You may have noticed that your child appears to be getting stuck on words or repeating words and sounds recently, what do you do? Your friends and/or family may have told you not to worry about it as they will likely grow out of the problem, is this true? How can you tell if my child is stuttering? When do I seek help for this problem?
In this post, you will be provided with a brief summary addressing questions related to childhood stuttering.
According to the American Speech-Language-Hearing Association (ASHA), in preschool age the prevalence of stuttering can be as great as eleven percent. The prevalence of stuttering is also greater in boys than girls up to 4:1 as the stuttering progresses.
Characteristics of Stuttering
Disfluency is anything that interrupts the forward flow of speech. Stuttering occurs when this disruption occurs within a word.
There are two forms of stuttering:
1) Sound/Syllable Repetition: repeating a single sound or syllable (e.g., g-g-g-going, bi-bi-cycle, etc.) and 2) Sound Prolongations; pausing or stretching out single sound (e.g, g__oing, ____bicycle).
Associated and/or secondary characteristics may also be present for a child who stutters. These are described as movements as a reaction to the stuttering including but not limited to: distracting sounds, facial grimaces, head movements, movement of the extremities, etc.
Stuttering is a disorder of childhood with typically emerges between the ages of two and a half and five years old. While genetics and neurophysiology appear to be related to the underlying causes of stuttering, environmental factors, temperament, and speaking demands may influence a child’s reactions to stuttering.
80% of children will outgrow stuttering within four years. During the first year however, 12% recover spontaneously. Indicators that your child may continue to stutter includes but not limited to: no changes in frequency of stuttering, changes in stuttering type, persistence of associated behaviors six months post onset, family history of stuttering, increased communication demands, etc.
When therapy is recommended
If you notice that your child is stuttering, mark when you first noticed the problem begin. Initially, do not draw attention to the stuttering, decrease the communication demands and model slow and smooth speech when speaking to or near your child.
If you are concerned about your child’s stuttering, have them evaluated by a Speech-Language Pathologist who specializes in assessing and treating children who stutter.
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Jamie Bodden Austin, M.S. CCC/SLP-L- Assistive Technology Speech and Language Pathologist
Learning a language is a journey – be it a a first language, a foreign language, a light tech symbols systems (e.g. PODD Communication Books) or a high technology voice output system (e.g. Proloquo2Go on an iPad, NOVA chat 10 or Tobii Dynavox). It begins with one step. A baby hears words for the first year said by all of their family members. The family members repeat these words, use gestures, point to things, say single words over and over words such as “Daddy”, “Up”, “Uh oh”. They focus on favorite words (e.g. “doggie” and ‘Swing”), familiar words (e.g. “bottle”, “night-night”), greetings (e.g. “Hello”) and comments (e.g. “uh oh”). After one year, the first word, a single word is spoken by the baby. When learning a foreign language, the teacher speaks single words, uses gestures and points to items. She focuses on favorite words, greetings, comments and familiar vocabulary first.
The same is applied when learning any AAC system. It is another language. Did you know that baby hears 4,000-6,000 words per day for the first year, before they say their first word? This repetition of modeling of language is just as important through a Augmentative and Alternative communication (ACC) device. This can be formally called: Aided Language Stimulation, Partner–Augmented Input, Natural Aided Language or Aided Language Modeling. This means that all of the people in a child’s environment communicate using the AAC communication system. When we support someone to learn to use an AAC device, we talk with the device throughout the day ourselves. We can think about saying favorite words, familiar words, greetings and comments. While doing this we can use gestures, point to things and say single words with the AAC system. By having all of your family/friends involved in saying messages using the AAC system you create a language rich environment, in your child’s language. This language becomes another language in your home that you all speak.
The trick is that you and your family are also learning the AAC system. However, every journey begins with a single step. Like a baby learning to speak and like a person learning a foreign language, focus only on one word or one page of vocabulary at a time. The more you talk with the device with this one page or one word, the more your child will hear, see and follow your lead. You can start with a favorite activity, a greeting or with a few favorite actions. Next, find another page to focus on, such as position words, names, questions or places. You can’t learn the device in one day, but the more single words you find, you will see your own AAC vocabulary grow. Your one step is going to be the biggest step of your child’s AAC journey.
“A journey of a thousand miles begins with one step.” Lao-tzu
Parents understandably worry when they hear the words “speech generating device”, “AAC” and “augmentative communication”. Concerns are voiced such as:
The Speech Language Pathologist (SLP) doesn’t think she will talk and is giving up on her speech
My son talks, why is the SLP recommending a speech generating device? My son doesn’t fit this profile!
Won’t that device stop her talking and make her too lazy to talk?
That is just not the case. The American Speech Language Hearing Association (ASHA) defines augmentative and alternative communication (AAC) as “all forms of communication (other than oral speech) that are used to express thoughts, needs, wants and ideas. We all use AAC when we make facial expressions or gestures, use symbols or pictures, or write.”
There are many myths around the use of augmentative and alternative communication (AAC) in individuals of all ages but these myths are particularly prevalent with our young children. Below are the most common concerns (myths) that I continue to hear from families and professionals, especially those working with young children. I want to dispel the myths with the realities surrounding the concerns.
MYTH: The AAC system will become a crutch for my child. Parents are frequently concerned that their child will use the device instead of learning to communicate verbally.
REALITY: Many children’s verbalizations increase when they begin using a voice output AAC device. Research and clinical practice continue to indicate that AAC does not interfere with verbal speech and actually encourages spoken language. We frequently see increased imitation and spontaneous verbalizations when children use augmentative communication systems. Children will communicate with the easiest and most flexible means available to them. It is easier to use verbal speech when possible than it is to create a message on a communication device.
MYTH: The term ‘augmentative communication’ refers only to devices with voice output.
REALITY: There are many different types of augmentative communication with and without voice output. Some types include using objects, photographs, picture symbols such as Boardmaker or SymbolStix, gestures and manual signs. Other types are low tech battery operated single message voice output devices with as few as one message. Mid tech devices are available with multiple message selections. High tech devices are also available with robust language organization that can be modified for various stages in a child’s receptive and expressive language development.
Tablet systems such as iPads have a variety of communication apps from single messages to full robust language organizations. Frequently, children’s full communication systems include a combination of no tech, low-tech and high-tech AAC, in addition to their unaided communication including verbalizations.
MYTH: Individuals must progress through a specific hierarchy of skills before they are ready to use augmentative communication or before moving to the ‘next level’ of augmentative communication.
REALITY: There are no prerequisites for communication. A child does not need to understand cause-effect before he/she can use AAC. A child may actually learn cause-effect skills through the use of augmentative communication while she is learning new forms of communication. A child does not need to know that a picture represents an object. When a picture is attached to a voice output device or to a low tech surface, the child will begin to associate meaning between the picture and the object she receives when she selects the symbol.
For example, if you attach a picture symbol of ‘bubbles’ to a single message device, your child touches the picture and hears the message ‘bubbles’, then you blow bubbles for her, in time she will begin to associate the picture of bubbles with the actual bubbles.
MYTH: AAC is a last resort and we are giving up on my child’s speech.
REALITY: A child’s use of AAC can enhance speech, language and communication development while reducing frustration at the same time. Ideally, augmentative communication strategies should be introduced and implemented prior to communication failure in order to prevent communication failure. When AAC is introduced early, before increased frustration and communication failure occur, a child may naturally incorporate the system into their typical communication repertoire. Receptive and expressive language skills can be modeled using an AAC system. It is never too early to begin to incorporate AAC strategies into a child’s communication development. When introduced early, AAC can provide a strong foundation for a child’s receptive and expressive speech and language development.
MYTH: My child speaks and AAC is only for people who are completely nonverbal.
REALITY: AAC systems and strategies may be used as primary communication systems or as supplemental/augmentative systems for individuals. Many children are verbal and have trouble being understood by unfamiliar listeners or become frustrated when a familiar listener doesn’t understand a spoken message when the context is not known.
The following are some, but not all of the additional ways that AAC can be used with children who are verbal but may be difficult to understand:
repair communication breakdowns
receptive language development
expressive language development
It is important to remember that individuals with complex communication needs should have the opportunity to use augmentative communication strategies if they are not able to say what they want or need, share an idea or story, offer their thoughts, ask questions, tell you that they are afraid and what they are afraid of, and tell you if they are in pain. Augmentative communication can provide a means for them to share these types of messages to more people in more places more often.It is never too early to introduce AAC into communication intervention. There are no prerequisites for communication.