Identification and Treatment of Childhood Stuttering

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Identification and Treatment of Childhood
Stuttering

• J. Scott Yaruss, Ph.D., CCC-SLP
• Stuttering Center of Western Pennsylvania
• University of PittsburghChildrens Hospital of
  Pittsburgh
• Pediatric Grand RoundsMercy Hospital Continuing
  Education ProgramSeptember 14, 1999

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What Is Stuttering?

• An impairment of speech and language production,
  typically characterized by interruptionsin the
  forward flow of speech(speech disfluencies)

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What are the PrimarySymptoms of Stuttering?

• Speech disfluencies come in many forms
• Some disfluencies are considered normal(if
  they occur relatively infrequently)
• Interjections (um, er, like, you know)
• Revisions (I want- I need that)
• Others are more characteristic of stuttering
• Sound or syllable repetitions (li-li-like this)
• Sound prolongations (llllllike this)
• Blocks (l-----ike this)

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How Does Stuttering Develop?

• Typically begins between ages 3 and 5
• As the disorder progresses, 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,
  emotional, and educational consequences

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What Kinds of Consequences?

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

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What Causes Stuttering?

• NO single factor has been shown to beTHE cause
  stuttering
• Stuttering is not caused by childrens parents
• Stuttering is not caused by drawing attention to
  a childs normal disfluencies
• Stuttering is not a psychological problem(though
  it can have psychological consequences)
• Stuttering is not a sign of reduced intelligence,
  motoric weakness, or neurological injury
• Stuttering is not simply a bad habit

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Okay, soWhat Does Cause Stuttering?

• Current theories point to a complicated
  interaction between childrens language
  development and their motoric abilities for
  producing speech, combined with the multiple
  influences of the childs personality and the
  childs communicative and social environment

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Isnt Stuttering Genetic?

• Yes, stuttering tends to runs in families...
• If one family member stutters, 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,
  suggesting that there are also environmental
  influences
• Language development, motoric development, and
  personality are all influenced by genetics
• Most theorists believe that a predisposition to
  stuttering may be heritable but its expression
  maybe largely determined by the childs
  environment

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Doesnt EverybodyStutter Sometimes?

• Yes. Speech disfluencies are a normal part of
  childrens speech/language development
• All children go through a period of producing
  speech disfluencies when learning to speak
• Some children, however, will continue producing
  disfluencies and develop a fluency disorder
• No. Stuttering has emotional consequences not
  seen with everyday, normal disfluency

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Dont Most ChildrenOutgrow Stuttering?

• Yes. 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, some have
  advocated a wait and see approach before
  recommending assessment or treatment

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A Critical Period forRecovery from Stuttering

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

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Who Is At Riskfor 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
  persists for a long time before the family
  notices
• Sometimes children exhibit very severe stuttering
  at onset, but still make a full recovery
• Stuttering is highly variablefluctuating from
  one situation to another, one day to another

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So...Who Is At Risk?

• Certain risk factors can provide some clues
• Number, nature, and types of speech disfluencies
• Length of time the child has been stuttering
• Family history of stuttering
• Childs reactions to stuttering
• Familys reactions to stuttering (parents level
  of concern and attempts to help)
• Selected aspects of the communicative environment
• Selected aspects of the childs overall
  speech/language development

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Who Should Be Referredfor Evaluation?

• It is impossible to determine whether a disfluent
  child is at risk for developing a chronic
  stuttering disorder throughinformal or casual
  observation
• A thorough speech-language evaluation, with
  multiple observations from different perspectives
  is needed to determine whether treatment is
  indicated

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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 childs ability to communicate is affected
• The child seems to avoid certain sounds, words,
  or situations, or substitutes words to avoid
  stuttering
• The parents are concerned about their childs
  speech -- even if the concerns seem unfounded
• The child is concerned about his or her speech

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Who Should Evaluateand Treat Stuttering?

• Speech-language pathologists (SLPs), 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 Pennsylvaniacan
  act as a liaison to help families find specialists

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How Is Stuttering Treated?

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

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Summary

• Early stuttering can be difficult to distinguish
  from normal developmental 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
  childs speech

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Questions? Comments?Please contact me!

• J. Scott Yaruss, Ph.D., CCC-SLP
• Stuttering Center of Western PA
• University of Pittsburgh
• 4033 Forbes Tower
• Pittsburgh, PA 15260
• Phone [phone]
• Fax [phone]
• Email jsyaruss_at_csd.upmc.edu

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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,
  their families, and their clinicians

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