Speech articulation and language development are the most common communication topics I am asked about by fellow parents who know I am a Speech-Language Pathologist. However, I also receive a fair number of questions about childhood speech disfluencies, especially from parents of preschool-aged children.
Fluency, in the most simple terms, is how smoothly one speaks. It is not uncommon for someone to ask me ‘Is my child stuttering?’ or ‘My child keeps getting stuck on words when speaking; is this normal?’
When I respond to these questions, I answer cautiously; the answer is not simple in every case. I am able to give parents and caregivers general ideas about when I might be more concerned about language disfluencies and when I might not, but if your gut is saying there might be something wrong, request a speech and language evaluation through your school district.
Disfluency is likely not something addressed in early intervention because it is difficult to diagnose before three years of age, and even at age three or four, it can be tricky to diagnose. However, it is always your right as a parent to request an evaluation. Whatever the result, if something needs to be addressed it will be, but, if everything seems normal, you can relax.
The information I will share here is important because many caregivers and parents believe their child is stuttering when that may not actually be the case.
Not all preschool-aged children who are disfluent stutter.
Preschool-aged children typically develop their speech and language skills and are in a phase of their lives where they are learning an astounding amount of vocabulary and grammar every single day. Between the ages of two and five, children are expected to grow from using simple two-word utterances to understanding and using thousands of words in sentences. Their little brains do a lot of learning and using their new skills.
Think about all of the work your brain has to do when you communicate: you formulate a sentence, and make sure it has all the correct vocabulary, grammar, etc. Before you speak, you think about how you’re going to present your message (based on social aspects), and your brain gets ready for all of the motor movements involved in making the sounds you need. Once you’ve communicated the sentence, and your communication partner has responded, your brain processes the sounds you hear so you can interpret and understand their message. Then, you have to go right back to formulating yet another sentence.
Now picture a little brain having a ‘language explosion’ trying to do all this while applying constantly expanding new vocabulary and other language knowledge, and it’s no wonder some preschool-aged children end up repeating some words over and over again or using a lot of fillers like ‘um’ or ‘like’ before they move on.
Sometimes their mouths move so fast that their developing brains cannot catch up. In many cases, this may look like your child is stuttering, but it is not truly a problem. It is not abnormal, and many kids grow out of this phase.
That said, when I’m asked about a preschool-aged child’s speech fluency, there are signs that your child is stuttering and that a formal evaluation should be completed.
Again, it’s important to understand that disfluency in preschool-aged children does not always mean stuttering. Remain calm, don’t jump to conclusions, and take in information and results as they come.
Prior to formulating an opinion about whether a fluency evaluation is needed for a child stuttering, I ask parents or caregivers the following questions:
- Is there someone else in the child’s family (adult or older child) who stutters?
If there is, it is likely that the child may actually be stuttering; there is evidence that an individual is more likely to stutter if another family member does. In this case, I will tell a parent or caregiver to request a speech and language evaluation.
- How long has the child been displaying what the parent thinks is stuttering-like speech?
If it’s been going on for 4-6 months or more, I am more concerned about it than I am if it is a recent or short-term development. I don’t make any assumptions based on the length of time I am given, but I do take it into consideration before I make a recommendation.
- Does the child seem aware of or frustrated by their disfluencies? Do they prevent the child from wanting to talk?
Most children who are preschool-aged won’t have any idea that they are having fluency issues, but there are some children who may be very aware and which can create additional struggles. If the child is aware of their disfluency, I recommend not calling extra attention to it; this will likely make it worse.
- How much is the child “stuttering”?
I also consider the AMOUNT of “stuttering” a parent or caregiver reports their child to be displaying. I have them give me an estimate; if I had the child play with me and I looked at ten sentences, how many of those sentences does the parent think their child would get stuck on, or how many would be bumpy? Three? Eight? Honestly, even if the parent told me that the child had a lot of the signs of normal, age-appropriate disfluencies- but was not stuttering, I might still tell them to request an evaluation sooner rather than later if their answer was seven or more out of ten because it was happening so frequently.
After that, I usually ask some specific questions about what the supposed stuttering is like. I try to figure out if the child is displaying more typical fluency issues versus ones more indicative of stuttering.
Some typical disfluencies present in the speech of preschool-aged kids include:
- Repetition of entire words or phrases
- Common use of fillers, like ‘uh’ or interjections like ‘ah’ or ‘oh’
- Going back and trying again, maybe revising a word in the phrase they are trying to say so it still holds meaning
Speech patterns that are atypical and therefore more concerning include the following:
- Repetition of sounds or syllables of words (i.e. ‘bu-bu-bu-bubble’)
- When a child can’t even get part of a word out even though they are trying; it may seem like the word is in their throat and they are groping for it to come out
- Sound prolongations, or holding the first sound in a word for longer than they should before the rest of the word is articulated (i.e. ‘ffffffind’)
Asking parents about these signs of childhood disfluencies also plays a part in helping decide whether a child is in need of an evaluation but, still, the answer may not be clear.
Overall, I tend to recommend an evaluation be done for a child with speech and language disfluencies if:
- An older child or adult in their family stutters
- They seem to be producing atypical speech fluency patterns (described above) versus the more typical ones
- A caregiver or parent tells me that the disfluencies are frequent, happening 70% of the time or more
- The child is aware of or frustrated by their bumpy speech and fluency issues
- A parent tells me that the communication disfluency has gone on for more than 4-6 months
In most cases, I tell a parent it’s okay to wait a month or two to see if the issues resolve if ALL of the following are true:
- There is no family history of stuttering
- The child is producing typical patterns of disfluency instead of the atypical ones
- The child seems unaware of their disfluencies
- The child is displaying disfluencies less than 70% of the time
- The parent didn’t notice the disfluencies until pretty recently (less than 4-6 months)
Sometimes, I get a mixture of answers which might lead me to say I could go either way. I am honest with the parent or caregiver and tell them exactly that and often recommend the evaluation anyway out of caution.
As an SLP, my job isn’t just to evaluate children for speech and language disfluencies. Whether I determine that a child needs further professional evaluation and help or not, there are other things I recommend that parents do to help their child with their speech, such as:
NOT calling attention to a child’s speech disfluency.
Just wait, as unphased as possible, until the child finishes getting their message out. This includes not asking them to say something again, or to slow down, not interrupting them, and staying present in the conversation. These actions only put pressure on the speaker which usually causes them to be more disfluent or display even more tension while trying to speak.
Slowing down your own speech when talking to your child.
I don’t mean that adults should slow their speech to the point where it’s unnatural and they sound like a robot, but everyone should be aware of how fast they are speaking.
When people are excited or have a lot to say, they tend to increase their rate of speech, and some people have a rapid rate of speech no matter what their emotions are. Slowing your speech when you speak with a child, especially one with speech disfluency, puts less stress on their brain when they are processing what you said. Speaking slowly also provides a good model while not calling direct attention to the child’s struggles.
Limiting the number of questions you ask your child in conversation.
You can still ask a question or two or make comments and see how your child responds, but asking question after question can be stress-inducing and puts unnecessary pressure on your child when they are speaking, which doesn’t help fluency.
Building their confidence.
This is something you should be doing with any child, but maximize your attention to this if you have a child who is disfluent or who stutters.
Self-esteem issues are common in individuals who truly stutter. Stuttering isn’t something that can be cured; in therapy, individuals are taught strategies to help them speak as fluently as they can. Therapy also focuses on creating can-do attitudes towards speaking and holding conversations. As a parent, you can start building positivity in your child before they ever attend a therapy session. Make it a point to praise your child for working hard at school, being a good friend, sharing toys with a sibling, helping out at home, being a good teammate, or for any skill they are excelling at or have put solid effort towards.
As a parent of two, I know how difficult it can be to determine when and if you should be worried about your child’s speech and language development; both of my children had challenges that prompted me to turn to our local Early Intervention program for help. I understand what it’s like for parents who are concerned about a child stuttering.
Hopefully, I’ve given you some food for thought if you’ve been wondering if your child is stuttering to help you make a more informed decision. You know your child better than anyone else, however, so I encourage you never to be afraid to seek more information or request an evaluation for your child when you feel you should.
For more information on childhood disfluencies and stuttering, you can visit:
- The Stuttering Foundation’s Website at https://www.stutteringhelp.org
- The following article specifically targets the preschool population: https://www.stutteringhelp.org/content/parents-pre-schoolers
- The American Speech-Hearing and Language Association (ASHA): www.asha.org/public , and their publications ASHA Leader and ASHAWire, where this article can be found: https://leader.pubs.asha.org/do/10.1044/how-can-you-tell-if-childhood-stuttering-is-the-real-deal/full/
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