How to Treat Stuttering in Preschoolers and Toddlers

When to Get Help for Stuttering in Preschoolers

So how do you know which children will resolve stuttering on their own and which will need help from a speech-language pathologist?  The Stuttering Foundation at www.StutteringHelp.org has set forth these 6 warning signs based on the current literature.  If the child demonstrates any of these warning signs, a speech-language pathologist should be consulted.  The more warning signs the child has, the more likely he is to need direct speech therapy to improve his fluency.

Warning Signs for Persistent Stuttering:

• A parent, sibling, or other family member who still stutters
• Stuttering starts after age 3 ½
• Stuttering has been occurring for at least 6 months
• Preschooler is a male
• The child has other speech sound errors or trouble being understood
• The child’s language skills are advanced, delayed, or disordered

Source: http://www.stutteringhelp.org/risk-factors

How Long to Wait Before Beginning Therapy

The speech therapist should decide when to begin speech therapy with a preschooler who stutters.  Since many preschoolers will recover from stuttering on their own, Mark Onslow of the Australian Stuttering Research Centre recommends that the speech therapist should monitor the child for signs of natural recovery for about 6 months but no longer.  Onslow explains that other reasons a speech therapist may want to begin therapy sooner include:

• the child becomes distressed about the stuttering
• the stuttering is causing social problems or psychological issues

Source: http://www.nevdgp.org.au/info/std_misc/StutteringPreschoolers.pdf

How to Help Stuttering in Preschoolers, What Therapy is Best?

Although there have been many different types of stuttering therapy over the years, a systematic review in 2006 by Bothe, et. al. found that the response-contingency approach was most effective treatment approach for children who stutter. Source: https://pubs.asha.org/doi/10.1044/1058-0360(2006/032)

What is Response-Contingency Therapy for Stuttering?

Watch the video about response-contingency therapy here, or keep reading below:

Response-contingency therapy for stuttering involves the communication partner (the therapist or parent) responding differently when the child is fluent (no stuttering) vs. when he is disfluent (stuttering).  For example, if the child says something without stuttering, the listener may say something like “wow, I like how smooth that was” or “no bumps that time!”.  On the other hand, if the child begins to stutter, direct feedback is given to the child to let him know he is stuttering.  The listener may hold up a hand or say “oops”.

How to Conduct Response-Contingency Therapy for Stuttering?

This therapy should be conducted under the supervision of a licensed speech-language pathologist, but here’s how it works.  Bothe and Ingham present suggestions in a paper prepared for a presentation at the Annual Convention of the American Speech‐Language‐Hearing Association in 2010.

1. Reinforce fluent (non-stuttered) speech
   1. While playing with the child, comment on utterances that the child says that do not have any stutters.  You can say “oh I like how smooth that was” or “you say that without any bumps!”.
   2. If the child stutters frequently, try an activity that requires the child to use shorter utterances.  For example, you could play a game that requires the child to say a short sentence, like “Go Fish” (ex: “Do you have a ball?”).  If the child still stutters on these, back up to even shorter sentences, like having the child use one word to name an object in a picture.  Then, praise the fluent speech as above.
   3. If you need to shorten the utterance length down to have stutter-free speech, gradually build the utterance length back up by choosing slightly more demanding tasks.
2. Give direct corrective feedback for stuttering
   1. As soon as the child begins to stutter, corrective feedback should be given.  The research has shown that many different types of corrective feedback have worked so it doesn’t much matter what it is.  One study found that turning off the lights over a puppet that the child was talking to was effective.  Here are some ways that Bothe and Ingham suggest you can try:

i.      Say, “stop” ii.      Say, “that was bumpy, try it again” iii.      Say, “oops, hold on” iv.      Say their name as a reminder v.      Model the sentence without stutters vi.      Hold up a hand and raise an eyebrow

1. If the child is stuttering so much that you would be doing this kind of correcting constantly, try choosing just the most severe stutters or just some of them.  You can also try choosing activities that require a shorter utterance length as described above.

Source: http://www.asha.org/Events/convention/handouts/2010/1528-Bothe-Anne/

Doesn’t This Seem Harsh?

In the past, therapies to stuttering with preschoolers did not take such a direct approach.  If this is the approach you are used to, then these newer approaches may seem a bit harsh.  However, rest assured that response-contingency therapy is showing to be the best method in the current research.  Of course, you shouldn’t jump in with this therapy at the first sign of a preschooler stuttering, but once it is decided to begin therapy, this approach is the best one currently backed by research.  If you are concerned about frustrating or overwhelming the child, you can always start off slowly by reinforcing fluent speech more and correcting stuttered speech less frequently.  Then, you can gradually increase the number of times you correct stutters.

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