Stuttering in Children
The World Health Organization defines stuttering as a disorder in the rhythm of speech in which the child knows precisely what he wishes to say but at the same time has difficulty saying it, because of an involuntary repetition, prolongation, or cessation of sound.
Disruption in the fluency of speech is also known as stammering.
It is the commonest speech disorder, which has abnormal rhythm in flow of speech.
Stuttering is commonly seen among preschool children as a normal phenomenon in the process of language development:
- During early childhood development, children practice their recently acquired communicative skills.
- Besides, their mind is loaded with newly developed vocabulary that they can apply.
- Children in this phase of life have a natural desire to verbally express the numerous exciting events they experience in their newly expanding environment.
One percent of the children develop disruption in the fluency of speech, which continues into school years and constitutes the majority of the affected adults.
Fluency of speech
Fluency of speech is an outcome of interaction between speech and language development. Any compromise in the system leads to stammering in a child.
Speech fluency is the result of synchronized activation of several areas of the brain responsible for preparation and execution of the spoken language, together with the timely synchronization of phonatory and articulatory muscle groups.
Children most commonly have difficulty in starting a new sentence. Therefore they block, prolong or repeat the first syllable or the whole word. This results in an audible stammer.
Components of stuttering
Stammering has tonic and clonic components:
- Breaking a word in two parts:
For example; mo…. mother.
- Single syllable words are repeated:
For example; I….I…I saw blue bird.
- First word in the sentence, multi or single syllabic, is repeated:
For example; Uncle … uncle….uncle give the ball please
- A phrase, in the beginning of a sentence is repeated:
For example; I want … I want to go.
Very often this is mistaken for an expression of insistence.
- Repetitions occur before the blocks and prolongations in the verbal presentations
Interjections are sudden short utterances. It is self imposed interruption of a sentence half way through it, for example; I had ..uhhhhh….ice-cream.
It implies that the child leaves incomplete sentences and switches to an entirely different situation, for example - I hurt my………. What’s there for breakfast Mom?
In prolongations, one word in the sentence is unduly lengthened verbally, for example – I took a co..oo..ookie from the jar.
Tense pauses are mute phases in between a sentence, when a child suddenly purses the lips and skips 1-2 words of the sentence.
Normal developmental dysfluency of preschool children
Clinically significant stammering must be differentiated from the normal developmental dysfluency of preschool children
Normal developmental dysfluency is characterized by:
- Brief periods of stammering that resolve by school age.
- It usually involves whole words.
- It has less than 10 dysfluencies per 100 words.
- No active treatment required: Children with developmental dysfluency only need to be observed.
The parents of these children should be reassured that lack of fluency of speech during preschool years is a normal developmental phenomena.
Stuttering and Developmental Dysfluency
Frequency of syllable repetition per word
Frequency of prolongations per 100 words
Duration of prolongation
Silent pauses within a word
Silent pauses before a speech attempt
Silent pauses after the dysfluency
Reaction to stress
Faster than normal
May be Present
May be Present
May be Inappropriate
More broken words
May be Present
Source: Nature of stuttering,Englewood Cliffs,NJ,Prentice-Hall,1971,p28.From Lawrence M, Barclay DM III: Stuttering: brief review, Am Fam Physician 57:2175-2178, 1998.
Onset of stammering
Stammering usually starts abruptly at 2-4 years of age. It is not known why some children with disturbed fluency of speech due to physiological reasons develop a permanent stammer.
It is further noted that disruption in the fluency of speech usually does not occur when an affected child is in the company of familiar people, who know and accept that the child has dysrhythmic speech.
Furthermore, it is well recognized that stammering rarely occurs during singing, reading in unison, or talking to pets and infants. This could be because the stress and level of communication involved in these situations are low.
What is the cause of stuttering: Is the brain affected?
- The reason why some children continue to stammer beyond early childhood years is precisely not known.
- Pressure to improve vocabulary at an early age may lead to disruption in the fluency of speech in children. .
- Some of the affected children show evidences of emotional stress as an underlying factor; disturbed psychosocial development and/or childhood trauma could be the contributing factors.
- Neurological insult is yet another precipitating factor:
Communicative capabilities require intricate coordination between language delivery and speech generation, which involves interconnected neural networks’ synchronization in different areas of the brain. Any neurological hindrance in the system, will naturally cause disruption in the fluency of speech of a child.
- Studies show that
adults who stammer -
a.) Over activate some parts of the brain; parts of motor cortex and cerebellar vermis.
b.) Show right-sided laterality (usually it is left sided).
c.) Affected individuals have no auditory activation on hearing their own speech.
d.) Nevertheless, the areas of brain activated are similar to that of the normal individuals.
Factors that exacerbate stuttering
- Under emotionally demanding verbal expressions.
- Stress associated with need of appropriate grammar use in spoken language.
- Anxiety provoking situations.
- Often occurs when word combinations are involved
- Words that give meaning at the beginning of a sentence, especially the long words, are most likely to precipitate stammering.
Even so, there is no particular group of words in English language which is noted to be common to all the affected.
Psychological implications of stuttering
- Stammering often leads to embarrassment and frustration in the affected child.
- Stammerers avoid speaking due to speech-related anxiety and social phobia.
- These children often fall prey to bulling and teasing.
Incidence of Speech Dysfluency
- Stammering runs in families.
- It is seen four times more frequently in boys than in girls.
- The incidence of stammer in preschool children is found to be approximately 3-5 percent.
- Among young adults the incidence falls to 0.7-1 percent.
This is because about 75 percent of boys and 90 percent of girls recover spontaneously by adolescence. The spontaneous recovery from stuttering is independent of its severity.
- 90 percent of the adults who have persistent disruption in the fluency of speech have its onset before 8 years of age.
Spontaneous recovery from stuttering is common
- About 75 percent of boys and 90 percent of girls recover spontaneously by adolescence.
- The spontaneous recovery from stammering is independent of its severity.
It is interesting to note that some of the affected children can maintain the fluency of speech if they rhythmically tap a foot or a finger. However, these methods become the crutches rather than genuine relief.
When should the treatment for stuttering be considered?
Early reference to speech pathologist is indicated when a child has
- Consistent 3 or more dysfluencies per 100 syllables.
- Avoids or escapes some syllables as indicated by blinking, head nodding or abrupt pausing.
- Anxious appearance while speaking.
- Suspicion of an associated neurologic or psychiatric disorder.
- Stuttering that persists and is associated with tics may be a manifestation of Tourette's syndrome.
Positive reinforcement from calm and understanding parents helps the child to implement corrections according to the feedbacks received. Some children would however need therapy support, the question is at what stage. Early years could be very important. Most preschool children respond well to the inputs of speech pathologists. Click to read what speech therapy offers for children with stuttering.
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