pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Speech “Non-fluency” – Stammering, Hesitancy, Delay, and Stuttering in children.

It may surprise you to know that 10 – 15% of children go through a "phase" of speech "non-fluency".  That is: Stammering, Hesitancy, Delay, or Stuttering before they reach adulthood.

Worldwide, 1% of people stutter in the US speech therapists quote the figure 5 in 100. And there is a higher incidence in males than in females, approximately four to one.

There does seem to be some kind of hereditary predisposition because 25 – 60 percent (depending upon where you get your figures) of stutterers have other family members who stutter. But, there is also a definite relationship to stress levels of many types.

Assuming the child has been carefully examined by a pediatrician, tested and found to hear adequately, the physician must then differentiate between true stuttering and other types of what is known as “non-fluency.”

photo of boy taking a heaing test

Developmental non-fluency is an aspect of speech frequently occuring between the ages of 2 and 7 in otherwise normal children. It is a common part of some children’s cognitive development as they learn to speak a language.

Assuming the child has been examined, tested and hears adequately, the physician must differentiate between true stuttering and other types of non-fluency.

You may notice that the child repeats part words like; "ta-table" or "dow-down". ; whole words such as: "my, my, my"; phrases like: "let me, let me, let me do it."; or interjections like: "uh….," "um….", "err…" "ah…"

The important thing to notice is that these types of non-fluencies are usually not associated with any visible straining or tension during the child’s normal verbalization (stuttering is).

The frequency of non-fluencies may increase when he is in a hurry to speak or is under tension, but there is no facial contortion of obvious stress.

Stuttering, on the other hand, is an interruption in the normal rhythm of speech manifested by involuntary:
1- Prolongation of sounds,
2- repetitions, and
3- blocking of words.

There may be tense movements of a jaw and other parts of the body and the avoidance of certain sounds of words altogether.

Early diagnosis is important, but parental attitude and willingness for treatment make the biggest difference.

In reality it is important to diagnose stuttering and institute therapy very early (before age 5 – 7) in order to have a good outcome; but parental attitude and willingness for treatment make the biggest difference. If treated within a year of its occurrence and before a child reaches approximately age 8 years, stuttering can be cured in a great majority of children, with no recurrence in later life.

True stuttering is classified into four groups; First, temporary developmental stuttering.  Second, interference with normal development by emotional stress.  Third, a result of a psychiatric illness caused by disturbed family relationships.  And fourth, organic stuttering associated with brain damage or problems.

boy stutter

All children who stutter should be evaluated by a pediatrician and if necessary referred to either a speech therapist, child psychologist, or both.

Treatment Strategies There are, however, strategies recommended to the parents of children who are learning to speak.

1 — Parents can reduce the tempo of their own talking which the child will then model, helping his own speech development.

2 — Reduce the questioning of the child.  Do more commenting on the child’s daily activities, experiences, etc.  The child then can choose to speak or remain silent.

3 — Avoid the show-and-tell type of questioning.  Beginning most of verbal interchanges with a question about what the child remembers can dramatically increase speech anxiety.  Saying something like, "did, you see a fire engine today?" rather than "what did you see?" allows the child a lot more freedom of speech.

4 — Increasing the amount of listening, along with looking at the child when he is talking helps a stuttering child.  Give undivided attention as much as possible.

5 — Parents should talk in shorter sentences and possibly while engaged in shared physical play.  Be less focused on the teaching of vocabulary until later on.

6 — In children under three, simply slowly repeating back to the child reassures him that you have understood what he has said.  For children over three however repeating a child’s statement might increase anxiety.

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