This is a 2-part Q&A.
Stuttering is a language fluency disorder characterized by disruptions in speech flow, including pauses, hesitations, and repetitions of syllables, words, or sounds. Patients, especially those in early childhood, with stuttering may have trouble producing smooth and continuous speech despite a normally functioning vocal apparatus. The condition impacts approximately 80 million patients globally and can pose challenges for health care providers in terms of diagnosis as well as management.1 Thus, understanding its presentation and available interventions for the speech disorder may be essential for clinicians involved in the care of these individuals.
Research has shown that the disorder can have developmental, neurogenic, psychogenic, or pharmacological origins, with developmental stuttering being the most common and affecting approximately 5% to 10% of preschool-aged children.2 Studies have also shown that clinical features of stuttering may overlap across subtypes, which can make determining the underlying cause challenging for providers. Social responses and personal perceptions of stuttering can also impact the patient’s emotional well-being. Overall, management of this disorder may require a multidisciplinary approach to address both the communication and psychosocial needs of the patient.
At the recently concluded inaugural
What are the key risk factors that clinicians look for when evaluating early childhood stuttering?
Lisa LaSalle, PhD: The child being male, biological sex male is a big one, older age of onset. Most children begin before their third birthday, around 33 months of age. If it’s a little later, into 4 or 5 years, we have more concern from longitudinal studies. Poor speech sounds like not being able to be understood. If their speech sounds are a concomitant or co-occurring condition, then we are also interested. Time since onset, if it’s been more than a year and hasn’t gone away yet, it’s likely not going to. Then I would say genetic predisposition, which used to be the heaviest risk factor to consider, but genetics is changing so rapidly.
We got to hear from Shelly Jo Kraft, PhD, MS, at this conference, and there’s a lot we are learning about not just chromosomes, but now genes. Understanding that will also help with the risk factors. I feel like there are a couple others we can think of, but those are the top ones that are important. And tense stuttering—when it starts to get tense, when they really start to struggle, you see it. Little ones can’t express, “I can’t say that.” Sometimes they’ll say, “Take me to the speech doctor. My mouth is broke,” and they’re not even 3 years old. So, let’s help those kids.
How do co-occurring conditions and social support impact treatment outcomes for children who stutter?
About half the kids have a co-occurring condition. Of the kids who are only stuttering, we want them to find that they’re not alone. We are very much about the support for kids. When they get a little older, to know and accept the problem of stuttering, self-disclosure tends to bring more success. Like, “I want to let you know that I stutter, and I just went to a camp for kids who stutter.” That can be great for kids.
The other thing that helps success is if they do have a co-occurring condition, let’s work on that co-occurring condition. Sometimes by working on the speech sounds, kids who are better able to be understood by others, they tend to have better success because we’re working on the whole child. Or ADHD medication or autism. We do have kids on the spectrum who stutter as well, and many parents will opt for treatment, some will opt not for treatment. We do know, like the work that Gerald A. Maguire, MD, does, it’s a lot of work on what are the effects of the medication that they’re on and what are some options for them.
A lot of times stuttering is the most of their concern or it can be the least of their concern. Maybe their academics and how they’re handling fifth grade might be more of a concern for them sometimes. Sometimes the attitude of talking, communicating when kids get older and they know, “I happen to stutter along with other things you might want to know about me.” That can help their overall success.
Can you explain how the Lidcombe approach works and what makes it effective for children who stutter?
The Lidcombe approach is the newer one that we’ve had for a couple decades. It does involve response-contingent stimulation. It involves very neutrally introducing the child to the idea that speech is smooth or it’s bum-bum-bumpy. We just openly put the stuttering on the table, if you will, and say, “Oh, sometimes speech can be bumpy.” There’s a 5-to-1 rule. So, 5 times you are saying, “Oh, I like how you said that so smoothly.” I like to also add, “Cool story.” We all have our ways of delivering that. “I like what you said, and you said it smoothly.” We do that 5 times. Then we have the license to say 1 time, “That was a little bumpy, let’s make it smooth.” Sometimes a kid will say “no”, and I’ll say, “I’ll make it smooth then. Ba-ba, backpack, backpack, I made it smooth. Let’s keep playing.” So, these are little ones.
Originally, it was a parent-administered program. There’s been a study that shows it’s not really a factor that matters whether parents also do 5-to-1 at home, which I was relieved about because that’s a lot for parents to do. We might work with the parents, but we also need enough therapy, and the dosage of therapy needs to be frequent enough. That program takes about on average 10–11 sessions, if done well, to help the child into recovery. As long as we know that’s a child who was going to persist in stuttering, we have a good outcome.
Can you describe additional approaches you use to help children who stutter and how these strategies support fluency?
The other one is demands-capacity. We just look at what are the demands in the environment that tend to bring on stuttering. We don’t talk about the stuttering with the child. We might slow our rate, which works with some children and not others. My favorite one that I’ve researched is the recast, so that the child says, “I-I-I want to go, go, go surf.” We say, “You want to go surf? I do too. We will tomorrow.” We’re just acknowledging it, saying back, in essence, what the child said in a communicative manner that tends to bring on fluency as well.
Again, we also set it up where they’re just simple phrases, so we might be like, “I found a backpack. I found a flower. I found a shell. Your turn.” Because of the linguistic part of stuttering, by repeating, they tend to really get more fluent as a generalization. It’s like fluency begets more fluency, stuttering begets more stuttering. We keep them on a fluent role, but it still should be fun, and it still needs to be overall good communication.
We will work with kids. Sometimes I like to work with them for just several months if the risk factors are high. But many of these kids are already 1 and a half years, 2 years into stuttering, and we want to help them overcome it. But I’m learning so much from people who stutter. Nothing about us, without us. I am not a person who stutters. My dad stuttered. I love learning from the experiences of people who stutter. That’s a big part of our evidence as well, is what happens through their experiences.
Transcript edited for clarity.