Some Basic Facts About Stuttering

Hearing your child struggle when trying to get the words out is a painful experience for each parent. But is it a true stuttering? 

Developmental Stuttering

Young kids often go through a period of "developmental stuttering" as they learn to use new words and sentence structures. These disfluencies are associated with this period of rapid language growth. Guitar states that 75% of these children recover without intervention.

When does your child need to be seen by a speech-language pathologist? 

There are many different opinions, but the general consensus is that a child needs help when: 

1) the disfluencies have been present for the past 6 months 

2) there is a history of stuttering in the family 

3) boys are three times more likely to have a fluency problem

4) you notice tension in the face, neck or shoulders when your child talks

5) your child is very sensitive to the way he or she speaks and is starting to avoid speaking situations 

6) you notice an interruption of  breathing as the child speaks (e.g., the child runs out of breath in the middle of a word)

What does stuttering look like? 

Stuttering and cluttering are fluency disorders characterized by interruption in the rhythm of speaking in the form of sound/ word repetitions, prolongations, and blocks. 

Disfluency is another word for stuttering. 

There are three basic (or primary) speech behaviours associated with stuttering: repetitions, prolongations, and blocks. 

Repetitions

Repetitions are the most frequently observed of the three. They are most evident when a person initiates speaking and come in the form of a single sound, syllable, word or phrase repetition. 

"I I I I I want to go outside to park with dad." 

Prolongations

Prolongations are characterized by uneven duration of sounds in words (e.g., some sounds are last longer than they should). 

"Wwwwwwe were playing inside because it was raining." 

Blocks

Blocks are another core stuttering behaviour. The individual tries to say something, but appears stuck and is unable to produce the word.  

"I am looking for my....keys." 

Secondary Behaviours

Secondary behaviours are physical manifestations (e.g., eye blinks, tension in the upper body, tremor of the face, etc.) of stuttering which develop over time as the awareness of the individual of his or her difficulty increases. The speaker is using these behaviours when anticipating a period of  stuttering. 

Interjections are avoidance behaviours typically observed in older kids or adults who have had a fluency problem for some time. Interjections are used to "mask" the stuttering. Sometimes inserting little words like "um", "uh" or ''hm" helps them find a word which might be easier for them to say and avoid a moment of stuttering.   

"Um I am going to call um my friend um Nora to see if she wants to see the movie with me." 

Treatment

Stuttering is a difficult disorder to treat for many reasons. One of its most perplexing features is its unpredictable nature - it comes and goes, only to return in a few days, weeks, months or even years. Nobody can predict how long the stuttering will last for and when it will disappear. 

Along with the most obvious characteristics - the primary and the secondary behaviours - speech-language pathologists also have to address the feelings of each individuals who stutters. Some kids are very sensitive to the way they sound and might choose to avoid speaking situations due to their fear of stuttering; others seem not to notice their problem and show little motivation to participate in therapy. 

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Despite all challenges, I believe that even the most severe stuttering can be overcome. "Once a stutterer, always a stutterer" is an erroneous statement. We now know a lot about stuttering and the success of many of the excellent treatment programs have been documented. All it takes is some patience, persistence and determination. And a great therapist like Lionel!

Resources: 

 Guitar, B. (2013) Stuttering: An Integrated Approach to Its Nature and Treatment. 

http://www.stutteringhelp.org/

  

Denitsa Getsova

Denitsa graduated from the Master’s program in Speech-Language Pathology at Sofia University, Bulgaria. In her practice, she has worked with preschool and school-aged children with a wide range of communication difficulties – speech (articulation, phonology, motor speech), fluency (stuttering), language, preliteracy and literacy skills, cognitive-communication (social communication, executive functions). Denitsa has completed the It Takes Two to Talk®and More Than Words®family-focused intervention programs designed for parents of children with language delays and social communication difficulties/Autism Spectrum Disoders (ASD). Additionally, Denitsa has received training in the PROMPT system(for motor speech disorders), DIR®Floortime Model (child-centered approach for children with ASD) and PECS (augmentative/alternative communication program for nonverbal or minimally verbal children). Denitsa incorporates new technology and uses an iPad in her sessions both as a way to support her clients’ communication needs and a tool for language learning. She provides assistance to parents in the process of selection of educational iPad applications for home practice.

Indirect Language Stimulation Techniques

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Indirect language stimulation techniques are powerful, child-centered strategies to use with your kids to help them learn language. They are appropriate for ALL children (typically developing and those with communicative impairments), and can be used in many different environments. The focus is on the child’s interest and what he/ she is doing, seeing, and feeling. 

Indirect language stimulation does not pressure the child to provide a response. Instead, the adult uses simple, short phrases to describe each action or object while interacting with the child. This helps the child learn the language she/ he will need later to participating in the same or similar game. 

There are a number of  indirect language stimulation techniques, and they are all interesting and worth mentioning. In this post, I will review self-talk, parallel talk, expansion, expansion plus, and recasting. 

Self-talk

In self-talk, you talk about what you are doing as you are performing an action. The focus is on the action you are in the midst of doing. 

Example: 

         Adult:”I am taking my shoes off. My shoes are wet. Where did my umbrella go? Oh, here it is. I found it. It was behind my purse.” 

          “I am washing the dishes. I am using soap. ” 

Essentially, you are pairing your words with the actions, thus providing an excellent model for your little one(s) to learn language. 

These strategies can be used in many different settings: at the grocery store, at the park, at home (e.g., cooking, playing together, doing chores together).   

It is important to use short, grammatically correct sentences when you talk to your toddler. 

Parallel Talk

The difference between self-talk and parallel talk is that in the latter you take the perspective of the child.  

Example:
         
         “You are playing with the cars. The cars crashed.” 

How to use: Use on its own or pair up with another indirect language stimulation technique. In my speech therapy sessions, I often use self-talk and parallel talk in the same activity. 

Expansion

With this strategy, you add to what the child is already saying, making it sound more like how you would have said it. 

Example:
         
         Child: "Baby cry." 
         Adult: "The baby is crying." 

How to use: Expansion works great for toddlers who are learning to combine words. This is a technique I use every day in my practice. It does wonders!

Expansion plus

 Like in the indirect language stimulation technique which was described previously,  the child’s utterance is expanded to make it sound like the adult model. What is different here is that we also add additional information. 

Example: 

         Child: “Baby cry"
         Adult: “The baby is crying. He looks tired.” 

Description

The focus is on the objects the child's engaging with. Take a moment to observe and listen. What does she/he seems interested in at the moment? Use short phrases to describe what the child is seeing. 

Example:           

             Adult:  “Cookies are delicious.” 
                          "This is a big ball."  
                          "This car is fast."

How to use: I usually use description with kids who already have a fairly good vocabulary. What I like about it is that it provides opportunities to teach a bit more advanced words: e.g., feelings, adjectives, etc. 
               
Recast

Recasting helps correct grammatical mistakes in a noninvasive way. Instead of pointing out what the child is doing wrong, we provide a model of what he/ she should be saying. 

Example: 

            Child: “The dog barking.” 
            Adult: “The dog is barking.” 

How to use: I recommend recasting if your children have difficulties using grammatical markers (e.g., if you hear phrases such as “The dog sleeping”, “I goed to the park”, etc.)

I am sure you are already using some of these strategies when playing with your toddler. Which ones do you think would be most beneficial for your child?

Planning to see the indirect language stimulation techniques in action? Remember: there is no need to bombard your child! Choose  one or two of the strategies and spend some time in preparing they will be implemented in play. It might help to jot down some phrases before you start using them with your child. 

Example: Parallel talk ( play activity - playdough)

            Adult: “You are squishing the playdough. Now you are cutting the playdough. ”
                        “You made a horse. Wow!”
            
In order for the “teaching” process to be effective, you will have to dedicate some time to it. Spend 10-15 minutes each day playing while using the strategy. It might take a few weeks to see the effects, but it’s all worth it!  

Happy playing!

Adapted from: Oh Say What They See:  An Introduction To Indirect Language Stimulation (1984). Educational Productions, Portland, Oregon

Photo credit: www.flickr.com/photos/ameriswede/

Denitsa Getsova

Denitsa graduated from the Master’s program in Speech-Language Pathology at Sofia University, Bulgaria. In her practice, she has worked with preschool and school-aged children with a wide range of communication difficulties – speech (articulation, phonology, motor speech), fluency (stuttering), language, preliteracy and literacy skills, cognitive-communication (social communication, executive functions). Denitsa has completed the It Takes Two to Talk®and More Than Words®family-focused intervention programs designed for parents of children with language delays and social communication difficulties/Autism Spectrum Disoders (ASD). Additionally, Denitsa has received training in the PROMPT system(for motor speech disorders), DIR®Floortime Model (child-centered approach for children with ASD) and PECS (augmentative/alternative communication program for nonverbal or minimally verbal children). Denitsa incorporates new technology and uses an iPad in her sessions both as a way to support her clients’ communication needs and a tool for language learning. She provides assistance to parents in the process of selection of educational iPad applications for home practice.