Speech Therapy for Preschoolers Who Stutter 101
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The onset of stuttering can be distressing for parents, especially if it happens out of the blue, which is fairly common. The good news is that there is a lot that SLPs can do to reassure and support families!
The first thing that I do when a parent in this situation calls the office is to reassure them that stuttering occurs in 5% of children, and that initial severity does not predict whether or not the child will outgrow it. I share that many children outgrow stuttering and that there is a lot we can do to support their speech and language development (National Stuttering Association). I also reassure them that in the case that they do not outgrow it, they can still grow into confident communicators.
During an evaluation, I would ask parents questions about the child’s medical history and family history of stuttering to understand what risk factors they have for persistent stuttering. Then, I would collect a communication sample in order to analyze the types of stutters observed after the session. Finally, I might administer a communication attitudes questionnaire for preschool children to gauge the child’s self-awareness of stuttering.
Regarding treatment, I would first like to say that there are a few main approaches to treatment for stuttering for preschool children. You may hear about indirect approaches, direct approaches, and behavioral or operant approaches. Some specific approaches include the Lidcombe Program, the RESTART Demands and Capacities Model, the Palin Parent-Child Interaction Model, and more.
The Lidcombe Program is a direct approach that uses behavioral techniques from an operant perspective. Other direct approaches may simply teach children fluency-enhancing and stuttering modification techniques. The RESTART Demands and Capacities Model and Palin Parent-Child Interaction Model are indirect strategies that involve making modifications to the communication environment.
There have been two studies that compared direct and indirect treatment approaches. In the first study, “Experimental Treatment of Early Stuttering: A Preliminary Study,” no significant differences were found between the Lidcombe Program and Demands and Capacities Model with regards to levels of stuttering frequency and severity ratings after 12 weeks of treatment. Levels of parent satisfaction with treatment were comparable for both treatments.
In the second, “Direct Versus Indirect Treatment for Preschool Children who Stutter: The RESTART Randomized Trial,” researchers found that 18 months after beginning treatment, outcomes were comparable. They did note that children demonstrated decreased stuttering more quickly during the first three months of therapy in the direct treatment group than in the indirect treatment group.
These two studies were published in 2005 and 2015, respectively. ASHA also published a document on this topic in 2010. It is from the National Center for Evidence-Based Practice in Communication Disorders and is titled “Effectiveness of Interventions for Preschool Children with Fluency Disorders: A Comparison of Direct and Indirect Treatments.” According to the authors, there was insufficient evidence to support one approach over the other in general or in specific situations at the time of publication. Therefore, there is more than one way to approach therapy for preschool children who stutter. I’ll be sharing an approach that has worked well for many of my clients. Many of these ideas are based on a family-focused treatment approach described by Yaruss, Coleman, and Hammer in the study “Treating Preschool Children Who Stutter: Description and Preliminary Evaluation of a Family-Focused Treatment Approach.” This approach combines indirect and direct approaches to therapy.
When starting therapy, educating parents about stuttering and discussing how they feel about it is the first step. Parents may feel anxious about their child’s future, shame about their feelings about their child’s speech, or guilt that it may have been caused by something they did. It is important to create space for them to talk about these feelings in an understanding and nonjudgmental atmosphere, to dispel myths, and provide reassurance and support. I also ask about others involved in the child’s life and talk to the parent about how to talk to the child’s grandparents, aunts and uncles, and teacher and the parents of their peers about stuttering. These individuals in the child’s life may ask questions about stuttering or say things to the child that may be well-intentioned but are not helpful. Therefore, we can support the parent in talking to others in the child’s life about stuttering and how they can support the child.
Most of the time after that, I start with indirect therapy. I like to start with a tracking system. I ask parents to rate the child’s stuttering on a 10-point rating scale every day. I also ask them to make notes of any observations, such as what was happening that day if the stuttering was especially low or high. This is helpful for identifying factors that seem to have an influence on the child’s speech.
After that, we may work on communication modifications such as easy talking, limiting verbal competition, and reducing communication pressures. These modifications involved modeling a slightly slower rate of speech with pauses at expected times and limiting interruptions and other competing factors and pressures on the child’s speech.
In many cases, children will exhibit improved fluency within three months. This is true of my own personal experience as a clinician and in studies of indirect therapy strategies, such as those previously mentioned (Franken et al., 2005, de Sonneville-Koedoot et al., 2005, Yaruss et al., 2006). It is also known that many children experience natural recovery from stuttering. However, if children continue to stutter after indirect therapy strategies have been implemented, then I move on to direct therapy. This is important because some children will stutter for longer periods of time than others, and some will continue to stutter into adulthood. They will need more support to learn how to cope with stuttering and develop a healthy attitude towards their speech and communication.
Some of the goals of direct therapy include teaching the child about the speech mechanism and what happens when they stutter, identifying stuttering and desensitizing to it, if needed, learning how to modify their speech and stuttering, learning good communication skills, and developing healthy communication attitudes. Even if a child stutters over the long-term, they do not necessarily need therapy over the long-term. The goal of therapy is to help the child communicate effectively. Once they accomplish this, therapy may be reduced and eventually discontinued. It may be restarted if a particular challenge arises or to address speech and communication at a new stage. For example, many children return to therapy before entering middle school or before they start college. Support is available to help them navigate these milestones successfully!
It can certainly be scary to hear your child stutter for the first time. You can be assured that there is much that can be done to help your child become a happy and confident communicator! You are making a difference in their life by learning about stuttering and options to help your child. Your love and support means the world to them!
References:
de Sonneville-Koedoot, C., Stolk, E., Rietveld, T., & Franken, M.-C. (2015). Direct versus indirect treatment for preschool children who stutter: The RESTART randomized trial. PLOS ONE, 10(7). https://doi.org/10.1371/journal.pone.0133758
Franken, M.-C. J., Schalk, C. J., & Boelens, H. (2005). Experimental treatment of early stuttering: A preliminary study. Journal of Fluency Disorders, 30(3), 189–199. https://doi.org/10.1016/j.jfludis.2005.05.002
Frymark, T., Venediktov, R., & Wang, B. (2010). Effectiveness of interventions for preschool children with fluency disorders. ASHA’s National Center for Evidence-Based Practice in Communication Disorders, retrieved April 27, 2022 from https://www.asha.org/siteassets/uploadedFiles/EBSRFluencyDisorders.pdf
National Stuttering Association. (2022, February 7). Facts about stuttering. Retrieved April 27, 2022, from https://westutter.org/facts-about-stuttering/
Yaruss, J. S., Coleman, C., & Hammer, D. (2006). Treating preschool children who stutter: Description and preliminary evaluation of a family-focused treatment approach. Language, Speech, and Hearing Services in Schools, 37(2), 118–136. https://doi.org/10.1044/0161-1461(2006/014)