVALENCE, INCIDENCE, age children, there are three to stutter for every girl who stut-
AND RISK FACTORS FOR four times as many boys who ters. Why this difference? First,
CHRONICITY stutter as there are girls.4 it appears that during early
Risk factors that predict a childhood, there are innate dif-
About 5% of all children go chronic problem rather than ferences between boys' and girls'
through a period of stuttering spontaneous recovery include:* speech and language abilities.
that lasts six months or more. Second, during this same period,
Three-quarters of those who • Family history parents, family members, and
begin to stutter will recover by There is now strong evidence others often react to boys some-
late childhood, leaving about that almost half of all children what differently than girls.
1% of the population with a who stutter have a family mem- Therefore, it may be that more

4


STUTTERING

boys stutter than girls because problem; rather it is the cumu- stuttering are often difficult to
of basic differences in boys' lative or additive nature of differentiate. Thus, diagnosis of a
speech and language abilities such factors that appears to stuttering problem is made
and differences in their interac- differentiate children for whom tentatively. It is based upon both
tions with others. stuttering comes and goes direct observation of the child
versus those for whom stutter- and information from parents
• Other speech and language ing comes and stays. about the child’s speech in differ-
factors ent situations and at different
A child who speaks clearly THE PHYSICIAN’S ROLE times. The following section and
with few, if any, speech errors Tables 1 and 2 at the end of this
The physician is often the first
would be more likely to outgrow booklet should help the physician
professional to whom a parent
stuttering than a child whose distinguish between normal
turns for help. Knowing the
speech errors make him difficult disfluency, mild stuttering, and
difference between normal devel-
to understand. If the child severe stuttering, so that appro-
opmental speech disfluency and
makes frequent speech errors priate referral can be made.
potentially chronic stuttering
Normal Disfluency
such as substituting one sound enables the physician to advise
for another or leaving sounds parents and refer when appro-
out of words, or has trouble fol- priate. Early intervention for
lowing directions, there should Between the ages of 18 months
stuttering—which may range and 7 years, many children pass
be more concern. The most re- from parent counseling and indi-
cent findings dispel previous re- through stages of speech dis-
rect treatment to direct instruc- fluency associated with their
ports that children who begin tion—can be a major factor in
stuttering have, as a group, low- attempts to learn how to talk.
preventing a life-long problem. Children with normal disfluencies
er language skills. On the con- Data from several different
trary, there are indications that between 18 months and 3 years
treatment programs indicate will exhibit repetitions of sounds,
they are well within the norms substantial recovery if treat-
or above. Advanced language syllables, and words, especially at
ment is initiated in the the beginning of sentences. These
skills appear to be even more of preschool years.7,8,9
a risk factor for children whose occur usually about once in every
stuttering persists. ten sentences.
DIFFERENTIAL DIAGNOSIS After 3 years of age, children
At present, none of these risk
factors appears, by itself, suffi- Normal developmental dis- with normal disfluencies are less
cient to indicate a chronic fluency and early signs of likely to repeat sounds or sylla-
bles but will instead repeat whole
words (I-I-I can’t) and phrases
(I want…I want…I want to go).
They will also commonly use
*Longitudinal research studies by Drs. Ehud Yairi and Nicoline G. Ambrose and colleagues
at the University of Illinois provide excellent new information about the development of stut-
fillers such as “uh” or “um” and
tering in early childhood. Their findings are helping speech-language pathologists determine
sometimes switch topics in
who is most likely to outgrow stuttering versus who is most likely to develop a lifelong stutter-
the middle of a sentence,
ing problem. Research reports include:
Yairi, E. & Ambrose, N. (1992). A longitudinal study of stuttering in children: A preliminary
revising and leaving sentences
report. Journal of Speech, Language, and Hearing Research, 35, 755-760.
unfinished.
Ambrose, N. & Yairi, E. (1999). Normative disfluency data for early childhood stuttering. Normal children may be
Journal of Speech, Language, and Hearing Research, 42, 895-909.
Yairi, E. & Ambrose, N. (1999). Early childhood stuttering I: Persistence and recovery rates.
disfluent at any time but are
Journal of Speech, Language, and Hearing Research, 42, 1097-1112.
likely to increase their disfluen-
Yairi, E. & Ambrose, N. (2005). Early Childhood Stuttering: For Clinicians by Clinicians,
ProEd, Austin, TX.
cies when they are tired,
excited, upset, or being rushed

5


STUTTERING

be extremely sensitive to speech disfluencies. As suggested earlier,
development and will become normal disfluencies will appear
unnecessarily concerned about for a few days and then disap-
normal disfluencies. These pear. Mild stuttering, on the
overly concerned parents often other hand, tends to appear more
benefit from referral to a speech regularly. It may occur only in
clinician for an evaluation and specific situations, but it is more
continued reassurance. likely to occur in these situations,

Mild Stuttering
day after day. A third sign associ-
ated with mild stuttering is that
the child may not be deeply con-
Mild stuttering may begin at any cerned about the problem, but
time between the ages of 18 may be temporarily embarrassed
months and 7 years, but most or frustrated by it. Children at
frequently begins between 3 and this stage of the disorder may
5 years, when language develop- even ask their parents why they
ment is particularly rapid. Some have trouble talking.
children’s stuttering first ap- Parents’ responses to mild
pears under conditions of normal stuttering will vary.10 Most will
stress, such as when a new sib- be at least mildly concerned
ling is born or when the family about it, and wonder what they
moves to a new home. should do and whether they
Children who stutter mildly have caused the problem. A few
may show the same sound, sylla- will truly not notice it; still
ble, and word repetitions as chil- others may be quite concerned,
dren with normal disfluencies but deny their concern at first.

Severe Stuttering
but may have a higher frequency
to speak. They also may be of repetitions overall as well as
more disfluent when they ask more repetitions each time.
questions or when someone For example, instead of one or Children with severe stuttering
asks them questions. two repetitions of a syllable, they usually show signs of physical
Their disfluencies may in- may repeat it four or five times, struggle, increased physical ten-
crease in frequency for several as in “Ca-ca-ca-ca-can I have sion, and attempts to hide their
days or weeks and then be that?” stuttering and avoid speaking.
hardly noticeable for weeks or They may also occasionally Although severe stuttering is
months, only to return again. prolong sounds, as in “MMMM- more common in older children,
Typically, children with nor- MMMommy, it’s mmmmmy it can begin anytime between
mal disfluencies appear to be ball.” In addition to these speech ages 11/2 and 7 years. In some
unaware of them, showing no behaviors, children with mild cases, it appears after children
signs of surprise or frustration. stuttering may show signs of have been stuttering mildly for
Parents’ reactions to normal reacting to their disfluency. months or years. In other cases,
disfluencies show a wider range For example, they may blink or severe stuttering may appear
of reactions than their children close their eyes, look to the side, suddenly, without a period of
do. Most parents will not notice or tense their mouths when they mild stuttering preceding it.
their child’s disfluencies or will stutter. Severe stuttering is charac-
treat them as normal. Another sign of mild stuttering terized by speech disfluencies in
Some parents, however, may is the increasing persistence of practically every phrase or

6


STUTTERING

Case Example: Sally, a child with
Mild Stuttering
Sallyʼs mother and father were concerned because Sally, age
3, was beginning to avoid speaking. The problem had begun
several months earlier when Sally was repeating parts of
words, like, “Ca-ca-ca-can I ha-ha-ha-have some?” Then a
few weeks ago she had difficulty getting started making the
first sound of a word. She would open her mouth, quite wide
at times, but nothing would come out. Once she asked her
mom, “Why canʼt I talk?”
Sallyʼs speech and language development had been
normal. She began using single words at an early age—9
months—and was speaking in 2–3 word sentences by 13
months. She talked fluently and enjoyed the familyʼs fast-
paced conversations and word games.
When Sallyʼs father discussed her speech with Sallyʼs
pediatrician, she referred Sally to a speech-language
pathologist in private practice who was known to have
expertise in stuttering. Once-a-week treatment sessions
consisted of parent counseling and play-oriented interactions
between Sally and her
speech clinician. Over a
period of six months the
clinicianʼs model of a
relaxed, accepting style
of interacting, combined
with Sallyʼs parentsʼ
changes in the intensity
of speech and language
stimulation at home,
eliminated Sallyʼs
avoidance of speaking
and her inability to get
sounds started. She
continued to show a
slightly greater than
normal amount of word
repetition and phrase
repetition for several
more years and gradually
developed normal speech.

7


STUTTERING

Case Example: Barbara, a child with
Mild Stuttering
When Barbara was 3, her pediatrician noticed she
was repeating and prolonging sounds when he
talked to her. He discussed this with her mother and
father and found them to be aware of it. In fact, they
had been instructing her to stop and start over again
when she repeated sounds. He gave them guidance
about slowing their own speech rates and refraining
from criticism.
When her parents brought Barbara to his ofﬁce six
months later for a minor illness the pediatrician
inquired about her speech. Barbaraʼs parents were
frustrated by the lack of change in her speech and had
begun to correct her again. Barbara herself seemed
reluctant to talk to him. The pediatrician referred Barbara
to a speech-language pathologist and continued to
counsel the parents to ease conversational pressures
on Barbara and refrain from direct correction.
A month later, the pediatrician received a copy of
the speech-language pathologistʼs written evaluation
of Barbara. This indicated that her stuttering had
progressed from mild to severe, and that the parents
seemed willing to change some key variables in the
home speaking environment. The plan for treatment
included some direct treatment of Barbaraʼs
stuttering in the speech clinic.
Several months later, Barbaraʼs parents brought her
to the pediatrician for treatment of an infected insect bite.
The pediatrician noticed that Barbaraʼs speech seemed
to be the same as before. The parents indicated that they
didnʼt see the sense in using slower speech rates
themselves and have continued to try to correct Barbaraʼs
stuttering by instructions. They had discontinued speech
therapy because they were unable to afford it. At present
the pediatrician has given them a copy of If Your Child
Stutters: A Guide for Parents, and Stuttering and Your
Child: Questions and Answers, and is counseling them to
continue changes at home.

8


STUTTERING

sentence; often moments of
TAKE-HOME MESSAGE
stuttering are one second or
longer in duration. Prolon-
gations of sounds and silent A child who stutters often feels that he is the
blockages of speech are common.
The severely stuttering child only one to have the problem. He will
may, like the milder stutterer, appreciate hearing from his pediatrician that
have behaviors associated with other children stutter, too.
stuttering: eye blinks, eye clos-
ing, looking away, or physical
tension around the mouth and
other parts of the face. More- cases, parents have not done their own speech rates, use
over, some of the struggle and anything to cause the stutter- shorter, simpler sentences, and
tension may be heard in a rising ing. They have treated the child reduce the number of questions
pitch of the voice during repeti- who stutters just like they treat they ask.
tions and prolongations. The their other children, yet they They may also want to arrange
child with severe stuttering may may still feel responsible for times the child can talk to them
also use extra sounds like “um,” the problem. in a quiet, relaxed environment.
“uh,” or “well” to begin a word They will benefit from reassur- They should not instruct the
on which he expects to stutter. ance that their child’s stuttering child to talk more slowly or to say
Severe stuttering is more is a result of many causes and a disfluent word over again.
likely to persist, especially in not simply the effect of some- Instead, they should concentrate
children who have been stutter- thing they did or didn’t do. on calmly listening to what their
ing for 18 months or longer, The distinctions among nor- child is saying.
although even some of these mal disfluency, mild stuttering,
children will recover sponta- and severe stuttering are sum-
Counseling Parents of a
neously. The frustration and marized in Table 1: Checklist for
Child with Mild Stuttering
embarrassment associated with Referral.
real difficulty in talking may Parents of the child who has a
create a fear of speaking. Chil- mild stuttering problem should
COUNSELING PARENTS
dren with severe stuttering of- be advised not to show concern
Counseling Parents of a
ten appear anxious or guarded or alarm to the child, but
Child with Normal
in situations in which they ex- instead be as patient listeners
Disfluencies
pect to be asked to talk. While as they can. Their goal is to pro-
the child’s stuttering will proba- If a child appears to be normally vide a comfortable speaking
bly occur every day, it will prob- disfluent, parents should be environment and to minimize
ably be more apparent on some reassured that these disfluen- the child’s frustration and
days than others. cies are like the mistakes embarrassment. Parents are
Parents of children who stut- every child makes when he or usually upset when their child
ter severely inevitably have she is learning any new skill, repeats sounds or words, but
some degree of concern about like walking, writing, or bicy- they should be reassured that
whether their child will always cling. Parents should be advised these are just slips and tumbles
stutter and about how they can to accept the disfluencies with- as the child is learning to match
best help. Many parents also out any discernable reaction his ability to speak with the
believe, mistakenly, that they or comment. many ideas he wants to express.
have done something to cause Particularly concerned par- If the parents let the child
the stuttering. In almost all ents may find it helpful to slow know that repetitive stuttering

9


STUTTERING

need encouragement for continu-

Case Example: Jeremy, a child with
ing this practice after an initial
trial. Most children, whether they
stutter or not, will benefit from
Severe Stuttering adults’ speech that is close to

Jeremyʼs speech and language developed more slowly
their own natural rate. Children

than that of his older sister. He didnʼt start to speak until
who stutter may feel less need to

he was two; until then, he would point to what he
hurry their speech if their par-

wanted. When he started to speak, he was difficult to
ents speak slowly.
understand. Jeremyʼs parents often had to ask him to
While parents may provide
repeat what he said. His speech became a little clearer
models of a slower, more relaxed
at age 3, when he was using 2–3 word sentences. But at
way of speaking, they should re-
about that time he began to repeat initial sounds of
frain from criticizing, showing an-
words and soon he was prolonging sounds and opening
noyance, or telling the child to
his mouth extra wide when he couldnʼt get sounds
“slow down.” This may create a
started. Jeremyʼs cousin had also been late in
power struggle that makes it
developing speech, but never stuttered, so Jeremyʼs
parents assumed he would just outgrow it in time.
more difficult for the child to slow

Unfortunately, the stuttering worsened. Soon Jeremy
his rate.

was saying “um” several times just before a word to get it
It is also important for parents

started, in addition to using facial grimaces and wide
to provide daily opportunities for

mouth postures when he got stuck. When he made
one-on-one conversations with

several attempts to get a word started without success,
the child in a quiet setting, as

Jeremy would say “Oh, never mind” and give up. He was
frequently as possible.

gradually becoming more and more reluctant to talk.
These are times when the child

By this time, Jeremyʼs parents became concerned
has chosen the activity and can

enough to ask their family physician for advice. After talking
experience the feeling it’s a time

to Jeremy, the physician referred them to a speech-
to talk about anything he or she

language pathologist in a local pre-school program. The
wants.

speech clinician soon determined that immediate treatment
If the child asks about the prob-

was needed and worked with Jeremy and his family in their
lem, parents should talk about it

home for a year with good initial success. Following this,
matter of factly: “Everyone has
Jeremy entered first grade and was seen twice a week by
difficulty learning to talk. It takes
the school speech clinician and continues to make good
time, and lots of people get stuck.
progress. Although he still gets hung up on a word
It’s okay; it’s a lot like learning to
occasionally, his language development is normal and he
ride a bike. It’s a little bit tricky at
participates fully in class and in social situations.
first.”
The parent may mention
casually that going slow can
sometimes help or that the child
need not hurry, if the child seems
is acceptable to them, this can cially when the child is going to be asking for help.
help the child’s speech and lan- through a period of increased If the child’s stuttering persists
guage develop without increased stuttering. for four to six weeks or more de-
physical tension and struggle. It is often difficult for busy, con- spite these efforts on the parents’
Parents should also be advised cerned parents to provide models part, or if the parents are unable
to slow their own speech rates to of slow speech for the child to em- to follow these suggestions, the
a moderate and calm pace, espe- ulate. Therefore they are likely to child should be referred to a

10


STUTTERING

speech-language pathologist (see As mentioned earlier, some
later section on referral). speech-language pathologists
Treatment of the child with may choose to train the parents to
mild stuttering may be indirect provide some aspects of therapy
and focused on creating an in the home. The clinician will
environment in which the child ask the parents to keep careful
feels fairly relaxed about speak- records of the child’s responses to
ing, both at home and in the treatment and will closely moni-
treatment setting. tor the therapy.7
If more direct treatment is During a period of a year or
needed, the speech-language more, the child’s stuttering will
pathologist may show the child often gradually decrease in fre-
how to produce speech more easi- quency and duration. In some
ly, without increased physical cases, the child may recover com-
tension and struggle, so that stut- pletely. Treatment results depend
tering gradually diminishes into on the nature of the child’s
something more like normal problem, the presence of other
speech.10,11 Some speech-language strengths, the skills of the thera-
pathologists may choose to train pist, and the ability of the family
the parents to work more directly to provide support.
with the child.10
child might also encourage the
WHEN TO REFER TO A
parents to nod or comment on the
Counseling Parents of a Child SPEECH-LANGUAGE
child’s courage for “hanging in
with Severe Stuttering PATHOLOGIST
there,” when the child has a par-
The child with severe stuttering ticularly hard time on a word. In Children with severe stuttering
should be referred immediately to addition, the child with severe problems should be referred im-
a qualified speech-language stuttering would probably benefit mediately. Children who have
pathologist for an evaluation, fur- from being able to share his or mild stuttering problems that
ther counseling, and direct treat- her frustration with his or her have not shown marked improve-
ment of the child if appropriate. parents. This may be difficult in ment within six to eight weeks,
Because severe stuttering fre- many families, and may be best depending on the child, should al-
quently seems to develop when a handled with the help of a so be referred. These children
child struggles or becomes afraid speech-language pathologist ex- should be given direct treatment
of or concerned with speaking in perienced with the management if it is warranted, and their
response to his milder stuttering, of stuttering. parents will receive support and
anything that helps the child re- Professional treatment of severe guidance, and they will be
lax and take his or her disfluen- stuttering often consists of help- followed carefully.
cies in stride will be of benefit. ing the child overcome the fear of Some children with mild prob-
Parents should model a slower stuttering and, at the same time, lems may receive direct treat-
rate of speaking. They should try teaching the child to speak, re- ment, but it should be carefully
to convey acceptance of the child gardless of stuttering, in a slower, planned so as not to make the
regardless of the stuttering, by more relaxed fashion. In addition, child feel apprehensive or self-
paying attention to what the treatment is focused on helping conscious about the problem. As
child is saying rather than to the the child’s family create an atmo- Table 1 suggests, children with
stuttering. The speech-language sphere of acceptance of stuttering normal disfluency do not need to
pathologist working with the and conducive to ease in speaking.7,10 be referred unless the parents are

11


STUTTERING

The charts on the following three
pages may be photocopied
and distributed without
permission of the publisher.

4. Felsenfeld, S. (1996). Epidemiology and
genetics of stuttering. Chapter in R. Curlee
so concerned that they need reas- CONCLUSION
surance about the normalcy of Pediatricians, family physi- and G. Siegel (Eds.), Nature and Treatment of
Stuttering: New Directions. Boston: Allyn &
Bacon.
their child’s speech. They may al- cians, and other healthcare

5. Howie, P. M. (1981). Concordance for stut-
so be followed by the speech clini- providers are often the first pro-
tering in monozygotic and dizygotic twin pairs.
cian to provide additional guid- fessionals to whom parents turn
Journal of Speech and Hearing Research, 24,
ance if needed. for advice about their child’s dis-
317 321.
The speech-language patholo- fluencies.
6. Fox, P.T., Ingham, R., Ingham, J.C., Hirsch,
gist should have a Certificate of These professionals can help in
Clinical Competence (CCC-SP) T.B., Downs, J.H., Martin, C. et al. (1996).
A PET study of the neural systems of stutter-
the prevention of stuttering.

ing. Nature, 382:158-162.
from the American Speech- Early identification of children at

7. Fox, P.T., Ingham, R.J., Ingham, J.C.,
Language-Hearing Association, risk for chronic stuttering and ap-
Zamarripa, F., Xiong, J.-H., and Lancaster,
and should also be licensed by the propriate referral is critical.
J.L. (2000). Brain correlates of stuttering and
state in which he or she practices. Moreover, effective parent coun-
Certification requires a master’s seling can often create an envi- syllable production: A PET performance-
degree from an accredited univer- ronment conducive for children to correlation analysis. Brain, 123:1985-2004.
8. Sommer, M., Koch, M.A., Paulus, W.,
Weiller, C. and Buchel, C. (2002).
sity, a national examination, and outgrow their disfluencies.
Disconnection of speech-relevant brain areas
a year of supervised internship. The authors of this booklet too
in persistent developmental stuttering. Lancet,
In addition, the speech-language often meet severe adult stutterers
360: 380-383.
pathologist to whom a child is re- whose parents were told “Don’t
9. Ingham, R.J. (2003). Brain Imaging &
ferred for stuttering should be ex- worry, he’ll outgrow it” so that the
perienced with the disorder. Stuttering [Special Issue]. Journal of Fluency
Disorders, 28 (4).
opportunity for therapy when the
Many hospital and university disorder is most treatable has
speech and language clinics will been missed. We have repeatedly 10.. Harrison, E. and Onslow, M. (1998), Early

Program. In R. F. Curlee (Ed.), Stuttering and
have such persons on their staff found that when children are re- Intervention for Stuttering: The Lidcombe

Related Disorders of Fluency, (2nd ed.). NY,
or can suggest one. Most school ferred early, treatment is most ef-
systems also employ speech fective, even in cases of severe NY.: Thieme.
11. Pellowski, M., Conture, E., Roos, J.,
-language pathologists. The stuttering. Early intervention
Stuttering Foundation of Amer- prevents the development of life- Adkins, C. & Ask, J. (2000, November).
ica provides referrals to qualified long habits that interfere with so- A parent-child group approach to treating stut-

data. Paper presented to Annual Conference
therapists in most areas of the cial, academic, and occupational tering in young children: treatment outcome

of American Speech-Language- Hearing
country. Their toll-free telephone success.
number is 800-992-9392, and Association, Washington, DC.
12. Starkweather, W., Gottwald, S., and
Halfond, M. (1990). Stuttering Prevention
their web site is www.stutter-

A Clinical Method. Englewood Cliffs, N.J.:
inghelp.org. They also provide
Prentice-Hall.
books and DVDs for parents:
1. Andrews, G., Craig, A., Feyer, A. M., 13. Yairi, E. (1997). Home environment and
Stuttering and Your Child: Help
Hoddinot, S., Howie, P., and Neilson, M. parent-child interaction in childhood stuttering.
for Parents, a 30 minute DVD;
Stuttering and Your Child: (1983). Stuttering: A review of research find- In R. Curlee and G. Siegel, Nature and
ings and theories circa 1982. Journal of
Speech and Hearing Disorders, 48, 226 246. Boston: Allyn & Bacon.
Questions and Answers, a 64 page Treatment of Stuttering: New Directions.

2. Bloodstein, O. (1995). A Handbook On 14. Yairi, E. & Ambrose, N. (2005). Early
book; If Your Child Stutters: A
Stuttering (5th ed.). San Diego, CA: Singular Childhood Stuttering: For Clinicians By
Guide for Parents, 7th edition, a
Publishing Group, Inc. Clinicians, ProEd, Austin, TX.
64 page book; Stuttering: For
3. Drayna, D. (2004) Results of a Genome-
Kids By Kids, a 12 minute DVD
Wide Linkage Scan for Stuttering. In
for children; and for teenagers Do

124A:133-135.
You Stutter: A Guide for Teens, all American Journal of Medical Genetics
for a nominal cost.

12


Table 1: PHYSICIAN’S CHECKLIST FOR REFERRAL
The Child With The Child With The Child With
NORMAL DISFLUENCIES MILD STUTTERING SEVERE STUTTERING
Age of Onset: 11/2 to 7 years of age Age of Onset: 11/2 to 7 years of age Age of Onset: 11/2 to 7 years of age

Speech behavior you □ Occasional (not more than □ Frequent (3% or more of □ Very frequent (10% or more of
may see or hear: once in every 10 sentences), speech), long (1/2 to 1 second) speech), and often very long
brief, (typical 1/2 second or repetitions of sounds, syllables, (1 second or longer) repetitions
shorter) repetitions of sounds, or short words, e.g., li-li-li-like of sounds, syllables or short
syllables or short words, e.g., this. Occasional prolongations words. Frequent sound
li-li-like this. of sounds. prolongations and blockages.

Other behavior you □ Occasional pauses, hesitations □ Repetitions and prolongations □ Similar to mild stutterers only

Copyright © 2001-2007 by the Stuttering Foundation of America
may see or hear: in speech or fillers such as begin to be associated with more frequent and noticeable;
“uh,” “er,” or “um,” changing of eyelid closing and blinking, some rise in pitch of voice
words or thoughts. looking to the side, and some during stuttering. Extra sounds
physical tension in and around or words used as “starters.”

13
the lips.

When problems most □ Tends to come and go when □ Tends to come and go in □ Tends to be present in most
noticeable: child is: tired, excited, talking similar situations, but is more speaking situations; far more
about complex/new topics, often present than absent. consistent and non-fluctuating.
asking or answering questions
or talking to unresponsive
listeners.

Child reaction: □ None apparent □ Some show little concern, □ Most are embarrassed and
some will be frustrated and some are also fearful of
embarrassed. speaking.

Parent reaction: □ None to a great deal □ Most concerned, but concern □ All have some degree of
may be minimal. concern.

Referral decision: □ Refer only if parents □ Refer if continues for 6 to 8 □ Refer as soon as possible.
moderately to overly weeks or if parental concern
concerned. justifies it.

®
This chart may be photocopied and distributed
THE STUTTERING FOUNDATION
800-992-9392
without permission of the publisher.

SUGGESTIONS FOR PARENTS OF
CHILDREN WHO STUTTER

way, pausing frequently. Wait a few
1. Speak with your child in an unhurried 6. Observe the way you interact with your

seconds after your child finishes speaking Try to increase those times that give your
child.

before you begin to speak. child the message that you are listening to her
Your own slow, relaxed speech will be far and she has plenty of time to talk. Try to
more effective than any criticism or advice decrease criticisms, rapid speech patterns,
such as “slow down” or “try it again slowly.” interruptions, and questions..

2. Reduce the number of questions you 7. Above all, convey that you accept your

Children speak more freely if they are Your own slower, more relaxed speech and
ask your child. child as he is.

expressing their own ideas rather than the things you do to help build his confidence
answering an adultʼs questions. Instead of as a speaker are likely to increase his fluency
asking questions, simply comment on what and diminish his stuttering. The most powerful
your child has said, thereby letting him know force, however, will be your support of him
you heard him. whether he stutters or not.

3. Use your facial expressions and other

when she stutters, that you are listening to the
body language to convey to your child,

content of her message and not to how sheʼs For more information on stuttering and ways to help
talking. your child, write or call the nonprofit
3100 Walnut Grove Rd. Ste. 603
P.O. Box 11749, Memphis, TN 38111-0749
4. Set aside a few minutes at a regular
(800) 992-9392 www.stutteringhelp.org
time each day when you can give your

During this time, let the child choose what
undivided attention to your child.
The following books are available from them for
he would like to do. Let him direct you in a nominal cost:
activities and decide himself whether to talk or If Your Child Stutters: A Guide for Parents, 7th
not. When you talk during this special time, edition, Publication No. 0011, 64 pages,
use slow, calm, and relaxed speech, with
3rd edition, Publication No. 0022, 64 pages,
plenty of pauses. This quiet, calm time can be
Stuttering and Your Child: Questions and Answers,

Do You Stutter: A Guide for Teens, 4th edition,
a confidence-builder for younger children, Publication No. 0021, 72 pages.
serving to let them know that a parent enjoys The following DVDs are available at www.stutteringhelp.org:
their company. As the child gets older, it can
serve as a time when the child feels DVD 0073, 30 minutes
Stuttering and Your Child: Help for Parents,

comfortable talking about his feelings and
experiences with a parent. DVD 0172, 12 minutes
Stuttering: For Kids, By Kids,

DVD 1076, 30 minutes
Stuttering: Straight Talk for Teens,

Please see the Stuttering Foundationʼs catalog at
5. Help all members of the family learn to

Children, especially those who stutter, find it www.stutteringhelp.org for these and other resources.
take turns talking and listening.

much easier to talk when there are few This list may be copied and distributed without
interruptions and they have the listenersʼ permission of the publisher provided you acknowledge
attention. the Stuttering Foundation of America as the source.

®
Copyright © 2001-2007 by the Stuttering Foundation of America 800-992-9392

14


TABLE 2. QUESTIONS THAT MIGHT
BE ASKED OF PARENTS
Note: These questions are listed in order of the seriousness of the problem. If a parent answers
“yes” to any question other than number 1, it suggests the possibility of stuttering rather than
normal disﬂuency.

1. Does the child repeat parts of words rather than whole words or entire phrases?
(For example, “a-a-a-apple”)

2. Does the child repeat sounds more than once every 8 to 10 sentences?

3. Does the child have more than two repetitions? (“a-a-a-a-apple” instead of “a-a-apple”)

4. Does the child seem frustrated or embarrassed when he has trouble with a word?

5. Has the child been stuttering more than six months?

6. Does the child raise the pitch of his voice, blink his eyes, look to the side, or show
physical tension in his face when he stutters?

7. Does the child use extra words or sounds like “uh” or “um” or “well” to get a word
started?

8. Does the child sometimes get stuck so badly that no sound at all comes out for
several seconds when heʼs trying to talk?

9. Does the child sometimes use extra body movements, like tapping his ﬁnger, to get
sounds out?

10. Does the child avoid talking or use substitute words or quit talking in the middle
of a sentence because he might stutter?

®
800-992-9392

15


The Stuttering Foundation of America is a
tax-exempt organization under section
501(c)(3) of the Internal Revenue Code
and is classified as a private operating
foundation as defined in section 4942(j)(3).
Charitable contributions and bequests
to the Foundation are tax-deductible,
subject to limitations under the Code.

If you wish to help this worthwhile
cause, please send a donation to

THE

STUTTERING ®
FOUNDATION
A Nonprofit Organization
Since 1947—Helping Those Who Stutter
3100 Walnut Grove Road, Suite 603
P.O. Box 11749 • Memphis, TN 38111-0749
800-992-9392 901-452-7343
info@stutteringhelp.org


16


THE
STUTTERING ®
FOUNDATION
A Nonprofit Organization
Since 1947— Helping Those Who Stutter
3100 Walnut Grove, Suite 603
Memphis, Tennessee 38111-0749

1-800-992-9392

www.stutteringhelp.org
www.tartamudez.org

ISBN 0-933388-47-0

ISBN 0-933388-47-0

9 780933 388475

The Child Who Stutters: Guide for Pediatricians

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