To the Parents of the Non-fluent Child

Peter R. Ramig, Ph.D.

This page contains guidelines, suggestions, and general information for parents or other significant adults (e.g. day care providers) who have or know a young child who repeats, blocks, or hesitates when speaking.

Learning to speak is a highly complex task. As a result, children repeat sounds and words, hesitate, and stumble during the early developmental stage of speech and language. For most children, those "errors" are only normal nonfluencies. For some children, however, they can be the beginning signs of stuttering. 

Below is a list of danger or warning signs to look for in any child's speech. These signs can occur randomly; however, frequent and consistent appearance of one or more of them should be brought to the attention of a speech-language pathologist. 

STUTTERING DANGER OR WARNING SIGNS

1. Multiple part-word repetitions – Repeating the first letter or syllable of a word, such as t-t-t-table or ta-ta-ta-table.

2. Prolongation – Stretching out a sound, such as r------abbit.

3. "Schwa vowel" – Use of the weak ("schwa" in German) vowel. For example, instead of saying "bay-bay-bay-baby," the child substitutes" buh-buh-buh-baby."

4. Struggle and tension – The child struggles and forces in his attempt to say a word. For example, the child may exhibit eye blinks or facial grimaces when having difficulty speaking.

5. Pitch and loudness rise – As the child repeats and prolongs, the pitch and loudness of his voice increase.

6. Tremors – Uncontrolled quivering of the lips or tongue may occur as the child repeats or prolongs sounds or syllables.

7. Avoidance – An unusual number of pauses; substitutions of words; interjection of extraneous sounds, words, or phrases; avoidance of talking.

8. Fear – As the child approaches a word that gives him/her trouble, he/she may display an expression of fear.

9. Difficulty in starting and/or sustaining airflow or voicing for speech – This is heard most often when the child begins sentences or phrases. Breathing may be irregular and speech may occur in spurts as the child struggles to keep his/her airflow and voice flowing.

SOME IMPORTANT FACTS ABOUT STUTTERING

We hear many fallacies regarding the cause(s) of stuttering in children. Experts of stuttering openly acknowledge that the cause(s) are unknown and are multidimensional and multifaceted in nature. Much of the recent research, however, supports a possible weakness in the neurophysical or neuromuscular systems. Few specialists of stuttering support or subscribe to a totally psychological cause or base for stuttering. However, there is little doubt that stress created from feelings of embarrassment, inadequacy, shame, and frustration caused by stuttering may also increase and maintain it. There is no respected research evidence that targets parents as a primary cause of stuttering.

Stuttering can become an embarrassing and frustrating problem for the child and may influence behavior, academic performance, and self-esteem and confidence.

Stuttering can be changed and, in some cases, eliminated in younger children if professional help is sought before excessive struggle and tension develop.

We often hear that children who stutter should not be enrolled in treatment because "they will outgrow it." Is this true? Many very young stuttering children (3 years and less) do appear to outgrow stuttering: however, many in this age range do not, and far fewer outgrow it who are beyond the age of 5 years.

CHARACTERISTICS SOMETIMES EVIDENT IN NONFLUENT CHILDREN

1. The child may exhibit inadequate attending behaviors that may include hyperactivity, distractibility, and difficulty attending to tasks.

2. The child may have oral motor difficulty as evidenced by misarticulation of sounds and/or inability to rapidly coordinate tongue and/or lips.

3. The child may have perfectionistic tendencies and he/she may appear to be exceptional sensitive to environmental changes, disruptions, and stresses.

SOME CHARACTERISTICS OF THE ONSET OF STUTTERING

1. Some children may display nonfluencies or stuttering as soon as they begin combining words, but most do not start until approximately one year later.

2. Stuttering often begins gradually and its progression can be episodic, containing oscillations in severity across different communicative tasks and periods of time.

3. Repetitions of syllables which occur on the initial words of an utterance are one of the more common types of nonfluency occurring in beginning stuttering.

SUGGESTIONS FOR TALKING AND INTERACTING WITH
YOUNG NONFLUENT CHILDREN

1. Speak slowly. Use the appropriate names or words for objects and events. Use sentences and vocabulary appropriate for your child's age. This is important so that the child is not frustrated because he may be unable to repeat or imitate more complex words, phrases, or sentences.

2. Beginning at a very young age, associate talking with pleasant activities. Use a pleasant voice when speaking. For example, while rocking or holding your child, talk about pleasant daily activities or events.

3. Talk about people, objects and events that are meaningful to your child.

4. Promote spontaneous conversation with your child by waiting silently for him to initiate the conversation during free play. Reinforce your child's responses with smiles and praise.

5. Provide a variety of entertaining language experiences, such as trips to the zoo, amusement park, museum, circus, etc. Talk with your child about each experience.

6. Read to your child in a relaxed manner that is slightly slower than normal and has a natural rhythm. After you have read a story, discuss what happened. Let him finish sentences in familiar stories or tell them in his own words. Let him do as much talking as he desires. Tell stories about events in your own life and when he was smaller. Using familiar pictures for this activity may be helpful. Avoid frightening stories because they may be disturbing even though he may appear to enjoy them.

7. Help your child express his feelings, both verbally and nonverbally, by acting as a role model.

8. Listen to your child when he is expressing rage, anger, or frustration. Discuss what caused these feelings.

9. Pay attention to his nonverbal communication: Is he asking you something because he really wants to know the answer, or is he really asking for attention?

10. Consider your child's feelings. Neither children or adults wish to be ridiculed for speaking differently, or to frequently be told "no," or to be reprimanded for something that is insignificant.

The following are suggestions which may help your child deal with his feelings:

a. You can listen quietly and attentively.

b. You can acknowledge his feelings with a word. "Oh".."Mmm".."I see."

c. You can give the feelings a name. "That sounds frustrating."

d. You can give your child his wishes in fantasy. "I wish I could make the cold weather disappear for you right now!"

(Taken from Adele Faber and Elaine Mazlish, (1980), How to Talk so Kids will Listen and Listen so Kids will Talk, New York, New York: Avon Books.)

11. When you ask your child a question, use "close-ended" queries like "Did you have a good time at school today? What did you do that you liked best?" These types of questions are more likely to elicit short, simple responses. Short, simple responses are more desirable on days your child is especially nonfluent because they are more likely to be produced fluently.

12. When your child wants to talk to you, and you are busy doing something, stop if you can and give him your full attention. If you cannot do this:

a. Tell him you will listen soon, after you have finished what you are doing.

b. Try to find a convenient stopping place in whatever you are doing soon so your child does not have to wait longer that 1 - 2 minutes.

c. Give your full attention as much as possible.

d. If crying, nagging, or temper tantrums occur, explain that you will listen in a minute or two, but try not to engage in an argument.

e. Try not to pay more attention to your child when he is nonfluent than when he is fluent. The amount of time he must wait for you should depend on what you are doing, not on his fluency.

f. When you are ready to listen to your child, sit down with him so that you are at the same eye level.

13. Everyone should take turns talking.

a. If your child interrupts someone who is talking, he can be told: "When______is finished, it will be your turn, and no one will interrupt you." This should be applied to everyone (children and adults) in the family.

b. We suggest minimizing your child's interruptions.

c. You can role play interrupting and turn the taking; the one who interrupts is told to wait.

d. If one person's turn is lasting for an unusually long time, tell him it is someone else's turn now and he will have time to talk again later.

14. If possible, avoid using the word "stuttering" to describe your child's speech when talking to him. Instead, use descriptive words that demonstrate your acknowledgment of the difficulties, such as: "gets stuck" "bumpy speech," "hard talking," etc. However, if your child is well aware of his nonfluencies and casually refers to them as stuttering, it would be unnatural for other family members to avoid using the word.

15. Do not demand your child to perform in front of people (asking him to say the alphabet, recite nursery rhymes, etc.). If he wishes to and initiates the activity, then it is okay.

16. Avoid extensive questioning or interrogation.

17. Do not expect your child to speak excessively on days when he is extremely nonfluent.

18. After a nonfluent utterance you are encouraged to repeat back the content of what your child said. This will help reduce his memory of the nonfluency. In addition, you are showing your child that you are listening to him. (Child: "I went I-I-I-I went shopping with a-a-a-aunt Mary." Parent: "Soooo you went shopping today," etc.)

19. Try not to convey a sense of time pressure when talking. Behaviors can purposely be modeled to reduce time pressure by your speaking more slowly. Speech should be evenly paced and not contain fast rushes followed by long pauses. "Brisk" turn taking and frequent interruptions also convey a sense of time pressure and should be minimized.

20. Talk openly with your child about stuttering if he expresses a desire to do so.

21. A child usually develops his attitudes about talking by observing his parents' behaviors. Take advantage of everyday opportunities to see that your child experiences some form of success and praise.

SPECIFIC "DO'S" AND "DON'TS" WHEN YOUR CHILD IS NON-FLUENT

When your child is nonfluent, the following behaviors may only make him feel that you are dissatisfied with his manner of communication. They may make him feel that nonfluencies are "bad", resulting in his attempt to avoid being nonfluent. When apprehension and avoidance develops, the problem of stuttering often worsens.

IT IS NOT RECOMMENDED TO:

a. Hit him for stuttering.

b. Tell him to stop stuttering.

c. Threaten to punish him for stuttering

d. Help him with the word (unless your clinician states otherwise).

e. Tell him to think about what he is going to say.

f. Answer or "fill in" for him.

g. Look concerned or pained.

h. Appear angry or impatient.

I. Tell him to take a deep breath before speaking.

j. Ask him to stop and start over.

k. Suggest changing pitch.

l. Suggest avoiding or substituting words.

INSTEAD:

We suggest the following when your child is nonfluent:

a. Try to act the same as you do when he is fluent.

b. Remain calm and listen to what he is saying.

c. Try to show that you enjoy talking to him.

d. Seem interested in what he is saying.

e. If he seems especially excited or in a hurry, you might say: "Just a moment, I have the time and I want to hear what you have to say." This is different from telling him to speak more slowly. Instead you are telling him to slow down everything -- not just speech.

f. Calmly acknowledge the occurrence of any long, effortful or forceful awareness of obvious disruptions. A simple statement like "That was hard for you, wasn't it?" can defuse some of your child's concern and show him that the same lapses do not upset you. If your child states "I can't say it," or "I can't talk," assure him that talking will be easier if he talks softly and says the word with you, in unison, 2 -3 times. (CAUTION: This approach should be used only on those occasions when your child exhibits obvious distress over his speech failures.)

(For further information, refer to Stuttering and Your Child: Questions and Answers, Stuttering Foundation of American, 1989.)

THE NONFLUENT CHILD'S HOME AND SCHOOL ENVIRONMENT

Your child's home and school environment can have an impact on his stuttering. The following suggestions pertain to both environments.

1. Define rules so your child knows what is expected of him. Consistency in the home and school is important

a. When talking, your child should feel he will not be interrupted. He should also know that he will not be allowed to interrupt others who are talking.

b. Your child should know that he will receive specific, predictable, and noninjurious punishment when he seriously misbehaves.

c. Your child should know that he will be consistently rewarded for doing his assigned chores.

d. Praise your child for everything he does well.

e. Try to reduce the use of the words "no," "can't," "don't" and "stop."

2. Examine your child's schedule. Does he have enough free time? Does he have enough quiet time? Do you spend enough relaxed time with him?

Try to allow 15-20 minutes every day to spend alone with your child. During this time you might walk with him, play with him, or read to him. Before bed is a good time to be alone with him for a few minutes. During this time together, ask your child "how" his day went. This will enable you to find out about his feelings, rather than just asking, "what did you do today?"

3. Physical fitness is important to good speech. Your child should have adequate rest and fatigue should be kept to a minimum.

4. Keep your child's intake of sugar to a minimum.

5. Traumatic events such as illness, accidents, and emotional conflicts cannot be avoided. However, be aware that such events may be accompanied by more non-fluency

a. Accept this as normal and try not to give your child more to worry about by reacting to his/her nonfluencies.

b. Try to counteract the traumatic event by providing pleasant experiences and making him feel secure in his relationship with you.

6. Avoid discussing your child's speech difficulty in his presence. If, however, he mentions it, reassure him that everyone finds it difficult to talk at times

7. Vacations and events such as Christmas, Chanukah, out-of-town guests, or starting school, can also result in increased nonfluency. Reducing the intensity of those events is encouraged

8. Be alert not only for events but also people and places that result in increased non-fluency in the child's speech. When possible, change what you can to enhance his fluency.

9. Attempt to alter communicative stress both at home and at school so that more chances for fluency are provided. Try to remove any stigma attached to stuttering which the child may be experiencing. One way to do this is by occasionally modeling easy, unforced stuttering behaviors in your speech so your child begins to realize everyone is nonfluent sometimes, and that it can be done easily and without tension.

10. Be aware that your child may become frustrated if he experiences a great deal of severe nonfluencies. Try to provide a way to cope with this frustration, such as:

a. Outdoor exercise.

b. Allowing him to express his feelings without anyone displaying displeasure.

11. Parental intervention is recommended if brothers and/or sisters tease the nonfluent child.

a. Explain patiently and clearly that teasing is impolite and unkind.

b. Discuss the fact that all people have their weaknesses and strengths. Explain that the nonfluent child sometimes makes mistakes when he talks, and that this is no reason to make fun of him. (If teasing continues, it may be necessary to ask your speech-language pathologist to talk to the siblings.)

12. When your child is experiencing a period of increased nonfluency, try to provide him with successful speaking experiences. Encourage choral speaking, singing, recitation of nursery rhymes, rhythmic speaking, role playing using puppets, etc.

13. Remember the power of positive suggestion! You can use it to motivate children by helping them realize they can change.

14. Do not set unrealistic goals for your child. Try to keep your expectations appropriate for his age and level of maturity.

CHARACTERISTICS OF SOME PARENTS OF NONFLUENT CHILDREN

Research indicates that parents of nonfluent children do not cause stuttering. But unrealistic expectations can maintain or increase existing or developing stuttering. For example, some parents may expect their child to:

a. pronounce words perfectly;

b. use an unusually large vocabulary;

c. perform difficult motor tasks;

d. succeed in advanced academic activities;

e. be involved in too many activities outside of the home.

Some parents of nonfluent children speak rapidly or hurriedly. In turn, their children may speak quickly. Because speech and language is a very complex motor and cognitive act, rapid speech may cause your child to experience more nonfluencies such as repeating, hesitating, etc. Such mistakes may lead to even more mistakes because the child becomes frustrated, tense, self-conscious, etc.

If parents speak rapidly or act rushed, the home environment may become more stressful. Hurrying may then become a way of life. A hurried, impatient environment such as this may not be conducive to good speech development, normal parent-child interaction, or normal parent-parent interaction. Parents are encouraged to provide an even keel home environment, and model a calm, slower speaking rate. This is more effective than telling your child to slow down.

Putting this information to practice may be difficult. Lena Rustin (1991) describes a task called "talking time" in which the parents complete a home assignment involving a commitment to spend three, four or five minutes; four, five or six times per week playing with their child. "Talking Time" is structured accordingly:

1. Parents are to solicit help from their child with this assignment.

2. Parents should negotiate with their child for a mutually convenient time.

3. The parent asks the child to choose a toy to play with.

4. The parent and child then go into a room, close the door so that they cannot be interrupted by others.

5. During this interaction, the parent should not make any demands on or comments about the child's speech but should listen carefully to what is being said, not how it is said.

6. When the time is completed, the parent should thank the child for helping with their homework and record in a notebook hat the task was completed and make some comments about how they felt doing it. Time limits should be adhered to when participating in "Talking Time" activities.

(Rustin, Lena, 1991. Parent, Families and The Stuttering Child, pp. 63-64.)

WHEN YOU HAVE TO DISCIPLINE: SOME IDEAS & SUGGESTIONS

1.  Establish a non-injurious discipline system for your child's misbehaviors. This system should be consistent from day to day and from child to child

2. When the child unintentionally annoys you:

a. Try to be tolerant, if his behavior is unintentional, is not harmful to people or objects, and occurs infrequently.

b. Try to remain calm and collected.

c. Try not to verbally attack your child; (refer to his behavior, not to him).

- Describe the wrong act, (e.g., "You hit your sister.")

- State your feeling, (e.g., "That makes me angry.")

- Present a solution, (e.g., " Talk to me if your sister angers you.")

d. If the same behavior occurs often and apparently carelessly, and if he refuses to correct it, then reasonable, non-injurious punishment may be warranted.

3. When your child intentionally annoys you, and you are sure that he knows his behavior is wrong, we suggest the following:

a. Tell your child how you feel about what he has done. Be specific about what he has done that is wrong.

b. Do not argue with him. Ignore any crying, temper tantrums, or nonfluencies. Ignore any negative behavior when he is in his room.

4. When your child wants to do something he is not allowed to do:

a. Explain to him why he is not allowed to do the activity. For example, "It's too dark to play outside."

b. After you explain why, do not argue with him.

c. Acknowledge to him that you realize he is upset.

5. Discipline must be consistent from day to day and from parent to parent. Spanking may stop his behavior, but it can also create mistrust and fear in the child.

PARENTS AND TEACHERS AS MODELS

When considering the effects the general environment has on your child's speech, it is important to realize that the parents themselves serve as models to the child. Many of the child's behaviors, feelings, and attitudes are directly influenced by the behaviors, feelings, and attitudes of the parent.

1. Some behaviors are modeled directly; however, indirect influences of the parents and other adults important to the child are very powerful.

2. The nonfluent child may adopt the parent's feelings about stuttering. As a result, parents might ask themselves the following:

a. Do I feel guilty about my child's stuttering?

b. Do I blame myself for his stuttering?

c. Do I feel stuttering is shameful, embarrassing, or bad?

d. Am I angry at the child because he stutters?

e. Stuttering is one problem for which there is help and a great deal of hope. It can be overcome if dealt with at an early age, before the development of struggle, tension, and the self-concept of a person who stutters.

REFERENCES

Conture, Edward G. (1990), Stuttering, Englewood Cliffs, New Jersey: Prentice-Hall, Inc.

Faber, Adele and Elaine Mazlish (1980), How to Talk So Kids will Listen and Listen So Kids will Talk, New York, New York: Avon Books.

Ramig, Peter (1993), "Parent-clinician-child Partnership in the Therapeutic Process of the Preschool-and Elementary-aged Child Who Stutters." Seminars in Speech and Language, vol. 14, #3.

Rustin, Lena (1991), Parents, Families and the Stuttering Child, San Diego, CA: Singular Publishing Group, Inc.

Stuttering Foundation of America, The Child Who Stutters at School: Notes to the Teacher, , P.O. Box 11749, Memphis, TN, 38111-0749.

Stuttering Foundation of America, Stuttering and Your Child: Questions and Answers, P.O. Box 11749, Memphis, TN, 38111-0749.

Zwitman, Daniel H. (1978), The Disfluent Child, A Management Program, Baltimore, Maryland: University Park Press.

FOR MORE INFORMATION

Brochures and video tapes are available through the Stuttering Foundation of America, P.O. Box 11749, Memphis, Tennessee 38111-0749 (800 992-9392):