Most speech and language disorders of early childhood are obvious right from the start. If a child is having difficulty producing sounds or using language, the problem is noticed when speech development begins. However, stuttering typically begins when two and three-year-olds begin putting words together into short sentences, when speech and language development seems to be well under way.
It can be particularly distressing for parents when stuttering begins suddenly. For no obvious reason the child suddenly has a speech problem.
The first signs of stuttering are typically the repeating of words or parts of words. Repetitions and prolonging of sounds, speech blockages and signs of struggle to speak may follow. Grimacing, twitching and other body movements often occur.
What causes stuttering?
There are many theories about why this happens to some children. None of these is well supported, leaving stuttering as one of the unsolved mysteries of speech and language development.
It is becoming apparent, however, from studies of brain imaging that stuttering involves a problem with processing speech signals from the brain. That problem seems to render the speech system unstable.
Whatever causes the disorder, genetics certainly is involved. Around 60% of those who stutter have a family history of stuttering, although the precise details of how stuttering is genetically transmitted are not yet fully understood.
Stuttering is common during early childhood. A recent study in Melbourne followed a large group of children through the early years of life. The researchers found that 11% of the children, or around one in nine, began to stutter by four years of age.
It is known that the majority of pre-schoolers who stutter will recover without treatment by the teenage years. Unfortunately, it is not possible at present to predict which individual child will recover and which child will not.
The importance of early intervention
Fortunately, a well-researched treatment is available for children younger than six years. The Lidcombe Program is a behavioural treatment that parents administer with the supervision of a speech pathologist. Parents learn to measure their children’s stuttering and to praise them when they speak without stuttering and to occasionally ask them to say things again without stuttering. The speech pathologist will normally wait for a while before beginning treatment to see whether natural recovery will occur.
It is vital that parents take their children to a speech pathologist for advice as soon as they notice that stuttering begins. This is because outcomes are much better if treatment is complete by the time a child starts formal schooling.
When children are older than six years, stuttering is more difficult to treat. By adolescence and adulthood it can become a lifetime problem. Those affected take much longer to say the same number of words as their peers.
Early intervention is important because research has shown that children can be bullied during the school years because of their stuttering. Also, stuttering can interfere with children reaching their educational potential and their vocational potential later in life.
Stuttering is more damaging in adolescence and adulthood
Stuttering commonly results in fear of speaking in social situations. During adolescence and adulthood such fear of speaking in social situations — social anxiety — can be a debilitating aspect of chronic stuttering.
Those who come to speech clinics seeking help for their stuttering often experience anxiety about the normal, daily interactions with others that most of us take for granted. So much so that reports have shown that 40–60% of those who stutter and go to speech clinics are diagnosed with social anxiety disorder, also known as social phobia. Social anxiety disorder is a constant, pervasive and debilitating fear of humiliation in social situations.
All this means that treatment for adolescents and adults who stutter can be quite a complex process. It typically includes providing the person with techniques to talk more fluently. Treatment for social anxiety may be necessary.
These problems can be avoided if parents take children to a speech pathologist shortly after stuttering has begun. For pre-school children, it is far easier to get stuttering under control than waiting until later in life. But, most importantly, two reports have found with pre-school children who stutter that there is no sign of the social anxiety problems that can trouble adults who stutter.
Getting stuttering under control early in life can make all the difference.
Mark Onslow receives funding from the National Health and Medical Research Council of Australia and the Australia Research Council.