Stuttering

People who stutter know what they want to say, but have trouble expressing it fluently. Stuttering is a speech disorder that disrupts the flow of speech with repeated sounds, syllables, and words; prolonged sounds; and blocks (interruptions in speech). Some children also have eye blinks, breaks in eye contact, and tension in their lips, tongue, and jaw, when they stutter.

Some children stutter as they’re learning language skills. Most children outgrow stuttering, however, in about 1 percent of people, stuttering persists into adulthood (persistent stuttering).

Doctors don’t know what causes persistent stuttering. However, there are several features that make it more likely:

• Family history: Many people who stutter have a family member who also stutters.
• Age: Children who begin stuttering after the age of 3½ are more likely to continue stuttering.
• Sex: Boys are more likely to continue stuttering than girls.
• Time since onset: If a preschool-age child has been stuttering for more than 15 months, it is likely they will continue stuttering.
• Family recovery patterns: If a child has a family member whose stuttering has persisted, they are more likely to continue stuttering.
• Brain differences: Recent research has identified differences in how people who stutter process language compared to those who do not.

During their preschool years, children learn language at a rapid pace, and many have interrupted speech. These common speech disruptions are NOT symptoms of stuttering:

• Interjections: “I um… like to go to the uh park.”
• Phrase repetitions: “I like to I like to I like to go to the park.”
• Revisions: “I like to — I went to the park yesterday.”
• Abandoned ideas: “I like to… My friend’s name is Sam.”

Symptoms of stuttering in preschool-age children include:

• Whole-word repetitions: “I like to-to-to go to the park.”
• Part-word repetitions: “I li-li-li-like to go to the park.”
• Sound repetitions: “I like t-t-t-to go to the park.”
• Prolonged sounds: “I llllllike to go to the park.”
• Blocks: “I like (pause) to go to the park.”

Most children who stutter start before they turn 8. Many of the symptoms are the same as in younger children — repetitions, prolongations, and blocks — and can appear suddenly. Stuttering in this age group is often accompanied by physical symptoms:

• Eye blinks
• Arm and leg movements
• Tension in the jaw, lips, and tongue
• Sound insertions
• Breaks in eye contact

School-age children and adolescents are often more aware of their communication challenges and may therefore avoid certain social situations and school activities rather than risk stuttering.

If your child has symptoms of stuttering, it’s important to make an appointment with a speech-language pathologist (SLP). While many young children stop stuttering on their own, early intervention for stuttering can help children learn how to speak more fluently and may prevent persistent stuttering.

Bring your child for an evaluation with a SLP if:

• Your preschool-age child has stuttered for 6 months or more
• Your child starts stuttering in later preschool years (after age 4)
• Your child starts to stutter more
• You notice increased tension or struggle when your child is talking
• Your child begins avoiding social activities or says it’s too hard to talk

An SLP will listen to your child speak and look for signs such as:

• How your child’s speech is disrupted, and whether those disruptions follow a stuttering pattern
• How much your child’s speech is disrupted by stuttering
• How your child reacts when they stutter

The SLP will also listen to how your child pronounces words, how well they express their thoughts with language, and how well they understand other people.

Stuttering treatments for preschool-age children

Early intervention for young children can prevent stuttering from becoming persistent. Your child’s SLP may use both direct and indirect interventions:

• Direct intervention helps your child develop new speaking patterns. This type of therapy often works best for children who are aware of their stutter.
• Indirect intervention focuses on how you and other adults talk with your child. Strategies include speaking more slowly, asking fewer questions, and pausing before responding to something your child has said.

Stuttering treatments for school-age children and adolescents

Stuttering treatment for older kids typically teaches them how to manage their stutter for greater self-confidence and comfort in school and social situations.

• Fluency-shaping strategies teach new speaking patterns to help your child speak with greater ease.
• Stuttering-modification strategies help your child learn how to alleviate stuttering moments.
• Acceptance-based practices address any negative feelings and attitudes your child has about their stutter. This often includes facing speaking situations that make your child anxious. A support group can help your child connect with other people their age who stutter and introduce them to additional resources.

It is good idea to talk to your child’s teachers about their stutter and suggest ways for them to communicate effectively with your child. For young preschool-age children, you can suggest indirect strategies, such as speaking slower, increasing response time, and asking fewer questions.

If your child is school-age or an adolescent, it may help for them to talk with their teachers about their communication preferences. For instance, they may ask their teachers to only call on them if their hand is raised and to give them extra time during presentations. Some children who stutter benefit from giving a presentation on stuttering to their teachers and classmates.

There is currently no cure for persistent stuttering. While fluency-shaping and stuttering-modification strategies can help your child stutter less, they will not make persistent stuttering go away. As your child gets older, their therapy will include acceptance-based practices that will help them achieve their goals with a stutter.

The Speech-Language Pathology Program at Boston Children’s Hospital provides outpatient diagnostic evaluation and short-term therapy for children with communication challenges such as stuttering.

Some families seek our diagnostic services as a first stop in their journey. Others come to us for a second opinion about therapy or their child’s diagnosis. In all cases, the in-depth evaluation services we offer can lead to a more complete understanding of your child’s communication strengths and needs and help you establish a plan to address them.