A Loss For Words


by Lori Melnitsky, MA CCC-SLP

Imagine not being able to say your own name.  Imagine answering the phone and having the person on the other end hang up, thinking no one is there. Imagine the physical and mental exhaustion of having to force words out of your mouth that are spoken so easily by others. IMAGINE STUTTERING.

Stuttering is a communication disorder which involves an interruption of the continuous flow of speech. It is characterized by prolongations (ssssssnake), repetitions of words (I I I want milk) or phrases (I want I want milk), frequent use of filler words (uh, um) and/or blocking (silence and struggle before saying a word).  It is often accompanied by secondary behaviors, such as avoidance of eye contact or awkward movements of arms or legs to force words out. The exact cause is unknown.  However, recent research suggests that a genetic link exists.

Although stress often results in an increase in stuttering, it is not the origin.   It is often hereditary and affects more males than females. (5 to 1 ratio)  In fact, approximately one percent of the population stutters amounting to 3 million Americans.

Many preschool children, between the ages of 18 months and 5, experience signs of developmental dysfluencies.  Why? One reason is that children are still coordinating their speech patterns and acquiring language during this stage. Will these children outgrow it? Approximately 75 to 80% will, but there is no way of knowing for sure. This is why consulting a speech/language pathologist who specializes in stuttering is vital.  An extensive referral list and valuable information can be found from the Stuttering Foundation of America (www.stutteringhelp.org).

Various direct and indirect therapy options are available for preschool children who stutter. The goal at this age should be trying to produce stutter free or fluent speech.  The Lidcombe Program for Early Childhood Stuttering Intervention is one effective approach provided under the guidance of a Lidcombe Trained Speech Pathologist. The Lidcombe Program teaches parents how to provide treatment,   and aims at eliminating stuttering in a fun and structured manner.  A list of Lidcombe Trained speech pathologists can be found at www.montrealfluency.com.

Although parents are not to blame for their child’s stuttering, there are known environmental factors that might exacerbate stuttering once it begins.  It is important for parents to be educated about how to interact more effectively with their child.   Ways that parents can help facilitate fluency include not finishing a child’s sentence, not telling them to take a deep breath and slow down, establishing eye contact and allowing pause time before responding.  It is a common misconception that telling a person who stutters to talk slower and to take deep breaths will decrease stuttering.  Actually, the opposite occurs and stuttering often increases as well as frustration.

A speech/language pathologist may monitor the child or provide parents with guidance.  Some suggestions include looking directly into the child’s eyes to show that you are truly listening to the message, reducing questioning and allowing extra pause time. This will decrease demands placed on the child. Avoid putting the child in the spotlight-ex: “Tell Aunt Sue what you did in school today”. This puts too much pressure on the child. Avoid comments, such as “talk slower”. Try and model a slow relaxed speech pattern. (This is not as easy as it sounds). Delay responding to allow for more pauses and reduce time pressure for the child. Don’t ask the child to repeat the sentence. It will only increase awareness and frustration. Most importantly, don’t panic!!! Although we can’t identify who will eventually stop stuttering, we can give advice to parents on how to talk to a child who stutters and model the appropriate way to respond. Early intervention is a key ingredient for a successful outcome for the young child.

Once a child reaches the approximate age of six it becomes more difficult to stop stuttering completely. The approach chosen is individualized to meet the needs of the client.  A fluency shaping approach involves using strategies such as prolongations and easy onsets of words.  Stuttering modification involves teaching a child to stutter in an easier way and sometimes results in more stuttering with fewer struggles noted.  Ideally, the approach should be flexible and variable over time to meet the child’s changing needs.  The important thing is to not only improve fluency but encourage effective communication skills.  School aged children are often the most difficult to improve fluency due to motivational factors and lack of awareness. It is the role of the speech pathologist to foster motivation along with realistic goals. It is important to help children become confident effective communicators. It is also difficult for parents at this age because they are dealing with the fact that their child might stutter for the rest of their life. Thus, parent counseling is a vital part of therapy as well.  The teen years often carry a sense of maturity and motivational factors, such as dating and academic expectations, that facilitate increased fluency.

When internal feelings are not explored, many people who stutter develop fears and avoidances.  They are afraid to order in restaurants, call 911 in an emergency or raise their hand in class.  A simple task that the general public doesn’t think twice about, a person who stutters often ruminates incessantly over.  Many listeners don’t know how to react to a person who stutters. They often laugh when a person hesitates to say their name or finishes their sentences for them.  Jokingly, they might ask if the person has forgotten their name.  The social and emotional effects can be devastating if not addressed early.  It is vital for any fluency program to not only address the physical behaviors of decreasing stuttering but also the cognitive restructuring of eliminating years of fears and avoidances.  Ideally, once people reach the teen and adult years more intensive therapy is recommended involving a combination of easy onsets, full breath breathing and continuous phonation of phrases and sentences.  Also, desensitizing one self to stuttering which often accompanies low self esteem is essential.  This might include educating their listener.

Adults who stutter often feel like failures in stuttering therapy.  I equate it to a child at an amusement park who is climbing that wobbly ladder to ring the bell.  Unfortunately, no one has taught them how to maneuver the ladder to reach the bell.  The child almost reaches the top only to be flipped off at the last minute.  Their immediate reaction is failure and disappointment.  They think, “What did I do wrong?”  In reality they weren’t prepared for the outcome.  Well, if a teen or adult who stutters is promised that they will be fluent at the end of a therapy program; they get as excited as that child reaching for the bell.  When they can’t achieve the goal, they feel like failures and want to crawl away.  However, it is not their fault.  No one told them that they have layers and layers of negative self talk and listener’s perceptions to unpeel.  No one told them they couldn’t ring that bell without intensive practice, positive self talk and proper tools.  No one told them that one day they would ring that bell with the proper guidance and strategies.  Similar to the child who couldn’t get their stuffed animal for ringing the bell, the adult lost their hope of communicating effectively. They need to know that if realistic goals are set, success will come. Success means different things to different people.  Some will continue trying to be as fluent as they can be while others want to be confident speakers whether they stutter or not.  It is important to explore this with your patients.

There are many successful approaches to treating people who stutter (PWS) and many successful people who happen to stutter.  Did you know Vice President Joe Biden stuttered as a child? PWS are doctors, lawyers, speech pathologists, teachers and even the vice president of our country.  The earlier therapy is received the better.  Although there is no magic cure to eliminate stuttering, there are successful ways to improve fluency and communication skills.  Information regarding these methods can be found at www.allislandspeech.com (Lori@allislandspeech.com).   Support and meeting others who stutter is important as well.  The National Stuttering Association (NSA) has a national convention and support groups around the country for people who stutter (www.westutter.org )

It is vital and often life altering to seek help from a speech pathologist who specializes in stuttering therapy.   Speech pathologists should be encouraged to refer out to a specialist if they are not comfortable treating this population.  Stuttering is a complex communication disorder.  However, with the appropriate speech therapy and attitudinal changes, lives can literally be changed.   Effective communication is integral in our society and help is available for people who stutter. Improving fluency is an achievable goal for PWS.  Let’s help them not suffer in silence.

(A Loss for Words-published first in Therapy Times Magazine. March 2010)

* 6 year old-We are so glad we brought our son to you as he entered kindergarten. You helped him learn how to learn so many new words and improve his spelling. Thank you Lori (parent of a 6 year old with reading and writing issues)