Sweet Benjamin, since thou art young,
And hast not yet the use of tongue,
Make it thy slave, whilst thou art free;
Imprison it, lest it do thee.
Children who stutter are in a better position than adults regarding the possibility of a total cure. The disorder and its psychological impact are not yet fully established in the stuttering child.
Stuttering has been compared with the layers of an onion. The core of the onion represents the physical stuttering. As time passes, the young child begins to notice that something is wrong with him. This can add additional layers to the onion: worry, frustration and eventually fear of speaking situations, social maladjustment, avoidance behaviour, etc. All these factors increase tension, which again aggravates and feeds the stuttering so that a vicious circle is put in motion. As time passes the stuttering becomes established and chronic – and much more difficult to treat.
Stuttering in children should be monitored, and in certain situations it may be necessary to intervene. The vicious circle of stuttering-worry-tension-stuttering should not be allowed to establish itself; the disorder has to be prevented from continuing into adulthood. The sooner stuttering can be stopped, the better. Earlier it was mentioned that approximately three to four per cent of pre-school children stutter, but that about three quarters of these children are fortunate enough to outgrow the condition, with or without therapy. Those who do not outgrow it, become adult chronic stutterers. Our aim should be to prevent the other quarter from becoming chronic stutterers.
Fortunately statistics indicate that the success rate for treating stuttering in children is much higher than for adults. The treatment is also often far simpler. A child who stutters often stops stuttering completely and permanently once a single stressor (ie something that causes stress) is removed from his life.
The following basic principles apply to all stuttering children:
* Stuttering is stress-related. Try to remove all possible sources of stress from the child’s life. Protect him from traumatic experiences and provide him with emotional security. (Read the chapter ‘Stress Management’.)
* Keep a close eye on his diet for substances that increase tension, eg refined sugar and caffeine (eg in carbonated drinks, chocolates, coffee and tea).
* Consult your doctor and supplement the child’s diet with stress-reducing vitamins and minerals (see the ‘Stress Management’ chapter).
* Give the child opportunities to have his say. He should not have the feeling that he must quickly get a word in or else. Do not interrupt him – but allow him to interrupt you.
* Be prepared to listen to your child.
* If he happens to be fluent on a particular day, encourage him to speak. In this way you reinforce his fluency. In the same way you should not pressurise him to speak on days when he stutters a great deal.
* Keep in mind that stuttering constitutes more than external behaviour such as sound repetition – children often become self-conscious about the disorder and try to hide it. Be sensitive to warning signs such as a pre-school child speaking with his hand in front of his mouth.
* Reinforce the child’s self-image and confidence. Do this by emphasising and praising his positive qualities and abilities and by developing his skills (swimming, karate, etc). If he excels in some area and outshines other children, his self-confidence will be boosted.
* Try to rid yourself of whatever guilt feelings you may have about your child’s disorder. If parents feel guilt or any other negative feelings such as shame, tension and worry about the child’s speech, the child may pick this up and develop the same feelings himself.
Stuttering children can be divided according to age into the following groups: the pre-school child, the primary school child and the high school child.
The pre-school child
This is the age when most stuttering children begin to stutter – usually after an initial period of fluency.
It is also during this period that the child’s speech system is subjected to a lot of pressure. The child must learn how to pronounce words correctly. He must place words in the correct sequence and make sentences. Baby-talk words such as ‘bow-wow’ must now become ‘dog’. When he wants to say something, he is reminded of both the infantile word and the ‘adult’ word and has to choose between the two. Doubt can cause tension. This kind of tension – or any other kind – can activate the disorder.
The first thing to keep in mind is that not all speech irregularities in young children represent real stuttering. It is normal for children to deviate from accepted norms of speech as they learn to speak. They gradually outgrow these deviations.
If you are nevertheless worried about your child’s speech, you should consult a speech clinician so that she can tell you if your child is really stuttering and advise you on what to do to keep his tension levels low. Sometimes immediate therapeutic intervention is required, eg where the child becomes aware of the problem while still very young; or if the blocks are severe from the very beginning. It could be that the child has had a traumatic experience or is experiencing other psychological problems that cause excessive stress. If this is the case, psychotherapy is advised.
Severe blocks in young children may entail pressing the speech organs (lips, tongue and palate) together very tightly, preventing all sound from escaping. This could be accompanied by struggle behaviour such as bulging eyes and bulging veins in the neck. Struggle behaviour is usually initiated when the child becomes aware that something is wrong with his speech. He then overcompensates – he actually tries too hard to say the sounds.
During this stage the stuttering can be very erratic. It comes and goes, followed by periods of fluency lasting a few minutes, hours, weeks or even months. This is due to the immense degree of variation in the child’s base-level tension.
At this stage, the child is usually unaware of his problem and has consequently not yet started worrying or feeling anxious about his speech. Usually the stuttering consists of rapid sound repetitions which do not bother the child.
It is very important not to draw the child’s attention to his stuttering. As soon as he becomes aware of it, it will increase his tension and aggravate the problem. For this reason the following should be borne in mind by parents:
* Do not point out to the child that something is wrong with his speech. Do not correct his speech; do not even tell him to speak slower. It is important to avoid reacting negatively to the child’s speech – make sure that your body language does not show disapproval. Accept the stuttering patiently and without getting tense, but without ignoring it either. If the child is completely stuck and unable to continue, one can say things such as: ‘Don’t worry, you can tell me another time’, ‘Should I say the word for you?’ or ‘Some words are difficult to say’.
However, if he is already aware of the problem, encourage him to speak slower and softer, especially at the beginning of sentences – but do not let him feel that stuttering is ‘bad’.
* In the child’s presence, try to make your own speech slower, softer and less urgent – but without sounding unnatural. Make a special effort to slow down the first syllable. Children tend to follow their parents’ example.
* Use short and simple words and sentences when in the child’s presence.
* Bilingualism and multilinguism: In a bilingual or multilingual country it may happen that the child is exposed to two or more languages while growing up, eg. where the parents speak different languages in the home. This doubles the language-related pressures on the child, particularly while in the process of acquiring language: now he has to learn two sets of vocabularies, grammars etc. If parents notice the beginnings of a stutter, they should consider limiting or even eliminating the child's exposure to one of the languages if possible.
If, for instance, they find that the child is stuttering more in one language than in the other, it may be better to temporary reduce or eliminate the child's exposure to the language in which he is less fluent, until firm fluency in the other language is established. If his fluency in his 'best' language is fully established, the 'dysfluent' language can gradually be reintroduced. If dysfluency in that language persists, continue the exposure to the 'best' language only. It's better to have fluency in one language than to stutter in both.
Where the child hears one language at school and another at home, experts advise that, for a limited period of time, parents should speak the same language at home as the one spoken at school. If the stuttering ceases, gradually reintroduce the other language.
In the book Stammering in young children – a practical self-help programme for parents (1988, Thorsons), Ann Irwin describes a systematic preventative programme developed to temporarily reduce the child’s tension levels and in the process put an end to his stuttering. The programme is suitable for children up to the age of seven. While the programme is in effect, the child is temporarily as it were protected from exposure to any kind of stress. If he has been completely fluent for a period of nine months, the parents may assume that he is cured and return to a normal routine. This protection programme should be introduced gradually – too many changes can confuse the child and make him insecure.
The extent to which children’s base-level tension varies was mentioned above – they may not stutter for months due to low base-level tension. If a child does not stutter for several months, parents may draw the wrong conclusion and consider him cured. The fact is that he may only be experiencing a period of temporary fluency due to low stress levels. For this reason Ann Irwin uses a nine-month period of fluency as the criterion for determining if the child has in fact outgrown his stuttering.
Her programme includes the following strategies:
* Parents should identify the factors that improve or weaken their child’s speech. The next step would be to develop strategies to control the negative aspects and enhance the positive ones.
Parents may, for example, find that Johnny’s speech deteriorates when he is excited. The appropriate strategy would then be not to emphasise exciting events such as Christmas – do not ask him what present he wants six weeks in advance, but rather one week before the event. Also avoid exciting games, tickling, etc. If, however, parents notice that Johnny’s speech improves when he plays with his brother they should encourage it, eg by buying a game they can play together.
* If he is by nature a hurried and active child who speaks too fast, try to calm him down in general without pointing out that he must speak slower. One way of doing this is to play a game in which the child is given a small financial reward if he walks to school instead of running.
* Reduce the number of direct questions that you ask the child. Direct questions have to be answered and place the child under a great deal of speaking pressure. Bear in mind that your aim is to make Johnny enjoy speaking – since you want to encourage him to associate speech with pleasure, avoid unpleasant questions. Moreover many direct questions can be asked in an indirect way, eg instead of asking: ‘Do you want to play with these toys?’ you could say: ‘I put these toys on the table in case you want to play with them.’ Also ask questions that require a simple yes or no instead of a long explanation. A good idea is to inform outsiders, especially teachers, of what you are doing. With their cooperation Johnny would not have to answer many direct questions.
* Parents should reduce their speech demands and eliminate all sentences starting with ‘say’ and ‘tell’, eg: ‘Say hello to Uncle Pete’, ‘Say goodbye’, ‘Say please’, ‘Tell Granny that story’, ‘Tell Daddy what happened today’. Other speech demands include: `Johnny, come and talk to Granddad on the phone’ or ‘I saw you pull the cat’s tail. You have to tell me why you did it and promise that you will never do it again.’ Requests to repeat a word or sentence also constitute speech demands.
* Avoid interrupting the child. It only causes frustration and self-doubt and will force him to increase his tempo so that he can have his say before he is interrupted again. At the same time parents must allow the child to interrupt them. This is to prevent the type of self-consciousness and speech consciousness that would make him hesitate before saying something. He should not be thinking: Is it okay if I say something now?
* Pay attention to him when he speaks, so that he finds speaking an enjoyable and rewarding experience. Be a good listener. If you look bored, you will undermine his self-confidence. In real life, however, it is sometimes difficult to respond to your child with good listening – if giving him your undivided attention is difficult at a given moment, you should say something like: ‘I’m feeding the baby, so it’s difficult for me to listen to you right now. Give me thirty minutes and then you can tell me everything you want to.’ Bear in mind that children are often talking to themselves rather than to you – one should learn to distinguish between the different types of conversations children indulge in.
* Try to protect the child from competing for an opportunity to talk. It often happens – especially in families – that the stuttering child is deprived of an opportunity to speak his mind due to a lack of pauses in the conversation. This makes him conscious of speech. Give each child a turn to speak.
* Do not correct the child if his pronunciation or grammar is incorrect. If you make him aware of his language, he will also become aware of his stutter.
* Relax all discipline, criticism and punishment.
Keep in mind that all these do’s and don’ts are temporary. If the child remains fluent for nine months, you may resume the normal routine. The normal routine should be introduced gradually and in a step by step manner. If this process results in renewed stuttering, apply the relevant protective measure until the stuttering disappears.
If the stuttering persists in spite of the above guidelines, Ann Irwin has the following additional advice:
* Parents should not expect too much of their child. Avoid parental perfectionism.
* Is there something in the child’s life of which he is excessively afraid? Watch out for scary movies – try to reduce his fears and other negative emotions. If he fears something and wants to talk about it, he may stutter badly – it may then be better to express those fears on his behalf. Loneliness, sorrow, etc also increase stress. Children have been known to recover after receiving a present such as a pet, or after going fishing with their father.
* A warm and loving home atmosphere allowing conversation, emotional outbursts and spontaneity will be of benefit to the child. Comments such as: ‘Don’t ask so many questions’, ‘Don’t talk so much’ and too much discipline, criticism and punishment can be harmful. However, too little discipline or inconsistent discipline can lead to insecurity, resulting in ‘the stress of uncertainty’ and stuttering. Find the golden mean. Discipline should be fair.
* Relapses. After months of fluency a child may resume his stuttering due to a sudden frightening experience or stressful event, such as changing schools or going on a special holiday. This is unfortunate, but under normal circumstances the child’s fluency should return after a few weeks or months provided that he receives adequate protection against stress. However if he has a traumatic experience during this recovery period, the stuttering may increase in severity and last longer before improving. A third traumatic experience during this period may lead to chronic stuttering. One reason for this is that the child is growing up – and it is more difficult to treat older children. This illustrates the urgency of early intervention. It is even possible that a single traumatic event, such as a car accident, may induce enough stress to cause permanent stuttering due to high base-level tension.
The primary school child
Sooner or later the child who did not receive adequate preventative treatment, or continues to stutter in spite of it, will become aware of his speech disorder. Nevertheless children react to their stuttering in different ways. Some pay no attention to it, while others begin to worry about it, so increasing their base-level tension. Additional factors are the new stresses that may result from going to school. Such tension will increase if other schoolchildren tease him about his speech. Some children only start stuttering at this stage – they sometimes only stutter at school because it is so much more stressful there than at home.
Now may be the time to be open with the child about the disorder. After all, he is aware of it, and a ‘conspiracy of silence’ to avoid discussing the problem at all costs will simply make it worse.
Speech therapy for children may comprise the following: play-and-talk therapy through which the child learns to associate speaking with having fun and being entertained and where he gets the opportunity to express suppressed feelings he hides at home; learning a speech technique, for example slower and softer speech, and slowing the first syllable.
It stands to reason that therapy should be administered with care. The child should not get the impression that he is ‘different’. This means that eg. the child should not be singled out during a lesson by calling him for therapy with the school speech therapist. It will not be long before all the other children suspect that something is the matter with him.
Speech clinicians who work with stuttering children should consider using the principles set out by Prof Schwartz and on which this book is based. According to Schwartz the Passive Airflow Technique is suitable for stuttering children from the age of seven, on condition that the child is treated by a therapist who has been thoroughly trained in this technique.
When my own son began to stutter
I would like to add here my experiences on teaching fluency techniques to my young son when he began to stutter at about age three. Onset was sudden, without any apparent external stressors or traumas.
Having been involved with stuttering and the treatment thereof for most of my life I was nevertheless horrified. The problem which had so impacted my life, but which I had managed to control to a large extent, had again reared its ugly head – but this time to threaten my son. My wife and I had to consider carefully whether to either ignore the problem, hoping that he would outgrow it (as three quarters of kids do), or intervene and try to stop him becoming a chronic stutterer.
Initially we decided not to do anything and to simply monitor him and protect him against obvious stress, as per the guidelines provided by Ann Irwin (see above). For the first years, until he was nine, this strategy seemed to work. His stuttering was actually very intermittent, with long periods of complete fluency, reflecting his fluctuating tension levels. The stuttering certainly didn’t seem to have an effect on his confidence or communicative abilities.
Then, at age nine, we noticed a definite deterioration, with blocks that quickly became severe, and obvious worry and frustration on his part. I then decided to intervene. I discussed with him the speech techniques which I myself use, then taught him to slow the first syllables of sentences and use airflow before speaking.
I’m very happy to say that he took to the technique like a fish to water - he was an excellent student. His speech immediately improved; he simply stopped his blocks dead in their track. Today (May 2010) he is seventeen years old, very confident, loves debating in class and has joined his school’s debating team. He is fluent, though I suspect an underlying potential disfluency; but he seems to manage any potential blocks by quickly reducing his speech tempo. For all practical purposes he seems cured. He has built up a firm foundation of fluency and confidence, so I doubt if stuttering will ever be a major problem for him.
The high school child
If the child still stutters when he reaches high school, his stuttering is usually chronic and the chances that he will still outgrow it have decreased. By now stuttering’s vicious circle has been activated; the disorder may affect his ability to communicate, his social relationships and his self-image. The new demands and responsibilities of being in high school, together with adolescence, bring added stress. On the other hand he may now be using a variety of tricks, such as word substitution, to hide his stuttering so that the disorder goes ‘underground’, with the result that others wrongly assume that his speech is improving.
Adolescents can be difficult patients. They find it hard to confront their stuttering. They need the security of belonging to their peer group – they hate being different.
Advice to children on how to cope at school
Prof Schwartz has the following advice for school kids who want to use the Passive Airflow Technique:
* Use role-playing exercises (see the ‘Applying the Technique in Real Life’ chapter) at home to practise specific school situations. If possible, use an audio recorder and evaluate the recordings afterwards to check that you used the technique, ie that the recording indicates a passive airflow and slow first syllables. Practise the following:
1. Asking questions.
2. Answering questions.
3. Reading in class.
4. Ask your friends to take the part of aggressive and impatient teachers, then answer their questions and ask some of your own.
* Practise the secondary form of the Education & Demonstration Exercise (see the chapter ‘Applying the Technique in Real Life’) at home and use it on your classmates.
* Practise the Education and Demonstration Exercise at home with your teacher in mind. Then demonstrate the technique to your teacher.
* Practise in advance, tell your class about stuttering and demonstrate the technique in class.
* Just before asking a question in class, quietly practise it by applying airflow with your hand in front of your mouth, ‘thinking rest’ and moving your speech organs as if you are asking the question.
* Practise Low Energy Speech (see ‘The Passive Airflow Technique’ chapter) at home.
* Use Low Energy Speech whenever possible in class.
* Make labels with the letters PFSS (passive flow, soft and slow) and stick them on your satchel, desk, etc where they can serve as a reminder.
* If possible, do the Bathtub Exercise (see the ‘Stress Management’ chapter) and read the affirmations (see the “Power of Visualisation’ chapter) – emphasise the classroom in the tenth affirmation.
* Try to find a classmate to act as your monitor and remind you to apply the technique.
Advice to teachers
* A stuttering child must be treated with sympathy and patience, but do not give him – or the rest of the class – the impression that he is ‘special’ or ‘different’.
* Ideally the child’s parents, teacher and speech therapist should meet and devise a plan of action.
* Build up the child’s self-confidence by praising his positive qualities.
* When speaking to him, speak in a slow, relaxed and non-aggressive manner.
* If the child experiences a block, it may be inappropriate to advise him to slow down or relax. If he is too tense, you risk failure – his and your own. Sometimes it is better to accept the stuttering patiently and calmly – which will also serve as an example to the rest of the class. Let him finish speaking, and then shift the focus to another activity in which he can be successful.
* Keep to a minimum those situations in which the child’s struggle behaviour is exposed for the entire class to see. This was the problem a particular teacher faced with a primary school pupil who had great difficulty saying his name during morning roll call. She devised a clever plan, arranging that each day’s activities would commence at pre-determined tables. Every time a child’s turn came up, he or she had to walk to their table and at the same time say their name. This procedure sufficiently distracted the boy to enable him to say his name. Teachers can also decide to use a list to check for absentees, so that the stuttering child does not have to speak at all.
* Avoid enforcing strict discipline of the type where children have to say their names or answer questions in alphabetical order, or where questions are asked in rapid succession so that snappy, correct answers are expected.
Specific situations at school
When the child learns to read aloud
If the child stutters, consider creating opportunities for him to learn reading with only the teacher present. This would reduce his tension level. As his speech gradually improves, the situation could be changed to include more listeners: a second child joins the lesson and reads, then a third, until the child is able to read with the whole class present. This procedure should be followed in such a way that the child or the other children do not get the impression that he is ‘special’.
Reading or speaking aloud in class
The following strategies usually reduce or eliminate stuttering: when the whole class reads/speaks in unison; when the stuttering child has a very small audience or is alone; and when the teacher reads together with the child while alone.
Instead of each child in class reading aloud to the entire class, divide the class into smaller groups of for example three children each. Each group reads aloud together, or if they read individually, they only read aloud to the rest of the group.
One teacher dealt with the problem very constructively by asking the child to help him to clean the blackboard during playtime. Once the blackboard was clean, the child was given an opportunity to read to the teacher. The teacher accompanied the child’s initial reading in a hushed voice, but gradually withdrew his support so that the child read the last lines fluently by himself. The teacher would then praise the child and say: ‘See, you can do it. That was excellent.’ This gave the child an opportunity to develop speaking confidence with the rest of the class none the wiser.
If the child stutters badly during reading or oral work, the teacher should plan SHORT reading or speaking turns for everybody to minimise any trauma.
When the teacher asks questions in class, those directed at the stuttering child can be formulated in a way that requires a mere ‘yes’ or ‘no’, or a nod of the head, for an answer. This will allow the child to feel that he is still a part of the class: at least he will be answering questions like the others.
If a young child is very much aware of his stuttering (and severe struggle behaviour usually indicates such awareness) the teacher should take him aside to try and find ways of making things easier for him. The child may request that stuttering is discussed in class so that the other children can have a better idea of what it is all about.
If he is receiving therapy, the teacher should establish if he is working on a specific technique. He would then be able to help the child use the technique in class.
Teasing in the classroom
Half the battle to reduce other children’s teasing will already have been won if the teacher treats stuttering with patience and calm acceptance.
The teacher should not overreact if a child’s stuttering makes some pupils laugh. Punishing the guilty pupils is counter-productive. Simply treat the stuttering as merely one form of behaviour and not as something special. Say something to stop the laughter and put the child at ease. Then continue with the lesson. Teasing usually arises from ignorance, not malice.
If the child is being tormented by bullies, the teacher may have to talk to the ringleader after school. Tell him that his teasing is only making the stuttering worse. Most children stop their teasing once they realise that it can do real harm. The problem can be approached in another way: the teacher can consider appointing the ringleader as the stuttering child’s personal guard against the other teasers – thus placing him in a position of authority, albeit of a more positive nature.
It may also be necessary to teach the stuttering child a few verbal defenses, eg ‘Yes, I stutter – so what?’ or ‘If you think it’s funny, go ahead and laugh’ or ‘Watch out or you’ll catch it too!’ Without some form of verbal shield, the child will be completely defenceless. Nevertheless acceptance is the best way to cope with teasing, rather than aggression or withdrawal. Teasing tends to stop if the victim fails to respond to it.
The teacher and stuttering child should discuss this problem in advance. External examiners should be informed prior to the exam if a pupil stutters. Knowing that external examiners have been informed will in itself lower the pupil’s tension level. A speech technique should also help the pupil to control his speech. As a last resort it may be necessary for the pupil to write the exam – even though side-stepping the problem in this way could affect his self-confidence.
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