My Preschool Student is Stuttering! What do I do now? Connie Haines, M.S., CCC-SLP, Speech Language Pathologist Sumner School District Mary Turcotte, M.S., Early Intervention Specialist Olympia School District

Introductions Kahoot Go to kahoot.it

What is stuttering? Stuttering involves the repetition, prolongation or blockage of a word or part of a word that a person is trying to say. It could be accompanied by tension or struggle and avoidance of sounds, words or speaking situations.

Stuttering Vocabulary Fluency Disfluency Stuttering block Repetition (sounds, syllables, word, phrases) Prolongation

Stuttering Vocabulary Hesitations Interjections Revisions Secondary characteristics Speaking on residual air Avoidance behaviors

The stuttering iceberg Confusion Fear Shame Isolation Guilt Anxiety Hopelessness The stuttering iceberg

Myths About Stuttering Nervousness causes stuttering Stress causes stuttering You should not talk about stuttering with children Children who hear a lot of stuttering will start to stutter Stuttering always goes away on its own Many persistent myths about stuttering! Many have been perpetuated for generations.

Experience Stuttering Your assignment to stutter…. How did it feel? What reactions did you have?

How does stuttering develop? All of us exhibit disfluencies at times Making mistakes in talking is normal for kids while learning to talk.

What causes stuttering? It is widely accepted that there is no single cause of stuttering

Some factors that may contribute to stuttering: Linguistic ability – the child’s ability to put words or sentences together Motoric ability – the child’s ability to move his/her mouth in the rapid and exact manner needed for speaking Personality or temperament – the ways a child tends to react to events in his environment or within him/herself Environment – requirements placed on the child for producing speech

Normal disfluencies and true stuttering “Normal” Disfluencies “Stuttered” dysfluencies Hesitations Interjections Revisions Phrase Repetitions Disfluencies occur more frequently Reactions to disfluency increase Tension or struggle increase Duration of disfluencies increase Repetitions of whole words Tension during “normal” disfluencies Repetitions of sounds or syllables Prolongations Blocks

Video –If your child stutters https://www.youtube.com/watch?v=u2_mgt87g1Y

Stuttering Foundation of America, Stutteringhelp.org

Speaking Demands Intrapersonal Demands Temperament – frustration level Attitudes toward speech Fatigue Anxiety / stress Negative reaction toward disfluencies Word Retrieval Other speech/language deficits

Speaking Demands Interpersonal Demands Communication partner Speaking expectations of partner Time pressure Interruptions Fast rate Loss of listener attention Demand speech (“say ____”)

Speaking Demands Topic Stresses High linguistic load Specific words / sounds Asking questions High cognitive load High emotional load or topics Unknown topics

Speaking Demands Environment Multiple vs. single partner Hectic / unstructured routines Competitive situations Type of listener High expectations imposed by others New situation or changes

Speaking capacities Motor Skills Reaction time Coordination Movement timing Motor Programming

Speaking Demands Language Skills Word retrieval Grammatical formulation Pragmatics Phonological skills (speech sounds)

Speaking capacities Emotional Maturity Confidence Social skills Coping strategies

Speaking Capacities Cognitive Development Supports all the other skill development

Stuttering Demands and Capacities Interpersonal Intrapersonal Demands Environment Topic Stresses Capacities Interpersonal Stuttering Intrapersonal Adapted from Starkweather

Development of stuttering Normal Disfluency: Less than 10% more typical disfluencies No secondary behaviors Not aware, no concerns Adapted from Guitar

Development of stuttering Borderline Stuttering Over 11% disfluencies Combination of both typical and less typical disfluencies No secondary behaviors Generally not aware, occasional momentary Surprise or mild frustration Adapted from Guitar

Development of stuttering Beginning stuttering Repetitions are rapid, tense and irregular May appear ‘stuck’ Developing escape behaviors eye blinks pitch increases loudness increases Aware of disfluency May express frustration Adapted from Guitar

Stuttering is like a pendulum Stages of stuttering Stuttering is like a pendulum

Writing activity

Communicative/Interpersonal Circle of stuttering Stress Communicative/Interpersonal Subject More Tension And Disfluency Tension Increased Fear Normal Disfluencies Negative attention Brought to speech More disfluency Increased Tension Adapted from Gregory

What contributes to stuttering? Stressors Evaluation of speaking performance/expectation of fluency Time pressure to speak, including interruptions Corrections to communication attempts Advice that does not facilitate fluency Negative comments Adverse facial expressions or body language Linguistic, high cognitive “load” or complexity Fast-paced family speaking and lifestyle

When to get help Stuttering has been present for over 6 months Stuttering has increased since it was first noticed Family history of stuttering Struggle and tension are evident Other speech or language delays are present Child has become less communicative or more withdrawn There is a strong reaction to disfluent speech Child has expressed concern

What kids tell us about stuttering: I hope you understand. It makes me completely exhausted every day. Just because I stutter doesn’t mean I’m stupid. Don’t finish what your kids are trying to say. It’s hard to talk to multiple people because you get scared to speak. If I had a choice between a million dollars or my stuttering to be gone, I would decide on my stuttering to be gone.

Where to get help Clinics Schools University Private practitioners Referral list from Stuttering Foundation

Ways you can help the child who stutters. Respond to communication attempts Reduce pressure Questions Time pressure Pause before responding Model slower rate of speech Treat the child the same as other children Encourage all children to take turns talking

What fosters fluency reduce identified "demands" for that child Limit the language load Slow your rate; i.e. Fred Rogers Use pausing in your speech Be an accepting communication partner Reduce speaking pressure Types of questions Time pressure Clear communication turns reduce identified "demands" for that child

https://www.youtube.com/watch?v=wTpckAufNDE https://youtu.be/wTpckAufNDE

How to react to disfluency Maintain eye contact with the child while he is speaking Respond as you might to fluent talking Be accepting of the child’s efforts to talk Have patience during especially disfluent periods Verbally remind all children of these tenants of communication i.e. “We will all listen with our eyes and our ears.” “We will all have turns for talking” “We will take the time to hear what you have to say.”

How do we talk about stuttering? Treat talking as you might any other developmental skill Acknowledge the child’s efforts to communicate 1- We are all learning to run faster, talk, etc… 2- You stayed with it and told me your whole idea, thank you 3- If child expresses “I can’t talk, I’m stuck, etc..” can acknowledge “Sometimes talking is easy and sometimes it is hard.” Listen to the child’s concerns about speaking

How do we talk about stuttering? Use descriptive words to describe the stuttering: Repetition = “Going over a railroad” Prolongation = going over a bridge Block = hitting a brick wall

Educate others about stuttering

Famous People Who Stutter

Acknowledge the child's efforts to communicate