Transcript Diagnosing and Treating Children Who Stutter

Identification and
Treatment of
Childhood Stuttering
J. Scott Yaruss, Ph.D., CCC-SLP
Stuttering Center of Western Pennsylvania
University of Pittsburgh
Children’s Hospital of Pittsburgh
Pediatric Grand Rounds
Mercy Hospital Continuing Education Program
September 14, 1999
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What Is Stuttering?
An impairment of speech and
language production, typically
characterized by
interruptions
in the forward flow of speech
(“speech disfluencies”)
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What are the Primary
Symptoms of Stuttering?
 Speech disfluencies come in many
forms
 Some disfluencies are considered
“normal”
(if they occur relatively infrequently)
 Interjections (“um,” “er,” “like,” “you
know”)
 Revisions (“I want- I need that”)
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How Does Stuttering
Develop?
 Typically begins between ages 3 and 5
 As the disorder progresses, children are
likely to develop reactions to
stuttering...
 Tension and struggle in their speech
musculature
 More advanced types of speech
disfluencies
 Concern or anxiety about their speaking
abilities
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What Kinds of
Consequences?
 Affective, Behavioral, Emotional
Reactions:
Anxiety about speaking, avoidance of
speaking situations (reading in class,
talking to friends), embarrassment, shame,
guilt, low self-esteem, frustration, fear
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What Causes Stuttering?
 NO single factor has been shown
to be
THE cause stuttering
 Stuttering is not caused by children’s
parents
 Stuttering is not caused by drawing
attention to a child’s normal
disfluencies
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Okay, so…
What Does Cause Stuttering?
Current theories point to a complicated
interaction between children’s language
development and their motoric abilities
for producing speech, combined with
the multiple influences of the child’s
personality and the child’s
communicative and social environment
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Isn’t Stuttering
“Genetic”?
 Yes, stuttering tends to runs in
families...
 If one family member stutters, there is
an increased chance that another family
member will also stutter
 The few twin studies that have been
conducted show only 50% concordance
for MZ twins, suggesting that there are
also environmental influences
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Doesn’t Everybody
Stutter Sometimes?
 Yes. Speech disfluencies are a normal
part of children’s speech/language
development
 All children go through a period of
producing speech disfluencies when
learning to speak
 Some children, however, will continue
producing disfluencies and develop a
fluency disorder
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Don’t Most Children
Outgrow Stuttering?
 Yes. Most children who exhibit
disfluencies or even stuttering early
in their speech/language development
will recover without intervention
 Prevalence = 1%
 Incidence of Stuttering = 5%
 Incidence of Increased Disfluencies: 15-
25%
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A Critical Period for
Recovery from Stuttering
 If children do not recover by age 6
or 7, they are likely to develop
chronic stuttering
 Older children rarely achieve normal
fluency, and the negative consequences
increase over time
 Negative social and emotional
consequences can be minimized with
appropriate early intervention
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Who Is At Risk
for Chronic Stuttering?
 No single behavior categorically
differentiates children who stutter
from children who do not
 All children exhibit all types of speech
disfluencies
 Sometimes stuttering begins very
gradually, but persists for a long time
before the family notices
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So...Who Is At Risk?
 Certain risk factors can provide some
clues:
 Number, nature, and types of speech
disfluencies
 Length of time the child has been
stuttering
 Family history of stuttering
 Child’s reactions to stuttering
 Family’s reactions to stuttering (parent’s
level of concern and attempts to help)
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Who Should Be Referred
for Evaluation?
 It is impossible to determine whether
a disfluent child is at risk for
developing a chronic stuttering
disorder through
informal or casual observation
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Referral Guidelines
 I evaluate if any of the following are
true:
 The child produces 3 or more
disfluencies during a brief spontaneous
conversational interaction
 There is tension or struggle during
disfluencies (even if the disfluencies are
infrequent)
 The child’s ability to communicate is
affected
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Who Should Evaluate
and Treat Stuttering?
 Speech-language pathologists (SLPs),
licensed and certified by the
American Speech-Language-Hearing
Association (ASHA)
 Not all SLPs are comfortable with
stuttering, so there has been a move
toward specialization
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How Is Stuttering
Treated?
 Helping children learn to speak more
fluently
 Changing the timing and tension of
speech production
 Helping parents learn to facilitate
children’s fluency in everyday speaking
situations
 Parents can change their own speech and
manage children’s speaking situations to
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help them speak fluently
Summary
 Early stuttering can be difficult to
distinguish from normal “developmental”
disfluency
 Early intervention is critical for preventing
the development of chronic stuttering and
its negative social and emotional
consequences
 The safest practice is to refer children
for evaluation by a stuttering specialist,
especially if the parents or child are
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concerned about the child’s speech
Questions? Comments?
Please contact me!
J. Scott Yaruss,
Ph.D., CCC-SLP
Stuttering Center of Western PA
University of Pittsburgh
4033 Forbes Tower
Pittsburgh, PA 15260
Phone:
Fax:
Email
(412) 647-1367
(412) 647-1370
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tuttering
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estern
Pennsylvania
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Mission of the Stuttering
Center
 Provide effective client-centered
treatment for individuals who stutter
 Conduct meaningful research on the
nature and treatment of stuttering
 Provide on-going education for student
clinicians as well as practicing SLPs
 Provide support for individuals who
stutter, their families, and their
clinicians
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Participation
Fluency
Treatment
Communication
Research
Education
Support
S
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tuttering enter
of W estern Pennsylvania
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