Many misconceptions about stuttering have developed over the years. Treatment techniques have ranged from psychotherapy to ignoring the nonfluencies to saying, as the child is stuttering, "Slow down, take a deep breath, and think before speaking" (Bloodstein, 1981; Luper & Mulder, 1964). Teachers who have worked with children who stutter realize that none of these suggestions works. This article presents information about children who stutter, including a description of who is likely to stutter, the characteristics of stuttering, and techniques that preschool and elementary teachers can use in the classroom to help these students. Sources of additional information are also provided.

Approximately 3 million people in the United States stutter. Stuttering is more common in boys than in girls by a ratio of almost 5 to 1. The vast majority of individuals begin to stutter between the ages of 2 and 6 years; the mean age of onset is 5 years (Andrews et al., 1983).

Teachers working with very young children who stutter realize that many tend to be late in passing their speech and language developmental milestones. These children show a three times greater risk of speech sound errors than nonstutterers. In addition, reports of delayed language development are found more frequently in the case histories of children who stutter. More stuttering occurs on the first sound of the first word in a sentence, longer words, words that carry more meaning, and words that are used infrequently (Andrews et al., 1983).

The frequency and severity of stuttering varies from moment to moment and situation to situation. Children are more likely to stutter when talking with a partner who speaks much faster than they do; using long complex sentences; attempting less familiar vocabulary; talking to a nonattentive listener; speaking in front of a class; or when they are tired or excited.

Initially, children who stutter are no different intellectually or in personality from children who do not stutter. However, as stuttering persists or becomes more severe, it is not uncommon for a child to become socially withdrawn, shy, or anxious. These are reactions to the disorder rather than causal factors. Nevertheless, these reactions can make the problem worse.

Speech begins with a newborn's first cry and develops rapidly during the first several years of life. As children begin to explore their environment, they discover many new and complicated things to talk about and question. The desire to communicate is often far greater than the child's communicative ability. Young children are likely to experience problems with speech sound production, vocabulary, and sentence structure in the early stages of development. Word and phrase repetitions, hesitations, and phrase revisions occur frequently during this time. Sentences such as "Mommy, can I, can I, can I go outside, can I huh?" or "Mommy, Mommy, Mommy, Billy's ball is in, in the, in the yard and, and, and the dog (pause) ate it" are typical of young children. These nonfluencies occur as the result of confusing thoughts, uncertainty about the event, or a complicated sentence structure. This type of repetitive speech, if produced easily and without frustration, should not be of concern. In most cases, it is typical of the errors that occur in normal nonfluencies while good speech and language skills are developing.

Repetition of sounds and syllables; stretching or prolonging sounds; and speech that is accompanied by tension, struggle, or grimacing are of greater concern. Children who stutter seem to have trouble getting words started. They tend to repeat sounds or syllables rather than whole words or phrases. In addition, they frequently repeat portions of words two or more times before they are able to say what they want (e.g., "Ma-ma-ma-ma.ma-ma-mommy, I want a drink of water").

Children who stutter may also attempt to avoid certain sounds or words by using an unusual number of pauses in their speech, interjecting irrelevant sounds (e.g., "'um" or "ah"), substituting one word for another, or repeating inappropriate or unnecessary phrases. These avoidance behaviors are typically used in an attempt to speak more fluently

Another distinction between normal nonfluency and stuttering is the presence of physical tension in the face, neck, or upper body of the child who is having difficulty speaking or a sense that the child is forcing words out. When children stutter they may attempt to push through the non-fluencies by averting or blinking their eyes, jerking their heads, grimacing, or moving their extremities. Attempts to speak during periods of excitement, fatigue, nervousness, or more formal situations such as talking with an adult are likely to increase the amount of difficulty a child is experiencing.

There is no easy treatment for stuttering, because the causation, type, and severity of nonfluencies vary from child to child. In addition, some children are unaware of their nonfluencies. Although others are aware, they are comfortable with their speech and enjoy participating in classroom discussions. Many are self-conscious at a very early age and fear speaking aloud. Despite this variability, teachers can significantly help a child who stutters by enhancing the child's fluency. This can be accomplished by providing a good speech model, improving the child's self-esteem, and creating a good speech environment.

Provide a Good Speech Model

1. Reduce Your Rate of Speech - Parents of children who stutter speak significantly faster than parents of children who do not (Meyers & Freeman, 1955; Starkweather & Gottwald, 1984). Young children often imitate the speech rate of their parents and other significant adults in their environment. This rate may be inappropriately fast for the child's motoric and linguistic competencies. Slower speech will provide the child the time needed to organize thoughts, choose vocabulary and grammatical form, and plan the speech act motorically.
2. Create silences in your interactions. - Pauses, placed at appropriate places in conversation, help create a relaxed communication environment, a slower rate of speech, and a more natural speech cadence. Pause for 2 to 3 seconds before responding to a child's questions and statements. In addition, insert pauses at appropriate times throughout longer utterances.
3. Model simple vocabulary and grammatical forms. - Stuttering is more likely to occur in longer words, words that are used less frequently, and more grammatically complex sentences. When a child is experiencing a great number of nonfluencies, simplify language structures and restate the child's complex utterances.
4. Model normal nonfluencies. - If you are highly fluent, you may need to make a conscious effort to use normal nonfluencies such as interjections ("um" or Ňah"), or an occasional whole-word repetition, phrase repetition, or pause. Children should be aware than even fluent speech contains nonfluencies. This will help them accept nonfluencies and reduce the fear of speaking.

1. Disregard moments of nonfluency. - Create a positive communication environment by reinforcing moments of fluency and ignoring nonfluencies. Do not give instruction on how to be fluent. Saying "Slow down", "Take a deep breath" or "Stop and start over" implies that the child is not doing enough. This might increase guilt and diminish self-confidence.
2. Show acceptance of what the child expresses rather than how it is said. - Ask the child to repeat only the parts of the utterance that were not understood rather than those that were nonfluent. This indicates that you did listen and that it is the message that is important. Occasional rephrasing of what the child said focuses attention on content rather than production.
3. Treat the child who stutters like any other child in the class. - Do not reduce your expectations because of the nonfluencies. The child who stutters should be expected to perform all class-room assignments, although additional time may be needed for oral presentations. Take the child aside and talk about oral presentations, answering questions aloud in class, and ways you can help.
4. Acknowledge nonfluencies without labeling them. - Do not refer to the problem as stuttering. Instead, use words that the child uses to describe his or her speech such as "bumpy" or "hard." Assure the child that it is okay to have nonfluencies, everyone does.
5. Help the child feel in control of speech. - Follow the child's lead in conversation. Speech will more likely be fluent if the child can talk about areas of interest. Furthermore, avoid excessive questioning. Demands for speech may lead to the attitude that language interactions are "tests." In such situations, the child may feel a loss of control.
6. Accept nonfluencies. - Be aware of negative bias (i.e., being overly concerned about normal nonfluencies because you see the child as a stutterer). The child may develop a fear of speaking if he or she perceives anger, frustration, or embarrassment in the teacher. Maintain eye contact and remain patient. Avoid answering questions for the child or ignoring the child's comments.

1. Establish good conversational rules. - A child who stutters needs adequate time to formulate ideas and plan utterances motorically. Interruptions may distract the child and increase the nonfluencies. Therefore, ensure that no one interrupts and that everyone gets a chance to talk.
2. Listen attentively. - Do not react inappropriately. Listen to the child's speech and avoid absent-minded "uh-huhs". Active listening lets the child know that content is important. The child must perceive your response as sincere. Therefore, use naturalistic comments (e.g., "Yes Johnny, that is a large blue truck") in place of generic statements (e.g., "Good talking!"). This shows full acceptance of what the child said.
3. Suggest that the child cease other activities while speaking. - It is sometimes difficult to perform two different motoric acts such as coloring and talking simultaneously. Asking the child to stop other activities while speaking may improve fluency. In addition, reduce demands for speech during times when the child is required to perform other tasks, such as during art class, gym, and recess.
4. Prepare the child for upcoming events. - Stuttering is likely to occur when the child is excited. The emotionality of birthdays, holidays, field trips, and changes in the daily schedule may cause apprehension and increase stuttering. Discussing upcoming events can reduce the fear associated with the unknown and should enhance the child's fluency.

A speech-language pathologist should be contacted when a child exhibits signs of stuttering or when the parents are concerned about speech fluency. Seek this referral immediately; waiting to see whether or not the child will "outgrow" the stuttering is seldom beneficial. While some children who stutter get better without help, many do not. Early intervention may prevent the child from developing a severe stutter. In its initial stages, stuttering can almost always be treated successfully by teachers, parents, and speech-language. pathologists working together. Generally, the earlier intervention is begun, the shorter the therapy program (Stark-weather, Gottwald, & Halfond, 1990). Contact the American Speech-Language Hearing Association for more information about stuttering. The staff will provide a list of professional services for most geographic areas, as well as bibliographies. The toll-free number is 1-800-638-TALK (8255). Additional information may be obtained by writing the Speech Foundation of America (P.O. Box 11749, Memphis, Tennessee 38111) or by calling The National Stuttering Project (1-800-346-1NSP) or the Stuttering Resource Foundation (1-800-232-4773). These not-for-profit organizations publish excellent brochures and informative newsletters about stuttering.

Bloodstein, O. (1981). A handbook on stuttering. Chicago: National Easter Seals Society for Crippled Children and Adults.

Luper, H.L., and Mulder, R. L. (1964). Stuttering therapy for children. Englewood Cliffs, NJ: Prentice-Hall.

Meyers, S.C. and Freeman, F. (1985) Interruptions as a variable in stuttering and disfluency. JSHR, 28, 436-444

Starkweather, CW and Gottwald, S. (November, 1984). Parents' speech and children's fluency. Paper presented at Annual Meeting of the American Speech-Language-Hearing Association, San Francisco, California.

Starkweather, CW, Gottwald, SR and Halfond, MM (1990). Stuttering prevention: A clinical method. Englewood Cliffs, NJ: Prentice-Hall.