Recommending treatment for preschool stuttering, Cont.

Part 2.2

This is actually part 3, of a 3-part series of posts about referring parents who are concerned about

In Part 2.1, we looked at some of the warning flags for stuttering and how we can use them to help determine when treatment is recommended.  Here, in Part 2.2, we will look at different types of disfluencies and other characteristics to consider to aid in treatment recommendations.

As an SLP, how can I tell if the disfluencies are typical or stuttering?

As I mentioned in Part 2.1, I tend to err on the side of caution.  Growing up with stuttering is really hard.  For many people, the challenges can last a lifetime.  Since it’s hard to know which child will recover without any intervention, why take the risk?  Providing support to the family and child will never hurt and may mean that we can support the child’s recovery.

“Typical” Disfluencies

I put “typical” in quotes, because there are no hard and fast rules.  However, if you observe these types of disfluencies, the risk for developing persistent stuttering is lower.  It may be possible that the risk for persistent stuttering may change.  You may see a child who presents with signs that suggest lower risk of stuttering.  In these situations, I like to follow up with the parents after a month or so.  I want to find out if there have been any changes.  It is possible that over time some of the lower-risk factors may shift towards higher risk, and your treatment recommendations may change.

1. Whole-word repetitions: “Can can can I have some cookies?”

2. Phrase repetitions: “I want, I want, I want mac and cheese.”

3. Interjections: “I want, um, um, um, bubble gum ice cream.”

4. Revisions: “Do you want to play Batman, I mean Spiderman?”

5. Number of repetitions: Fewer than 3 or so units of repetition, e.g., “Lets p-p-p-play Legos”, are more suggestive of typical disfluencies, and tips the scale towards lower risk for stuttering.  In this case I would want to check in with the parents in a month or so and see if there has been any change in the disfluencies.

6. Percent disfluent words: If fewer than 7-10% of a preschool child’s words are disfluent, this also tips the scale towards lower risk of persistent stuttering.  In this case too, I would want to touch base with parents in a month or so to see if there have been any changes.

“Stuttering” Disfluencies

Just like above, there are no hard and fast rules here, only observations that suggest lower or higher risk for developing stuttering.  If you observe any of the following, the child is at higher risk for persistent stuttering

1. Part-word repetitions: Sometimes referred to as syllable repetitions, e.g. “C-c-c-c-c-c-can I have some cookies?“

2. Number of repetitions: More than 3-5 units of repetition, e.g., “Lets p-p-p-p-play Legos“, are more suggestive of stuttering disfluencies, and tips the scale towards higher risk for stuttering.  Remember to base your decision making on the big picture and not just any single factor or observation.

3. Silent blocks: “I want m——–ac and cheese.”  Silent blocks where there is not sound flowing suggest that stuttering may be starting to set in.  If you’re noticing these kinds of disfluencies along with other higher-risk factors, you may want to recommend treatment.

4. Prolongations: “IIIIIIIIIII want bubble gum ice cream.”  Like silent blocks, prolongations are more characteristic of stuttering and will tip the scale towards recommending treatment.

5. Percent disfluent words: If more than 10% of a preschool child’s words are disfluent, this also tips the scale towards higher risk of persistent stuttering.

These next three are all pretty related to each other. Presence of any of the following will tip the scales towards higher risk, while absence of any of the following will tip the scales towards lower risk.

1. Tension or struggle: Tension or struggle might be a silent block as the child is trying hard to force the sound out.  You might see tension in the muscles of the child’s face or in their neck as they struggle to get the sound or word out. 

2. Secondary behaviors: Secondary behaviors can include movements of extremities, eye blinks, facial grimaces, and distracting sounds, among others.  These secondaries are generally signs of struggle.

3. Frustration or concern: Signs of frustration might include giving up mid-sentence, making comments such as, “My mouth is broken” or, “Why can’t I talk?”  In my view, tension, struggle, and secondary behaviors are all signs of frustration or concern.  However, absence of frustration or concern does not mean a child is not at high risk for persistent stuttering.  Other high-risk factors may be present, and a big picture view is important.

Are you an SLP with a fluency kiddo?  Are you feeling unsure about how to proceed?

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