General practitioners, pediatricians and other medical professionals
What actions can you take when you receive a request for help about stuttering?
What will you find out here?
Origin of stuttering
Characteristics of stuttering
When do we speak of stuttering?
How can we help a child who stutters?
Talking about the stuttering
This information is certified by CEBAM
It is important to diagnose stuttering in preschool age children early, because early treatment by a specialized speech therapist produces the best results.
Before the age of six years, stuttering is significantly more common than in persons older than six years. This means that stuttering often recovers, either spontaneously or through early treatment.
When stuttering is not treated timely, it can have a negative impact on the person who stutters and the environment. Children may become aware of their disfluencies at a very young age. Negative effects in the child itself may include anxiety, frustration, anger, avoidance behaviour ...
Besides this, additional reactions may be present on top of the stuttering, for example, blinking of the eyes.
But also the child's parents often experience difficulties: they may be overprotective, anxious, insecure, concerned ...
Research shows that general practitioners and pediatricians are often the first contact for the parents of preschoolers who stutter. Their willingness to refer young children who stutter often depends on their knowledge about stuttering.
Do you think a child stutters? If so, don't wait. Parents best contact a speech therapist specialized in stuttering. With proper advice or treatment, there is a better chance of recovery before the age of six years. Waiting until the child is six is not the way to go. Treatment by a speech therapist specialized in stuttering should be initiated earlier.
The cause of stuttering is very complex and there is no consensus on it yet. In most children, it is explained by the processing of speech in the brain that is running differently and by genetic factors.
When stuttering persists, learned behaviours are frequently involved as well.
Some research findings are recurring consistently in different studies:
Differences in brain anatomy and function
Imaging has shown differences in the anatomy and physiology of the brain in persons who stutter compared to persons who do not stutter.
These differences may increase over time in persons who do not recover from stuttering.
It is not clear whether the anatomical and functional differences are causes of stuttering or adaptations to stuttering.
Several studies identified several genes allegedly associated with stuttering. There is no clarity on this yet. Multiple family studies showed that individuals who stutter are more likely to have family members with a history of stuttering than those who do not stutter.
Twin studies confirm these findings.
In addition, boys appear to be at higher risk for persistent stuttering than girls.
Genetics is not the only factor underlying stuttering. There is often some predisposition, but there are also other factors that can trigger stuttering in some children.
To refer a child who stutters in time, you first need to be able to recognize stuttering.
Visible features of stuttering are repetitions of sounds or words and being stuck in or in front of a sound.
Every preschooler produces disfluencies, but there is a difference between normal disfluencies and stuttering.
Normal disfluencies occur in all preschoolers and are part of normal language development. A child with normal disfluencies sometimes repeats sounds, syllables and words, but these do not interfere with the child's speech.
Preschool age children who stutter produce similar repetitions, but at a higher frequency and often on shorter parts, such as sounds or syllables. Furthermore, stuttering may be characterized by prolongations and blocks.
Stuttering can also impact social and emotional functioning. Some children may develop feelings such as anxiety, embarrassment ... because of stuttering. Sometimes children show secondary behaviours such as blinking their eyes, which indicates fighting against the stuttering.
Difference between normal and abnormal disfluencies
A (part of a) multisyllabic word is repeated
A monosyllabic word in a sentence is repeated
eg: That... that... that is tasty
A sentence is corrected
eg: I go... i have been there
A sound or a syllable of a word is repeated
eg: I... i... i don't want that
A part of a sentence is repeated
eg: I know... i know... i know that
A sound of a word is prolonged
Speech is filled with words such as 'euhm'
eg: I think... euhm... dog!
The child blocks before a word
A part of a word is broken off
eg: Um... (brella)
> Occur in all children, but also in
preschoolers who stutter (in higher
frequency and possibly in combination
with additional behaviors).
> Occur (mainly) in children who stutter.
When there is an increased presence of abnormal disfluencies, it is adequate to speak of stuttering.
When the above characteristics occur approximately three times out of every 100 words, it is indicative of stuttering. As a general practitioner or pediatrician, this is difficult to identify.
Sometimes, however, the presence of fewer stuttering moments is sufficient to speak of stuttering as well. This is possible if the stuttering moments are tensed.
Do not just wait and see. In the past, people often used the wait-and-see approach, because many children recover spontaneously from stuttering. Now we do this "in a controlled way", that is, under the professional guidance of a speech therapist who is specialized in stuttering. Sometimes tailored advice from the speech therapist leads to recovery from stuttering. When spontaneous recovery does not occur, stuttering treatment is necessary. The speech therapist makes a decision together with the parent(s) about starting stuttering treatment and takes factors such as family prevalence of stuttering, the evolution of stuttering since onset ... into account.
Contact a speech therapist in time. It is essential that stuttering treatment is delivered by a speech therapist specialized in stuttering. Research shows that early treatment (at least one year before the age of 6) is most effective. Parents themselves can also contact the speech therapist for support.
It is normal to be concerned if you notice that stuttering fluctuates. Stuttering often becomes more severe when the child is tired or excited, is talking about complex or new topics, is asking or answering questions, or is talking to inattentive listeners. Talking in a calm way with the child helps. It is important to show the child that you are listening. Look at the child and respond to what he or she says. In addition, acknowledge the child's concerns when he or she indicated being bothered by them.
Some tips for a conversation:
- Take time for a conversation.
- Be relaxed and look at the child while you listen.
- Wait your turn to speak and do not interrupt the child.
- Respond to what the child says and not to how it was said.
In this way, children experience that they are given time to speak and that stuttering is allowed.
Talking about the stuttering with the child is a good idea.
It is important that the child and his/hers environment acknowledge their thoughts and feelings and discuss the stuttering.
Even young children are often already aware of stuttering. Talking about it will make the child worry less.
Get concrete tools from a speech therapist specialized in stuttering so parents have a good idea of how to approach these conversations with their child.
On this website you can find information on various topics:
- Timely referral
- Causes of stuttering
- Characteristics of stuttering
- How often do these characteristics have to occur to speak of stuttering?
- How can we help a preschool age child who stutters?
- Talking about the stuttering
You can find a poster and brochure (free to download) on our website. They contain information that you can give to parents. Be sure to watch or share our video with information about stuttering in preschoolers. When in doubt, you can always contact a speech therapist in your area who is specialized in stuttering. They can determine best whether a child needs therapy. Feel free to contact us (email@example.com) if you would like to organize a training for you and your team.
You can download all information here
Information package for general practitioners, pediatricians and other medical professionals