Positive Relationships: Speech - Go with the flow

Q: A two-year-old girl in my nursery was making rapid progress with her language but now that she's at the stage where's she's trying to form sentences, she tends to stutter. Can you explain why this is happening? And how should we respond?

A: Young children face a significant task in learning to talk and understand what is said to them. It is not unusual that they go through a period when their words do not flow as easily as they wish.

Young boys and girls often stop, search for the words they want, substitute different words, use meaningful gestures or their versions of 'um' and 'er'. They persevere in getting their message across, and you can observe them using a variety of strategies to cope with their limited language until their working vocabulary has expanded.

Any temporary stops and reversals are not a 'problem' within language development. However, the Royal College of Speech and Language Therapy estimates that about one in five children experience a noticeable period of non-fluency, when the flow or easy timing of speech is disrupted. And about one in 20 children experience a struggle to speak, a problem that emerges as a stammer and lasts for more than six months. Only about one child in every 100 develops a stammer that is more persistent, possibly throughout their life.

WHAT IS STAMMERING?

The words 'stammering' or 'stuttering' are used to cover the same pattern of disruption in the flow of speech. Stammering usually appears for the first time in childhood, rather than emerging in adulthood, and can take different forms.

• - Some children show a visible struggle to start what they want to say. Then after a matter of seconds the words tumble out over each other in a rush.
• - Other children's speech emerges in a stop-start way from the beginning. They manage to express part of their message and then come to a halt.
• - For many, the same sound may be repeated - sometimes but not always the first sound in a word, like 'c-c-c-cup' - or a single word is stretched out like a length of verbal elastic, like 'ssssstory'.

WHAT CAUSES STAMMERING?

There is no single cause of stammering and the likelihood is that children begin to stammer as the result of a combination of events.

• - There is a possible genetic component, since about 60 per cent of children who stammer have another family member who also stammers (or used to).
• - Maybe there is a biological component, because stammering is more common in males than females. Studies of this sex imbalance report a proportion varying from 3:1 to as high as 5:1.
• - Sometimes problems of fluency are linked with other difficulties or delays around language development. But sometimes, as it sounds with this particular girl, a child's language development has so far gone smoothly.
• - Social influences can be a factor in the onset of stammering. Even articulate children try to rush when there is limited time to talk. Familiar adults may be impatient or critical of ordinary childhood mistakes in speech.

WAYS TO HELP IN NURSERY

Children need support with any disruption in the fluency of their speech, and these ideas can also be shared with parents.

• - Show you are interested and are happy to wait for children to stop, have another go or reword what they want to say.
• - Friendly body language and ensuring that you are at a child's height will communicate the message, 'There's no rush'. Maybe it will help a child if you say out loud, 'I'm listening.'
• - Monitor how you talk and listen to the children in your setting. Ensure a steady, unrushed pace for your own speech, which a child is then more likely to mirror.
• - Be a patient listener, make friendly eye contact and help turn-taking if you are supporting a child while other children are part of the exchange.
• - Pause briefly for thought before replying. Lead through example by engaging in relaxed conversation rather than simply telling children to 'slow down'.

• - Keep your sentences short and appropriate for the child's age.Avoid bundling up several ideas or requests into one long utterance.
• - With over four- and five-year-olds, consider acknowledging with the child what is happening. The British Stammering Association suggests talking about 'bumpy speech' or 'getting stuck'.

• - Avoid leaping in to finish children's sentences, and dissuade their friends from offering this 'help'. Peers are not being unkind for noticing that their play companion is struggling.
• - Definitely step in if children are being mocked for their stammering. Your overall message should be: 'Here we help each other with any problem. We don't make hurtful remarks'.

SUPPORT FOR PARENTS

Advice for parents should stress that families do not cause stammering. A child's key person may need to reassure parents, if only because blaming themselves does not help the child. However, you do need to explain that adult choices over behaviour make a difference. Find a friendly way to dissuade parents from impatience or embarrassment about their child, and share positive strategies with them.

In partnership with parents, it is helpful to establish whether individual children are prone to stammer under particular circumstances.

• - Is stammering more likely when the child is tired? Are they getting enough rest and sleep each day?
• - Is the child's confidence actually a barrier to them speaking fluently? Are they so keen to talk that they struggle to find the words amidst their enthusiasm? Or are they keen to explain something for which they have few words? Can familiar adults help with, 'Is it the cuckoo clock? Yes, we saw the funny clock'.
• - Are there times or routines that children find stressful? How can these times be made more relaxed?
• - If children stammer more in the company of one person - a practitioner or family member - how is this adult behaving and how should they change the way in which they engage with the child?
• - Does a child become concerned about speaking up in a group? All young children need opportunities to have one-to-one conversations, rather than in a large group. Help them with turn-taking in small conversational groups, including mealtime chat in families.

SPEECH THERAPY

With the appropriate help outlined so far, some young children emerge relatively swiftly from their period of non-fluency. However, early years settings should have established links with the local speech and language therapy team and be ready to consult them, both for general advice on strategies and to ease contact for a parent concerned about their child's language development.

In partnership with parents, you should definitely make contact with the speech and language team if:

• - your consistent help has had little effect on the child's language development over a few weeks - do not wait for months
• - children are distressed by their struggle to speak fluently, especially if they have developed facial twitches or repetitive physical gestures when they speak. These habits may evolve because the child is trying anything that seems to edge along their flow of speech
• - it has become clear that a child has other difficulties or delays in language development
• - another member of their family stammers, or did in the past
• - a child already stammers in their home language and is now faced with learning English as an additional language.

FURTHER INFORMATION

• - Royal College of Speech and Language Therapy, www.rcslt.org/speech_and_language_therapy/commissioning/fluency
• - Talking Point, a website about children's speech, language and communication, www.talkingpoint.org.uk/EY-worker.aspx
• - The British Stammering Association, www.stammering.org/parents_help.html and www.stammering.org/under5.html
• - The Association For Research Into Stammering In Childhood www.stammeringcentre.org