Understanding Developmental Stuttering: A Stuttering-Affirming Perspective
April 30, 2020
American Institute for Stuttering
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As children begin to speak, their speech and language development are rapidly expanding, and their brains are working to master complex skills.
This includes learning new vocabulary, sentence structures, grammar rules, speech coordination, and other language abilities, all of which are natural aspects of a child's development.
Some children, as part of this process, experience developmental stuttering—a fluency disorder that affects the normal flow of speech. At AIS, we work to help celebrate the many different ways of speaking, especially the voices of people who stutter.
Developmental stuttering, also know as childhood stuttering or persistent stuttering, is the most common type of stuttering and is a fluency disorder that affects speech fluency and usually appears between the ages of 2 and 5, when children experience a rich burst of language growth and increased speaking experiences.
The average age of onset is around 3 years old, with approximately 80% of children spontaneously recovering. The remaining 20% go on to continue stuttering, including roughly 3 million Americans of all ages.
It’s known clinically as childhood onset fluency disorder, a type of speech disorder characterized by speaking disruptions such as repeated sounds, prolongations, and blocks in speech production. This form of stuttering begins early and evolves alongside a child's development, affecting the speaking interactions that they have as they grow up.
Neurogenic stuttering is an acquired form of stuttering that occurs later in life after an injury or neurological disorder, such as a stroke, traumatic brain injury, or brain tumors.
Often the cause of neurogenic stuttering can be identified, and prior to the injury individuals generally have typical speech fluency with no stuttering. Neurogenic stuttering may involve frustration with speaking, but generally does not include the same degree of negative experiences and emotions related to stuttering as developmental stuttering does.
Psychogenic stuttering is another acquired form of stuttering; however, it emerges due to psychological or emotional factors rather than neurological factors. Psychogenic stuttering typically involves a sudden onset following a traumatic experience involving severe emotional trauma or shock.
While no single cause explains why stuttering occurs, research suggests that genetic factors, brain structure, environmental factors, and social/emotional factors all play a role.
A family history of stuttering is often present - for example, having a first degree relative who stutters may increase the likelihood of stuttering to occur.
Brain scans and brain imaging, including functional MRI, show subtle differences in how speech and language skills are processed in those who stutter compared to those who don’t. These differences don’t indicate a deficit—they’re simply part of how people who stutter experience speech.
Environmental factors that may affect stuttering include big life events, such as moving to a new place or school, getting or losing a job, or losing a loved one. Social and emotional aspects also play an important role in influencing stuttering, and certain speaking situations such as talking on the phone, speaking in a group, talking in an interview, ordering food, and so forth can result in more stuttering.
This is because different situations have different factors that tie into stuttering, such as the following possible layers:
Common stuttering symptoms and signs include:
Stuttering may also involve other speech-related behaviors, such as avoiding certain syllables (or avoiding speaking altogether), showing cognitive reactions like frustration or embarrassment, or feeling low self esteem due to how others respond to the speech difficulties. It is important to note that how people define "mild" or "severe" stuttering typically involves only the physical component of stuttering
However, a speech language pathologist can more appropriately assess for the overall impact that stuttering has, including emotional and cognitive aspects as well as the physical. All of these components are important to consider together, because how a person who stutters feels and what they think about stuttering impacts their communication experiences on a daily basis.
Furthermore, negative thoughts and emotions about speaking can lead to avoidance of stuttering, which increases the struggle associated with stuttering. Direct observation by a stuttering specialist can help clarify whether your child may benefit from stuttering therapy.
A speech language pathologist is the go-to professional for getting stuttering diagnosed. This involves evaluating speech and language milestones, speech production, and communication skills through observation as well as by communicating with parents.
Although there is no known underlying cause for stuttering, there are factors that can influence stuttering and a child's speech fluency.
Clinicians will consider whether there's a family history, if stuttering occurs more in certain situations, and whether the child’s confidence or participation is affected by their stuttering. Most children develop negative thoughts and emotions related to stuttering based on the ways in which others react and respond to their stuttering.
Speech language pathologists will take these aspects into consideration as part of the assessment process to evaluate the impact that stuttering has on a person's quality of life. They will assess for other potential language disorders or speech problems as well.
Enhancing fluency? Reducing physical tension? What does it mean to "treat" stuttering?
Absolutely—but let’s reframe what we mean by stuttering “treatment." In speech therapy, the goal isn’t always fluent speech. Instead, we focus on comfort and confidence in a child's speech and finding ways to support their active, effective, spontaneous communication, working towards building a healthier relationship with stuttering.
As a part of this process, we do work towards changing the moment of stuttering, but instead of trying to achieve fluency by hiding stuttering or using electronic devices, we aim to make the stuttered moment easier, less tense, and more comfortable overall. This may involve direct or online stuttering therapy working with the child as well as indirect stuttering therapy working with caregivers (parents, families, teachers, etc.) to create a healthy and safe environment for the child.
We involve parents in speech therapy and recommend early intervention—especially if the speech disorder persists for over 6 months or interferes with the child’s speech and overall communication.
Stuttering treated with early intervention often leads to significant improvements in a child's communication skills. Our stuttering therapy focuses on enhancing comfort with speech, fostering self esteem, and building communication skills rather than using tools like electronic devices or other strategies that aim solely to enhance fluency.
Because every child stutters differently, therapy is individualized to meet their unique stuttering pattern, emotional needs, and communication goals.
Speech language pathologists may treat stuttering by focusing on:
Most children recover spontaneously from developmental stuttering as their speech and language skills mature. But, for those who do not, their relationship with stuttering is crucial in determining the impact it has on their speaking and on their lives as a whole.
Speech therapy that is aimed to treat stuttering is important in helping children to create a healthy relationship with stuttering, as well as helping important figures (e.g., parents, teachers, caregivers, etc.) understand how to talk about, respond to, and support the child in a way that fosters confidence, acceptance, and effective communication.
Whether or not a child stutters into adulthood, what matters most is that they feel seen, heard, and supported, and that they have the language to talk about their stuttering and the emotions connected to it.
These skills help people who stutter to participate fully, without their stuttering negatively impacting their lives. Even in cases of stuttering that continue into adulthood, many adults who stutter thrive in their personal and professional lives.
If your child is showing signs of developmental stuttering and you are wondering how to support a child who stutters, here are a few stuttering-affirming actions you can take:
And above all, remember: speech fluency is not the same as communication success. Developmental stuttering is one of many ways speaking can look, sound, and feel.
With support from a speech language pathologist, speech and language resources, and affirming family and school environments, children can thrive and find comfort and confidence in their own speech—regardless of if they stutter or not.
