Identification and Treatment of Childhood Stuttering

1. Identification and Treatment of Childhood Stuttering J. Scott Yaruss, Ph.D., CCC-SLP Stuttering Center of Western Pennsylvania University of PittsburghChildren’s Hospital of Pittsburgh Pediatric Grand RoundsMercy Hospital Continuing Education ProgramSeptember 14, 1999

2. What Is Stuttering? An impairment of speech and language production, typically characterized by interruptionsin the forward flow of speech(“speech disfluencies”)

3. What are the PrimarySymptoms of Stuttering? • Speech disfluencies come in many forms • Some disfluencies are considered “normal”(if they occur relatively infrequently) • Interjections (“um,” “er,” “like,” “you know”) • Revisions (“I want- I need that”)

4. How Does Stuttering Develop? • Typically begins between ages 3 and 5 • As the disorder progresses, children are likely to develop reactions to stuttering... • Tension and struggle in their speech musculature • More advanced types of speech disfluencies • Concern or anxiety about their speaking abilities

5. After Yaruss (1998) What Kinds of Consequences? • Affective, Behavioral, Emotional Reactions:Anxiety about speaking, avoidance of speaking situations (reading in class, talking to friends), embarrassment, shame, guilt, low self-esteem, frustration, fear Click for larger picture

6. What Causes Stuttering? • NO single factor has been shown to beTHE cause stuttering • Stuttering is not caused by children’s parents • Stuttering is not caused by drawing attention to a child’s normal disfluencies

7. Okay, so…What Does Cause Stuttering? Current theories point to a complicated interaction between children’s language development and their motoric abilities for producing speech, combined with the multiple influences of the child’s personality and the child’s communicative and social environment

8. Isn’t Stuttering “Genetic”? • Yes, stuttering tends to runs in families... • If one family member stutters, there is an increased chance that another family member will also stutter • The few twin studies that have been conducted show only 50% concordance for MZ twins, suggesting that there are also environmental influences

9. Doesn’t EverybodyStutter Sometimes? • Yes.Speech disfluencies are a normal part of children’s speech/language development • All children go through a period of producing speech disfluencies when learning to speak • Some children, however, will continue producing disfluencies and develop a fluency disorder

10. Don’t Most ChildrenOutgrow Stuttering? • Yes. Most children who exhibit disfluencies or even stuttering early in their speech/language development will recover without intervention • Prevalence = 1% • Incidence of Stuttering = 5% • Incidence of Increased Disfluencies: 15-25%

11. A Critical Period forRecovery from Stuttering • If children do not recover by age 6 or 7, they are likely to develop chronic stuttering • Older children rarely achieve normal fluency, and the negative consequences increase over time • Negative social and emotional consequences can be minimized with appropriate early intervention

12. Who Is At Riskfor Chronic Stuttering? • No single behavior categorically differentiates children who stutter from children who do not • All children exhibit all types of speech disfluencies • Sometimes stuttering begins very gradually, but persists for a long time before the family notices

13. So...Who Is At Risk? • Certain risk factors can provide some clues: • Number, nature, and types of speech disfluencies • Length of time the child has been stuttering • Family history of stuttering • Child’s reactions to stuttering • Family’s reactions to stuttering (parent’s level of concern and attempts to help)

14. Who Should Be Referredfor Evaluation? • It is impossible to determine whether a disfluent child is at risk for developing a chronic stuttering disorder throughinformal or casual observation

15. Referral Guidelines • I evaluate if any of the following are true: • The child produces 3 or more disfluencies during a brief spontaneous conversational interaction • There is tension or struggle during disfluencies (even if the disfluencies are infrequent) • The child’s ability to communicate is affected

16. Who Should Evaluateand Treat Stuttering? • Speech-language pathologists (SLPs), licensed and certified by the American Speech-Language-Hearing Association (ASHA) • Not all SLPs are comfortable with stuttering, so there has been a move toward specialization

17. How Is Stuttering Treated? • Helping children learn to speak more fluently • Changing the timing and tension of speech production • Helping parents learn to facilitate children’s fluency in everyday speaking situations • Parents can change their own speech and manage children’s speaking situations to help them speak fluently

18. Summary • Early stuttering can be difficult to distinguish from normal “developmental” disfluency • Early intervention is critical for preventing the development of chronic stuttering and its negative social and emotional consequences • The safest practice is to refer children for evaluation by a stuttering specialist, especially if the parents or child are concerned about the child’s speech

19. Questions? Comments?Please contact me! J. Scott Yaruss, Ph.D., CCC-SLP Stuttering Center of Western PA University of Pittsburgh 4033 Forbes Tower Pittsburgh, PA 15260 Phone: (412) 647-1367 Fax: (412) 647-1370 Email

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21. Mission of the Stuttering Center • Provide effective client-centered treatment for individuals who stutter • Conduct meaningful research on the nature and treatment of stuttering • Provide on-going education for student clinicians as well as practicing SLPs • Provide support for individuals who stutter, their families, and their clinicians