1. It is important to remember that some children are predisposed to stutter by virtue of their genetic makeup. Stuttering does tend to run in families (about 40% of the time). Add to this environmental conditions that can trigger stuttering and you have an at-risk child who can develop stuttering. No child operates in a vacuum so it is important to do an environmental analysis to determine if there are "disfluent" environmental conditions which can act as the trigger(s) for stuttering. Our publication "Signals For Parents Of Children Who Stutter" explains the environmental analysis.
2. In addition to the genetic factors for stuttering it must be understood that the developing brain determines the child's "fluency" for, learning, behaving, personal development, etc. In some people who stutter the brain is confused as to which side is the dominant side for speech. In most people the left side of the brain is dominant for speech. In many stutterers the right side attempts to exert its dominance. These "brain wars" can disrupt the normal flow of speech and make speech disfluent. Add to this brain dysfunction any negative environmental conditions and the child might begin to develop disfluent speech and possibly stuttering.
3. As stuttering develops it becomes very complex. The Dynamics of Stuttering are as follows: "Stuttering, with its neurological, physiological, chemical, and genetic underpinnings, along with its negatively enhanced developmental, environmental, sociological, psychological, and behavioral components, and which manifests itself in negatively reinforced episodic stuttered speech and disordered language, becomes a powerful, self-reinforced behavior which ultimately becomes totally integrated into a person's life." In trying to understand stuttering's complexity it becomes important to remember that the shortest distance between the time of onset of stuttering to the time of diagnostic and/or therapy the better it is for the at-risk child.
4. Some children develop a mind-set about talking that it is hard--difficult to do. These children often develop disfluent coping behaviors that become integrated into their speaking pattern. These disfluent behaviors are sometimes so obvious to other people that the listeners start to react to the child's fallacious coping strategies for speech--HOW the child talks--and they do not listen or hear the content of what the child is trying to say. The child "reads" his/her listener's negative listening and he/she tries not to "talk that way." Often, these children become caught in a vicious cycle--the harder they try not to stutter the more they stutter. After all, for a little kid who is caught-up in his/her developing web, they can really only cope with so much disruption at any one time. Caregivers need to give the child quality time, and plenty of it, to help him/her develop naturally.
5. Many times it is important to talk to the child about talking--what speech is all about--in order to remove any mystique about this process. Depending upon the age, intellect, maturity, and the severity of the child's stuttering, it is often necessary to talk directly to the child about his/her stuttering. The therapist can help the child understand that stuttering is not his/her fault and to talk about the risk factors that precipitated and are contributing to the continuation of his/her stuttering. Combining this talk with the introduction of therapy often helps the child gain an understanding of what he/she needs to do to get better and often improves the child's motivation to be in therapy. The therapist can also help the child become a partner in developing his/her personalized therapy. Developing this partnership between therapist and child often makes the child proud of his/her contribution to the therapy process. Too often, children are not talked to about their disfluency or stuttering and they only continue to be stumped as to "why me?"
A general principle for any therapy program is to have as many family members involved in the ongoing therapy process as is possible. How this direct involvement by family members occurs during the therapy will be developed by the therapist. However, at all times, when the caregivers need information or they could benefit from the observation of the child's therapy the therapist should be most eager to accommodate those requests.
1. Behavioral spontaneity is to be preserved and enhanced. The less little kids have to think about how to perform and speak the better. Some behavioral limits, are to be established and expected, but be sure to realize how wide the space is between the negative and the positive developmental boundaries so as to allow the child some latitude for his/her behavioral imperfections. As caregivers, we must be careful not to stifle the child's spontaneity. In "Signals For Parents Of Children Who Stutter, E. Imperfection is a signal" there is information about this issue.
2. The self-esteem of the child should be measured and enhanced. The child should feel good about him/herself and be able to stand-up to criticism or teasing. Ego-strength and ego-power are to be recognized and enhanced so that the child believes in him/herself. Good physical, mental, social, educational, and competitive health are vital ingredients in the child's self-esteem. We want a whole child who can stand on his/her own two feet and feel proud about him/herself.
3 . Some children who struggle with their speech need to be taught different coping strategies from the ones they developed to stop stuttering. We Make this process as simple and matter-of-fact as possible. Gentle, easy, flowing, lyrical, light speech is modeled for the child. Sometimes the child is directed to imitate this type of speaking if he/she does not catch on to it through the modeling process. Relaxing activities are established without pressuring the child to perform or achieve at a certain level. After a time, some performance pressure is reintroduced to see if the child can tolerate environmental pressure--and how much of it--and still maintain fluency. This type of therapy is usually called fluency enhancement because it highlights the ever present fluency of the child. This highlighting demonstrates to the child that he/she ran talk "this way" rather than the "other harder" way.
4. Sometimes fluency enhancement is not powerful enough to overcome the child's negative coping strategies for stuttering. For this at risk child--the child who believes that talking must be hard and who realizes that sometimes words just don't come out fluently, and who struggles and forces and bobbles along with his/her speech--the therapist must teach direct speech modification techniques for stuttering. The child is taught how to ease through words, and some specific speech sounds that have become focal points for the childs stuttering. Care must be taken in using this method so that the child can retain as much spontaneity as possible while using the speech modifications techniques only when the need arises. In this way the child will only need to tune in to a specific word or speech sound rather than to every word the child speaks. To insist that the child monitor all his speech all the time is not realistic--this would be impossible to do anyway--and often causes the child to not use what he/she has learned in therapy. Stuttering becomes easier to do than all the required monitoring of the speech modification techniques The easiest direct speech modification technique for the child should be used.
5. A combination of fluency enhancement and direct speech modification sometimes is used and can be a very effective therapy approach. However, the goal is always to do the easiest therapy for the child and to preserve his/her spontaneity for fluency, while at the same time presenting speech modification techniques that will help the child overcome his/her stuttering.
6. Stuttering in children can be stopped, or at least improved to a point that the child and his/her peers will not pay attention to any residual speech disfluency. All people who surround this child must be clued in as to how to be helpful listeners and to help the child overcome any reluctance he/she might have to speak in spite of talking disfluently. All this takes time and patience, but good things can happen if all of the parts of therapy come together for the child.
7. Older children (8-10+), who continue to stutter and are convinced that they do indeed stutter, need to be supported in and out of therapy for some time. Speech modification and fluency enhancement are prime targets for therapy along with much holistic supportive help from persons connected with this child. Many of these children can improve to a point where stuttering no longer is a focal point in their lives.