Ages & Stages: 0-5: Preschoolers and Stuttering – Developmental Phase or Disorder?

Why do children stutter?
Over the last 20 to 30 years, much research has been dedicated to understanding the presence and nature of stuttering (also known as “dysfluency”). Unfortunately, no one specific cause of the disorder has been found because it may have many subtle and fleeting contributors.

Fortunately, research has revealed some commonalities among those who stutter, age of onset and recovery trends, which have guided speech-language intervention toward identifying and addressing stuttering in young children (ages 2-6 years).

For example, the onset of stuttering is usually in the preschool years and onset is rare after 12 years old. Males are three times more likely than females to stutter, especially in lower grades. Family history also plays a part, as risk is 14 percent among relatives of individuals who stutter. Young children stutter more often on conjunctions and pronouns (e.g., and, but, I, my, we), and stuttering occurs more often on initial word (or first three words) of an utterance and at major clause boundaries (e.g., “If we don’t hurry, …” ).

Distinguishing Types of Speech Fluency
To adequately understand “stuttering” or what is referred to in technical terms as “dysfluency,” it’s important to first explain what speech fluency means. Fluency refers to a speech pattern which flows in a rhythmic, smooth manner. Conversely, dysfluencies are disruptions, or breaks, in the smooth flow of speech. However, most speakers, including young children, who are perceived as “normally fluent,” experience some dysfluencies. One reason for these dysfluencies is that young children are learning to coordinate many systems (i.e., speech production, vocabulary use, correct word order in sentences and verb tense).
Because of these naturally occurring dysfluencies, a question parents might ask is, “Is this stuttering normal, the kind resulting from normal language acquisition, or should I seek help from a professional?” The following sections list descriptions of dysfluency types and criteria for normal versus atypical dysfluencies, which may help to either eliminate your concern or validate it.

Types of Dysfluency:
• Repetitions of sound/syllable/word/phrase (e.g., “C-c-can I have…”/”to-to-day is…”/ “but-but-but …”/ “that’s not- that’s not fair!”); and, three or more repetitions of an utterance is usually considered disordered.
• Prolongations occur when one sound is held longer (e.g., “thththth-aaank yyyyou!,” “nnnno, iiit’s nnot,” “Wwwhat’s yyyoooour fffavorite collllor?”)
• Blocks occur when the air is prevented from escaping from either the mouth or nose and no audible sound is made (e.g., “Heh—lllo, this is P—aul,” “Ih—–t’s nnnuh—ice t—o meet —-you t—oo”).
• Silent Pauses (e.g., “(SP) — Hello, (SP) … this is Tony (SP) from (SP) hhh-ousewares”)
• Interjections (e.g., “Um, first you … um, second you put it on the … uh, you know …”)
• Incomplete Phrases (e.g., “Well, she said she would call, but then she didn’t and … I don’t know if …”)
• Revisions (e.g., “When — I mean where is my backpack?” “Can I have a napkin … I mean, may I have a paper towel, please?”, “I shaw– I saw a shark at the zh-zoo!”)
• Perception of schwa sound (“uh”) in the context of a repeated syllable (“buh-buh-buh-beet”) probably indicates disordered, dysfluent speech. When the vowel is preserved, (e.g., bee-bee-beet), the repeated syllable is usually considered a normal dysfluency.
• Dysfluencies lasting longer than 1 second may indicate disordered speech.

Physical Behaviors May Indicate Speech Dysfluencies
Physical behaviors that accompany speech dysfluencies may indicate your child is struggling to speak. These behaviors may include rapid eye-blinking, increased mouth, face or body tension; and frustration when trying to speak. Likewise, a child’s awareness of his/her dysfluencies may influence the severity of dysfluent moments. For example, awareness may increase as others reactions indicate discomfort or embarrassment, possibly indicating they’ve noticed the “stuttered” moments. This nonverbal communication may result in an anxious feeling about his/her speech, for fear of future dysfluencies. If your child seems to avoid certain words or speaking situations, there may be cause to seek professional intervention.

Tips To Help Your Child Speak Clearly
• Be a good model of slow, easy speech. For example, if your child says, I lu-lu-like this one,” reply with, “You llllike this one?” (slightly elongating the sound).
• Create pleasurable speech experiences (e.g., sing while holding your child, read stories, play games involving verbal interaction).
• Minimize background noise and other distractions when possible.
• Take good breaths between sentences, so your child observes you breathe.
• Maintain consistent eye-contact. Try not to require competition for “talk time.” Avoid interrupting.
• Make sure your child gets enough rest and nutrition, as tired kids are often more dysfluent.
•Talk WITH rather than AT your child, during which there is a true interchange of ideas and feelings.

If you feel that your child exhibits any of the atypical dysfluencies described above, contact your child’s pediatrician to refer him/her to a licensed speech-language pathologist (SLP) in your medical network, or find a local SLP to address your concerns.

Hollie G. Bowling, M.A., is a certified speech/language pathologist (CCC/SLP) with the Charlotte Speech and Hearing Center. Contact her at hgriffith@charlottespeechhearing.com.