Updated: Nov 17, 2022
This week is National Stuttering Awareness Week.
But what if I told you that during graduate school, I didn’t have a “Stuttering” course.
No, it’s true. Kind of.
In the field of Speech Language Pathology, stuttering is called a fluency disorder and in fact, the DSM-V labels stuttering as Childhood Onset Fluency Disorder. Assessments and treatment often focus around the idea of “creating fluent speech."
I was fortunate that my graduate school program had a robust fluency program. We learned not only about fluency-enhancing techniques but also the importance of counseling to address underlying feelings about stuttering. I felt confident in my ability to treat a child who stuttered to help them achieve greater fluency and more confidence in their lives.
So why was I uncomfortable saying the word "stutter"?
As a new therapist, I used the word fluency as much as I could, thinking this would make my clients and their families more comfortable. I tried to avoid saying the word stutter in therapy sessions, talking about how their child’s speech was disfluent and focusing on times their child was fluent.
Recent research indicates that, when we use the word "fluency" instead of "stuttering", we incorrectly and hurtfully imply that fluent speech is the goal. We make "stuttering" into a negative word rather than a neutral descriptor. And we are not fully inclusive of people who stutter and their lived experiences (Tichenor et al, 2022).
This is what ableism looks like.
The idea that how fluent a person is or how much a person stutters matters is an ableist mentality. It's time that we put that aside and stop implying that the goal of speech therapy is to be "more fluent."
So, listening to voices of my colleagues and clients who stutter, we are saying the word:
Read on to learn more about stuttering and please join us in spreading acceptance and awareness of stuttering this week and all weeks.
Wait -- So Does My Kid Need Therapy?
As a speech pathologist, I often work with kids who stutter.
Stuttering is a form of neurodiversity. It is not something that can be “overcome” or “cured."
So what is the goal of therapy?
To eliminate the stutter? NO
To reduce frustration and increase confidence? YES
To encourage self-advocacy? YES
To reduce moments of stuttering? MAYBE
Some clients desperately want to be able to get their words out when talking. They struggle with physical tension in their body and negative feelings about their stutter. They might even avoid activities they enjoy because of their stutter. These clients do want to reduce their moments of stuttering. They want strategies to help them talk more fluently. They want to work on their feelings around their stutter and how to self-advocate in different environments.
However — not all kids are like this! (Yet another thing that blew my mind as a new therapist.)
And as their therapist, I did not need to make my kids more fluent! Some of my clients were comfortable with their stutter – they talked confidently and had an easy, forward rate of speech. Stuttering didn’t bother them right now. Maybe the best use of therapy was to work on self-advocacy or teach a few strategies to have in their playbook for higher-stress environments like school presentations or talking on the phone.
But maybe — ahhhh wait for it —- maybe therapy was not the right choice for them at that time!
This is a crucial mindset shift for both parents and clinicians. Kids who stutter often come in and out of therapy. There will be times when they need or want therapy. And other times when they don’t.
And that’s okay.
What Causes Stuttering?
The cause of stuttering is generally unknown; however, stuttering is a neurodevelopment disorder that involves the language, motor, environmental, and emotional networks (Smith & Kelly, 1997).
Genetics also contributes but is one of many factors which means that you are more likely to stutter if someone in your family stutters.
One common way of conceptualizing fluency disorders is by considering the balance between a child’s capacities (e.g., ability to plan their language and coordinate speech movements) and demands (e.g., complexity of linguistic expectations; emotional or environmental factors)(Smith & Weber, 2017).
Stuttering may emerge when the child’s capacities for fluent speech (e.g., ability to plan language and coordinate speech movements) are overwhelmed by demands (emotions like stress and excitement, time pressure, language expectations).
One way of reducing demands is often to reduce environmental pressures, such as competition for talk time, interruptions, or the need to rush. In addition, if a child struggles with their receptive or expressive language, working on strengthening their language may help with their stutter.
What Does Stuttering Sound Like?
Stuttering varies from person to person. Some people have mild stuttering with easy, forward-flowing speech. Others have more severe stuttering with increased tension in their body and difficulty getting out their message.
And it isn’t just about disfluencies. In fact, everyone has some level of disfluency in their speech including:
Repeated words (“Can- can I have a drink?”)
Repeated phrases (“I want- I want a sandwich”)
Interjections (“The dog is um sleeping”)
Revisions (“Did you see- hear that sound?”)
These happen to everyone and so we call these “typical” disfluencies.
But people who stutter also use different kinds of disfluencies including
Sound repetitions (“b-b-b-baby”)
Syllable repetitions (“tur-tur-turtle”)
Blocks (a tense pause where no sound comes out)
These types of disfluencies are sometimes called “stuttered syllables” or “atypical” disfluencies.
Will My Child Outgrow Stuttering?
I get asked this question a lot as a clinician of young children.
The answer is: maybe.
Disfluent speech in toddlers and preschool aged children is very common and typically resolves on its own within 6-12 months. It can fluctuate over time, with periods of fluent and disfluent speech.
This is not really “stuttering” -- the disfluencies are often typical disfluencies rather than stuttered syllables -- however, it is sometimes described as “developmental stuttering.” Unlike persistent or chronic stuttering, developmental stuttering is believed to be a result of increased language demands as the child is learning to talk and express themselves.
Here is a helpful chart for thinking about whether your child might have developmental stuttering or chronic stuttering:
Helping Stuttering at Home
If you notice your child is stuttering at home, try reducing the environmental and emotional demands to help them feel more confident in their speech.
Reduce time pressure in speech – slow your own rate, increase pause times, reduce interruptions, and provide the child time while you listen.
Reduce language demands – make comments rather than asking questions, reduce the amount of talking, and bring the language complexity to an age-appropriate level.
Alter the environment – establish turn-taking rules in conversation, build structure and routines into daily activities and language opportunities, and have dedicated quiet times when language is not demanded.
Acceptance of ‘bumpy’ or stuttered speech – Avoid comments about the stutter and focus on the content of their message.
SLP Stephen is an SLP who stutters. He has fabulous resources for families and clinicians on his website: https://slpstephen.com/stuttering and on Instagram @slp.stephen
The Stuttering Foundation has many resources available for parents about stuttering. See their website at http://www.stutteringhelp.org.
The National Stuttering Association also has many resources for parents and families. See their website at http://www.westutter.org.
Gerlach-Houck, H. & Constantino, C. D. (2022). Interrupting ableism in stuttering therapy and research: Practical Suggestions. Perspectives of the ASHA Special Interest Groups. https://doi.org/10.1044/2021_PERSP-21-00109
Smith, A., & Weber, C. (2017). How Stuttering Develops: The Multifactorial Dynamic Pathways Theory. Journal of speech, language, and hearing research : JSLHR, 60(9), 2483–2505. https://doi.org/10.1044/2017_JSLHR-S-16-0343