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Identification and Treatment of

Childhood StutteringJ. Scott Yaruss, Ph.D., CCC-

SLPStuttering Center of Western

PennsylvaniaUniversity of Pittsburgh

Children’s Hospital of Pittsburgh

Pediatric Grand RoundsMercy 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 PrimarySymptoms of Stuttering?

Speech disfluencies come in many formsSome 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

Disability

Reactions

EnvironmentalInfluences andOther Factors

Behavioral

Affective

Cognitive

HandicapImpairmentPresumedEtiology

After Yaruss (1998)

Click for larger picture

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What Causes Stuttering?

NO single factor has been shown to beTHE 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 EverybodyStutter 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 ChildrenOutgrow 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 forRecovery 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 Riskfor 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 Referredfor Evaluation?

It is impossible to determine whether a disfluent child is at risk for developing a chronic stuttering disorder throughinformal 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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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

Who Should Evaluateand Treat Stuttering?

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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 help them speak fluently

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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 concerned about the child’s speech

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Questions? Comments?Please contact me!

J. Scott Yaruss, Ph.D., CCC-SLP

Stuttering Center of Western PA

University of Pittsburgh4033 Forbes TowerPittsburgh, PA 15260

Phone: (412) 647-1367Fax: (412) 647-1370Email

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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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