Stuttering Children And Treatments
Stuttering is developmental speech disorder, which usually appears in children between the ages of 3 and 8 years. It does not remit before puberty, but it can persist into adult life. Stuttering is defined by involuntary syllable repetitions, syllable prolongations, or interruptions in the smooth flow of speech. (Gordon, 2002) It is a form of dysfluency, an interruption in the flow of speech. There may sometimes be difficulty in differentiating infants who definitely stutter from those who show the dysfluency as a normal stage of speech development in infancy. However, the two are distinct. The frequency of dysfluency, the proportion and duration of dysfluency types, and the associated behaviours not directly related to speech such as eye, head, and body movements, can help to distinguish between the two.(Gordon,2002). Stuttering is not uncommon for young children. In fact, about 5% of all children are likely to stutter at some point in their development, usually during the preschool years. (Ducworth, 2004). According to Gordon (2002) it is usually accepted that the overall incidence of stuttering is about 1%, but in the preschool and school populations it is around 4%, and all ages seems to be more common among males than females. It is also very normal for a child going back and forth between periods of fluency and disfluency. Sometimes, this can occur for no apparent reason, but often this happens when a child is excited, tired, or feels rushed to speak. (Duchworth,2004). Stuttering appears to be a highly stressful experience that must be coped with and it is associated with a risk for the development of personality disorders. (Plexico et al., 2009).It is also well known that stuttering negatively effects social, emotional and mental functioning and people who stutter are at risk of having a reduced quality of life. Several studies have emphasized the existence of a negative stereotype of people who stutter. People who stutter have been stereotyped as nervous, anxious, tense, insecure, shy, introverted, withdrawn, quiet, nonassertive, afraid (Craig et al., 2003) Negative perceptions and attitudes towards individuals who stutter may also impact the formation of romantic relationships. It is also showed that stuttering might become an obstruction on romance. Opportunities in a long-term relationship were thought to be greatly diminished. (Borsel et al.,2011) Regarding of these effects, in this paper the purpose is to explore possible causes of stuttering in children and its treatments.
The first signs of stuttering tend to appear when a child is about 18-24 months old as there is a disturbance in vocabulary and kids start to put words together to form sentences. (Gordon, 2002). A child may stutter for a few weeks or several months, and the stuttering may be sporadic. The exact cause of stuttering remains unproven but it is multifactorial. It may be that the causes are organic, psychological, and social, but PET studies favor an organic cause with both the motor and perceptual elements of speech. (Gordon, 2002).
Firstly, hereditary factors appear to contribute to stuttering. According to Drayna and coworkers (1999), among monozygotic twins there is a 90% chance that if one twin stutters the other sibling will stutter, whereas there is only a 20% chance of stuttering in dizygotic twins and there is frequently a family history of the disorder. In addition to underlying abnormalities that make a child more at risk of stuttering, the type of stuttering does not appear to be a milder form, appears to be depending on other transmitted genetic factors. (Gordon, 2002). So genetic is believed to play an important part that stuttering tends to run in families. Most children that stutter have a family member that also stutters or stuttered as a child. About 60% of those who stutter have a close family member who stutters. (Ducworth, 2004).
The second cause of stuttering of children is developmental factors which suggest stuttering appears since childhood may result from disturbances in auditory, motor, and linguistic systems. In the study of Salmelin and coworkers (1988) it was shown that in some affected individuals, the functional organization of the auditory cortex differed from that in normally developing control individuals. According to Brown and colleagues (1975) it is not differences in hearing thresholds between those who stuttered and those who did not, but those who stuttered have a lower threshold for auditory discomfort. Especially when stuttering is treated it should be considered that dysfluency occurs due to the signals are abnormal and masking reduces malfunction by providing additional encoding activity and by altering the duration, frequency, and intensity of the physical qualities of the perceived stimuli. (Gordon, 2002). So it is concluded that stuttering is a disorder affecting the multiple neural systems used for speaking.
The other thing about developmental factors is that during the preschool years, a child’s physical, cognitive, social/emotional, and speech/language skills are developing at a very rapid. (Ducworth, 2004) This rapid development can lead to stuttering in children who are predisposed to it. This is why stuttering often begins during the preschool years. On the other hand linguistic skills do not differ between children who stutter and those who do not, and that a persistent stutter is linked to a child’s articulatory skills and the mother’s communicative style and language complexity. (Gordon,2002)
Some examples of environmental factors include parental attitudes and expectations, the child’s speech and language environment, and stressful life events. This does not mean that parents are doing anything wrong. Often these things are not harmful for a child that doesn’t stutter, but can worsen for a child that has a tendency to stutter.
Finally, the child’s fear and anxiety of stuttering may have an effect on stuttering that there are reasons to believe that there is a relationship between stuttering, and trait and state anxiety, with its theoretical and clinical importance. Anxiety may have a mediating role in the disorder, being determined by interplay between communication attitude and apprehension. Conture et al. (2006) suggests that stuttering events, resulting from deficiency in speech planning and production, are influenced by emotional regulation (including anxiety). Therefore anxiety and its determinants may mediate instances of stuttering including its surface features, frequency of stuttering and type of stuttering, depending on the effect of this arousal on speech motor control (Conture et al., 2006). It is essential to note that rather than childhood, adolescence is more important developmental period in which the role of social anxiety and communication attitude place in stuttering individuals.
There are many effective treatments for the problem of stuttering. Research and clinical experience show that early intervention can actually increase a child’s chance of recovering from stuttering. However, we don’t know exactly which children will not naturally avoid their stuttering. So, the aim should be to identify which children are more at risk of continued stuttering, and to give them the best opportunity to recover from stuttering as quickly as possible. (AIS, 1998)
Most of treatments involve making changes in the manner of speaking. Treatment often focuses on having children produce fluent speech as they learn to self-monitor. (Ducworth, 2004). This can be done by first encouraging the child to say single words in a slow, relaxed way. The number of words the child says may be slowly increased until the child is saying sentences. For example, “ball,” “red ball,” “a big red ball,” “I have a big red ball.” This process can take between a few weeks and six months. (Ducworth, 2004)
Another stuttering treatment technique focuses on helping children decrease secondary characteristics like twitching, blinking, and a closed or clamped jaw. This can be provided by behavioral treatment. It is also suggested that ‘behavioral treatment’ involving awareness training, use of a competing response and social support decreased stuttering in children (Webster, 1980)
According to Healey and coworkers (2004) recent view suggests stuttering is a multifactorial speech disorder has facilitated a broader perspective for understanding the complexities of stuttering. The multidimensional model of stuttering was developed to enhance the collection, organization, and interpretation of clinical data associated with the assessment and treatment of stuttering. It focuses on five components believed to be important to maintaining stuttering. The model includes cognitive, affective, linguistic, motor, and social (CALMS) components, which form a basis assessment and treatment planning. (Healey et al., 2004) Specifically, the model regards individual differences in the performance that each client has in the five components and it regards how changing demands influence a client’s overall communicative abilities.
The ‘cognitive’ component includes thoughts, perceptions, awareness and understanding of stuttering. Thought are typically negative for people who stutter, which are associated with either negative views of their own stuttering or people’s reactions to their stuttering. (Healey et al., 2004) The ‘affective’ component contains thoughts that are directly connected with feelings, emotions, attitudes that accompany stuttering and communication. It is stated that affective and cognitive factors have been acknowledged as factors that expedite and maintain stuttering, particularly as they interact with behavioral factors. (Healey et al., 2004) The ‘linguistic’ component is related to the disfluent speaker’s language skills and abilities, which impact the frequency of stuttering. One of the key things involved with this component is the impact of the types of language formulation on stuttering. Because of variations, language formulation demand can precipitate changes in the frequency and form of disfluencies as well as the integrity of the language. (Healey et al., 2004). The ‘motor’ component is related with some factors which impact stuttering such as the frequency, type, duration, severity of stuttering. Moreover it is related with the presence of secondary coping behaviors and overall speech motor control that is associated with stuttering. (Smith, 1999). Lastly, the ‘social’ component also is concerned with any avoidances of speaking situations as well as peer exclusivity that may occur as a result of the stuttering.
There are some duties that the parents should do for their child during the treatment of stuttering. The most important thing that they can do is to use a smooth, relaxed rate when talking to their stuttering child. They should speak to child in simple, short sentences, pausing slightly before responding will be. While parents are talking, they should also be sure to listen to what their child is saying without interrupting or finishing sentences for him/her. It is very important that their child knows that he/she is being understood. (Ducworth, 2004) Trying to slow the pace of their household, minimizing the level of excitement are other critical points. When he/she has difficulty speaking, it’s essential to acknowledge it by saying, “You had a little trouble getting that out.” (Ducworth, 2004) this is also the part of Lidcombe Program (LP) treatment; one of the main intervention is to administer verbal contingencies in conversation with the child. Fluent speech is followed by praise, or by an acknowledgment of its fluency.(Franken et al.,2005) Disfluent speech is followed by an attempt to encourage the child to produce a fluent correction, or by an acknowledgment of its disfluency. This is done by the parent responsible for treatment. The parents are instructed about it. (Franken et al.,2005)
To conclude, although stuttering is not a severe problem, it has kinds of substantial impacts on people in every stage of development in terms of social, emotional and mental functioning and quality of life. Luckily there are kinds of treatments for stuttering including focusing on having children produce fluent speech as they learn to self-monitor, helping children decrease secondary characteristics, The multidimensional model of stuttering and some programs like Lidcombe Program (LP) treatment. Despite of the treatments there are some deficiencies that should be cared for further prospective studies on the incidence of stuttering. They should be more interest in planning services, and in defining more accurately how urgent it is to start a particular child on treatment. (Gordon,2002) The recovery of stuttering is another subject that should be more emphasized in studies. Also, there may be other questions about how patterns in children who spontaneously recover from stuttering differ from those who do not.
References
American Institute for Stuttering. (1998). Stuttering therapy for preschool children. Retriewed
from http://www.stutteringtreatment.org/treatmentpreschool.php
Brown, T., Sambrooks, J.E., MacCulloch, M.J. (1975). Auditory thresholds and the effect of
reduced auditory feedback on stuttering. Acta Psychiatrica Scandinavica, 51, 297–311.
Borsel, J. V., Marie Brepoels, M., Coene J. (2011). Stuttering, attractiveness and romantic
relationships: The perception of adolescents and young adults. Journal of Fluency Disorders, 36, 41–50
Craig, A., Tran, Y., & Craig, M. (2003). Stereotypes toward stuttering for those who have
never had direct contact with people who stutter: A randomized and stratified study. Perceptual and Motor Skills, 97, 235–245.
Conture, E., Walden, T., Graham, C., Arnold, H., Hartfield, H., Karrass, J. (2006).
Communication–emotional model of stuttering. Lawrence Erlbaum Associates, 17–46
Drayna, D., Kilshaw, J., Kelly, J. (1999). The sex ratio in familial persistent stuttering.
American Journal of Human Genetics, 65, 1473–1475.
Ducworth, D. (2004). Causes and treatment of stuttering in young children. Retriewed from
http://www.superduperinc.com/handouts/pdf/65_Cause_and_Treatment_of%20Stuttering.pdf
Franken, M-C.J, Kielstra, C.J., Schalk, V., Boelens, H. (2005). Experimental treatment of
early stuttering: A preliminary study. Journal of Fluency Disorders, 30, 189–199.
Gordon, N. (2002). Stuttering: incidence and causes. Developmental Medicine & Child
Neurology, 44, 278–282.
Healey, E.C., Trautman, L.S.,Susca, M. (2004). Clinical applications of a multidimensional
approach for the assessment and treatment of stuttering
Plexico, L. W., Manning, W. H., & Levitt, H. (2009b). Coping responses by adults who
stutter: Part II. Approaching the problem and achieving agency. Journal of Fluency Disorders, 34, 108–126.
Salmelin, R., Schnitzler, A., Schmitz, F., Jäncke, L., Witte, O.W., Freund, H. J. (1998).
Functional organization of the auditory cortex is different in stutterers and fluent speakers. Neuroreport, 9, 2225–2229.
Smith, A. (1999). Stuttering: A unified approach to a multifactorial, dynamic disorder.
Stuttering research and practice: Bridging the gap.
Webster, R. L. (1980). Evolution of a target-based behavioral therapy for stuttering. Journal
of Fluency Disorders, 5, 303-320.
The first signs of stuttering tend to appear when a child is about 18-24 months old as there is a disturbance in vocabulary and kids start to put words together to form sentences. (Gordon, 2002). A child may stutter for a few weeks or several months, and the stuttering may be sporadic. The exact cause of stuttering remains unproven but it is multifactorial. It may be that the causes are organic, psychological, and social, but PET studies favor an organic cause with both the motor and perceptual elements of speech. (Gordon, 2002).
Firstly, hereditary factors appear to contribute to stuttering. According to Drayna and coworkers (1999), among monozygotic twins there is a 90% chance that if one twin stutters the other sibling will stutter, whereas there is only a 20% chance of stuttering in dizygotic twins and there is frequently a family history of the disorder. In addition to underlying abnormalities that make a child more at risk of stuttering, the type of stuttering does not appear to be a milder form, appears to be depending on other transmitted genetic factors. (Gordon, 2002). So genetic is believed to play an important part that stuttering tends to run in families. Most children that stutter have a family member that also stutters or stuttered as a child. About 60% of those who stutter have a close family member who stutters. (Ducworth, 2004).
The second cause of stuttering of children is developmental factors which suggest stuttering appears since childhood may result from disturbances in auditory, motor, and linguistic systems. In the study of Salmelin and coworkers (1988) it was shown that in some affected individuals, the functional organization of the auditory cortex differed from that in normally developing control individuals. According to Brown and colleagues (1975) it is not differences in hearing thresholds between those who stuttered and those who did not, but those who stuttered have a lower threshold for auditory discomfort. Especially when stuttering is treated it should be considered that dysfluency occurs due to the signals are abnormal and masking reduces malfunction by providing additional encoding activity and by altering the duration, frequency, and intensity of the physical qualities of the perceived stimuli. (Gordon, 2002). So it is concluded that stuttering is a disorder affecting the multiple neural systems used for speaking.
The other thing about developmental factors is that during the preschool years, a child’s physical, cognitive, social/emotional, and speech/language skills are developing at a very rapid. (Ducworth, 2004) This rapid development can lead to stuttering in children who are predisposed to it. This is why stuttering often begins during the preschool years. On the other hand linguistic skills do not differ between children who stutter and those who do not, and that a persistent stutter is linked to a child’s articulatory skills and the mother’s communicative style and language complexity. (Gordon,2002)
Some examples of environmental factors include parental attitudes and expectations, the child’s speech and language environment, and stressful life events. This does not mean that parents are doing anything wrong. Often these things are not harmful for a child that doesn’t stutter, but can worsen for a child that has a tendency to stutter.
Finally, the child’s fear and anxiety of stuttering may have an effect on stuttering that there are reasons to believe that there is a relationship between stuttering, and trait and state anxiety, with its theoretical and clinical importance. Anxiety may have a mediating role in the disorder, being determined by interplay between communication attitude and apprehension. Conture et al. (2006) suggests that stuttering events, resulting from deficiency in speech planning and production, are influenced by emotional regulation (including anxiety). Therefore anxiety and its determinants may mediate instances of stuttering including its surface features, frequency of stuttering and type of stuttering, depending on the effect of this arousal on speech motor control (Conture et al., 2006). It is essential to note that rather than childhood, adolescence is more important developmental period in which the role of social anxiety and communication attitude place in stuttering individuals.
There are many effective treatments for the problem of stuttering. Research and clinical experience show that early intervention can actually increase a child’s chance of recovering from stuttering. However, we don’t know exactly which children will not naturally avoid their stuttering. So, the aim should be to identify which children are more at risk of continued stuttering, and to give them the best opportunity to recover from stuttering as quickly as possible. (AIS, 1998)
Most of treatments involve making changes in the manner of speaking. Treatment often focuses on having children produce fluent speech as they learn to self-monitor. (Ducworth, 2004). This can be done by first encouraging the child to say single words in a slow, relaxed way. The number of words the child says may be slowly increased until the child is saying sentences. For example, “ball,” “red ball,” “a big red ball,” “I have a big red ball.” This process can take between a few weeks and six months. (Ducworth, 2004)
Another stuttering treatment technique focuses on helping children decrease secondary characteristics like twitching, blinking, and a closed or clamped jaw. This can be provided by behavioral treatment. It is also suggested that ‘behavioral treatment’ involving awareness training, use of a competing response and social support decreased stuttering in children (Webster, 1980)
According to Healey and coworkers (2004) recent view suggests stuttering is a multifactorial speech disorder has facilitated a broader perspective for understanding the complexities of stuttering. The multidimensional model of stuttering was developed to enhance the collection, organization, and interpretation of clinical data associated with the assessment and treatment of stuttering. It focuses on five components believed to be important to maintaining stuttering. The model includes cognitive, affective, linguistic, motor, and social (CALMS) components, which form a basis assessment and treatment planning. (Healey et al., 2004) Specifically, the model regards individual differences in the performance that each client has in the five components and it regards how changing demands influence a client’s overall communicative abilities.
The ‘cognitive’ component includes thoughts, perceptions, awareness and understanding of stuttering. Thought are typically negative for people who stutter, which are associated with either negative views of their own stuttering or people’s reactions to their stuttering. (Healey et al., 2004) The ‘affective’ component contains thoughts that are directly connected with feelings, emotions, attitudes that accompany stuttering and communication. It is stated that affective and cognitive factors have been acknowledged as factors that expedite and maintain stuttering, particularly as they interact with behavioral factors. (Healey et al., 2004) The ‘linguistic’ component is related to the disfluent speaker’s language skills and abilities, which impact the frequency of stuttering. One of the key things involved with this component is the impact of the types of language formulation on stuttering. Because of variations, language formulation demand can precipitate changes in the frequency and form of disfluencies as well as the integrity of the language. (Healey et al., 2004). The ‘motor’ component is related with some factors which impact stuttering such as the frequency, type, duration, severity of stuttering. Moreover it is related with the presence of secondary coping behaviors and overall speech motor control that is associated with stuttering. (Smith, 1999). Lastly, the ‘social’ component also is concerned with any avoidances of speaking situations as well as peer exclusivity that may occur as a result of the stuttering.
There are some duties that the parents should do for their child during the treatment of stuttering. The most important thing that they can do is to use a smooth, relaxed rate when talking to their stuttering child. They should speak to child in simple, short sentences, pausing slightly before responding will be. While parents are talking, they should also be sure to listen to what their child is saying without interrupting or finishing sentences for him/her. It is very important that their child knows that he/she is being understood. (Ducworth, 2004) Trying to slow the pace of their household, minimizing the level of excitement are other critical points. When he/she has difficulty speaking, it’s essential to acknowledge it by saying, “You had a little trouble getting that out.” (Ducworth, 2004) this is also the part of Lidcombe Program (LP) treatment; one of the main intervention is to administer verbal contingencies in conversation with the child. Fluent speech is followed by praise, or by an acknowledgment of its fluency.(Franken et al.,2005) Disfluent speech is followed by an attempt to encourage the child to produce a fluent correction, or by an acknowledgment of its disfluency. This is done by the parent responsible for treatment. The parents are instructed about it. (Franken et al.,2005)
To conclude, although stuttering is not a severe problem, it has kinds of substantial impacts on people in every stage of development in terms of social, emotional and mental functioning and quality of life. Luckily there are kinds of treatments for stuttering including focusing on having children produce fluent speech as they learn to self-monitor, helping children decrease secondary characteristics, The multidimensional model of stuttering and some programs like Lidcombe Program (LP) treatment. Despite of the treatments there are some deficiencies that should be cared for further prospective studies on the incidence of stuttering. They should be more interest in planning services, and in defining more accurately how urgent it is to start a particular child on treatment. (Gordon,2002) The recovery of stuttering is another subject that should be more emphasized in studies. Also, there may be other questions about how patterns in children who spontaneously recover from stuttering differ from those who do not.
References
American Institute for Stuttering. (1998). Stuttering therapy for preschool children. Retriewed
from http://www.stutteringtreatment.org/treatmentpreschool.php
Brown, T., Sambrooks, J.E., MacCulloch, M.J. (1975). Auditory thresholds and the effect of
reduced auditory feedback on stuttering. Acta Psychiatrica Scandinavica, 51, 297–311.
Borsel, J. V., Marie Brepoels, M., Coene J. (2011). Stuttering, attractiveness and romantic
relationships: The perception of adolescents and young adults. Journal of Fluency Disorders, 36, 41–50
Craig, A., Tran, Y., & Craig, M. (2003). Stereotypes toward stuttering for those who have
never had direct contact with people who stutter: A randomized and stratified study. Perceptual and Motor Skills, 97, 235–245.
Conture, E., Walden, T., Graham, C., Arnold, H., Hartfield, H., Karrass, J. (2006).
Communication–emotional model of stuttering. Lawrence Erlbaum Associates, 17–46
Drayna, D., Kilshaw, J., Kelly, J. (1999). The sex ratio in familial persistent stuttering.
American Journal of Human Genetics, 65, 1473–1475.
Ducworth, D. (2004). Causes and treatment of stuttering in young children. Retriewed from
http://www.superduperinc.com/handouts/pdf/65_Cause_and_Treatment_of%20Stuttering.pdf
Franken, M-C.J, Kielstra, C.J., Schalk, V., Boelens, H. (2005). Experimental treatment of
early stuttering: A preliminary study. Journal of Fluency Disorders, 30, 189–199.
Gordon, N. (2002). Stuttering: incidence and causes. Developmental Medicine & Child
Neurology, 44, 278–282.
Healey, E.C., Trautman, L.S.,Susca, M. (2004). Clinical applications of a multidimensional
approach for the assessment and treatment of stuttering
Plexico, L. W., Manning, W. H., & Levitt, H. (2009b). Coping responses by adults who
stutter: Part II. Approaching the problem and achieving agency. Journal of Fluency Disorders, 34, 108–126.
Salmelin, R., Schnitzler, A., Schmitz, F., Jäncke, L., Witte, O.W., Freund, H. J. (1998).
Functional organization of the auditory cortex is different in stutterers and fluent speakers. Neuroreport, 9, 2225–2229.
Smith, A. (1999). Stuttering: A unified approach to a multifactorial, dynamic disorder.
Stuttering research and practice: Bridging the gap.
Webster, R. L. (1980). Evolution of a target-based behavioral therapy for stuttering. Journal
of Fluency Disorders, 5, 303-320.
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