by Gerald Johnson, Ph.D.

1. You are justified in being concerned about a child who stutters. You are the best judge as to whether this child stutters or not because you see him/her in their natural environment on a continuing basis. You have good sound judgment as to the child's condition. If no one else around you will take action, you must. Do not feel intimidated by other people or professionals such as doctors or speech & language pathologists (SLP).

2. The shorter the distance in time between the onset of stuttering and diagnosis and treatment the better the result will be. Stuttering can be prevented through early intervention in most children. A differential diagnostic can be accomplished to determine whether your child is at risk and whether therapy is warranted. Beware of the "don't worry he'll outgrown it" diagnostic. If the diagnostic and your concern do not match It is probably because the skill of the diagnostician is lacking.

3. A differential diagnostic takes time to do. Probably 2-3 hours with a part of it conducted with the child placed under stress in order to mirror his natural environment. A thorough case history must be taken with medical, family, and environmental histories a necessity. You should be called upon to participate to the fullest during this diagnostic.

4. Stuttering in children comes and goes-it is episodic in nature and often occurs when the child is disturbed by internal and/or external events. The problem becomes worse when the child begins to develop a belief system that talking is "hard to do" regardless of the events which might have triggered it. We do not like to see this stage develop in the child and therapy and environmental analysis and reorganization is mandated.

5. Stuttering is a complex disorder. Even though we think that there might be some neurological, physiological, chemical, and genetic underpinnings along with developmental, environmental, sociological, psychological and behavioral components which manifests itself in negatively reinforced episodic stuttered speech and language, some condition or conditions must trigger the stuttering for it to be present. Some children are at risk, about 40%, if there is stuttering in the family. Many times we cannot pinpoint the triggering condition, but we can analyze and treat the child's developing stuttering.

6. Only competent, well trained, and experienced speech and language pathologists (SLP) should perform the differential diagnostic and prescribe the treatment program for children who stutter. Interview the SLP and ask about his/her qualifications: Is the SLP certified (CCC/SLP) by the American Speech-Language-Hearing Association (ASHA)? Where was he/she trained? What types of supervised practicum experience did he/she receive? How many children who stutter has he/she treated, and what were the treatment outcomes for these children? What treatment program or programs does he/she prescribe? Were you impressed with the answers? Do you like the SLP?

7. Only competent, well trained, and experienced caregivers should perform the treatment program. Are you committed to the child's program? Will you carry through with the environmental analysis and reorganization to help insure that the child will get better? Are you committed to attend and participate in the child's clinical therapy program? Will you become informed about stuttering in children so that you can become a partner in the child's program?

8. The treatment of stuttering in children takes time, patience, and love. Behavioral change is not easy to do and sometimes there are setbacks in the child's stuttering. Look for longer periods of fluency and shorter periods of stuttering, lesser intensity and duration for stuttering, and self-correction and easier stuttering. Watch for less reaction to environmental events and stress and greater tolerance for internal/external pressures. Watch for changes in your own behavior and your reactions to the same conditions we have outlined for the child.

9. Don't feel guilty about the stuttering in the child. Guilt is very destructive to your mental health and will interfere with your involvement in the child's program. Through the environmental analysis you will he able to identify the changes, if any, that should be accomplished to affect a lasting change in you and your child. There are very few "bad parents" and you, through your interest in this child are showing that you are a good parent who is concerned about the child's welfare-even at some sacrifice to yourself.

10. Feel good about what you are doing for the child. Feel proud of your self-direction and motivation to help another person who is not old enough to fight for him/herself. You will become an ambassador to help other caregivers learn where to go for treatment and to support them get over many emotional hurdles as they confront the disorder of stuttering in children.

added with permission, October 12, 1998