Speak easy

By Dr Raj Khillan and Michael Audas
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Stuttering is relatively common condition affecting 1 in 100 Australians, but there are treatment programs to help both children and adults through it

Verbal communication is fundamental to quality of life and society. Stuttering is a disorder of verbal communication where speech is interrupted by repeated movements and fixed postures of the organs involved in speech production. These interruptions can often have struggle and tension, and unusual movements of the body and face. The speech disruptions of stuttering range from mild through to severe. In severe cases, a speech interruption of stuttering can last for 30 seconds.

How to identify stuttering

In stuttering speech is interrupted. It is either repetition of sounds (c-c-can), syllables (da-da-daddy), words (and-and-and) or phrases (I want-I want-I want). Repetition can be once or over and over again. Some people stretch out the sounds in words (caaaaan I go) or make no sound at all (this is called a ‘block’—when it looks like you are stuck and trying to speak but no sound is coming out).

Some people with stuttering also grunt, make other small sounds, or use a lot of ‘ums’ and ‘errs’. Some make facial expressions, blink, or move body when trying to speak.

Stuttering is more common than you think

Stuttering is relatively common condition affecting 1 in 100 Australians. It generally starts in early childhood between 2 to 4 year of age, though it can begin at any age; late childhood, adolescent or adult age. The onset can be sudden overnight or gradual over few weeks to months. Stuttering may be cyclical in nature—starting, stopping for a time, and then starting again—or it may be consistently present, with or without fluctuations in severity. Around 70% of children recover naturally within a few years but it is not possible to predict whether an individual child will recover without treatment. In early childhood, stuttering is more common in boys and can vary in severity over time, and even throughout the day.

If stuttering persists into adulthood it can cause associated social and anxiety-related difficulties such as avoiding talking in front of the class, fear of using the telephone, negative self-image. Children may be mocked or bullied because of their stuttering, even in the pre-school years. Stuttering is legally a disability in Australia and in many other countries.

To date, though, no definitive cause of stuttering has been found. Some tentative evidence suggests that a family history of stuttering may play a role, and that there might be ways that the brain functions during speech that differ to a small degree in people who stutter versus those who do not

Stuttering affects speakers of all languages and backgrounds. Most people who stutter are more fluent when singing, whispering, and reading aloud with someone. Some children who are already stuttering may stutter more when they are: excited, tired, nervous, arguing, given limited time to speak, competing to be heard, or using complicated language. Some children who stutter may also avoid speaking situations (e.g. on the telephone), using certain words, or speaking with some people.

What causes stuttering

Many hypotheses have been advanced to explain what gives rise to stuttering in some individuals. To date, though, no definitive cause of stuttering has been found. Some tentative evidence suggests that a family history of stuttering may play a role, and that there might be ways that the brain functions during speech that differ to a small degree in people who stutter versus those who do not. At present it looks like stuttering involves some problem with the neural processing—the brain activity—that supports speech production. That just means that stuttering is a physical problem, not a psychological problem, as was once thought.

Low intelligence, emotional problems, parenting style and personality type do not cause stuttering. Anxiety and stress do not cause stuttering but can make stuttering worse (i.e. a child may stutter more when they are anxious). Stuttering is not caused by copying children or adults.

The impact of stuttering on daily life

The impact of stuttering on people will differ. For example, someone who stutters only occasionally may experience extreme frustration and anxiety about speaking, while another person whose stuttering is more severe may not be affected in the same way. There is no doubt, though, that stuttering interferes with communication as soon as it begins in pre-school children. Sometimes, children show signs of frustration about their stuttering soon after onset. More commonly, school-age children report feelings of embarrassment about stuttering when answering questions or reading aloud in class. Adults whose work requires effective communication may find their stuttering prevents attainment of their vocational potential.

Stuttering may interfere with social interactions and may lead to development of social anxiety. Social anxiety can significantly impact day-to-day life. More seriously, it is known that adult stuttering is greatly at risk of having social anxiety disorder, also known as social phobia. Social anxiety disorder is a debilitating condition. It involves constant fear of humiliation, embarrassment, and negative evaluation in social situations. Sufferers experience extreme distress in social situations. They can have trouble participating in relationships at work, socially, and with partners and friends. This can make them become socially isolated.

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Treatment programs

There are many treatments available for both children and adults who stutter. For children, the treatments supported by the most robust research evidence are:

Stuttering in children is usually treated using the Lidcombe Program. This program is very effective and often stops children from stuttering altogether. It is a type of therapy you provide at home that involves giving positive feedback when your child says something without stuttering. The child will need to see a speech pathologist every week. The Lidcombe Program is best for children under 6, although it can also be used for older children.

For adults, the approach demonstrated to reduce stuttering behaviours most effectively is the Camperdown Program. This is what is known as a “speak more fluently” approach. Other treatments take a “stutter more fluently” approach and place a greater level of importance on dealing with the covert stuttering behaviours.

The reason that different programs exist for children and adults is that effective treatment in the early years can often eliminate stuttering altogether. Past a certain age, however, stuttering behaviours become well enough entrenched that management, rather than elimination, becomes the goal.

No matter the age of the person seeking treatment, or what treatment he or she ends up selecting, however, it is vital that to the success of these treatments that they enjoy the support of their loved ones: both on an emotional level, but also as active participants in the treatment itself.

If your child starts stuttering, it is recommended that you see a paediatrician and speech therapist as soon as possible. While there is a chance that your child may recover naturally, it is not possible to predict which children will recover without therapy

If your child starts stuttering, it is recommended that you see a paediatrician and speech therapist as soon as possible. While there is a chance that your child may recover naturally, it is not possible to predict which children will recover without therapy. Therefore, it is best to refer early as there may be a wait for speech pathology services. Research shows that stuttering therapy has significantly better outcomes for pre-schoolers than it does for older children or adults. There is no medications or surgery can help in stuttering improvement. But if the child is being bullied at school, as it can have serious consequences for a child who stutters—or any child, it needs to be stopped. Talk to your paediatrician and speech therapist who can help in stuttering and guide you to talk to school authorities.

Dos and Don’ts of stuttering

Dos:

  • Have your child assessed by a speech pathologist
  • Take time to listen to your child without distractions or competition from other family members. Listen to what your child is saying, not how it is being said (i.e. do not worry about the stutters)
  • Let your child finish what they are saying, do not finish words or sentences for them
  • Repeat or rephrase what your child says to show that you have understood
  • Reassure your child if he or she is aware of the stutter and is concerned
  • Interact normally with your child

Don’ts

  • Make intrusive comments to fix or treat the stutter
  • Comments like ‘take a breath, slow down’, etc. rarely help, and can make a child feel more self-conscious
  • Draw attention to your child’s speech in front of others or put them in situations where speech is on display
  • Interrupt your child’s speech or complete sentences for them
  • Criticise your child’s speech
  • Tease your child about their stutter
  • Let other people (i.e. friends, parents) make comments or try to correct your child’s speech

The Australian Speak Easy Association (ASEA) offers support to all people who stutter and organising online conference: Connecting the Community on 24 and 25 October.


Dr Raj Khillan is a consultant paediatrician at Western Specialist Centre, and Michael Audas is a speech pathologist at Change for Life. Information courtesy: Sydney Children Hospital Network, Raising Children Network, Australian Speak Easy Association, Speech Pathology Australia

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