Children who stutter present puzzling problems to parents and teachers. Parents wonder what can be causing the breaks in fluency. They wonder too, why the difficulty varies so much. On some days, and sometimes for weeks, little or no trouble is apparent. Then, suddenly, the speech of some youngsters is filled with long series of repeated words or syllables, noticeable facial contortions or even more unusual evidences of strain and effort. Adults are unable to understand why a child at times becomes shy and may even refuse to talk to some individuals while with others converse freely. And, occasionally, parents understandably are puzzled by the report of a teacher that their child, seldom if ever observed having trouble at home, has a stuttering problem in school.
When the classroom teacher is confronted with a student who stutters, the teacher often does not know how to react. Sometimes in an honest effort to help, teachers are often perplexed because a stuttering child becomes more shy, less talkative and responsive to their efforts and the speech interruptions become more frequent and pronounced. Would it be best to supply words as soon as any stuttering commences? Should the teacher reassure that it doesn't matter that the student has trouble when reciting? Should the student be excused from oral presentations and oral responses and be allowed to do extra written assignments? Or, is it best to ignore the stuttering altogether and pretend it just doesn't exist?
Although a great deal of research has been done in the area of stuttering, we still do not know why some children stutter, or why most children become fluent speakers while others become adult stutterers. We do know however, that the environment plays a very important role in determining how students who stutter feels about themselves, and how their speech will be affected by certain situations.
Given these facts, it is very important for teachers and educators to examine the school environment and determine how it might be affecting the student who stutters. For example: Are classroom expectations unrealistic? Is the student feeling pressure from teachers, family or peers? Is there some area of school life particularly affected by the student's speech problem? Are teachers and/or peers embarrassed by the student's speech? Can the student sense everyoneÕs discomfort? Is the student treated differently because of the speech problem?
A student who stutters should be assessed by a registered Speech-Language Pathologist either at school, in a local hospital or health centre, or at a private practitioner's office. These professionals are qualified to manage stuttering in children and adults. They can help the student deal with stuttering and assist teachers, parents and all those involved with the student to understand and deal most effectively with the problem.
This booklet is written especially for teachers and educators in the hope of providing useful information about stuttering. Teachers can do a great deal to help the student who stutters. It is estimated that 1-2 % of school-aged children stutter. The teacher's attitude about stuttering and the example that is set in the classroom will influence to a large extent, the attitude of the other students and it will determine how students who stutters reacts to their own speech.
Before trying to help the student who stutters, it is important to learn as much as you can about stuttering - to be forewarned about common superstitions, to learn how speech develops normally, and to learn about how true stuttering develops. You should become aware of the types of conditions in the classroom, home, and/or neighbourhood that promote stuttering, and understand the types of conditions in the student's environment that promote fluent speech. With this kind of information in hand, teachers and educators can make a more informed decision about the kind of corrective measures they should use and most importantly, the kind of attitude they should develop toward the student who stutters and stuttering as a speech problem.
Communication is a very complex process and one that is crucial for academic success. The student who stutters can't always communicate effectively. Like all children, the student who stutters spends a large part of the day in school, and the attitudes of their teachers and educators can have a profound effect. With sensitivity and understanding, the teacher can reduce communication stress in the classroom, help students who stutter accept themselves as a valuable members of the class, and give much needed confidence and success in speaking situations. Further information on stuttering and treatment options for the student who stutters can be obtained from the school's Speech-Language Pathologist by contacting the Metropolitan Separate School Board, Speech and Language Department, at 222-8282, ext. 2261.
Stuttering (or stammering) is defined as any disturbance in the flow and time patterning of speech. These disturbances may include one or more of the following behaviours:
part or whole-word repetitions (e.g. pa-pa-paper)
phrase repetitions (e.g. what is-what is- your name?)
sound prolongations (e.g. f-f-f-flower)
broken words (e.g. ha-ppy)
interjections (e.g. um, uh, like, you know)
words produced with too much tension
circumlocutions (i.e. talking around a certain idea)
any form of struggling behaviour associated with speech production.
Occasionally, stuttering arises in an older child or even an adult. It may follow an illness or an emotional event. It may also occur following brain injury due to stroke or a head injury, however, these instances are rare. For the majority of children, the cause of stuttering is not known.
Although stuttering can begin quite suddenly, it usually develops over a period of time and follows an unpredictable pattern. The child's speech difficulties can disappear for weeks or months only to return in full force.
All individuals who stutter can speak fluently some of the time. Most can also whisper smoothly, speak in unison and sing with no hesitation. Most people who stutter can also speak easily when they are prevented from hearing their own voices, when talking to pets or small children, and when addressing themselves in front of a mirror. All these instances of fluency suggest that nothing is basically wrong with the speech mechanism of the student who stutters.
Students who stutter generally experience their worst moments under conditions of stress or emotional tension. Situations that are generally associated with increased stuttering include speaking in front of a group, answering questions in class, and speaking on the telephone.
Stuttering does not occur equally among the sexes. Boys are four times as likely as girls to be stutterers. The reason for this is not known.
Hereditary factors play some role in stuttering even though genetic transmission from one generation to another has not been proven. Stuttering has been found to run in families. Children with a first degree relative who is either an active or recovered stutterer have a slightly greater likelihood of stuttering than the normal population. Nonetheless, environmental influences also play an important role in some if not all onsets of stuttering.
Stuttering does not come from imitating other stutterers. Although children often imitate differences they notice, imitation alone does not cause stuttering. If a family member or friend stutters, a child may - for a time - imitate the unusual speech pattern. In time the child will stop imitating the stutter and speech will again become fluent as long as no one displays anxiety or discomfort or draws attention to it. If others become anxious for fear that the child will become a stutterer, the child may also become anxious and self-conscious about speaking. True stuttering might then result - not because of imitation - but because of the anxiety and tension around communication created between the child and family members.
The intelligence of stutterers is in no way inferior to that of non-stutterers.
Emotional problems do not cause stuttering; however, stuttering may cause emotional problems.
It is estimated that 3-4% of preschool children and 1-2% of school-aged children stutter. Of these, approximately one half will outgrow their stuttering by early adulthood.
Unfortunately, it is not possible to determine who will recover and who will continue to stutter into adulthood, therefore, it is recommended that all children who stutter be assessed by a Speech-Language Pathologist. In Ontario, Speech-Language Pathologists should be registered by the provincial organization O.S.L.A. (Ontario Association of SpeechLanguage Pathologists and Audiologists). These professionals are employed by the Metropolitan Separate School Board. They also work in hospitals, public health and community programs and in private practice.
What teachers call stuttering is sometimes normal nonfluency. A young child who repeats a s-s-sound or syl-syl-syllable or word like-like-like this is not necessarily stuttering. The repeating, pausing, backing up, holding on to sounds and general confusion of "thinking and talking" are normal and may reflect some of the speech and language hurdles that all children must conquer while mastering oral language.
Kindergarten and primary school teachers have likely met young children who display normal nonfluency. In their haste to express their thoughts and needs, the speech of young children sometimes contains repetitions and prolongations which may sound like stuttering. Although some of the characteristics of stuttering may be present, this is not true stuttering.
All those involved with the child should be aware that a certain amount of nonfluency is to be expected in the speech of young children. The average child between the ages of two and seven years repeats sounds, words and phrases 45 times for every 1000 spoken words.
There are positive ways to react to a child's normal nonfluencies. It is important that the teacher not show any concern or anxiety over the child's speech. The student should be given all the time needed to talk and the teacher should not interrupt or ask the student to repeat the nonfluent sentence.
Normal nonfluencies in a child's speech may also reflect attempts to cope with the increasing linguistic demands in the classroom. Research has shown that more normal nonfluencies occur when children try to use complex as opposed to simple language structures. However, such nonfluencies tend to decrease as the child's language skills improve. Teachers should therefore be sensitive to the interplay between language complexity and a young student's level of fluency. The complexity of language used by the teacher, and that expected from the students should be considered and adjusted accordingly in order to reduce communication stress. A concise, and structurally simple language model will be easier for the normally nonfluent student to copy.
It is impossible to identify any single factor as the cause of stuttering. In fact, it is felt that the difficulties in talking from which a severe stuttering problem can develop are caused by several conditions or circumstances.
Although stuttering sometimes begins quite suddenly, it usually develops over a period of time. The usual onset is between the ages of two and seven - ages at which all children hesitate and repeat in their speech, even as adults do. In homes and classrooms where no concern is shown about these repetitions, the likelihood is that the child's speech will develop normally. If unusual attention is given to these natural nonfluencies, the child may also become concerned about speaking and stumble over sounds and words even more so. This in turn increases the parents' and teacher's anxiety, and a vicious cycle is begun.
Even though a certain amount of hesitation and repetition is normal in children's speech, some experts believe that this normal nonfluency may be aggravated by fear, unattainable standards of performance, and emotional pressures.
Some children are expected to perform on a level above their ability. Perhaps it is from the desire to acquire adult speech, to talk in phrases and sentences before the skill of talking has had time to mature, that most stuttering starts. Fluent speech is very important in our society and the struggle to obtain fluency may be too great for some children in an environment complicated by busy parents, talkative brothers and sisters, and the new experience of school.
A home environment may be disturbing to the normal development of speech in other ways. Homes in which parents quarrel and living is a constant battle, or homes in which discipline is too strict, too lax, or inconsistent are homes which make for basic insecurity that may well be reflected in the child's speech.
Because of their particular personalities, some children are less able to handle the ordinary problems associated with growing up. For them, hesitant nonfluent speech may be the result of their trying too hard to be perfect. Such children may feel the pressure from within themselves rather than from their environment.
To summarize then, stuttering is a complex problem. Biological, environmental and emotional factors may contribute to the problem; however, despite extensive research in this area, a definitive cause of stuttering has not been identified. A certain amount of hesitation and repetition is normal in children's speech. This normal nonfluency may be aggravated by fears or unattainable standards of performance. Depending on their individual personalities, children cope with these obstacles to their normal speech development with different degrees of success. However, if these nonfluencies are given undue attention or arouse excessive anxiety in the teacher or parent, a more serious speech problem may result.
There are certain pressures which tend to make all of us more nonfluent and the student who stutters may be especially vulnerable to them. The following list includes a number of these. Elimination or reduction of these pressures may minimize the occurrence of dysfluent episodes in a stutterer's speech and increase the likelihood of fluency.
1. Listener Loss: When listener' attention is lost, the student will often keep repeating a word until attention is regained. Therefore, when a student is talking, listen carefully to what is being said.
2.Interruptions: We all feel annoyed and frustrated when we are interrupted before we have finished what we are saying. To reduce this pressure, as far as possible, allow the student to finish talking without being interrupted.
3. Many people become more nonfluent when they have to compete for speaking time. DonÕt let the most vocal students do all the talking; give everyone a chance to speak.
4.Time Pressure People tend to become more and more nonfluent as they have to talk increasingly faster. Therefore. when possible, try to avoid making the student who stutters feel hurried. Speed drills and oral accounts from memory may be useful learning stimulants, but they may also be too pressing or embarrassing for the student who stutters. Try to keep your own speech as calm and unhurried as you can. Children need a good speech model.
Display Speech: Most people become nervous when asked to speak before an audience. Most nonfluent children have more difficulty speaking in front of the classroom than they do in a one-on-one situation or in a small group format.
6.Demand Speech: Sudden, unexpected questions often cause individuals to hesitate or falter in their speech. Avoid asking the student who stutters unnecessary questions such as: "Why did you get your shoes muddy?", "Just what do you think you're doing?" etc. Also, avoid asking the stutterer to report an unpleasant experience or to confess a wrong-doing of which you are already aware.
7.Natural Emotions: Fear, anger, grief, humiliation and frustration can cause speech disruption. When possible, don't encourage the student with a speech problem to talk while experiencing these emotions. You can show that you understand by verbalizing the student's feelings (e.g. "That loud noise scared you.", "You were angry when you couldn't keep that toy." etc.). This will minimize the disruptive influence of these natural emotions on the student's speech.
8.Excitement: When excited or overwrought, the student who stutters often experiences more breaks in speech. Therefore, try to limit unnecessary over-stimulation. A calm classroom environment helps a young student in adjusting to the experience of school.
The following is a list of practical suggestions to help teachers and educators manage a student's stuttering. These have been shown to minimize the occurrence of nonfluent episodes in other children's speech. Some have already been mentioned in previous sections of this booklet, however, they are worth reiterating because although easy to learn, these corrective measures are not always easy to carry out. They demand real effort, understanding, persistence, and patience over a long period of time. These measures may even require serious consideration of the classroom routine and the ways that teachers relate to their students.
1. Help the student who stutters in every way possible to feel like a normal and adequate student.
2. Be ready to make reasonable changes in the classroom environment to facilitate verbal communication. The student cannot make these changes alone. These changes can be implemented within the context of the regular classroom schedule.
3. Be a good listener:
Show interestin what the student is saying not how the student is saying it.
Do not interrupt.
Do not constantly criticize what the student is saying.
Accept a certain amount of nonfluency in every speaker's speech.
5. Do not fill in words when students who stutter are "stuck". By doing so, you provide a crutch and increase their feelings that they cannot talk for themselves.
6. Reduce communication stress:
Reduce competition in speaking. It is polite to take turns speaking.
Allow the student ample time to speak.
Part of being a good communicator implies being a good listener as well.
7. Be aware of your own speech. Speaking slowly will encourage the student who stutters to slow down. If you speak too rapidly or with language structure and vocabulary that is above the student's level of comprehension, you are setting unrealistic goals and causing frustration when the student attempts to respond to you verbally.
8. If the student is having a good day with very little stuttering, try to provide speaking opportunities to experience success: e.g.
call on the student more often (e.g. when the student raises a hand) and listen carefully and attentively to what is being said.
10. Since most students who stutter talk fluently at times, do not publicly praise them unduly for their fluency as this may serve to remind them of their previous nonfluencies, and will likely cause them to be more embarrassed the next time they stutter. All children need and deserve praise, therefore, supply it for things other than fluency.
11. On days when speaking is difficult, try to plan activities which minimize or do not require speech.
Try to give chances for leadership in recreational activities.
Try to assign definite classroom duties which do not require speech responses.
13. Don't refer to a student as a "stutterer", especially in the student's presence. Think of the student as a normal child who is presently having difficulty talking.
14. Call as little attention as possible to the stuttering of a young child who may not be aware of the speech problem.
15. Don't protect a student who is conscious of stuttering by pretending not to notice it.
16. Do not react emotionally to stuttering. Do not show embarrassment, impatience, or anxiety.
17. If a student asks about stuttering, be open, calm and accepting. Say that you have noticed the student's speech, but that everyone finds it difficult to talk at times. Try to be honest and objective without calling adverse attention to the stuttering.
18. Help an older student develop an objective attitude. Older students who may be embarrassed by their speech problem sometimes appreciate a heart-to-heart talk with the teacher when other students are not present. At such times, try to explain that it doesn't really matter how individuals talk, and that your student should not be concerned about it either.
19. Do not insist that the student try not to stutter. This may lead to greater attempts to force through the block and may increase secondary symptoms.
20. Don't teach the student any tricks or devices which you have heard may help speaking easier (e.g. slowing down, repeating, relaxing, stopping, thinking before speaking, taking a deep breath, speaking to a beat etc.). Some of these techniques have helped children who are coping with grammatical inconsistencies or experimenting with new words. Some of these techniques may also help briefly, but shortly the student may find that they are no longer helpful and may seek other devices. In time, the student will likely develop a bizarre pattern that includes these secondary behaviours when experiencing a speech block.
21. Help those who tease and mimic students who stutter to understand that they are not good at doing everything either and that as they grow, they become good at many things that were once difficult.
22. Do not place students who stutter under unnecessary time pressure. If a student is working or talking as rapidly as possible, the problem will be complicated when rushed further. Speed drills and oral recitations may be useful learning stimulants, but they may also prove to be too pressing and embarrassing for the student who stutters.
23. Avoid going "up and down the rows" for calling on students. When a student who stutters knows turns are being taken in order, this creates more anticipation and tension. If this practice cannot be avoided, try to arrange that the student who stutters be one of the first students to respond. (Alphabetical roll-calls would present a similar problem for the student.)
The following are answers to questions that teachers have asked about dealing with the student who stutters in the classroom.
1. What should I do when a student in my class stutters?
Listen to what is being said, not how it is being said. Let the student take all the time needed to make a point. Never supply words or finish sentences for the student. Don't ask the student to "slow down" or "relax" - you will only draw attention away from the topic to the speech difficulty.
2. Should I talk to the student about stuttering?
If the student seems to be experiencing bouts of normal nonfluency or does not seem to be aware of the nonfluent speech, do not comment on it. Don't ask for repetition of the sentence, to stop and start again, or to take a deep breath.
It will be important for you to show no anxiety or discomfort while the student is stuttering. Children are very sensitive to adult reactions, and a negative reaction (verbal or nonverbal) from you could result in increased dysfluency on the part of the student.
If, however, the student is clearly struggling to talk and is unhappy or frustrated, it is unrealistic to ignore the situation. The student probably knows about the difficulties and if you ignore it, it may make the student feel the problem is so serious that it can't even be discussed.
Speak to the student quietly and privately. Don't use the term "stuttering" unless the child does, but refer to the fact that you know sometimes it is difficult to "get words out". Ask how the student feels about this and assure that it doesn't affect your feelings for the student. Help the student understand that you are interested in what is being said, and not how it is being said.
By the fifth grade, the student usually is aware of difficulties talking in the classroom and to peers. A great deal of oral participation is required at this level, and this will almost certainly cause anxiety and fear in the student who stutters. A private discussion will probably serve to reduce this fear and anxiety immensely. You will want to tell the student that you recognize the difficulty, but reassure that you want participation in class because you are interested in ideas and thoughts, and that you won't push. Encourage the student to talk with you about problems and try to develop a solid relationship. The student who stutters needs to know that someone will listen to feelings and fears.
3. Sometimes the student's speech is very fluent, and other times it is quite severe - why does it change?
Most of the time, a student who stutters will have more fluent than nonfluent speech. Speech will probably deteriorate during periods of tiredness, anxiety, worry, or uncertainty. The student may be less fluent when talking to an authority figure (e.g. teacher. principal. adult), than when talking to a peer. The student may have more difficulty speaking in front of a class than in a small group setting.
Amount and severity of stuttering is affected by the situation and the alert teacher can help structure the school environment so that the student will encounter more success than failure. For example, avoid asking questions on a day when speaking is difficult for the student, but do capitalize on a good day. The student's confidence will increase as more fluency is experienced.
4. Should I excuse the student from oral presentation of projects or reports?
Excusing the student who stutters from oral classroom work may result in momentary relief, but the next time such a situation is faced, the fear and anxiety will be even greater.
We all feel better once we face a feared situation, and the student who stutters is no exception. When you speak. explain that excusing the student from oral assignments wonÕt help, because eventually the student will have to learn to speak to a group.
To make things easier you might suggest some of the following:
tape record part of the presentation. (People who stutter are usually more fluent when they talk with one person, or speak into a tape recorder in the privacy of their own home.)
arrange for the student to meet with you two or three times before the presentation day for "rehearsal" - Once the student knows you are on the same side, anxiety will lessen.
Students with severe stuttering problems might be given the opportunity to do the first few oral presentations privately in front of the teacher, the next few in front of a small group, and gradually work up to presenting in front of the entire class.
None of the above suggestions would be pampering the student who stutters. Remember how fearful of speaking the student will be. Remember also, that through your efforts, speech may become a less feared and more rewarding experience. Improvement in any activity only comes with practice and a student needs practice in oral work to alleviate her fears.
5. Since much of the French program is oral, how can I grade a student who stutters or is very hesitant to speak?
Students who stutter have difficulty in any activity which involves speaking to a group. Imagine how much more difficult it must be to try and speak in a language which is unfamiliar in both vocabulary and syntax.
Encourage class participation, and ask questions that you know the student can respond to. If by the end of the term you are unsure of this ability, speak with the student privately for half-an-hour to assess these skills. If you still feel that the student might have more facility than is shown to you, tape record questions and set a reasonable time limit to record the answers.
Remember that stuttering is a speaking problem, not a learning problem. Anxiety, fear and tension may work together to prevent the student from being able to express what is known.
6. Should I discuss the stuttering problem with the student's other teachers?
It is important that the rest of the staff (especially those involved with the student and the guidance department) be made aware of the problem. Help everyone to realize how this speech problem might affect the student's work in their class.
7 How can I prevent the rest of the class from laughing or teasing the student who stutters?
Often, very young children don't take too much notice of differences between themselves and their peers. By grade one though, there may be problems with teasing and imitating. Some teachers have introduced the topic of individual differences to the class. They have asked each student, and themselves, to reveal a trait or habit which makes them different from the others. Emphasize the idea that we are all different and that these differences make us more and not less valuable.
If the student is clearly upset by the teasing, discuss this privately and quietly - at a time when the student will not feel punished (e.g. don't keep the student in at recess for a chat). Tell the student that you know about difficulties with certain people in the class. Help identify those few who are teasing and also help to recognize that most of the class is on Ōthe student's side". Let the student know that you are available for more talks. Assure the student that you don't regard the stuttering as a problem, and that you are really interested in what the student has to say.
To increase self-confidence, consider making the student your "helper". Maximize and praise skills and achievements - be it in art, math, or simply neatness. Teasing may be a very difficult problem and one which is not easily solved in the upper grades. It will depend a great deal on the personality of the student. Probably the most helpful and positive move would be for the student to speak to the class about the problem. Most children respond sensitively when a problem is discussed openly, and many Speech-Language Pathologists encourage students who stutter to discuss the problem openly with their peers.
A classroom discussion of individual differences with personal input from everyone may also prove beneficial in the intermediate and senior grades.
8. Should I discuss the speech problem with the parents?
If you are concerned about a student's stuttering, initially discuss the problem with the Speech-Language Pathologist servicing your school. The itinerant Speech Language Teacher who visits your school on a weekly basis will be able to assist you in identifying and contacting your Speech-Language Pathologist.
If the student is obviously concerned and anxious about stuttering, the Speech-Language Pathologist will probably contact the family and discuss the problem with them.
If the family raises the problem with you and shows their concern, request that the Speech-Language Pathologist contact the family.
9. A student in my class is being seen for stuttering therapy - what can I do to help?
Speech-Language Pathologists are the professionals qualified to manage stuttering in children and adults. They work directly with the speech problem itself, help the student deal with this problem, and assist parents and teachers and all those involved with the student to understand and deal most effectively with the stuttering. Your student may be receiving therapy from the Speech-Language Pathologist servicing your school, or from one working at a hospital, health and community centre or in private practice.
The Speech-Language Pathologist should contact the classroom teacher to discuss the student's program. If not, the teacher should initiate contact to discuss how they can help and to ask for management suggestions.
The classroom teacher might be asked to help by documenting the student's daily speech behaviour using a simple checklist, or to set aside a short time each day to allow the stutterer to practice the techniques learned in therapy.
10 Can the student's stuttering be overcome?
Studies show that approximately one half of all children who stutter become fluent. (However, the probability of this occurring decreases with each passing year that the school-aged child stutters.) Some children improve significantly with treatment. We generally do not speak of "a cure" for stuttering. Our aims are to increase fluency, build self-confidence, help to reduce communication stress in the environment, and help students accept themselves.