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Identification and Treatment of Childhood Stuttering

J. Scott Yaruss, Ph.D., CCC-SLP
Stuttering Center of Western Pennsylvania University of Pittsburgh Children¶s Hospital of Pittsburgh Pediatric Grand Rounds Mercy Hospital Continuing Education Program September 14, 1999

What Is Stuttering?
An impairment of speech and language production, typically characterized by interruptions in the forward flow of speech (³speech disfluencies´)

´ ³er.´ ³you know´) ‡ Revisions (³I want.I need that´) ± Others are more characteristic of stuttering ‡ Sound or syllable repetitions (³li-li-like this´) ‡ Sound prolongations (³llllllike this´) ‡ Blocks (³l-----ike this´) .What are the Primary Symptoms of Stuttering? ‡ Speech disfluencies come in many forms ± Some disfluencies are considered ³normal´ (if they occur relatively infrequently) ‡ Interjections (³um.´ ³like.

emotional. children are likely to develop reactions to stuttering. ± Tension and struggle in their speech musculature ± More advanced types of speech disfluencies ± Concern or anxiety about their speaking abilities ‡ These reactions can have profound social... and educational consequences .How Does Stuttering Develop? ‡ Typically begins between ages 3 and 5 ‡ As the disorder progresses.

guilt.What Kinds of Consequences? ‡ Affective. talking to friends). avoidance of speaking situations (reading in class. embarrassment. reduced economic opportunities . fear ‡ Without intervention. negative reactions can lead to: ± Disability: Difficulty communicating with peers or in social situations (reading in class. shame. talking on the phone). Behavioral. low self-esteem. reduced participation in educational opportunities ± Handicap: Reduced ability to fulfil occupational goals. Emotional Reactions: Anxiety about speaking. frustration.

After Yaruss (1998) .

or neurological injury ± Stuttering is not simply a bad habit . motoric weakness.What Causes Stuttering? ‡ NO single factor has been shown to be THE cause stuttering ± Stuttering is not caused by children¶s parents ± Stuttering is not caused by drawing attention to a child¶s normal disfluencies ± Stuttering is not a psychological problem (though it can have psychological consequences) ± Stuttering is not a sign of reduced intelligence.

Okay. combined with the multiple influences of the child¶s personality and the child¶s communicative and social environment . so« What Does Cause Stuttering? Current theories point to a complicated interaction between children¶s language development and their motoric abilities for producing speech.

and personality are all influenced by genetics ± Most theorists believe that a predisposition to stuttering may be heritable but its expression may be largely determined by the child¶s environment . ± If one family member stutters. stuttering tends to runs in families.Isn¶t Stuttering ³Genetic´? ‡ Yes. suggesting that there are also environmental influences ‡ Language development. motoric development. there is an increased chance that another family member will also stutter ± The few twin studies that have been conducted show only 50% concordance for MZ twins...

Doesn¶t Everybody Stutter Sometimes? ‡ Yes. normal disfluency . Stuttering has emotional consequences not seen with everyday. Speech disfluencies are a normal part of children¶s speech/language development ± All children go through a period of producing speech disfluencies when learning to speak ± Some children. will continue producing disfluencies and develop a fluency disorder ‡ No. however.

Most children who exhibit disfluencies or even stuttering early in their speech/language development will recover without intervention ± Prevalence = 1% ± Incidence of Stuttering = 5% ± Incidence of Increased Disfluencies: 15-25% ‡ Because of the high rate of recovery.Don¶t Most Children Outgrow Stuttering? ‡ Yes. some have advocated a ³wait and see´ approach before recommending assessment or treatment .

it can be very risky for individual children . they are likely to develop chronic stuttering ± Older children rarely achieve normal fluency.A Critical Period for Recovery from Stuttering ‡ If children do not recover by age 6 or 7. although the ³wait and see´ approach may be statistically defensible. and the negative consequences increase over time ± Negative social and emotional consequences can be minimized with appropriate early intervention ‡ Thus.

but persists for a long time before the family notices ± Sometimes children exhibit very severe stuttering at onset. one day to another .Who Is At Risk for Chronic Stuttering? ‡ No single behavior categorically differentiates children who stutter from children who do not ± All children exhibit all types of speech disfluencies ± Sometimes stuttering begins very gradually. but still make a full recovery ± Stuttering is highly variable«fluctuating from one situation to another.

. nature.Who Is At Risk? ‡ Certain risk factors can provide some clues: ± Number. and types of speech disfluencies ± Length of time the child has been stuttering ± Family history of stuttering ± Child¶s reactions to stuttering ± Family¶s reactions to stuttering (parent¶s level of concern and attempts to help) ± Selected aspects of the communicative environment ± Selected aspects of the child¶s overall speech/language development .So..

with multiple observations from different perspectives is needed to determine whether treatment is indicated .Who Should Be Referred for Evaluation? ‡ It is impossible to determine whether a disfluent child is at risk for developing a chronic stuttering disorder through informal or casual observation ± A thorough speech-language evaluation.

or situations. words.Referral Guidelines ‡ I evaluate if any of the following are true: ± The child produces 3 or more disfluencies during a brief spontaneous conversational interaction ± There is tension or struggle during disfluencies (even if the disfluencies are infrequent) ± The child¶s ability to communicate is affected ± The child seems to avoid certain sounds.even if the concerns seem unfounded ± The child is concerned about his or her speech . or substitutes words to avoid stuttering ± The parents are concerned about their child¶s speech -.

licensed and certified by the American Speech-Language-Hearing Association (ASHA) ‡ Not all SLPs are comfortable with stuttering. so there has been a move toward specialization ± ASHA is currently certifying stuttering specialists who have additional experience and training with stuttering ± Support groups maintain lists of stuttering specialists ± The Stuttering Center of Western Pennsylvania can act as a liaison to help families find specialists .Who Should Evaluate and Treat Stuttering? ‡ Speech-language pathologists (SLPs).

How Is Stuttering Treated? ‡ Helping children learn to speak more fluently ± Changing the timing and tension of speech production ‡ Helping parents learn to facilitate children¶s fluency in everyday speaking situations ± Parents can change their own speech and manage children¶s speaking situations to help them speak fluently ‡ Helping children and parents develop appropriate reactions and healthy attitudes toward stuttering ± We must educate parents about children¶s fluency ± It is not sufficient to simply tell parents not to worry -.they need training about how to react to stuttering .

Summary ‡ Early stuttering can be difficult to distinguish from normal ³developmental´ disfluency ‡ Early intervention is critical for preventing the development of chronic stuttering and its negative social and emotional consequences ‡ The safest practice is to refer children for evaluation by a stuttering specialist. especially if the parents or child are concerned about the child¶s speech .

D. PA 15260 Phone: (412) 647-1367 Fax: (412) 647-1370 Email: jsyaruss@csd.. CCC-SLP Stuttering Center of Western PA University of Pittsburgh 4033 Forbes Tower Pittsburgh.edu . Scott Yaruss.Questions? Comments? Please contact me! J.upmc. Ph.

tuttering enter of W estern P ennsylvania A joint venture of Children's Hospital of Pittsburgh and the Department of Communication Science and Disorders at the University of Pittsburgh .

their families.Mission of the Stuttering Center ‡ Provide effective client-centered treatment for individuals who stutter ‡ Conduct meaningful research on the nature and treatment of stuttering ‡ Provide on-going education for student clinicians as well as practicing SLPs ‡ Provide support for individuals who stutter. and their clinicians .

Participation Fluency Communication Treatment E ducation R esearch S upport tuttering enter of estern Pennsylvania S C .

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