An insightful master's level student, Linda, who had been working for me at the stuttering clinic for children who stutter for four months, looked at me one day, and said, "These kids who stutter are different from other kids." I knew that was true, and looked at her asking, "How?" Linda hesitated and then said, "It's subtle. They're so responsive and stimulable. They're warm but often more cautious. They seem so aware of people and everything in their surroundings. In therapy with you, they have so much fun, and I know you're good but they're just so responsive to you and much more responsive than other kids in speech therapy!" We agreed that they tended to just be more sensitive overall.

With over three decades of experience working with people who stutter, I, a speech-language pathologist who also stutters, prefer working with this group of people over all other special populations. In my private practice, I work primarily with children and adults who stutter. Recently, a four and one-half year-old boy was referred to me revealing a severe phonological disorder with mild disfluency. A stuttering disorder was ruled out and I am working with him on the phonological challenges he exhibits. From the first time I met him, I was struck at how different he was from most children who stutter that I have known over the years. This little guy is just not as sensitive. His temperament falls into the average sensitivity range, and of course, he is also a joy with which to work.

I define sensitivity as temperamental and sensory responsiveness and susceptibility to people and the environment (Oyler, 1996b, 1999). The construct of temperamental sensitivity include the following components: emotional sensitivity, reactivity, stress awareness and coping ability, sensitivity to time pressure, noise, light, and touch (Oyler, 1999, 2001).

While I was in graduate school, I developed a user-friendly screening scale, Parent Perception Scale, that identifies a level of sensitivity in children. Using the Parent Perception Scale and several other published measures, I completed a research study that investigated vulnerability and sensitivity in a group of children who stutter as compared to a group of children who do not stutter between the ages of seven and twelve. The results of this study found that children who stutter were significantly more sensitive and vulnerable than nonstuttering children, p > .001(1996b). In addition, 84% of the children who stutter fell in the highly sensitive range as compared to 36% of the children who do not stutter. At the same time, the study found sensitivity and vulnerability to be positively related.

Another finding that surprised some professionals and lay persons alike in the 1996 study was as follows: The rating of overt stuttering severity was not related to degree of vulnerability, but the number of concomitant problems was. In other words, a child who exhibited severe overt stuttering behavior was equally as vulnerable as the child who displayed mild overt stuttering behavior. Likewise, a child who stutters with a greater number of concomitant problems was more vulnerable than a stuttering child with fewer concomitant problems.

Using a larger pool of stuttering and nonstuttering children between ages three and seventeen in a later study, the findings revealed significantly greater sensitivity in the group of stuttering children as compared to the group of children who do not stutter (p = .000) (Oyler, 1999). Furthermore, the sensitivity in this group of children who stutter suggested a possible innate temperamental sensitivity that was evident at age three. Also, the groups of stuttering children did become more sensitive over time, probably due, at least partially, to the experience of stuttering.

To further support some of the above findings, Guitar (1998) did state that heightened sensitivity is one of two biological predispositions seen in children who stutter. Likewise, Guitar posited that a behaviorally inhibited temperament, which typically includes heightened sensitivity in stuttering children (Oyler, 1996a), is a risk factor for the development of chronic stuttering. Indeed, there is a clear relationship between sensitivity and those who stutter.

To better understand the experience of being a more sensitive person whether he/she stutters or not, it is important to realize that the threshold to arousal and reactivity is lower for those with heightened sensitivity (Aron, 1996; Aron & Aron, 1997). The highly sensitive person (HSP) is more aware of subtle levels of stimulation than other people, and therefore, the HSP will react more readily to subtle experiences (Aron, 2002). That is to say that the HSP has a built-in tendency to react to stimuli more strongly, and experiences more intense stimulation levels. One who is highly sensitive can become overstimulated, overwhelmed, and stressed more readily than the less sensitive person. In the same way, the stimulation tends to distress and exhaust people with heightened sensitivity.

For example, a HSP will become highly aroused to the same stimuli that a person with average sensitivity would only become moderately aroused. Furthermore, if a person with average sensitivity is highly aroused, a HSP will become so highly aroused that he/she will eventually shut down (Aron & Aron, 1997).

Parents of highly sensitive children realize very early that challenges are prevalent in raising their exceptional child. From a very young age, parents deal with the important balance of loving the sensitive child for who he/she is, and encouraging their child to learn necessary skills and approach experiences. These children feel intensely vulnerable and need a buffer as they proceed in the world. For example, the child learns to wear earplugs so he/she can go watch the fireworks on July fourth.

Achieving a balance of patience and encouragement is essential with highly sensitive children. It is important to give the highly sensitive child (HSC) adequate time as he/she tends to be naturally cautious. We help the child to look at progress in measured quantities. We are constantly prioritizing tasks and goals, breaking them down into workable steps. Indeed, these children typically do have to work harder at developmental tasks and we need to be alert to emphasize progress (Aron, 2002, Poland, 1995).

Oftentimes, these children are sensitive to change, and we are allowing adequate time to help the child learn how to cope with transitioning from task to task easier. Since sensitive children typically do not become bold and assertive quickly, we focus on behavior not emotions, and use positive words to encourage and define sensitivity. We also demonstrate how to deal with stress, difficult transitions, and too many people or noise by our words and our behavior. At the same time, we do need to talk about how we break down the process, that things do get easier, and we often refer to the child's accomplishments (Aron, 2002; Poland, 1995).

For sensitive children with a low sensory threshold, we parents and professionals work with these exceptional children with an even gentler touch, i.e. careful awareness of temperature and noise at a very early age. We introduce things step-by-step and gradually. We role-play and rehearse our plan of action. We focus on developing self-confidence and teach confidence-building self-talk. We teach our children to calm themselves, especially when experiencing surprises. We continue to offer experiences in a step-by-step fashion with advance warning of changes. We need to be careful to not overprotect, but at the same time give the child shielding and ways to buffer the bombardment of noise, light, and movement in the environment. Sensitive children typically accept limits and respond readily to discipline, much more so than less sensitive children. Highly sensitive children like predictability.

As highly sensitive children grow into adulthood with careful parenting, they often develop into adults that will live very rich and full lives. They offer much to the world. Highly sensitive people typically have depth and awareness, and are highly conscientious. Nature is often a central part of the highly sensitive person's life. Moreover, highly sensitive people tend to be right-brain processors, which allows them to be more creative in the way they process information and they are less linear. HSP tend toward the following career direction types: helping profession, inventor, intuitive artist, and visionary (Aron, 1996, 2002; Poland, 1995). Indeed, sensitivity is a gift with which some people are born, a gift that does not come free (Kagan, 1994; Poland, 1995).

Aron, E. N. (1996). The highly sensitive person. New York: Broadway Books.

Aron, E. N. (2002). The highly sensitive child. New York: Broadway Books.

Aron, E. N., Aron, A. (1997). Sensory-processing sensitivity and its relation to introversion and emotionality. Journal of Personality and Social Psychology, 73, 345-368.

Guitar, B. (1998). Stuttering: An integrated approach to its nature and treatment (2nd ed.). Baltimore: Williams and Wilkins.

Kagan, J. (1994). Galen's prophecy. New York: Basic Books, Inc.

Oyler, M. E. (1996a, November). Temperament: Stuttering and the Behaviorally Inhibited Child. Seminar presented at the American Speech-Language-Hearing Association Annual Convention, Seattle, WA.

Oyler, M. E. (1996b). Vulnerability in stuttering children. (No. 9602431). Ann Arbor, MI: UMI Dissertation Services.

Oyler, M. E. (1999, November). Nature-Nurture Controversy: Temperamental Sensitivity in Children Who Stutter. Technical session presented at the American Speech-Language-Hearing Association Annual Convention, San Francisco, CA.

Oyler, M. E. (2001, November). Sensitivity and Sensory Integration Abilities in Children Who Stutter. Technical session presented at the American Speech-Language-Hearing Association Annual Convention, New Orleans, Louisiana.

Poland, J. (1995). The Sensitive Child. New York: Skylight Press.

You can post Questions/comments about the above paper to Libby Oyler before October 22, 2003.