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Helping children who stutter: what teachers need to know.

Annie carefully studies the story in her reading book. She counts ahead to the paragraph she will read aloud, hoping it will be short. She hopes the paragraph will not contain words she cannot say. Her hopes fade as she skims the paragraph--there is one word, then another and one more.

For Annie, the rest of the story was just a blur. All she could think about were the words she was afraid she would not be able to say. She hated read-aloud time. Oh, Annie loved to read and she read well, but she still hated read-aloud time. She hated read-aloud because of her stuttering.

When she stuttered she repeated the word's initial sounds over and over or, even worse, she would block on the word and nothing would come out at all. Some classmates stared at her, others laughed at her and, usually, the teacher would say the words for Annie. This made Annie feel relieved, but embarrassed at the same time--relieved that the teacher had said what Annie could not say, embarrassed because she could not get out the words.

It was a painful, recurring scenario Annie knew well--too well. All Annie wanted was to read and talk like the other kids, but she didn't and didn't know what she could do about it.

This is a true story about a young child who stutters; it is my story. I chose to share the humiliation, frustration and fear I experienced as a young child in order to help teachers appreciate the struggle faced by an estimated 1.5 to 3 million Americans, half of whom are young children (Vincent Times, 1992). I also share my personal struggle in the hope that other children may not have to cope with stuttering throughout adulthood. Early detection of stuttering can lead to appropriate treatment and increase the likelihood of full recovery for those children. "If stuttering continues after puberty, it usually persists in one form or another" (Perkins, 1990, p. 61).

Early childhood teachers who are knowledgeable about stuttering are in a unique position to help young children who stutter. With the goal of appropriate early intervention in mind, this article offers educators insight into stuttering and its early warning signals. It also suggests ways teachers can help all children achieve greater oral fluency.

What Is Stuttering?

All children experience disfluencies, disruptions in the flow of speech, from time to time. Young children, in particular, are in a period of rapid language and speech development. Disfluencies are normal and to be expected as children attempt to assimilate their growing linguistic awareness into their speech patterns. Stuttering, on the other hand, is the involuntary repetition, prolongation or cessation of a sound when speaking, as well as the speaker's reactions to these disfluencies. Although knowing exactly what to say, the speaker is unable to say it (Curlee, 1990).

Because the onset of stuttering usually occurs during this period of rapid language and speech development (ages 2-6), the problem for teachers will be distinguishing normal disfluencies from abnormal disfluencies. A comparison of these disfluencies is necessary to help teachers recognize when a child is stuttering.

Normal disfluencies teachers will most frequently observe include: whole word repetition (the...the toy); phrase repetition (give me...give me the toy); interjection (I want the...uh...blue one). Common, but less frequent, normal disfluencies include pauses and hesitations (I want the...blue one) and, occasionally, single part word repetitions spoken with an easy vocal onset (g - give me the toy) (Gottwald, Goldbach & Isack, 1985). These disfluencies are normal and can be the result of strong emotions such as excitement, attempts at hurried speech or merely simple random hesitations.

Abnormal disfluencies that may signal the onset of stuttering differ in type from the disfluencies experienced by nonstutterers (Ainsworth & Fraser, 1990; Gottwald et al., 1985). These warning signals include: multiple part word repetitions (l...l...l...like) or (li...li...li...like); repetitions incorporating a short vowel (lu...lu...lu...like) instead of (li...like); prolongations lasting more than one second (hhhhhhhhouse).

Other behaviors frequently accompany disfluencies when the stuttering child attempts to initiate or resume speech. Behavioral manifestations to note include:

* Language modifiers. Teachers may observe the use of a sound (uh, um), a word or a phrase to initiate speech or the pronunciation of a feared word (Leith, 1984). For example, if the child wants to say "please" and is fearful of stuttering, the child may use a language modifier to initiate fluent speech (e.g., "Uh, please pass the cookies").

* Struggle and tension. Teachers may observe visible tension--quivering or tightening in the muscles of the lips, mouth or face area as the child attempts to say a word.

* Rise in pitch and loudness. Teachers may hear a change in the sound (pitch or loudness) as the child attempts to get the word out.

* Moment of fear. Teachers may see a facial expression of fear as the child attempts to speak.

* Avoidance. Teachers may notice that the child will avoid situations that require speaking or refuse to talk altogether (Ainsworth & Fraser, 1990).

* Nonverbal mannerisms. Teachers may notice a variety of physical movements the stuttering child may use to avoid or terminate a stuttering episode: eye blinks and closures, head nods and jerks, finger or foot tapping, arm swings or altered breathing patterns. The nonverbal mannerisms children develop are unique and may vary from child to child (Leith, 1984).

A child exhibiting such abnormal disfluencies and coping mannerisms should be examined by a speech pathologist trained to work with children who stutter. The child may or may not be developing a stuttering problem; professional guidance is necessary to determine if a problem exists. While it is true that three-fourths of the children who stutter will spontaneously recover or improve, the remaining one-fourth do not and only recover or improve after minimal or time-consuming therapy (Perkins, 1983). Since there is no way of knowing who will spontaneously recover or who will continue to struggle with stuttering, a professional evaluation should be sought.

Emotional and Social Aspects of Stuttering

Although stuttering is a communication disorder, there is an accompanying emotional aspect to the problem. The involuntary nature of stuttering can be emotionally unsettling. Stutterers are never quite sure when speech will be fluent or when a block or stutter will occur. Those who stutter, even young children, experience feelings of frustration, embarrassment and anger. These negative feelings can have a detrimental effect upon the individual's self-image (Wells, 1987). Van Riper (1982) contends that those who have never experienced the disorder cannot fully appreciate how almost every aspect of the stutterer's life "is colored by his communicative disability...and can be a devastating personal problem.... Even those who cope with the disorder can do so only through continual vigilance."

To help speech pathology trainees fully appreciate the difficulties faced by those who stutter, a frequent class assignment requires students to fake stuttering in public places. Trainees pair up and approach sales clerks, customers and passersby to ask questions or otherwise engage in conversation fitting the situation. Comments and reactions following this assignment are revealing:

"People looked at me like I was stupid or something," offered one student.

"And," added another trainee, "people would just interrupt and say the words for me instead of waiting for me to finish."

"It was awful," shared another. "Some people even backed away from me."

Most trainees agreed the assignment was an emotional and stressful one, one they were relieved they did not have to repeat daily. Stutterers are not so fortunate.

"Stuttering is not merely a speech impediment; it is an impediment in social living" (Van Riper, 1982, p. 2). Society values verbal communication and expects members to speak with ease and fluency. Being a stutterer puts one at a distinct social and economic disadvantage. For example, research indicates that teachers and speech clinicians alike tend to hold stereotypical views about stutterers and attribute negative personality traits (submissive, insecure, timid, nervous) to stutterers. And the more severe the stuttering, the greater the increase in negative attitudes. Teachers' and speech clinicians' attitudes reflect the typical general response of the culture to those who stutter--an unfavorable one.

What Teachers Can Do

Teachers, particularly early childhood teachers, have a vital role in helping children who are experiencing abnormal speech disfluencies. The following strategies will enable teachers to help the child who stutters gain greater oral fluency and self-confidence.

* Give all children your full attention when engaging them in conversation, especially the child who stutters. Look directly at the child, focus on the content of the message, make no comment if stuttering occurs and patiently wait for the child to finish speaking. Looking away or interrupting the child to supply words only embarrasses the child more, sends a message of nonacceptance of the stuttering and makes the stuttering worse (Leith, 1984).

* Create a relaxed, unhurried learning environment. Use and model a relaxed, unhurried rate of speech for all students. Time pressures when speaking increase disfluencies for all speakers, particularly young children who may be taxing their current level of speech maturity. Time pressures are especially detrimental to the child who stutters (Gottwald et al., 1985). Avoid telling the child to "slow down," "think of what you want to say" or "take a deep breath." This advice compounds the child's problem because it emphasizes that the child is actually doing something wrong (Ainsworth & Fraser, 1990). Remember, stuttering is involuntary.

* Demonstrate and encourage polite speaking manners; do not allow students to interrupt, speak for or finish words for others (Curlee, 1990).

* Become sensitive to the attitudes and reactions of classmates toward a child who stutters; do not permit teasing or laughter (Leith, 1984). Deal directly with the situation by providing classmates with information about stuttering and show them how they can help by using relaxed speech and polite speaking manners.

* Provide successful speaking experiences for all children, such as choral speaking and reading, as well as singing. These activities enhance oral fluency (Gottwald et al., 1985). Minimize demands for impromptu "command performances" and, when possible, allow time for students to practice speaking prior to performing before classmates.

If you suspect a child is developing a stuttering problem, express your concerns to the parents or guardians. Be sure to provide specific instances indicative of developing stuttering and note (if possible) the type of stutter, any accompanying mannerisms and frequency of occurrences. If the child is receiving school-based therapy already, seek guidance from the speech therapist concerning the child's therapy program. The suggestions presented here are general in nature and do encourage fluency, but the speech therapist can provide specific recommendations designed to enhance the child's treatment program.

Also plan a conference with the child's parents or guardians to discuss the child's speech disorder and therapy program. A team approach in which efforts are coordinated not only benefits the child, but also lets the child know others care.

Teachers can do much to minimize the emotional and social trauma of stuttering and also encourage increased oral fluency for children. In addition to creating a learning environment that encourages fluency for all children, teachers can identify children displaying abnormal disfluencies and intervene, thus giving them opportunities to develop normal to near normal fluency.

In my own situation, I did not receive any help or guidance from my teachers. In fact, none of them even seemed to acknowledge my stuttering. Based on my informal conversations with other teachers about stuttering, I am inclined to believe that my teachers simply did not know I was stuttering or, if they did know, they were unsure about what to do and so did nothing. Therefore, I continued to struggle on my own and developed coping mechanisms that sometimes worked and other times did not.

I continue to deal daily with my stuttering, and it still causes me embarrassment. At a recent presentation, one professor informed me that I said "You know" 21 times in a half hour (I use "You know" as a starter phrase for feared words). After the initial shock of learning what I was doing, I used the information in my self-therapy. Even though my stuttering causes me embarrassment, I refuse to let it control my life. Some days are easier than others, but isn't that the way it is for everyone?

Ann M. Swan is a free-lance writer and Language Arts Consultant, Sarasota, Florida.

References

Ainsworth, S., & Fraser, J. (1990). If your child stutters: A guide for parents (3rd ed.). Memphis, TN: Stuttering Foundation of America.

Curlee, R. F. (1990). Does my child stutter? In E. G. Conture & J. Fraser (Eds.), Stuttering and your child: Questions and answers. Memphis, TN: Stuttering Foundation of America.

Gottwald, S. R., Goldbach, P., & Isack, A. H. (1985). Stuttering: Prevention and detection. Young Children, 41(1), 9-14.

Leith, W. R. (1984). Handbook of stuttering therapy for the school clinician. San Diego, CA: College-Hill Press.

Perkins, W. H. (1983). Onset of stuttering: The case of the missing block. In D. Prins & R. J. Ingham (Eds.), Treatment of stuttering in early childhood: Methods and issues. San Diego, CA: College Hill Press.

Perkins, W. H. (1990). Should we seek help? In E. G. Conture & J. Fraser (Eds.), Stuttering and your child: Questions and answers. Memphis, TN: Stuttering Foundation of America.

Staff. (1992, Winter). The word on stuttering. St. Vincent Times, pp. 6-7.

Van Riper, C. (1982). The nature of stuttering (2nd ed.). Englewood Cliffs, NJ: Prentice-Hall.

Wells, B. G. (1987). Stuttering treatment: A comprehensive clinical guide. Englewood Cliffs, NJ: Prentice-Hall.

Teacher Resources

The Prevention of Stuttering: Part 1 (30-minute videotape). Available for $10.00 plus postage and handling from the Stuttering Foundation of America.

Stuttering Foundation of America (formerly Speech Foundation of America), P.O. Box 11749, Memphis, TN 38111-0749

National Association for Hearing and Speech Action, 10801 Rockville Pike, Rockville, MD 20852

The Stuttering Foundation of America asks...

DID YOU KNOW...

* Over 3 million Americans stutter.

* Stuttering affects four times as many males as females.

* People who stutter are as intelligent and well-adjusted as nonstutterers.

* Despite decades of research, there are no clear-cut answers to the causes of stuttering, but much has been learned about factors that contribute to its development.

* As a result, tremendous progress has been made in the prevention of stuttering in young children.

* People who stutter are self-conscious about their stuttering and often let the disability determine the vocation they choose.

* There are no instant miracle cures for stuttering. Therapy is not an overnight process.

* Twenty-five percent of all children go through a stage of development during which they stutter. Some 4 percent may stutter for six months or more.

* Stuttering becomes an increasingly formidable problem in the teen years as dating and social interaction begin.

* A qualified clinician can help not only children but also teenagers, young adults and even older adults make significant progress toward fluency.

* Winston Churchill, Marilyn Monroe, Carly Simon, James Earl Jones, Ken Venturi, John Updike, Lewis Carroll and King George VI all stuttered and overcame their problem.

* The Stuttering Foundation of America maintains a toll-free Stuttering Hotline (1-800-992-9392). Call for free informative brochures and a nationwide resource list of licensed speech-language pathologists who specialize in the treatment of stuttering.

* The Stuttering Foundation is the first nonprofit, charitable organization in the world concerned with prevention of stuttering in children and improvement of treatment for adults who stutter.

* The Foundation has distributed well over 2 million books covering every phase of stuttering to both the public and professionals. It has long led the way in supplying accurate information.

Stuttering Foundation of America (formerly Speech Foundation of America) P.O. Box 11749, Memphis, Tennessee 38111-0749
COPYRIGHT 1993 Association for Childhood Education International
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Author:Swan, Ann M.
Publication:Childhood Education
Date:Mar 22, 1993
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