About Stuttering
Stuttering is a disorder whereby the flow or rhythm of speech is disrupted. These disruptions are not typical and may interfere with or prevent normal communication.
What stuttering can look/sound like:
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Repetitions of sounds (s-s-s-so)
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Repetitions of parts of words (be-be-be-because)
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Repetitions of words (and, and, and, and)
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Repetitions of phrases (can I- can I- can I- can I go)
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Prolongations of sounds (mmmmmaybe)
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Blocks (where the articulators and the sound trying to come out seem stuck in place)
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Secondary behaviours involving parts of the body (rapid eye blinking, head/torso movements, facial grimacing, breath holding, inspiration of breath, grunts, nasal flaring etc.)
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Excessive use of fillers that disrupt the forward flow of the speech and are not intended to be a part of the spoken utterance (e.g., um, and I, ah, yeah, because, and um, um, yeah because I want to…)
It is important to note that while there are commonalities in the above features, stuttering can look and sound different across all individuals.
Stuttering typically begins in the preschool years (around 2 to 5 years or so), often during a period of rapid language acquisition. Sometimes, stuttering can come on gradually over time, and sometimes it be very sudden, almost as if it has appeared overnight. Stuttering affects about 1% of population, and often more males stutter compared to females. The cause of the disorder is currently unknown, but research is ongoing, and it is likely to be related to speech motor processing factors and also thought that genetics (i.e., it can run in families) may be involved. Stuttering is not caused by psychological factors or experiences, however stuttering may be exacerbated by these things, as well as fatigue, stress and anxiety.
A substantial proportion of children who start stuttering will recovery naturally. However, there is no definitive way of predicting who will and will not naturally recover. So, whilst many children recover without the need for treatment, others do not, and research indicates that as a child gets older, the stuttering becomes less likely to lessen. For that reason, early intervention is crucial. If stuttering is observed, it is ideal to get this assessed straight away by a speech pathologist.
Assessment
During a stuttering assessment, my aim is to try and confirm whether or not a person is stuttering, and to observe how the stuttering presents during the clinic and understand what this looks like outside of the clinic as well. I also aim to consider the impact of the stuttering on an individual, their family, and how the disorder has developed over time.
To do this, I will go through an extensive stuttering-based background/history, provide education around the disorder (and treatment if recommended) and aim to observe the stuttering in the assessment session.
For preschool aged children, stuttering is observed during either a conversation or during play. Sometimes, children can be shy at first in the clinical environment and may not want to talk immediately. Stuttering is also known to be cyclical in nature (some days stuttering may be more or less frequent). For these reasons, caregivers/siblings etc. are encouraged to be involved in the conversation/play. I may also ask caregivers to bring a recording of their child with them to the assessment session so that I can hear how the stuttering presents away from the clinic.
Treatment
For children (especially younger children), stuttering treatment will involve parents/caregivers. The speech pathologist will provide training, modelling and supervision to the parents so that they can deliver treatment effectively in the child’s natural environment.
Treatment for pre-school aged children:
Treatment for this age group can be either indirect or direct in nature.
Indirect treatments (e.g., RESTART-DCM etc.) works on the stuttering indirectly by modifying the child’s environment to reduce demands on the child and build the child’s capacity to speak more fluently.
Direct treatments (e.g., Lidcombe Program, Westmead Program etc.) aim to work directly on the child’s speech, and often involve rewarding a child for speaking fluency and correcting the stuttered speech. Whilst all treatments mentioned here are supported by evidence, direct treatments are currently supported by the most evidence and the highest levels of evidence. However, the type of treatment recommended should be based on other factors including what is right for the individual and their family. Sometimes a hybrid approach (using a combination of treatments – e.g., the Oakville Program) may be considered.
Treatment for school aged children:
As children get older, stuttering can become more entrenched, and the disorder can become chronic. There is evidence that speech related social anxiety and other psychological impacts related to stuttering can begin during the school years. Direct treatment is recommended for this age group (e.g., there is evidence for the Lidcombe Program in early primary school age children, along with the Westmead Program etc.). However, it is important for treatment to consider more than the speech behaviours alone. Your speech pathologist will talk this through with you make may make recommendations and/or referrals where warranted.
Treatment for adolescents and adults:
Treatment in this age group involves provision of strategies and techniques for speaking in a way that aims to offset the stuttering (e.g., speech restructuring techniques; LaTrobe Smooth Speech Program, Camperdown Program) etc. Chronic stuttering is also linked to speech related social anxiety and other mental health disorders, and for this reason techniques (e.g., CBT) may also be recommended and/or referrals made to relevant professionals in this regard.