Speech & Language: Part 6 - Smooth talking

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QUESTION…

I am working with a young boy who is four years old. For over six months, I have noticed he finds talking difficult. He often repeats words when starting a sentence or sometimes when he starts to speak no sound comes out. I am wondering if he has a stammer and, if so, what I can do to help him.

Stammering, also called ‘stuttering’ or ‘dysfluency’, is when a child or adult struggles to talk and say words fluently. It is very common especially in young children. Around 5 per cent of children will stammer at some point and more than 150,000 children and young people in the UK have a stammer.

It can affect children in different ways, but the most common features are:

• repetition of sounds – for example, ‘that’s my c-c-c-cat’.
• repetition of whole words – ‘it’s my my my my turn’.
• getting stuck on a sound. This is known as ‘blocking’ and is when the mouth is ready to make the sound but no sound comes out.
• stretching sounds – ‘ssssssssorry mmmmummy’.
• Children who stammer:
• may sometimes show facial tension or body movements, such as tapping their feet or clenching their fist when they stammer
• will often develop feelings about their stammer such as anger, frustration, sadness and embarrassment
• may also start to avoid talking in certain situations, or they may learn to avoid certain words.

CAUSES

Stammering is a complex difficulty, and research suggests that it is caused by a number of factors, including neurological, genetics, language, environment and psychological. Research into the causes of stammering is ongoing, but what is universally agreed is that parents do not cause stammering.

WHEN TO BE CONCERNED

Stammering often begins between the ages of two and five and so coincides with the rapid development of children’s language skills. As a result, most children will have moments when they are not fluent, making it tricky for carers to know at what point to be concerned about a child’s speech.

Typically, a child going through this period of normal non-fluency will use fillers such as ‘um’ and ‘er’. They may repeat syllables and words, but are unlikely to show characteristics such as ‘blocking’, facial tension or stretching sounds. They will also have more times when they are fluent than not. If you have any concerns about a child’s fluency or if they have been stammering for several months, it is always worth seeking advice.

Research has shown that early intervention is key to helping children with their stammer. While there is no cure for stammering, early therapy gives children the best chance to overcome the problem. Many people fail to realise that if children go unsupported early on, their stammer may become lifelong.

Given the child you are caring for has been stammering for over six months and is showing features that you would not expect with a child who is typically non-fluent, you should encourage his parents to contact your local speech and language therapy team. As supporting children with stammering or dysfluency is time critical, it is likely that this child will be seen fairly quickly.

STRATEGIES TO HELP

There are plenty of strategies you can use to support the child you are working with and you might want to share these with parents. As you can see, they are often about taking pressure off the child. Interestingly, many of these strategies are considered to be good practice when it comes to increasing children’s confidence in communicating:

Wait for the child to finish speaking. Do not try to finish the sentence for the child; although this can feel like you are helping the child, children who stammer often become frustrated by this, especially if the person finishes the sentence with the wrong word.

Keep making eye contact with the child when they are stammering and show that you are listening. This shows the child you are interested in what they have to say. It will also allow you to know when the child has finished talking, which can sometimes be tricky when a child has a stammer.

Avoid telling the child to ‘slow down’ or ‘take a breath’. It can be hard for young children to understand this, and it will not help to make them more fluent. It may also create feelings of frustration.

Slow down your own pace of talking and use pauses. This allows a child to think about what they want to say as well as encouraging them to talk slower and take pauses. When a child talks slower, it is often easier for them to be more fluent.

Show through your body language that you have time for the child. Try sitting down or squatting.

Prevent other children from talking over the child or interrupting. Knowing that other children may take over increases a child’s anxiety.

Try not to ask too many questions. Asking questions puts pressure on a child’s language skills, and pressure can often increase a stammer. Ask one question at a time and give plenty of time for the child to answer before asking your next question.

In group settings, be aware of situations when there is an expectation that the child should talk – for example, when taking the register or during circle times – as this type of situation can put too much pressure on a child.

Avoid asking questions to the whole group, however general. This creates a competitive situation where the fastest children to respond gain your attention. Instead, address questions or comments to specific children – for example, ‘Arthur, did you have a nice weekend?’.

MYTHS ABOUT STAMMERING

There are various myths about stammering, and here are just a few of them:

• Children who stammer are nervous and shy
• Children who stammer are not as intelligent as children who do not stammer
• Stammering can be ‘caught’ be someone copying someone who stammers

MORE INFORMATION

• A concise explanation of the causes of stammering is here
• Find out more about International Stammering Awareness Day 
• www.actionforstammeringchildren.org
• Part 7 of this series will be published in the 28 October issue of Nursery World