About the Authors: Joeri van Ormondt, MSc, SLT, CESS-certified stuttering specialist from The Netherlands, owns private practice De Stotterpraktijk, specialised in stuttering and cluttering. He is a person who stutters, RESTART-DCM-trainer, CESS-board member and ESS-teacher/coach. He co-founded Stotterconnect, an organization dedicated to Camp Dream. Speak. Live. and the training of SLT’s. Femke de Smit, MSc, SLT, CESS-certified stuttering specialist from The Netherlands, is co-owner of private practice Logopediepraktijk Tilburg, and founder of the stuttering team consisting of in total four stuttering therapists specialised in stuttering and cluttering. She also is a RESTART-DCM-trainer and co-founded Stotterconnect, an organization dedicated to Camp Dream. Speak. Live. and the training of SLT’s. Tjitske Hofstee-Bootsma, MSc, SLT, CESS-certified stuttering specialist from The Netherlands, is working as an SLT in the private practice De Stotterpraktijk. She will be a RESTART-DCM-trainer and works for Stotterconnect, an organization dedicated to Camp Dream. Speak. Live. and the training of SLT’s.

When a young child begins to stutter, it can be a challenge for the child, their parents, or both. When faced with such a challenge, people often turn to therapy, hoping it will ease the difficulty. Put simply, therapists see two groups: one in which stuttering continues, and another in which it fades away. How can we optimize early stuttering therapy to meet the needs of both groups? In this article, we argue for a reset of the general approach to stuttering in children under six. If we shift our focus in early stuttering therapy, it can build strength and reduce stigmatization from the very moment stuttering appears. 

Traditionally, therapy has aimed to reduce or eliminate stuttering. In early stuttering therapy, measuring the effectiveness of therapy with this outcome has been a persistent challenge for decades. Exact figures are hard to establish,[3, 8] -as percentages vary across studies- but a visual impression helps convey the general picture (see figure). One group of children will continue to stutter throughout life, even after early childhood therapy (group 1). The other group consists mostly of children whose stuttering would have disappeared without therapy (group 2a), and of children for whom therapy may have contributed to the fading of stuttering (group 2b).

While research on possible negative side effects of early therapy programs in the long term -so for group 1- is lacking, evidence is growing that efforts to minimize stuttering may harm children’s self-confidence and development later in life. Many adults who stutter say they wish stuttering had truly been accepted as okay when they were young[1, 2, 4] . Children who stutter also face stigma in a society that largely views stuttering as a problem to be solved, a view likely reinforced by the common belief that therapy exists to eliminate stuttering. We believe the general public overestimates the size of group 2b, which is understandable, since many in group 2a also believe they no longer stutter only because of therapy – and in doing so, unintentionally contribute to that stigma.

We still don’t know what the working ingredient is in early childhood stuttering programs that aim to reduce overt stuttering[7]. What we do know is that growing up with a stutter puts these children at risk of developing negative beliefs about their speech and themselves. We also know how to reduce this impact of stuttering. So let’s look at the commonly used general approach and its consequences. 

We once worked with the traditional focus. Together with parents, we made a therapy plan with reduction of stuttering as the primary outcome, presumably leading to the child’s stuttering to disappear. We made parents aware of the ‘window of opportunity’ and therapy was viewed as a last chance to benefit from it. For both parents and therapists, success meant being able to say the child no longer stuttered.

As mentioned before, stuttering did not always fade (group 1) during therapy. From the start, we included a disclaimer, telling parents about this group who would continue stuttering. For every child in group 1 after a year or more, therapy did not achieve its main goal. We then shifted focus to a different outcome: reducing the impact of stuttering. The shift to this ‘second-best’ outcome implies failure, possibly reinforcing the idea that stuttering is undesirable. As a result, negative beliefs and attitudes -the stuttering iceberg- may have grown already. And note, there has -as far as we know- never been a study on harmful side effects of therapy.

In the past decade, there have been ongoing discussions, alongside a shift in our field, toward neurodiversity and stuttering-affirming therapies. Young children’s therapy was largely left out of these discussions. We therefore call for a critical evaluation of therapy for children under six. What if we turned therapy around and affirmed stuttering in all children? When a child begins to stutter, we do not know to which group the child will ultimately belong.Therefore, let us consider as if all children belong in group 1 from the very beginning. Because for children that are in group 1 it is crucial to give them -right from the first session- the strengths they need. No growing iceberg. No undoing of earlier therapy. Accepting parents. Strong children. We strongly believe this shift of focus benefits all children without the side effects mentioned above. This is why we believe early therapy remains vital. Below, we outline some key considerations for this paradigm shift[2]: rephasing therapy goals, changing language and helping children and parents feel relaxed about stuttering.

The first change we suggest is rephrasing the goal of therapy into one that is realistic and accessible for all children. For these children, the aim is to enjoy communication, speak freely, or communicate effectively. These objectives give parents and children the satisfaction of working toward something they can influence. So, no goal focused on stuttering reduction. 

Changing the language around stuttering is another key factor to be considered[5]. This runs throughout therapy. Languagestems from how we view stuttering. If you see stuttering as a disorder, you will use different language than if you see it as a human difference; a variation in speaking or a communication difference. This matters: the framework shapes the language we use. For example, it is still common -especially with this age group- to speak of recovery from stuttering. Yet recovery, like terms such as risk factors and stuttering severity, is mainly associated with disease. Much medical-model language remains embedded in our thinking. Because it was once so widespread, we may not even notice when we use it. However, it is just a word you use. And words can be replaced; doing so can greatly influence how parents view stuttering and their child. By modeling, explaining, and rephrasing language, we help parents build the strength in their child to foster confident, strong communication.

We think therapy is unlikely to be effective while environmental pressure to cure stuttering persists. We therefore see it as crucial to help parents and children feel relaxed about stuttering. Any form of pressure shapes the communication style modeled for the child. We illustrate this with some examples. 

A four-year-old girl showed many secondary behaviors, which stressed her mother considerably. It did not matter what approach we used, the girl’s secondary behaviors and frustration did not change. Attending therapy itself created a constant urge in the mother to eliminate stuttering, so her daughter wouldn’t face negative experiences later in life. In the end, what proved effective was fully letting go of therapy. This allowed the mother to release her focus on controlling stuttering, leading to more relaxed communication for both mother and child.

Recently we saw another child, three years of age. Therapy had not yet begun when the parents, calling from their holiday, panicked because stuttering had increased significantly. We taught the parents how to talk about stuttering with their son. A few days later, the parents heard him tell the neighbors that he stutters – and that it’s okay. He still stuttered, of course, but secondary behaviors decreased significantly. Communication became fun and easy again. And importantly, the parents were at ease. 

In general, we see parents value such openness about stuttering greatly. Their child acquires useful tools to be independent in future situations and to build strengths. This gives parents confidence their child can handle questions or ‘jokes’ about their speech. It greatly reduces parents’ worries. This also works with younger children. We have seen it time and time again. The above examples show why early therapy with parents and children is vital, with reducing stress around stuttering as the first step. This means talking and learning about stuttering, exploring it, and making room for the emotions of both children and parents. A next step in therapy can be easing communicative pressure (for example, turn-taking behavior, reducing questions asked by parents, and adjusting language to the children’s needs). We make communication fun (again) and give the children the best opportunities to express themselves with strength and ease. 

Since we started reframing our thinking and language about stuttering to be more inclusive and (neuro)diversity-affirming, something interesting happened. Parents and children seem far more relaxed about stuttering. For most parents, it no longer matters whether a child continues to stutter, because they have the strengths to keep the iceberg from growing. We believe this attitude makes therapy far more effective and shorter. 

We invite fellow professionals to reflect on their own work and, regardless of the program or components used, critically reconsider elements that focus mainly on reducing stuttering and may unintentionally raise communicative tension or reinforce stigma.

Finally, what about children whose stuttering will fade eventually (group 2)? It does no harm to approach them as children who stutter. After all, during therapy they are children who stutter. During their life, stuttering may come and go. That’s all okay. Imagine that a sibling of a child who used to stutter begins to stutter at some point. How powerful would it be if not only parents but also the older sibling – though no longer stuttering- knows everything about stuttering and can advocate for their younger sibling. Or to support others who stutter whom they encounter later in life. Or even themselves if their own stuttering returns. Therapy with this new focus will give  the diverse stuttering community true strengths.

References

1. Byrd, C., O’Dwyer, M., & Eggers, K. (2022). Building resilience through Camp Dream. Speak. Live. In K. Eggers & M. Leahy (Eds.), Clinical cases in fluency disorders (pp. 44–54). Routledge. https://doi.org/10.4324/9781003179016-5
2. Byrd, C. T., Coalson, G. A., & Conture, E. G. (2024). CARE model of treatment for stuttering: Theory, assumptions, and preliminary findings. Frontiers in Psychology, 15, 1488328. https://doi.org/10.3389/fpsyg.2024.1488328
3. Carey, B., Onslow, M., & O’Brian, S. (2021). Natural recovery from stuttering for a clinical cohort of pre-school children who received no treatment. International Journal of Speech-Language Pathology, 23(1), 48–56. https://doi.org/10.1080/17549507.2020.1746399
4. Gerlach-Houck, H., Kubart, K., & Cage, E. (2023). Concealing stuttering at school: “When you can’t fix it… the only alternative is to hide it.” Language, Speech, and Hearing Services in Schools, 54(1), 96–113. https://doi.org/10.1044/2022_LSHSS-22-00029
5. Lamoureux, G., Tessier, A., Finlay, S., & Verduyckt, I. (2024). Critical perspectives in speech-language therapy: Towards inclusive and empowering language practices. Disabilities, 4(4), 1006–1018. https://doi.org/10.3390/disabilities4040062
6. Phillips, M. C., & Spaulding, T. J. (2025). Listening to voices that matter: The speech therapy experiences of people who stutter. Journal of Speech, Language, and Hearing Research. Advance online publication, 1–28. https://doi.org/10.1044/2025_JSLHR-24-00792
7. Sjøstrand, Å., Næss, K.-A. B., Melle, A. H., Hoff, K., Hansen, E. H., & Guttormsen, L. S. (2024). Treatment for stuttering in preschool-age children: A qualitative document analysis of treatment programs. Journal of Speech, Language, and Hearing Research, 67(4), 1020–1041. https://doi.org/10.1044/2024_JSLHR-23-00463
8. Yairi, E., & Ambrose, N. G. (2013). Epidemiology of stuttering: 21st century advances. Journal of Fluency Disorders, 38(2), 66–87. https://doi.org/10.1016/j.jfludis.2012.11.002