When Should Stuttering Treatment Begin?

When Should Stuttering Treatment Begin?

So your three-year-old child might be stuttering. Should you get treatment immediately or wait for a bit? For a short answer, I recommend seeking formal evaluation if the stuttering continues longer than 3 to 6 months. Some early childhood stuttering resolves on its own. For some more thoughts about this and recent events surrounding this issue, read on…

Many preschoolers experience some form of stuttering, or “disfluency,” as part of typical development. Research suggests that about 5% of children will have “bumps” in their speech, perhaps getting stuck on a single syllable or part of a word, such as “Whe-whe-whe-where can it go?” Many of these children will make a spontaneous full recovery without formal treatment. The rate of spontaneous recovery has been estimated from 50% to as high as 80% (Saltuklaroglu & Kalinowski, 2005; Yairi & Ambrose, 1999).

If a child might recover all on his or her own, when should you seek treatment? This question has received some recent attention by researchers and the general public alike. Last year, an article by researchers out of Australia received a lot of attention due to a seeming implication that treatment could be delayed for 12 months after the onset of stuttering (Reilly et al, 2013). The article, part of a long term study, reported that children who stuttered in preschool did not score lower than other children on measures of language development and quality of life. The article garnered so much attention worldwide that the Australian Stuttering Research Centre released a formal response to the publicity (read the full response here).

What the ASRC pointed out was that the Reilly et al study includes data from all children, including those children who may go on to spontaneously recover. No one is able to predict for certain which children will persist in stuttering and which will recover. Children who persist are at higher risk for other speech impairments, such as delayed or disordered language or articulation of speech sounds.

Speech-language pathologists would love a reliable way to separate children who will spontaneously recover from those who will not. There is quite a lot of research going on with that aim, including the Purdue Stuttering Project at my own alma mater. At present, the state of the art in the prediction of stuttering persistence is a list of risk factors, including (adapted from the Stuttering Foundation webpage):

  • Family History – There is greater risk for the persistence of stuttering if the child has a relative who stutters.
  • Age – If stuttering begins after age 3 ½, there is greater risk for persistence into adulthood.
  • Length of time stuttering – Children who have been stuttering for 6 months or longer are more likely to persist.
  • Gender – Boys are about 4 times more likely than girls to continue stuttering into adulthood.
  • Other speech problems: Many sound substitutions, such as substituting a “w” for an “r” sound, are normal for young children. However, children with many sound errors are more likely to persist in stuttering.

While “wait and see” is an attractive idea, beginning treatment for stuttering early is important. Treatment is not harmful for any child, including those who spontaneously recover. Therapy can reduce the impact of persistent stuttering by enabling children to manage disfluency early on, and also minimizes the risk of developing lifelong negative feelings about speaking in public. So my recommendation: let the prevailing clinical wisdom of the day guide you, and get it checked out!

References

Reilly, S., Onslow, M., Packman, A., Cini, E., Conway, L., Ukoumunne, O., Bavin, E., Prior, M., Eadie, P., Block, S., & Wake, M. (2013). Natural history of stuttering to 4 years of age: A prospective community-based study. Pediatrics, 132(3), 460-467. Retrieved from https://pediatrics.aappublications.org/content/early/2013/08/20/peds.2012-3067

Saltuklaroglu, T., & Kalinowski, J. (2005). How effective is therapy for childhood stuttering? Dissecting and reinterpreting the evidence in light of spontaneous recovery rates. International Journal of Language and Communication Disorders, 40(3), 359-374.

Yairi, E., & Ambrose, N. (1999). Early childhood stuttering: Persistence and recovery rates. Journal of Speech, Language, and Hearing Research, 42, 1097-1112.