COMMENTARY

When Is Stuttering Cause for Concern?

Joseph G. Donaher, PhD

Disclosures

July 01, 2019

Editorial Collaboration

Medscape &

This transcript has been edited for clarity.

Hello. I'm Joe Donaher, from the Center for Childhood Communication at the Children's Hospital of Philadelphia.

While speech and language skills are emerging, it is not uncommon for children to struggle with producing clear and fluent speech. Typical issues that children experience can include mild articulation errors, like a lisp, or more significant expressive and receptive language concerns.

At times, everyone struggles to figure out exactly what they want to say. During these moments of uncertainty, people will often repeat words, short phrases, or even sounds to gain extra time to organize what they want to say. For example, if I asked you what you did on Saturday night, you might say, "We, we, we went out to dinner with some friends." By repeating the word "we," you are buying time. You gained extra time to organize and formulate your thoughts. This is an example of a typical disfluency.

Another form of disfluency that impacts nearly 3 million Americans is stuttering. It is vitally important for pediatricians to have a thorough understanding of stuttering and typical disfluencies because 85% of families turn to their pediatrician when they are concerned that their child might stutter. Today we will define stuttering, discuss warning signs, where to refer when concerned, and where families can go for help.

Stuttering is a neurologically based, genetically transferred disorder. The heritability factor for stuttering is about 75, which means that stuttering is not caused by bad parenting or talking too fast. And stuttering cannot be "caught" by hearing another child stutter.

Stuttering impairs an individual's ability to time and sequence the underlying movements necessary to produce speech. This often results in the characteristic stuttering behaviors whereby the individual repeats sounds or words, prolongs sounds, or completely blocks, [a situation] where no sound is produced. Additionally, stuttering often causes a lack of confidence in one's ability to effectively communicate and a sense of "losing control" for the speaker. Often, people who stutter anticipate future speech breakdowns which causes them to avoid talking, to switch words, or to do anything to hide from the overt stuttering behaviors.

Certain risk factors are indicative of increased concern. For example, because stuttering tends to run in families, a family history of stuttering indicates greater risk. If the behaviors have been present for longer than 6 months, are occurring more often, or occur consistently when the child speaks, there should be greater concern.

If the child appears to be pushing words out or physically straining while talking, or if the child avoids talking or appears increasingly troubled by their speech, there should be greater concern.

If you are concerned that a child might be stuttering, or if a parent reports the presence of increased risk factors for stuttering, it may be time to refer that child to a speech-language pathologist who is experienced and comfortable working with people who stutter. These professionals can be found in your school districts, at hospitals, at universities, or even in your neighborhood in private practice.

Foundations like The Stuttering Foundation provide detailed information for parents and professionals and offer a list of specialists broken down by state. The specialty board on fluency disorders of the American Speech-Language-Hearing Association also lists certified stuttering specialists on its website.

Last, when someone stutters, they typically know exactly what they want to say but are struggling to motorically produce the words. At that point, the best thing for a listener to do is to wait, give the individual time to finish, and listen to the great things that they have to say.

If you would like more information on stuttering, you can refer to the links below. Thank you.

Resources

American Board of Fluency and Fluency Disorders

The Stuttering Foundation of America

National Stuttering Association

FRIENDS: The National Association of Young People Who Stutter

American Speech-Language-Hearing Association (ASHA)

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