Preschool Stuttering

Speech therapy for preschool disfluency is controversial. I'm not even going to try to address this topic completely. This blog entry is about my own perspective. It is based as much on experience as on published literature.

Some preschool children do stutter. That is, some 2-, 3-, 4- and 5-year olds experience blocks with struggle behavior, prolongations, and multiple sound and/or syllable repetitions. Some preschoolers respond to their stuttering by whispering, using their hands to pull on the tongue, reticence about talking, and gross motor movements such as hitting and jumping while stuttering. I've seen all of these reactions. These children need direct speech therapy, in my opinion. They need some kind of direct instruction and modeling to help them find more relaxed sound production. Preschoolers are often natural imitators, so that I can describe the slow-smooth way in which I am pronouncing words in an activity and they will imitate that style of speaking without needing repeated prompts to do so.

Preschool children love to play. Therefore, laying the groundwork for changing speech may need to be taught in play. These are the concepts I teach in play: empowerment, change, we learn from our mistakes, bumpy vs smooth, fast vs slow, and the child's ideas are important to me. I briefly describe each concept in a single page handout for parents. Role modeling for parents is an essential part of speech therapy with preschoolers.

When I appreciate a child's words and play, I signal that his input has value. If this child continues to stutter, he will need to value his own observations as he experiments with speech changes or stutters with peers. When I suggest that we change leggo building plans, change crayon colors, change playdo creations, change dramatic play scenarios, etc., I hope that my student is learning that change can be fun. If this child will eventually need to consciously change the way he talks to reduce articulatory tension, I want him to already be prepared for coping with the feelings of differentness that change brings. He may need to selectively change bumpy words into smooth words or perhaps reduce speaking rate. When I 'accidentally' knock over blocks, drop glue, and skip pages in a book, I model that making mistakes is a normal part of living. In fact, we need to make mistakes to learn what works for us and what doesn't.

I generally follow a treatment process described in "Treating Preschool Children Who Stutter: Description and Preliminary Evaluation of a Family-Focused Treatment Approach" by Yaruss, Coleman, & Hammer (Language, Speech, and Hearing Services in Schools, Vol. 37, 118-136, 2006 ). This is only one way to approach stuttering in preschoolers and a follow-up article, "Differing Perpectives on What to Do With a Stuttering Preschooler and Why" by Onslow & Yaruss can be found in the American Journal of Speech-Language Pathology, Vol. 16, 65-68, February 2007. Many SLPs are now trained in the Lidcombe Program of treatment. I opted not to do this training since it seemed to emphasize data collection, explicit correction of the child's stuttering, and training parents to assume the role of SLPs. I encourage parents interested in the Lidcombe Program to learn more specifics from SLPs who have completed its intensive training.

Helpful resources include an in-depth interview form called "When It Comes to Assessment Parents Know Best" by Janice Westbrook, Ph.D. http://www.mnsu.edu/comdis/kuster/gjohnson/parentsknowbest.html. I really like a coloring book called The Many Voices of Paws by Julie Dzewaltowski Reville and published by The Speech Bin (This fabulous book is likely out of print.) This is a simple, gentle story that introduces the very young child to the concepts of changing vocal output. Paws is a overweight, fluffy cat who experiements with making the sounds of other animals. "Our first talk about talking..." an oldie but goodie for young children at http://www.mnsu.edu/comdis/kuster/TherapyWWW/ourfirsttalk.pdf.

Parents willing to do some reading will benefit from "Stuttering Prevention: A Manual for Parents" by Starkweather, Gottwald, & Halfond at (broken link). The Stuttering Foundation http://www.stutteringhelp.org/ has an updated , now 7th, edition of if your child stutters: a guide for parents. Parents MUST actively participate in the preschool child's speech therapy. I no longer accept preschool children into speech therapy if both parents work full time and are not able to modify the child's daily environment or carryover therapy techniques at home. (I have a colleague who will not see any child who stutters unless both parents attend speech therapy sessions.)

A word about etiology: why does a preschool child stutter? This is the $64,000 question. Some children who stutter have a parent, grandparent, or other relative who stutters or who has recovered from stuttering. In this situation, it is tempting to presume that the young child has inherited stuttering. Some children have no known reletives who stutter. My observation has been that some of these children are eventually diagnosed with other problems. I would say that the vast majority of my students have had concerns in addition to stuttering: emotional sensitivity, dyslexia, sensory integration disorder, Down's Syndrome, learning disability, articulation disorder or delay, or gross-/fine-motor delay/disorders. Consequently, speech therapy for stuttering nearly always occurs in the context of larger therapeutic goals.

Judy