Anna Ramey, Gladys Kolenovsky, Sue Jones
Texas Scottish Rite Hospital for Children

The sudden onset of stuttering, though alarming, is not in itself unusual. What is more important is how the family responds to the child.

Frequently staff members at Texas Scottish Rite Hospital for Children are contacted by a concerned parent or grandparent regarding the behavior of a youngster in their family. We recently received a call from a grandparent about his three-year-old grandchild who was thought to be “stuttering badly.” A brief discussion with the grandfather revealed there was now a seven-month-old baby in the family, which ex- plained the more infantile behavior in this child.

When a new baby arrives and immediately requires a great deal of time and attention from both parents, an older child quickly recognizes that less time is being de-voted to him or her. Visits with grandparents usually center around the new baby as well. In this particular example, the new arrival, who needed to be fed, held and changed almost constantly, was taking precious time that previously had been devoted solely to the older sibling. Much of that time spent with the new baby is associated with feeding and diaper changing, and the three-year-old reacted to the situation by reverting to behaviors associated with a younger developmental stage, thus regaining some of the parents’ attention.

Although this regression is perceived by the family as somewhat alarming, the behavior itself is not unusual. What is more important is how the family responds to the child. We all want our children to behave in a way that is age appropriate. If we want to see the child behave like a three-year-old instead of like an infant, then we will have to reinforce and reward three-year-old behavior.

Quiet time together with the older child, although difficult to find, is very rewarding. During these special times, comments from the parent or grandparent should be something like, “I am so glad you are three years old and not a baby anymore,” or “Now that you are three, I can take you places and do things with you that I couldn’t do when you were a baby.” These discussions, along with special outings and other one-on-one activities that give positive attention to the child will reinforce the age-appropriate behavior you want and will reward the child for being him or herself.

As for apparent changes in the child’s language skills, there are certain ways to determine whether the child has developed a true stutter or whether this is just a normal phase in his or her language development. Keep in mind that many young children go through periods of normal dysfluency between eighteen months and six years of age.

Normal dysfluencies may include hesitancies and use of fillers such as “uh” or brief repetition of syllables and small words. When children are first learning to talk, speech dysfluencies are common. Between the ages three and seven, the child is learning to use language in new ways. This practice in using language may be more fluent in some children than others.

Normal dysfluencies may also occur in new situations or during times of stress, such as the addition of a new sibling or entering school for the first time. Normal dysfluencies will come and go, and often disappear when they are accepted without reaction or comment.

The following suggestions can help parents and grandparents work through language changes when their child or grandchild shows some dysfluency.

1. Listen attentively to your child.
Set aside an uninterrupted time each day when your child has your complete attention. You might refer to it as “your special time together.” Listen to him or her intently, using sustained eye contact. Let your child talk about whatever is on his or her mind in an unhurried, easy-going manner. Respond with positive comments or approval rather than questions.

2. Model slower, unhurried speech for your child.
Children learn by example much more effectively than exhortation. Instead of exhorting your child to slow down and think about what he or she wants to say, which can actually increase tension, listen and then verbally walk your child through your own thought process. When we hurry our speech, children think they must hurry, and this usually exacerbates dysfluency. Send the message that your child does not have to rush to speak because mom and dad or grandmother and granddad have time to listen. When it is not possible to give your child your undivided attention, ask him or her to wait a moment. Quickly come to a stopping point and then devote your full attention to your child.

3. Accept your child’s dysfluency as a normal stage of language development.
Children pick up on their parents’ attitudes about their speech. Rather than criticize, correct or show worry, reassure your child with a touch, a hug, or “I know some words are hard. It’s okay. Lots of people get stuck on words.”

4. Seek professional help if dysfluencies persist or increase.
If dysfluencies continue and become more pronounced and frequent in spite of these efforts, the child may have a true stuttering problem. The child who stutters may repeat sounds or parts of words more than twice, for example “l-l-l-like,” or “coo-coo-coo-cookie.” Tension and struggle may be evident in the child’s facial muscles, especially around the mouth. “Blocks” may occur when little or no sound comes out for several seconds. Sound or part-word prolongations will last longer than one second.

It is important to keep in mind that many young children go through periods of normal dysfluency between eighteen months and six years of age.

The child with mild stuttering will often show frustration but not avoid speaking. A child may outgrow mild stuttering if his frustration doesn’t develop into struggle and language avoidance. The child who has a true stuttering problem can be identified by signs of tension, fear of speaking, and efforts to hide the problem.

For the severe stutterer, stuttering is present most of the time and may become worse in certain situations. Facial tension, body movement, and eye blinks may be associated with the stuttering. The child is very aware of his stuttering and may change words or avoid speaking altogether in certain situations. For the severe stutterer, complete “blocks” of speech are more common than repetitions or prolongations. Early intervention with close parental involvement in a plan developed by a language or speech expert can help reduce severe stuttering.

For more guidance, contact one of the 122 Scottish Rite Language Disorder Clinics, Centers, or Programs; a local certified speech-language pathologist; or the Stuttering Foundation of America, P.O. Box 11749, Memphis, TN 38111.

Note: This article is the first in a series titled “Medical Moment.” The series will focus on the problems of children and how the Scottish Rite is providing assistance. Next month, the series will continue with an article from the Scottish Rite Children’s Medical Center in Atlanta, Georgia. Articles may be contributed to the series by professional personnel from any of the Scottish Rite’s 122 Clinics, Centers, and Programs. Send articles to: Scottish Rite Journal, 1733 16th St., NW, Washington, DC 20009-3103. When possible, in addition to a typescript, enclose (1) a PC format electronic record on disk (2) photographic illustration (3) a close photo of the author and his/her brief biography in under 100 words. Contact Dr. John W. Boettjer, Managing Editor of the Scottish Rite Journal, at 202-232-3579 for more information.

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