Treating Stuttering or Monitoring
Hi! My name is Milee Blanton. I am a graduate student at Stephen F. Austin State University. I am currently in the fluency disorders class and have many questions regarding stuttering/cluttering. This class has sparked an interest in PWS. One question I have is this: Given that many children who stutter recover naturally while others develop persistent stuttering, what clinical markers or assessment strategies do you find most reliable for distinguishing between transient stuttering and a disorder requiring early intervention?
Hello, Milee. Welcome to the ISAD Online Conference! Thanks so much for asking this question to the professional panel! I hope that you are enjoying your graduate school experiences and I am excited to hear that you are interested in the treatment of PWS (People Who Stutter). I am in Texas as well! I am excited to hear what my colleagues on this professional panel have to say with your question. You are right in saying that many children “recover naturally”, as of right now in the literature, we say that about 80% of children who start to stutter, “recover” or “grow out of it” so-to-speak. There are components/parts that do make children more vulnerable for continued stuttering like being male (there was a really thought engaging comment in another question on this forum from one of my colleagues on the panel that you should check out regarding male vs female), and having a family member that stutters. In terms of assessment and determining if intervention is needed or not, we need to decide if a child is displaying developmental disfluencies or developmental stuttering. With our assessment, we can look at the types of stuttering and get a holistic view of what is happening to distinguish developmental stuttering (child-onset stuttering that is often characterized by whole word repetitions, hesitations and sound repetitions and sometimes tension and secondary characteristics but not always at first) from developmental disfluencies (disfluencies that happen as a part of language development that are characterized by whole word repetitions, interjections like um and uh, phrase repetitions- and no sound repetitions or accompanying tension)- so I think it’s important to first determine if a child has developmental stuttering or developmental disfluencies (you’ll get referrals for developmental disfluencies and developmental disfluencies themselves are not a need for intervention). Once you have determined if a child is truly stuttering or not, then there is the decision of is early intervention treatment needed or not. Something to keep in mind: here in the United States I do know that most parents bring up concerns regarding stuttering and their child at a pediatrician appointment and there are still medical doctors telling parents to “wait until the age of five” or even six to seek help. Early intervention is always best in terms of treatment and stuttering is no different, so we have worked pretty hard to try to help keep physicians informed (to be fair, their coursework in medical school is limited and I have heard likely doesn’t address stuttering). Additionally, I think it’s important that the 20% of children that do not “grow out” of stuttering are considered every time we do an evaluation so that kiddos do not fall through the cracks (meaning that we also must recognize that early intervention is needed as we don’t know at that point if a child will stop stuttering or not). Beyond that there are also considerations to be made for indirect versus direct therapy services but this is determined on a case-by-case basis and so much of what we do at the early intervention age is indirect with counseling parents/caregivers (but I LOVE direct therapy with littles, too!) But some concepts for you to think about are: someone doesn’t necessarily need speech therapy based on the sole fact that they stutter- they need speech therapy because of how stuttering affects the domains in their life (social, emotional, cognitive) and in different communication settings in their life (academic, home, etc) and that’s how we apply the WHO (World Health Organization’s) ICF (International Classification of Functioning, Disability and Health)framing of therapy specifically to determine if CWS and PWS need intervention. I went a bit beyond your question here, and I hope it was more helpful than confusing but I’d imagine you’ll learn about assessment and treatment determinations shortly in your coursework (I think I know your professor at SFA) and hopefully between the responses you get here and your course you will feel like you have more footing in determining early intervention needs. Take care!
Hello, again. I came across a research article about non-word repetition tasks in helping to try to determine recovery or persistence of stuttering- there is an article that talks about this some if you cannot access the scientific literature and here is the link: https://reachmd.com/news/new-research-provides-insight-into-the-underlying-neural-mechanisms-of-stuttering/2463209/
Hope that’s more helpful to you as well. Take care!
Hi Milee, Steff Lebsack provided a detailed response, so I’ll just add one thought in regard to early intervention. Even when we don’t know if the stuttering will resolve or persist, there’s a lot we can do to support families in terms of alleviating parental concerns, dispelling myths, and promoting a healthy communicative environment at home. There’s a caregiver video entitled “Nurturing and Empowering Your Child Who Stutters” that you might find helpful that encourages focus areas such as fostering communication, connection, confidence, compassion, and resilience (https://youtu.be/GPjKPYUB9qw).
Hi Milee,
So pleased that you have an interesting in stuttering!!
In addition to the amazing and detailed answers provided by Steff and Ana Paula, when I’m in a first appointment (usually a phone call) with the caregiver, I find out the following information to help me think about whether the stuttering is transient or likely to continue into adulthood, based on what we know from the research:
– Biological sex
– Family history of stuttering (and whether that was transient or continued into adulthood)
– How long the child has been stuttering for (most children stop within the first 6 months, some, particularly boys take longer to stop – sometimes up to 5 years)
– Age the child started stuttering
– The pattern of the stuttering over time (there is research showing that no change/increase in prolongations or secondary behaviours over time suggests the child is more likely to continue)
– Whether the child has periods with no stuttering and if these are increasing (more likely to stop)
– The child’s speech and language (delayed/advanced/mismatched)
However, despite this information, the biggest factor that I consider in a first appointment is the impact the stuttering is having on the child and/or the family. As much as we try to think about which children will stop stuttering, we never truly know. Therefore, if the child is showing upset, distress, frustration, anger or is bothered about their stuttering, then I’ll do more. If the family is worried, concerned and does not know how to create an environment that welcomes and gives space for stuttering, then I’ll do more.
Early intervention can help all children who stutter and their families learn more about stuttering, dispel any myths, reduce stigma and create environments that promote joyful, spontaneous communication whether the child continues to stutter or not. (For more information Joeri, Femke and Tjitske have written a great paper about early intervention in the research, therapy and support section of the online conference).