Helping Parents Understand the Importance of Early Assessment in Childhood Stuttering

Many clinicians recommend that parents ignore their childs stuttering. This outdated advice is based on the old theory that drawing attention to a child's stutter could cause the stutter to increase. Today, we know that this is not true.

Telling parents to ignore stuttering can have unintended negative consequences and cause us to miss opportunities to help children and families cope effectively with stuttering right from the very beginning!

Former Schools of Thought on Stuttering

Historically, speech-language pathologists (SLPs) taught parents and others to ignore early childhood stuttering. The idea was that talking about stuttering would cause children to become self-conscious, and this could lead to increased stuttering.

This school of thought stemmed from an old theory that suggested stuttering was caused by parentsmisidentifyingtypical disfluenciesas stuttering. This theory also presumed that calling attention to a childs disfluencies would cause the child to become concerned about speaking, leading the tension and struggle that characterize stuttering.

The problem isthats not how stuttering works!

Wait. What?

This theory was perhaps the most influential in the history of our field, and not just among SLPs! Pediatricians, educators, family memberseveryoneknew that you werent supposed to draw attention to stuttering.

Many people (especially SLPs) avoided saying the word stutter altogether for fear that it might cause a child to become aware of the issue. This is one of the reasons that people refer to fluency kids on their caseload rather than "children who stutter."

Did people really believe that?

From todays perspective, this may seem odd, but the notion was consistent with the perspectives of the day, and people believed that there was evidence to support these ideas. Still, the ideas were complex and nuancedand many people today have misinterpreted and overextended the ideas behind the theory.

Certainly, we dont want people to make negative comments about a childs speech. Harsh reactions to stuttering (or any difference) can cause children to feel self-conscious. When people feel self-conscious, they may have more difficulty expressing themselves (or performing any task).

Still, making comments that might lead to self-consciousness are not the same as causing stuttering. This idea is what gets us into trouble today, so we must rethink how we respond to early childhood stuttering to better help children who stutter.

The Problem with Ignoring Early Stuttering

Even today, we still find people, including SLPs and pediatricians, who advise parents to ignore stuttering. This guidance can commonly be found in social media groups where even ASHA-certified clinicians will say, Oh, my child stuttered for a while. I ignored it and it went away! Dozens of people will chime in with, I did that too! (This is in addition to those who feel compelled to recommend their favorite therapy approach or materials packet even though they dont yet know anything about the child in question!)

Why do they say that?

Here's one of the most challenging aspects of early childhood stuttering: most preschool children who stutter, stop stutteringeven without intervention! Recovery rates are about 75 percent, so no matter what parents do or do not do (ignore stuttering, use a specific treatment, or stand on their heads), it will appear to work 75 percent of the time!¹

This can mislead people into thinking that something helps even when its irrelevant. This has been the case with the advice to ignore stuttering because three-quarters of children whose parents ignored stuttering were going to recover anyway. The approach of ignoring stuttering had nothing to do with why those children recovered.

The problem arises for that 25 percent of children who continue to stutter. Ignoring their early stuttering costs them a really important opportunity, because delaying treatment may increase the risk that the child will continue stuttering! Early intervention can also help children recover more quickly than just waiting and hoping for natural recovery.²

Ignoring early stuttering is not consistent with best clinical practices and too many professionals are still giving outdated advice, thereby putting children at risk because they harbor old beliefs.

What Can Be Done Instead?

Rather than telling parents to ignore childhood stuttering, we should first follow the principles of evidence-based practice (EBP) and assess whether that advice is appropriate for the child in question. This means conducting a full evaluation to determine whether the child is at risk for continuing to stutter. A full discussion of what is included in a comprehensive evaluation for young children who stutter is the subject for another post; however, there is a general consensus among stuttering specialists that assessment should examine factors related to the childs and familys experience of stuttering (e.g., length of time since onset of stuttering, negative reactions to stuttering by the parent or child, etc.), the childs language and speech abilities, whether there is a family history of stuttering, and other key variables³ that are the subject of ongoing research.^4,5

If the child is at low risk for persistence, then it may be safe to monitor stuttering for a short period of time (perhaps three to at most six months) while continuing to watch for any increase in risk factors or negative experiences associated with stuttering.If a child is at elevated riskthat is, if the child exhibits characteristics such as a family history of stuttering, longer time since onset of stuttering, reduced speech language skills etc.then we should take every opportunity we can to ensure that the child has the greatest chance for recovery. In most cases, that means that we should recommend treatment!

Bottom line: Dont just tell parents to ignore stuttering!

We have learned a tremendous amount about stuttering over the years. That increased knowledge should lead to improved clinical practice. Nowhere is this truer than in the advice that we provide to parents of young children who stutter. Rather than telling parents to ignore stuttering, we should apply the principles of EBP to evaluate the childs risk for continued stuttering. They'll then be equipped to make specific recommendations that will decrease the likelihood that the child will continue to stutter and increase the childs ability to communicate more easily.

To increase your level of comfort and knowledge surrounding the evaluation and treatment of school-age children who stutter, I offer this three-part course which is designed to help you learn more about the nature of stuttering so you're able to determine which school-age children are most likely to benefit from stuttering therapy.

For additional reading on this topic, I recommend the following resources:

• Early Childhood Stuttering: Information Support for Parents by Nina Reeves and J. Scott Yaruss

• Early Childhood Stuttering Therapy: A Practical Guide by Nina Reeves and J. Scott Yaruss

• Exploring Relationships Among Risk Factors for Persistence in Early Childhood Stuttering by Bridget Walsh, Sharon Christ and Christine Weber

• Predicting Persistent Developmental Stuttering Using a Cumulative Risk Approachby Cara M. Singer, Sango Otieno, Soo-Eun Chang and Robin M. Jones

• How do I know if treatment is indicated for a young child who stutters? byJ. Scott Yaruss