Understanding Stuttering in Children “If knowledge can create problems, it is not through ignorance that we can solve them.” Isaac Asimov* Anna Birstein University of Pittsburgh

Stuttering is: Stuttering is “a marked impairment in speech fluency, that reflects an underlying problem with speech production rather than a language problem” (Weis, 2013, p. 150). The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, edited by American Psychiatric Association, DSM –V (2013), gives this communication disorder a new name: “Childhood-Onset Fluency Disorder” (APA, 2014)..

Diagnostic Criteria (DSM-V) Childhood-Onset Fluency Disorder (Stuttering) Is a condition characterized by disturbances in the normal fluency and time patterning of speech that are inappropriate for the individual’s age and language skills, and persist over time. Is an impairment in speech fluency that is not attributable to another developmental disorder, a mental disorder, or a medical condition (like stroke). The onset of symptoms is usually in the early developmental period (i.e., prior to the age 5). The disturbance [in speech fluency] causes anxiety about speaking, limitations in effective communication, social participation, and academic performance or occupational performance (APA, 2013, pp ).

Symptoms Symptoms The disturbances in the normal fluency of speech may be characterized by one or more of the following:  Sound and syllable repetitions (part-word repetitions): “ba – ba — baby”  Sound prolongations: “S>>>>sometimes”  Broken words (pauses within a word): “Ta – table”  Audible or silent blocking (filled or unfilled pauses in speech): “I like to – go home”  Monosyllabic whole-word repetitions: “I-I-I see him”  Circumlocutions (word substitutions to avoid a problematic word)  Words pronounced with an excess of physical tension (APA, 2013, pp ; Weis, 2013, p. 151)

Eligibility for Services: A child who stutters may be eligible to receive speech therapy under a federal law, the Individuals with Disabilities Improvement Act of 2004 (IDEA, P.L , Part 300 / A / / c / 11 )* IDEA’s definition of a Speech-Language Impairment includes communication disorders, such as stuttering, impaired articulation, language impairment, or voice impairment, “that adversely affects a child’s educational performance.”* *(U.S. Department of Education, n. d.)

Early Identification The following signs may help to distinguish between stuttering and developmentally appropriate disfluencies. Many preschool-age children demonstrate age-appropriate disfluencies, which do not appear often, and may include whole word repetitions, pauses in speech, and relaxed hesitations. “The warning signs that should alert parents and teachers are: 1.Frequent part-word repetitions rather than word repetitions, more likely ‘B-b-but’ than ‘but, but.’ 2.Repetition of a part of a word more than 2 times 3.‘ba-ba-ba-ba-ball.’ 4.Repetitions having an irregular rhythm ‘b-ba--b-ball.’ 5.A sound held longer than normal (more than 1 second) ‘Mmmmmy ball.’ 6.Excessive tension in the speech muscles (in the neck and face). 7.Fear of speaking in public.” * *(Haynes, Moran, & Pindzola, 2006, p 28)

Age of Onset and Recovery An onset of stuttering is usually between ages 3 and 6 with almost no new cases being reported after age 12. Boys are 2 to 5 times more likely to exhibit stuttering than girls. Boys begin stuttering, on average, 5 months later than girls. Recovery: 5% of preschool children are affected, but by adolescence this percentage drops to 1%. the highest rate (70% or higher) of recovery exists during the first 15 months post-onset.* *(Dworzynski, at al., 2007)

Causes and Treatment The exact causes of stuttering are unknown.* There are strong genetic influences in the etiology of stuttering (family history of disorder).** No single treatment or strategy will work for each and every child who stutters** Behavioral intervention strategies are most effective before age 8.** *(Dworzynski, et al., 2007, Nye, at al., 2013, Weis, 2013) **(Nye, at al., 2013)

Stuttering Stereotype Many myths and misconceptions about stuttering exist in the society. Examine your own perceptions toward people who stutter through the “Myth vs. Truth” activity.

Myth OR Truth?* 1. There is exactly the same range of intelligence among children who stutter as there is among non-stuttering children. 2. Parents, their behaviors, or parental practices do not cause stuttering. 3. Stuttering is caused by nerves (children may stutter because they are nervous or anxious). 4. Stuttering is caused by an event in life. 5. Children who stutter are usually shy and lack confidence. 6. Children who stutter need help to speak (to finish their sentences). 7. Children who stutter experience reduction in stuttering when they sing, speak to an infant or a pet, or read aloud the passage in unison with a large group. *This activity is based on the information from Kelman and Whyte (2012, pp ) and Weis (2013, p. 152)

Myth OR Truth? 1 truth 1 truth 2 myth 3 truth 3 truth 4 truth 4 truth 5 myth 6 truth 6 truth 7 truth 7 truth

Suggestions for Teachers: “PRIME” speech P - Create p auses (silences) in interactions. R - Reduce your r ate of speech. I - Show your i nterest in what the child expresses, rather than how it is said. M - Model simple vocabulary and normal non-fluencies in your speech E - Do not reduce your e xpectations (treat the child who stutters as any other student in the class)* *LaBlance, Steckol, and Smith (1994)

Suggestions for Teachers: Do’s Listen attentively. Give him/her opportunities to talk. Praise the student for sharing his/her ideas. Prepare the student for the upcoming events. Have a one-on-one conversation with the student about needed accommodations. Acknowledge disfluencies. Let the student who stutters know it’s OK to stutter. From: LaBlance, Steckol, and Smith (1994) and Stuttering Foundation (2015)

Suggestions for Teachers: Do’s Create a comfortable speaking climate in the classroom: Educate your students about stuttering. Establish the “conversational rules” (together with your students). Model and reinforce your students to follow those rules. (LaBlance, Steckol, & Smith, 1994)

Suggestions for Teachers: Don’ts Do not interrupt the student who stutters. Do not finish his or her sentences. Do not tell the student to “relax” or to “take a deep breath.” Don’t make stuttering something to be ashamed of. Talk about stuttering just like any other matter.* * (Stuttering Foundation, 2015)

Implications from Research 1.Be aware that a child may be prone to stuttering when there is a strong family tendency. 2.Consult with the child’s Speech and Language clinician (SLP) to learn about the course and current treatment. 3.Address anxiety early. Proper intervention may prevent many negative consequences of stuttering. 1. (Dworzynski et al., 2007). 2. (Nye, et al., 2013). 3. (Iverach & Rapee, 2013, p. 220).

Implications from Research 4. Establishing a comprehensive bullying prevention program can effect positive changes in peer attitudes toward children who stutter and toward bullying in general. 5. Advise a student who stutter to join support groups to connect to others who share similar emotional experiences. 6. Help him or her find local support groups in your area. 4. (Langevin & Prasad, 2012) 5, 6. (Guntupalli et al., 2006).

A Case Study Meet Davis, a 4-year-old boy.* What would you recommend the parents of Davis if they asked your advice as a teacher of their child, or as a family friend who works on the field of education? *A Case Study from the Chapter 5 “Communication Disorders in Children” of the book Introduction to Abnormal Child and Adolescent Psychology by Robert Weis (2013, pp )

References: APA (2014) A new name for stuttering in DSM-5 Retrieved from: APA (2013) Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) Dworzynski, K., Remington, A., Rijsdijk, F., Howell, P., & Plomin, R. (2007). Genetic etiology in cases of recovered and persistent stuttering in an unselected, longitudinal sample of young twins. American Journal of Speech-Language Pathology, 16(2), Flynn, T. W., & Louis, K. O. S. (2011). Changing adolescent attitudes toward stuttering. Journal of fluency disorders, 36(2), Haynes, W. O., Moran, M., & Pindzola, R. (2006). Communication disorders in the classroom: An introduction for professionals in school settings. P 28. Jones & Bartlett Learning. Howell, P., Davis, S., & Williams, R. (2008). Late childhood stuttering. Journal of Speech, Language, and Hearing Research, 51(3), Kelman E., Whyte, A (2012) Understanding Stammering or Stuttering. A Guide for parents, teachers, and other professionals, pp Jessica Kingsley Publishers: London, UK LaBlance, G. R. (1994). Stuttering: The Role of the Classroom Teacher.Teaching Exceptional Children, 26(2), Stuttering Foundation (2015) Special education law & children who stutter. web. Retrieved from: Langevin, M., & Prasad, N. N. (2012). A stuttering education and bullying awareness and prevention resource: A feasibility study. Language, speech, and hearing services in schools, 43(3), Guntupalli, V. K., Kalinowski, J., Nanjundeswaran, C., Saltuklaroglu, T., & Everhart, D. E. (2006). Psychophysiological responses of adults who do not stutter while listening to stuttering. International journal of psychophysiology, 62(1), 1-8. Iverach, L., & Rapee, R. M. (2014). Social anxiety disorder and stuttering: Current status and future directions. Journal of fluency disorders, 40, Stuttering Foundation (n. d.) Special Education Law and Children Who Stutter. Retrieved from: Weis, R. (2013). Introduction to abnormal child and adolescent psychology, pp Sage Publications. U.S. Department of Education (n. d.) Building the Legacy :IDEA ED.GOV Website. Retrieved from: *Quotation of Isaac Asimov as it cited in Liebersoh, A (2009) World Wide Agora p Publisher: Lulu Enterprises, UK Ltd The background image was created: March, 2015, by Anna Birstein (using the PickArt software).