Preschool Stuttering
Hi, my name is Abby and I am a second-year graduate student in speech pathology. We are currently talking about preschool stuttering in our fluency class, and how some will persist and some will grow out of stuttering. What are some tips to help guide us in deciding if a child should receive therapy or be monitored? I know we can look at factors such as family history, temperament, and the child’s reaction to their stutter, but I still feel as though it can be a grey area. I also could foresee it being difficult to tell some families that you recommend monitoring, so what suggestions do you have for going about that conversation? Thank you!
Hi Abby, a great question and ceertainly a difficult decision when you are just starting as an SLP. You mentioned some important factors. Other factors are how concerned the parents are. Very concerned parents can react different than they might want and put some pressure on the speech. Not only the child’s reactions to the stutter, but also that of the parents and the way the child stutters. If there is a lot of tension, blocks, etc. I prefer to start earlier. In The Netherlands guidelines were set up. An SLP should not start before 12 months have past since unset, just monitor. I think this might be a bit much in some cases. They advise to start earlier if there are other disorders that might influence the stutter and if there were no changes in the speech for the last 3 to 6 months of those 12 months. And an earlier start is also possible in case of family history, temperament, gender and phonological abilities.
Personally I feel that with time you learn to decide when to start and at the beginning it is not a problem to start when you are unsure and if there is a spontaneous remission, that is great.
Manon
Abby, Dr. J Scott Yaruss (a specialist, professor, and researcher in stuttering) speaks of “evaluation triggers” that should guide us in deciding when to assess and potentially begin treatment. He indicates that parental concern, child awareness and concern, and family history of stuttering are important factors to consider. I believe early intervention is important, particularly for the parents, because decreased parental anxiety and worry is one of the first evidences of change in the therapeutic process (Millard et al., 2018).
I always promote caregiver education because it alleviates fears, blame, guilt, etc., reduces negative reactions, and enables caregivers to respond and advocate in helpful ways. We can help 1) increase their awareness and understanding about stuttering, 2) make stuttering an open topic of discussion, 3) foster realistic expectations, 4) increase their confidence in their ability to help, 5) promote positive communicative interactions at home (without pressure for fluency), 6) cultivate a healthy and supportive communicative environment for the child, and 7) facilitate a support network through parent support groups, for example. I believe all of this will help prevent what leads to children’s attempts to hide and suppress stuttering (see Gerlach-Houck’s work on concealment), which always has a negative impact on the child.