by Stephen B. Hood, Ph.D.

As parents, we tend to worry about whether our child will be normally formed at birth. Thereafter, we worry about whether something might "show up later." In the case of stuttering, there is nothing that can be determined at birth. The signs of a potential stuttering problem usually appear between the ages of three and five years, when the developmental nonfluencies which can lead to a full blown stuttering problem become apparent. What should we watch for? What are the danger signs? What can we do about them?


Many children pass through stages of developmental nonfluency. These stages tend to come and go in episodes or cycles that may last for several weeks or even a month. There are some episodes where the child is remarkably fluent and verbal, only to be followed by periods where the child is excessively hesitant in talking.

Normally nonfluent children tend to be disfluent on approximately 5% of the words they speak. In other words, they experience breaks in their fluency on roughly 50 words per 1,000 words spoken. Disfluencies are more frequent at times of excitement, linguistic uncertainty occurring when formulating sentences that are overly long and complex -- or when trying to think of the name of a particular word--, times of high communication demand, and other forms of communication stress. These disfluencies are easy and effortless, and there are no signs of tension or struggle: the child is generally unaware of these disfluencies. For the most part, these disfluencies will involve the easy, effortless and rhythmic repetition of whole word and phrases, the simple interjection of "ums and ahs" and other simple forms of fluency failure. The number of units of repetition will generally be just one or two: like-like this, or like-like-like this.

Children at Risk for Stuttering show disfluencies well in excess of 5%, and these disfluencies are more fragmented; in other words, they will more likely involve the repetition of single sounds and syllables, sound prolongations, and stoppages in speech flow. The number of units of repetition will generally be more than just two units: like-like- like-like-like this, or li-li-li-li-like this.

Danger Signs: What are they? Signs of increased fragmentation are a concern. For example, the child used to repeat phrases or whole words, and who later repeats syllables or sounds; or the child who used to repeat words and syllables and now prolongs sounds of becomes inaudible, is at higher risk for a stuttering problem. Increases in effort, tension and struggle are also important danger signs; for example, disfluencies accompanied by increases in loudness and/or pitch. In addition, children who mispronounce the first syllable during a repetition are at higher risk: for example, repetition of the correct syllable base-base-baseball is less serious than repetition of an incorrect syllable such as buh-buh-baseball.

With respect to emotional characteristics, disfluencies in normally nonfluent children, even when they are more nonfluent than usual, cause little or no concern or awareness to the child. Most children will be totally unaware of these breaks and bobbles in fluency. It is a danger sign when the child shows marked awareness, especially when this awareness lasts for any considerable time period.


Regardless of the exact cause of the problem, there are a number of factors that tend to make the problem worse, and increase the likelihood of the problem developing into one of increased severity. Clinically, we try on the one hand to reduce the occurrence of these negative influences, and work to help the child cope with them when they do occur. Listed below are some examples of factors that generally tend to increase disfluencies and stuttering in young children and, for that matter, in all of us:

Negative Influences: Things to reduce.

Positive Influences: Things to Increase

It helps to keep the environment and atmosphere as calm and non-hurried as possible. Try to plan ahead so that your "walk, not run". This is easier said than done, but a little goes a long way.

To the extent possible, speak slowly, speak with increased melody and inflection, and allow greater pause time between speaking... and speaking again. Young children have problems when others speak too rapidly. By allowing pause time to occur we reduce the pressure to hurry, and this in turn allows time to organize our thoughts and formulate our language.

Advice to the child to "slow down and take your time" really isn't helpful. The child simply will not slow down when those around him are going 90 miles per hour. Slowing down must be a joint effort on the part of all. This is further enhanced when there is a degree of additional melody and inflection attached to the message. For those who would like a role model, it is suggested that you watch the Mr. Rogers program on television.

Allow the child to finish his thoughts before interjecting your own. It's often easy to anticipate what the child is saying and to begin your answer before the child has finished. It's more positive to allow the child to finish, then pause, and then respond. This is all part of the concept of turn taking.

The modelling of talking skills is important. In your own speech, strive for a slower rate and with increased melody and inflection. Children tend to copy the adult models to which they are exposed, so be a good model. Telling the child to "slow down and take your time" will be of little or no value if the rest of the people are talking rapidly, interrupting, contradicting and verbally competing with each other.

Reducing verbal competition can be helpful. When children must compete with siblings, parents and other persons for recognition, this can be difficult. The above mentioned ideas for verbal turn-taking, sharing the talking time and slowing down the overall pace of the communication can often prove helpful.

It helps to minimize distractions, and other things that compete for the child's attention. For example, it is often difficult to carry on a conversation when the child's attention has been captured by a television, radio or stereo.

Personality Traits and Family Dynamics Can Be Important

A number of personality traits and issues pertaining to family dynamics are important. As with any list, parents need to carefully consider the extent to which any one, or several of these factors, might be serving as a source of actual or potential stress. Realize also that there are areas of considerable overlap among these factors. These factors, in and of themselves, are not necessarily the "single cause of stuttering:" however, when they co-exist with significant amounts of disfluency and stuttering, they may serve to make the problem worse.

Some Closing Thoughts

Any list of suggestions has strengths, as well as weaknesses. Not all suggestions apply equally to all children. Further, there is always the problem that people will feel that these suggestions must be followed at the 100% level to be effective, and this is of course unrealistic. But coming closer can help. As a supplement to what is listed above, here are some examples:

  1. Strive to be firm, fair and consistent. Children need limits that are reasonable and fair and consistent, and learn best when they are reasonably enforced. It's generally better to have fewer limits that are consistently enforced than more limits that are enforced on a hit and miss basis.
  2. Keep things as simple as reasonably possible. For example, while it may be beneficial to make things available to a child and encourage participation, there is a find line between encouraging and pushing. Awareness of this can make a difference. When in doubt, DON'T BE A PUSHY PARENT. Young children do not need to talk like, or read like, or behave like miniature adults.
  3. Show interest and comment, but reduce where possible the questions you ask. Verbal show and tell can be taken too far. Ask fewer questions of the child, especially those that are irrelevant. And, where possible, refrain from asking the same question(s) again and again.

There are several sources of information that may be helpful in providing additional information. Interested readers can contact the Stuttering Foundation of America or the National Stuttering Association for printed materials and audio tapes.

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