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What is typical fluency development?

Fluency describes our ability to easily and quickly share information. Everyone will have moments of dysfluency when they are speaking under pressure and/or expressing complex information. Examples of dysfluency include the use of interjections such as ‘um’ or ‘er’ or the repetition or rephrase of a sentence or idea. For most individuals, the level of dysfluency produced is low, and it does not impact their ability to communicate.

The level of dysfluency is highest in children between 2 and 3 years of age. This is because the language areas of the brain are growing very rapidly at this age, often more quickly than the motor areas, and the dysfluency fills the space in a sentence while the motor skills catch up with the language skills. It is common that children will experience alternating periods of fluency and dysfluency during this period. 75% of children will outgrow these fluency issues and go on to be component communicators. The remaining 25% are at risk of developing a stutter.

What is stuttering?

A stutter or stammer outlines a difficulty progressing forward in one’s speech due to the intrusive repetition of words or physical stopping of the air flow. It occurs when a child is significantly more dysfluent than other children of a similar age and language ability, and/or displays dysfluent behaviours that are not seen in typical development. Children who speak multiple languages will usually stutter across all their languages, not just in English. While stuttering most commonly appears around 2 or 3 years of age, it can also occur following school commencement, the onset of puberty, a traumatic event, or brain injury.

What are the signs of a stutter?

Some of the signs of typical fluency may include:

  • Repetitions of words or phrases
  • Restarting or rephrasing sentences
  • Use of interjections, such as ‘um’ or ‘er’
  • Pausing in sentences

Some of the signs of disordered fluency or a stutter may include:

  • Excessive repetition of sounds, syllables, words, or phrases
  • Lengthening or prolonging of sounds
  • Physical stopping or blocking of the airflow
  • Excessive restarting or rephrasing sentences
  • Excessive use of interjections, such as ‘um’ or ‘er’
  • Unusual pausing in words
  • Fast speech rate
  • Stumbling over or hesitating on words in sentences
  • Appearing to avoid certain words in sentences or substituting incorrect synonyms
  • Loss of eye contact when speaking
  • Unusual facial, head, neck, or body movements when speaking
Child In Speech Therapy Appointment
Toddler Sitting On Ground

What causes stuttering?

Stuttering often occurs in isolation and has no known cause. It can sometimes be is linked to medical, health, or developmental delays.

Stuttering can be associated with certain conditions including:

  • Speech and language delays
  • Intellectual or developmental delays
  • Psychiatric illness
  • Traumatic brain injury
  • Childhood stroke

Other risk factors for stuttering include:

  • Male gender
  • Family history of stuttering

Does stuttering occur due to anxiety?

No, anxiety does not cause stuttering; however, these conditions are undoubtedly linked. Stuttering can lead to stress or anxiety (especially with speaking or socialising). Stress or anxiety can exacerbate stuttering. Some individuals can experience a negative spiral where both conditions continue to make the other worse. While these conditions often occur separately, this is also common to see them diagnosed together. Co-occurring treatment of stuttering and anxiety can be beneficial for some individuals. Young children are less likely to be aware that they stutter than older children and adults and so are less at risk of associated anxiety. Referral and/or treatment should be expediated if a young child appears anxious about speaking, particularly if stuttering is a concern.  

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Two Children With Adult Doing Craft

What is cluttering?

Cluttering is a communication disorder where fluency, speech, and language difficulties occur in combination. It is characterised by rapid speech, unusual intonation, poor grammar/sentence structure, and/or speech sound errors.

Clutterers are more easily able to move forward in their speech than stutterers but are often more difficult to understand. Diagnosis of cluttering is difficult, and treatment contains both stuttering therapy and other intervention approaches.

How is stuttering diagnosed?

If you have concerns regarding your child’s communication, a fluency assessment with a speech pathologist is recommended. This may be a brief screening or a detailed comprehensive assessment depending on the age of your child and the nature of their difficulties.

For young children, the assessment often includes observations of their speech during play or conversation. Older children are asked to complete more formal assessment activities to evaluate their dysfluency.

Group Of Teenage Girls Sitting Down Chatting

What are the different treatment options for stuttering?

The treatment options for speech delays are individualised for each child depending on the outcome of their assessment. Our speech pathologists will work with each family to develop a therapy plan with goals, actions, and strategies to address your child’s stuttering. Therapy goals are continually adjusted according to your children’s progress and needs.

Children under 6 years usually undertake the Lidcombe Program which facilities remediation of the stuttering so that it no longer occurs.

Children over 6 and adults may undertake one or a combination of treatment approaches that aim to modify or control the stuttering to lessen its impact. Examples include smooth speech strategies, the Westmead program, the Camperdown program, and/or the BERL program. Some children over 6 may still have success with the Lidcombe Program.  

While therapy sessions with a speech pathologist will support your child’s development, many children will display progress at a quicker rate with access to therapy strategies and activities on a daily basis. These strategies should be implemented across all their regular environments such as home and childcare, kindergarten, or school. For this reason, a portion of each therapy session is dedicated to training families to facilitate their child’s speech at home. For young children, these may include strategies to implement during play time or during everyday routines. For older children, these may include activities to complete during set “homework” times each day.

Children Drawing On Easel

The number and frequency of therapy sessions will depend on:

  • your child’s current abilities
  • the severity of their stuttering
  • type of therapy being implemented
  • their progress in response to this therapy
  • the family’s familiarity and confidence with the home strategies and activities

Therapy sessions run for either 30, 45, or 60 minutes and take place weekly, fortnightly, or monthly. They may be scheduled in therapy blocks or on an ongoing basis. They also include additional administration time for the therapist to plan activities, document progress, and write reports.

Therapy sessions may also be offered via telehealth if this is their preference and they live in a regional or remote area.

Government funding programs such as the National Disability Insurance Scheme (NDIS) or a GP Management Plan may assist families to access services.

What is involved in the Lidcombe Program?

The Lidcombe Program is the only research-based, behavioural intervention for treating stuttering in children under 12 years.

It is a parent-run program, in which the speech pathologist trains the parent to complete therapy at home. 

It has two stages:

Stage 1

  • The aim is to eliminate the child’s stuttering behaviours.
  • It takes around 4-5 months.
  • The speech pathologist teaches the therapy technique to the parent during weekly intervention sessions with the child at school.
  • Parent administered the therapy technique to the child during daily practice sessions at home. These sessions are eventually replaced with using the therapy technique at any time during natural conversations.

Stage 2

  • The aim is to maintain the child’s stutter-free speech.
  • It takes around a year.
  • The parent and child attend intervention sessions with the speech pathologist of decreasing frequency to monitor the child’s progress.
  • The parent gradually reduces the amount they use the therapy technique at home.

The parent is taught the therapy technique, which involves:

  • Rate the severity of their child’s stuttering every day on a scale of 0-9.
  • Control the amount of speech the child produces to minimise stuttering, using structuring.
  • Provide the child with feedback on their speech, using verbal contingencies.

When should I see a speech pathologist about my child's fluency or stuttering?

The intuition of parents regarding their child’s development is often a significant indicator of their progress; therefore, any concerns are always taken seriously. Early assessment and intervention enable the best opportunity for optimal communication outcomes; therefore, prompt action to investigate any concerns is recommended.

Teenage Girl Smiling
Young Adult Sitting At Table

Referral for stuttering is recommended if your child presents with greater dysfluency than other children of a similar age and language ability, and/or displays dysfluent behaviours that are not seen in typical development, particularly if they are over 3 years of age and/or their dysfluency occur consistently every day (without periods of fluency). Other factors that may prompt referral include a family history of stuttering if the child appears hesitant or apprehensive to speak, or their fluency is having a significant impact on their communication.

If you are worried about your child’s fluency, it is important to seek advice from a speech pathologist as early as possible to ensure any stuttering is addressed. If you are unsure if an appointment is required, call our friendly team to discuss your thoughts. Alternatively, a conversation with your child’s GP or teacher may also be helpful.

How else can I help improve my child's fluency or stuttering?

Parents are encouraged to ignore stuttering behaviours unless you are undertaking a specific program set by your speech pathologist.

The research is mixed on whether using techniques and strategies from a program is effective without completing the entire program so this is not recommended unless suggested by your speech pathologist.

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