There are more than 3 million people in the United States who stutter. Pediatricians and teachers are often the first professionals that a parent will go to for advice. In order to determine when to refer to a speech/language pathologist, these professionals are faced with the challenge of differentiating between typical disfluencies and true stuttering.
Research suggests that anywhere between 75 to 80 percent of children who go through a period of disfluency will outgrow stuttering. This statistic can often lead teachers and pediatricians to suggest that the family “wait and see” before consulting a speech/language pathologist.
However, one must also consider the risk of missing a critical window in which treatment is optimal. Early intervention plays a vital role in reducing the likelihood that a child will continue to stutter and can minimize the impact of stuttering on a child’s life--both socially and academically. There are certain risk factors that professionals, as well as families, should consider when deciding what’s best for the child.
Many children go through a period of temporary disfluency. If this persists in excess of 6 to 12 months, the child is at increased risk for a fluency disorder. However, this is only one of the risk factors to consider. If the child is stuttering for less than 6 months, but is demonstrating other warning signs, it is wise to seek the advice of a speech/language pathologist. The age of onset is also important to consider. Children who begin stuttering after the age of 3.5 are at increased risk for persistent stuttering.
Recent developments in stuttering research has provided evidence for a genetic basis to stuttering for some (but not all) people who stutter. If there is a family history of stuttering, the child is at increased risk for a fluency disorder. This is especially true for children with family members who continued to stutter in adulthood.
If a child is showing signs of tension or struggle associated with speaking, a referral is warranted. Common signs of tension or struggle include, but are not limited to, facial grimacing, blinking of the eyes, movement of trunk or limbs, breathing irregularities and increasing pitch or volume during stuttering moments. Some children may make attempts to avoid or hide stuttering by covering their mouth, changing words or by giving up altogether.
Children who present with other speech/language concerns, such as an expressive/receptive language disorder or an articulation disorder, are at an elevated risk for persistent stuttering. Interestingly enough, not only children with delayed language are at risk. Research suggests that children with advanced language skills also may be at greater risk for a fluency disorder.
Have compassion for parents and validate their concerns. Stuttering is variable by nature and it is possible that they are noticing more frequent or severe stuttering moments than what the child is presenting with at school or during a doctor’s visit.
It can be terrifying for parents to feel they have to watch their child struggle without knowing ways to help. Even if direct therapy is not yet warranted, a speech/language pathologist can alleviate parents’ worries by educating them on stuttering and training them in ways to make changes to the environment that will enhance fluency.
Professionals who work with children may observe many of their students or patients outgrow stuttering without intervention. Based on these observations, it can be tempting to reassure concerned parents that there is no reason to worry. Unfortunately, just because one child outgrows stuttering does not mean that another child will.
By telling parents to ignore stuttering they may miss out on a critical window in which intervention is optimal or send the message that stuttering is their child’s fault or something shameful that they can not talk about.
When instructing a parent to ignore stuttering, the parent may avoid speaking directly about stuttering with their child. However, often their startled looks or body language speaks for itself. By referring a parent to a speech/language pathologist, the family can learn how to acknowledge stuttering in a way that lets the child know he/she is not at fault and has the support of their family.
It is important to be mindful of the factors that put children at an elevated risk for a stuttering disorder. These factors may help differentiate between the children that outgrow stuttering on their own and the children that may benefit from intervention.
If you are not sure, refer! A speech/language pathologist can screen the child to determine if the family should continue to monitor their child’s speech--or if a formal assessment is warranted.
Stuttering is a fluency disorder that has the potential to impact a person’s ability to successfully communicate in academic, work and social settings. Unfortunately, we cannot predict with 100% certainty which children will outgrow stuttering on their own and which children require intervention.
However, there are certain warning signs that teachers and pediatricians can consider when determining if a speech/language pathologist should be contacted. The child needs only to demonstrate one of the risk factors for a referral to be appropriate. With the proper referral, a family can maximize their child’s chances of eliminating stuttering and reduce the negative impact it has on their child’s life.
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