Creation Date: July 2000
Last Review Date: July 2000
Peer Review Status: Internally Peer Reviewed

Guests 1 and 2 have asked a number of good questions that are related so I will start with the first question. The problem of stuttering begins between the ages of 2 and 5 in most children, with the average age of onset at around 3 years of age. Stuttering is a problem of childhood, and it usually is the case that most young children will exhibit recovery within one to two years of onset. Current estimates of recovery in childhood range from 32 percent to about 85 percent. Recent data suggests that around 90 percent of children who begin to stutter during the preschool years will recover with minimal or no treatment.

Does stuttering go away with age?

As the child gets older, the probability of developing a stuttering problem decreases so this is a good time to bring up guest 1's question about whether stuttering goes away with age. If your child is six years of age or older and has never exhibited a stuttering problem, the probability is very low that he/she will. The older a child gets without exhibiting a stuttering problem, the less likely that he ever will. What we have is this scenario: young children who begin to stutter, typically recover. As the child gets older, if there hasn't been evidence of stuttering, it is very unlikely that there will be. Elementary school aged children, teenagers and adults who stutter are those who did not recover and are actually in the minority.

Is stuttering more frequent in different sexes?

The problem of stuttering is unequally distributed between the sexes. When it first begins, equal numbers of little boys and little girls show stuttering problems. More little girls than little boys recover. If you are a girl, you are more likely to "outgrow" stuttering. The distribution of males to females who continue to exhibit chronic stuttering is about three males to every one female. One thing I would like to add is that speech disfluency is a normal part of communication. That means that most speakers are disfluent to some extent. Stuttering, however, is a form of disfluency that is characterized by a high frequency of sound repetition, sound prolongation, and visible struggle behavior. That is the way that speech pathologists tell the difference between which children are normally disfluent and which are stuttering. This is important because parents need to know that disfluency is not always stuttering.

I have heard of stuttering counselors. Do they help? How can you help yourself stop stuttering?

There are many effective treatments for the problem of stuttering. Most of these involve making changes in the manner of speaking. They are conducted by speech and language pathologists. Sometimes additional counseling is required, especially for older children and adults and the families of small children because stuttering sometimes is accompanied by strong emotional reactions on the part of the speaker. That means that people who stutter can react negatively to their speech and to speaking in general. It does not mean that psychological problems cause stuttering. Rather, those emotional or psychological problems can result from trying to cope with stuttering. If you want to help yourself to stop stuttering, you need to get some form of assistance from a speech and language pathologist. The amount of time it will take you to show improvement will vary from person to person.

Is it possible to get therapy as an adult if the stutter still exists?

It is possible and suggested that adults who stutter receive therapy if they want to change their speech. In fact, many adults who struggled with stuttering in childhood and maybe even received therapy but were not successful, do find success in therapy as adults, probably because they are more mature and perhaps motivated to make some changes in their speech.

To what extent does external factors -- fatigue, noise, and disruption of routine -- affect fluency?

We know that people who stutter often show variability in their stuttering, and this is sometimes related to internal as well as external factors. If a person who stutters is feeling tired or anxious, he/she may see an increase in stuttering during that time. Sometimes, for young children, disruption of routine, fatigue, or any excitement or arousal state can lead to increased stuttering. What is very important to note is that these things do not cause the stuttering to begin in the first place. That is, they may exacerbate or make worse an already existing stuttering problem. That is why, for young children who stutter, therapy usually involves analyzing the environment and the child's reaction to the environment to see what factors may lead to increased stuttering and which may lead to increased fluency. Some children react well to reduced time pressure in their daily routine. That is, they may actually speak more fluently if the tempo of daily life and scheduling of their daily lives is slowed. That doesn't mean that busy schedules cause stuttering, and it doesn't mean that things like anxiety cause stuttering. If that were the case, most of us would have stuttering problems. While slowing down may help young children to speak more fluently, speaking quickly does not cause stuttering.

Is stuttering considered a speech impediment or a learning disability? Neither/both?

The answer is that it is a problem with speech. People who stutter are not more likely to exhibit learning disabilities. They are just as likely as non-stuttering people to do so. Not more likely.

What causes speech impediments? Are they hereditary? Both my brother and his son have them.

Speech problems, including stuttering, seem to have a genetic component for some people. Some where between 60 to 70 percent of people who stutter report a history of stuttering in their family. Recent studies have shown that recovery in young children might be related to family history such that if a child has no family history of stuttering, or a positive history where the affected family member has recovered, it is more likely that the child will also recover. We are just beginning to do genetic linkage studies with families of people who stutter.

Is there an age at which a child should have outgrown stuttering if it is going to be outgrown?

I spoke to that before, but it bears repeating. The longer the interval from onset of stuttering, the less likely it is that the child will recover. That doesn't mean that a child who is several years post onset will not recover. We are talking about probabilities, not absolutes. It does mean that the longer a child stutters, the less likely it is that he/she will recover or outgrow stuttering without any treatment. Most kids who are going to outgrow stuttering without treatment do so between 6 and 36 months post onset. If your child is 2 1/2 and has been stuttering for 6 months, there is still a fairly high probability that he will outgrow the problem. The difficulty is that there are no absolute predictors of which children will outgrow stuttering and which children will persist in stuttering.

At what age should parents seek professional help for a stutterer?

My practice is to suggest that parents seek assistance or consultation or an evaluation if they are worried that the child is stuttering. Even if the child is not, if the parents believe there is a problem, they need to receive information about what stuttering is and what it is not. If parents are worried that the child is developing a stuttering problem, their concern and their attempts to help might interfere with the child's development of speech fluency. However, a good rule of thumb is to seek assistance as soon as you become concerned and if the child is producing large frequency of repetition of individual sounds or syllables or prolonged sounds. If you see that the child is worried or concerned or upset about speaking, avoids speaking situations, or shows visible signs of struggle when talking, it is also a good time to seek professional help.

Should parents correct mispronunciations in stutterers, or work first on the stuttering, then on pronunciation later?

Often young children who stutter also show difficulty in saying some of the sounds of speech. They may substitute easier to produce sounds for those that are harder to produce. A good example is substituting "th" for "s" or substituting "w" for "r" or "l." Oftentimes, speech pathologists help children with both problems simultaneously. My advice for parents is that they should not try to correct the child's speech, especially if the errors the child is making in pronunciation are normal errors for children of that age. It is very likely that the child will develop correct pronunciation. Frequent correction can sometimes promote the child's feeling that speech is difficult and also that speech has to be precise, correct and adult-like. For children who stutter, this may compound the problem they have in producing fluent speech. One thing parents can do to indirectly work with the child on articulation problems is to repeat what the child said using the correct sound. Providing lots of modeling is often the most effective way to help children develop speech. If the child says that's a "wabbit", the parent can say "Yes, that is a rabbit. Let's go look at it. However, if your child stutters and is unintelligible or has a severe speech articulation problem, then it may be the case that he will require treatment to improve intelligibility along with stuttering therapy. A speech and language pathologist following an evaluation can make that decision. By the way, regarding therapy for stuttering, there is an excellent resource available to people who stutter and their families in the Stuttering Foundation of America. The Stuttering Foundation of America is a nonprofit organization dedicated to providing information for people who stutter and their families in the form of books, brochures and videotapes. Their 800 number is: 800-992-9392. They also have a website and the address is: www.stutterSFA.org. Besides providing lots of information about the problem of stuttering and its treatment, the Stuttering Foundation of America keeps lists of speech/languages pathologists around the world who specialize in the treatment of stuttering. You can call them and they will provide you with the name of a clinician in your area to contact for therapy/stuttering. It is also possible to get services in schools, hospitals and university clinics. What one needs to do is to ask whether or not there is a clinician on staff with expertise in stuttering.

What should therapy be like? That is, what does a therapist do for child stutterer?

The therapy for stuttering children depends on the child's age, the nature of the stuttering problem, the child's level of worry or concern about stuttering, and the concern on the part of the parents. For preschool children who stutter, therapy usually involves setting up situations in the therapy room that elicit high levels of fluency from the child, along with modeling what we call "easy speech or smooth speech." Easy speech or smooth speech involves a slower rate and smoothly connecting sounds and words. Some children, who are too young to receive direct instruction in speech, benefit from indirect modeling while other preschool children benefit from both modeling and instruction on how to use easy speech. Another large part of stuttering therapy for preschool children is parent education and counseling. There are a number of things that parents can do to facilitate fluency in their young child who stutters. These include pausing before responding to the child in conversation. We call this increased turn switching pauses. An example would be that the child says something and rather than responding either before the child has finished with his turn or immediately following his turn, parents can wait one second or so before responding. This has the effect of slowing the overall tempo of the interaction and usually helps children to initiate their own speech slowly and perhaps more smoothly. It can help them to feel as though they are not rushed to talk with mom or dad. We know that when little children who stutter take their time to talk, it can be easier for them to do so fluently. Again, this is not to be confused with the idea that talking fast causes stuttering. There is no evidence of that. There is some evidence that when parents talk more slowly, some children who stutter respond more fluently. When parents increase the duration of turn switching pauses, that is the pause between what the child says and the parent's response, some children respond more fluently. If speech rate caused stuttering, many more people would be stuttering. If your child is of school age, therapy usually involves direct intervention. By that, I mean the child is shown how to use easy or smooth speech and may also be shown how to change a stuttered disruption while he is producing one. An important part of therapy for school aged children and older is to talk to the child about stuttering, about what it is and is not, about what his attitude and beliefs are about stuttering and so forth. I often ask adults who stutter what piece of advice they would give to the parents of young children who stutter. Almost always, they say that the parents should talk openly and objectively about stuttering and the child's stuttering in specific. It must be a discussable subject in the home. It is NOT the case that the child's stuttering will become worse if he talks about it or if the parents talk about it. What is important is the way stuttering is discussed. If the parents repeatedly tell the child to "stop that stuttering" or correct his speech, then that is not an appropriate way to talk about stuttering. However, if the parents acknowledge that the child is having some difficulty talking, without trying to tell the child how to talk, if they ask the child about therapy and encourage the child to speak often and that stuttering is okay, the child will learn that stuttering is something that he does, and he can change behavior, and he should not feel ashamed. I would like to reinforce the idea that talking about stuttering with your child is a good thing to do, but make sure that you get guidance about how to do this, either from a speech pathologist or from published material such as pamphlets or books that one can get from the Stuttering Foundation of America. An excellent publication from the Stuttering Foundation is one called "If Your Child Stutters" which is a guide for parents and provides lots of excellent information about stuttering and the families' reaction to stuttering and how to help the child.

Should siblings, classmates, and teachers be included in therapy information?

The decision to include siblings, classmates, and teachers in the childÕs therapy is an individual one. It really depends on the child and whether or not he needs extra support from these individuals. If, for example, the child's siblings frequently interrupt him, finish sentences for him or tease him, then of course they need to be included and helped to make some changes in the way they verbally interact with the child. I think it is a good idea to include the teacher to some extent, especially in cases where the teacher decides not to call on the child in class because of stuttering. Many children who stutter want to answer questions and teachers need to know how to do this in a way which will allow the child to participate in class and will promote fluency. One way that older children can include classmates in their stuttering treatment is to provide the class with some information about what stuttering is and what they do in therapy. This should be done with the support and assistance of the speech language pathologist. I have seen children give short talks to their class on what stuttering is and have shown their class what their stuttering looks and sounds like followed by a session in which the child "teaches" classmates how to stutter. This can be a very good activity for dispelling myths about stuttering and for bringing the stuttering "out in the open." When children who stutter try to hide their stuttering, which can come about if they feel it is a bad thing to do and cannot be discussed, usually their stuttering behavior worsens. If stuttering is talked about objectively and freely, it helps not only the child but also the people in the child's environment.

What can a classroom teacher do to help a stutterer and how do you discourage children from teasing?

I think that there are a number of things teachers can do to help individual children who stutter in the classroom. One thing is to let the child know when he will be required to speak in class or when he will be able to answer a question. For many children who stutter, the worst thing about talking in class is the anticipation of talking. Being unsure of when they will be called on or waiting their turn to talk can lead to anticipation that they will stutter. In turn, they do things to help themselves to not stutter, and these things usually are not helpful. If teachers can tell children, for example, "I will ask you a question today in class about the assignment and I will ask you either first or second", then that can be helpful. Teachers can also give children who stutter an opportunity to orally rehearse or practice answers to questions or presentations. And, they can provide feedback. From time to time, teachers may also reinforce the child for simply speaking. That does not have to be in front of the class so the teacher can say "I liked the way you said that" "You said that very smoothly" and such comments during the course of the school day. Above all, teachers should attempt to treat the child just like he/she would treat other children and enlist the child's help in developing the best way to deal with the stuttering in the classroom. Ask the child what kinds of things would be helpful. You will be surprised at how much the child knows about the things that help him to talk fluently and the things that can sometimes lead to more stuttering. In terms of teasing, I recommend dealing the way that you would about teasing for any other problem or issue. It should not be tolerated. One good way of helping to dispel teasing is something I suggested before and that is to provide the child's classmates with information about stuttering and what it is and allowing the topic of stuttering to be allowed in the classroom.