The formative preschool years, when a child's speech and language skills progress by leaps and bounds, is also the time when the seeds of stuttering often take root. Ignored or inadvertently fertilized, the roots of stuttering grow longer and stronger until the growing child is unable to uproot it.
Those of us who have worked with adults who stutter understand the enormity of their struggle to speak fluently. When working with someone who stutters, it is easy to lose sight of the time when it began to take root. That begs the question as to how we can help children during those critical preschool years? Perhaps the answer is not complicated.
Over the nearly 40 years I have worked as a clinician, I have been keenly aware of the significant role parents play in the progress of their children during therapy. When parents understand their child's disorder and commit to doing their part to help their child, their child's progress is positively affected. When it comes to helping the preschool child who stutters, the assistance of the parents is paramount. I have found that when parents follow my suggestions, the child may learn to regain fluency without my direct intervention.
Working
closely with parents is a process that starts with the initial parent
interview. The initial interview gives me the opportunity to learn about
the parent's understanding of the stuttering, how they react to hearing
their child stutter, and their perceptions of the problem. When I first
meet with the parents, I ask them general questions about the child's
development and health. I then ask them questions specific to their
child's speech. I write as they answer the following questions: 1. When did the child begin stuttering?
2. Who was the first person to notice the stutter?
3. Are there any family members who stutter? If yes, who?
4. What do they feel caused the child to begin stuttering?
5. How do they feel their child feels about his/her stuttering (frustrated, refuses to talk, embarrassed, angry, doesn't seem to care)?
6. Does the child avoid certain words, change words, avoid talking, lose his/her temper, or hit other children?
7. Does any of the following happen when the child is trying to get his/her words out: blink his or her eyes, move his or her eyes sideways, lips quiver, he or she inhales deeply, his or her body stiffens, his or her head jerks, and he or she stamps or taps her foot? I will ask the parents if there is anything else they have noticed the child do when stuttering.
8. Is the child's speech better in the morning, after school, at night, when talking to a pet, when talking to a specific person, when relaxed, when playing with, when reciting (numbers, nursery rhyme, alphabet), when singing? Are there other times when the child's speech is better?
9. Is the child's speech worse in the morning, after school, at night, when talking to a pet, when talking to a specific person, when relaxed, when playing with a certain person, when tired, hungry, frustrated, anxious, angry, stressed, excited, or afraid? Are there other times when the child's speech is worse?
10. What has been said or done to help the child stop stuttering?
11. How concerned are you about your child's speech (not concerned at all, somewhat concerned, very concerned, extremely concerned)?
12. How well does the child get along with mother, father, brother(s), sister(s) and anyone else living in the home?
13. What does the child enjoy doing?
14. What does the child dislike doing?
I ask each parent to reply to the questions. It is surprising how many parents have different viewpoints, opinions and perceptions of the child's speech. Thus, it is important to hear what each has to say. This type of interview gives me the leeway to ask them to expand on a response if I need clarification or to ask another question based on their response. If an adult, other than a parent, cares for the child during the day, I ask the adult to respond to the questions as well. If the parent or caregiver cannot attend the session, I telephone the person and write his/her answers on the form.
After I have completed the questionnaire, I spend time talking with the preschooler. The parent is welcome to stay in the room and engage with the child. I listen carefully to the child's speech and record it. I note the type of stuttering (repetitions, prolongations, hesitations), the frequency of the stuttering and if there are any secondary stuttering behaviors. I observe the parent-child interactions. Based on the responses the parents gave during the interview and my observations, I decide if the child needs therapy or if I can work with the parents and hold off on therapy. If I feel comfortable holding off on therapy, I ask the parents if they are in agreement and if they feel they can the implement the suggestions I share with them. The suggestions can be specific to the family dynamics I learn about from our interview. However, the generic suggestions are:
1. Avoid offering their child advice on how to talk, such as slow down, take your time, breathe before you talk, relax, stop talking that way, say it the way I do, and think before you talk.
2. Avoid finishing your child's sentences or words for him or her, talking for him or her, or interrupting him or her when he or she is speaking.
3. Avoid calling their child a "stutterer."
4. Avoid getting upset when their child stutters.
5. Do not tease or mock their child's speech.
6. Avoid asking their child to recite or perform in front of others.
7. Get down to the child's level, make eye contact and listen, without interrupting, to what the child has said.
8. Comment on what the child says not how he or she has said it.
We do not yet have a cure for stuttering. However, what we help families understand and do during the preschool years can make a difference and may be the closest opportunity we have for a cure at this time.
Mirla G. Raz a certified and licensed speech-language pathologist, lives and works in Scottsdale, Ariz.. She has worked extensively with the pediatric population remediating speech sound disorders, language disorders and stuttering. Raz recently published Preschool Stuttering: What Parents Can Do. Her popular Help Me Talk Right series of books have been used by parents and professionals throughout world. Information about the books and her blog can be found on her website, http://www.helpmetalkright.com
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