Research Journal ISSN-2348-3717 Introduction Stuttering in Children : Causes and Management Assistant Professor, Department of Psychology DAV College for Women, Ferozepur Cantt., Punjab Abstract Stuttering is common in children. It is typically de ned as involuntary dys uency in verbal expression. Stuttering is identi able when a child is learning to talk. It include prolongation of sounds in words, use of ller words, dif culty with starting to speak (blocks), and repetitions. It can cause signi cant anxiety for children and their families. The contributing factors may include cognitive abilities, genetics, sex of the child, and environmental in uences. When a child demonstrates inconsistent production of consonants and vowels on repeated productions of syllables or words, lack of smooth transitions between sounds and syllables, he should be referred for a full speech and language evaluation. Speech-language pathologists can assess speech using subjective and objective testing. The treatment mainly focuses on the prevention and elimination of stuttering behaviours. Key Words : Stuttering, Cognitive Abilities, Genetics, Speech-language Stuttering is typically de ned as involuntary dys uency in verbal expression. Usually, stuttering occurs as repetition of sounds, syllables, or words or as speech blocks or prolonged pauses between sounds and words.it occurs in 1.4 percent of children younger than 10 years. Secondary behaviors associated with stuttering include eye blinking, jaw jerking, and head or other involuntary movements. These behaviors are learned approaches to minimize the increasing severity of stuttering and can add to the patient's embarrassment and fear of speaking.older children and adults often develop additional secondary behaviors to hide stuttering which include word substitutions, use of interjections, and sentence revisions. Causes of Stuttering A variety of factors may in uence stuttering events, although the etiology of the condition is unclear. Possible contributing factors include cognitive processing abilities, genetics, sex of the patient, and environmental in uences. Cognitive ability INQUISITIVE TEACHER A Peer Reviewed Refereed Biannual Research Journal of Multidisciplinary Researches Vol. II, Issue II, December 2015, pp. 33-37 Published By: S.R.S.D. Memorial Shiksha Shodh Sansthan AGRA, INDIA www.srsshodhsansthan.org th st th Received: July 25, 2015, Revised: August 01, 2015, Accepted: August 10, 2015 Some children who stutter have different cognitive processing abilities as compared to those who do not stutter. Children who stutter use more of the right hemisphere of the brain than was used in uent speakers (Bosshardt,2006).Functional magnetic resonance imaging scans of persons who stutter with those who do not stutter found that neural systems activate differently during the generation and production of speech (Weber-Fox, 2004). Because there are no studies of brain 33
Stuttering in Children : Causes and Management scans in children who stutter, the link between cognitive function and childhood stuttering has not been determined. Genetics Research evidence supports that there is a link between genetics and stuttering. In a study of twins, nearly 70 percent of the variance in stuttering was attributable to genetics, with the remainder attributable to environmental in uences The sex of the patient also in uences stuttering. There is a higher incidence of stuttering in males than in females, even in young children.stuttering appears to occur more often in girls than in boys. The male-to-female ratio of stuttering is nearly 2:1 in children and is as much as 5:1 in adults (Yairi, et. al.,1996). Environment Environmental in uences, such as stressful social situations, talking on the telephone, and negative experiences associated with speaking, may also contribute to the persistence of stuttering. Anxiety levels of children who stutter are speci c to the communication situation (Miller & Watson,1992). The onset of stuttering is typically during the period of intense speech and language development as the child is progressing from 2-word utterances to the use of complex sentences, generally between the ages of 2 to 5 but sometimes as early as 18 months. These rst signs of stuttering gradually diminish and then disappear in most children, but some children continue to stutter. In fact, they may begin to exhibit longer and more physically tense speech behaviors as they respond to their speaking dif culties with embarrassment, fear, or frustration. If treatment is made before the child has developed a serious social and emotional response to stuttering, chances for recovery is good (Suresh, et. al., 2006). Diagnosis of Stuttering Diagnosis of stuttering is based upon both direct observation of the child and information from parents about the child's speech in different situations and at different times. Physicians mainly distinguish between normal dis uency, mild stuttering, and severe stuttering, so that appropriate referral can be made. Normal Dis uency: Between the ages of 18 months and 7 years, many children pass through stages of speech dis uency associated with their attempts to learn how to talk. Children with normal dis uencies between 18 months and 3 years exhibit repetitions of sounds, syllables, and words, especially at the beginning of sentences. These occur usually about once in every ten sentences. After 3 years of age, children with normal dis uencies are less likely to repeat sounds or syllables but will instead repeat whole words (I-I-I can't) and phrases (I want I want I want to go). They will also commonly use llers such as uh or um and sometimes switch topics in the middle of a sentence, revising and leaving sentences un nished. Dis uencies in children increase when they are tired, excited, upset, or being rushed. Mild Stuttering: Mild stuttering may begin at any time between the ages of 18 months and 7 years, but most frequently begins between 3 and 5 years, when language development is particularly rapid. Stuttering in some children rst appears under conditions of normal stress, such as when a 34
new sibling is born or when the family moves to a new home. Children who stutter mildly may show the same sound, syllable, and word repetitions as children with normal dis uencies but may have a higher frequency of repetitions and more repetitions each time. For example, instead of one or two repetitions of a syllable, they may repeat it four or ve times, as in Ca-ca-ca-ca-can I have that? They may also occasionally prolong sounds, as in MMMMMMMommy, it's mmmmmy ball. In addition to these speech behaviors, children with mild stuttering may blink or close their eyes, look to the side, or tense their mouths when they stutter. Another sign of mild stuttering is that it tends to appear more regularly.other sign of mild stuttering is that the child may be temporarily embarrassed or frustrated by it. Children at this stage of the disorder may even ask their parents why they have trouble talking. Severe Stuttering : Children with severe stuttering usually show signs of physical struggle, increased physical tension, and attempts to hide their stuttering and avoid speaking. Although severe stuttering is more common in older children, it can begin anytime between ages 11/2 and 7 years. Severe stuttering is characterized by speech dis uencies in every phrase or sentence; often moments of stuttering are one second or longer in duration. Prolongations of sounds and silent blockages of speech are common. The severely stuttering child may show behaviors such as eye blinks, eye closing, looking away, or physical tension around the mouth and other parts of the face. The child may also use extra sounds like um, uh, or well to begin a word on which he expects to stutter. Severe stuttering is more likely to persist, especially in children who have been stuttering for 18 months or longer, although even some of these children will recover spontaneously. Such children often appear anxious and develop a fear of speaking ( Ludlow,2006). Counseling Parents Child with Normal Dis uencies If a child appears to be normally dis uent, parents should be reassured that these dis uencies are like the mistakes every child makes when he or she is learning any new skill, like walking, writing, or bicycling. Parents should be advised to accept the dis uencies without any discernable reaction or comment. Particularly concerned parents may nd it helpful to slow their own speech rates, use shorter, simpler sentences, and reduce the number of questions they ask. They may also want to arrange times the child can talk to them in a quiet, relaxed environment. They should not instruct the child to talk more slowly or to say a dis uent word over again. Instead, they should concentrate on calmly listening to what their child is saying. Child with Mild Stuttering Parents of the child who has a mild stuttering problem should be advised not to show concern or alarm to the child, but instead be as patient listeners as they can. Their goal is to provide a comfortable speaking environment and to minimize the child's frustration and embarrassment. Parents are usually upset when their child repeats sounds or words, but they should be reassured that these are just slips and tumbles as the child is learning to match his ability to speak with the many ideas he wants to express. If the parents let the child know that repetitive stuttering is acceptable to them, this can help the child's speech and language develop without increased physical tension and struggle. Parents should also be advised to slow their own speech rates to a 35
Stuttering in Children : Causes and Management moderate and calm pace, especially when the child is going through a period of increased stuttering. Parents may provide models of a slow, more relaxed way of speaking, they should refrain from criticizing, showing annoyance, or telling the child to slow down. It is also important for parents to provide daily opportunities for one-on-one conversations with the child in a quiet setting, as frequently as possible. If the child's stuttering persists for four to six weeks or more despite these efforts on the parents' part, the child should be referred to a speech pathologist. Child with Severe Stuttering The child with severe stuttering should be referred immediately to a quali ed speechlanguage pathologist for an evaluation, further counseling, and direct treatment of the child. Because severe stuttering frequently seems to develop when a child struggles or becomes afraid of or concerned with speaking in response to his milder stuttering, anything that helps the child relax and take his or her dis uencies in stride will be of bene t. Parents should model a slower rate of speaking. They should try to convey acceptance of the child regardless of the stuttering, by paying attention to what the child is saying rather than to the stuttering (Armson, et. al.,2006).the speechlanguage pathologist working with the child might also encourage the parents to nod or comment on the child's courage In addition, the child with severe stuttering would probably bene t from being able to share his or her frustration with his or her parents. During a period of a year or more, the child's stuttering will often gradually decrease in frequency and duration. In some cases, the child may recover completely. Treatment results depend on the nature of the child's problem, the presence of other strengths, the skills of the therapist, and the ability of the family to provide support. Management of Stuttering Treatment of stuttering can be challenging because there is a lack of evidence-based consensus about therapy. Providing an environment that encourages slow speech, affording the child time to talk, and modeling slowed and relaxed speech can help reduce stuttering events (Venkatagiri,2005).Gentle, nonjudgmental acknowledgment of stuttering does not worsen the problem and may comfort a frustrated child. The treatment of early, mild stuttering (generally in children younger than six years) focuses on the prevention or elimination of stuttering behaviors. Therapy is usually characterized by parental involvement and direct treatment. The likelihood of eliminating stuttering behaviors decreases if they persist beyond eight years of age. For those who have more advanced forms of stuttering and secondary behaviors, therapy is generally a variation or combination of two approaches. The rst approach is a uency-shaping technique that replaces stuttering with controlled uency (a speaking style requiring careful self-monitoring). The second approach focuses on reducing the severity of stuttering so that speaking is performed without struggle by controlling primary symptoms, eliminating secondary behaviors, and reducing the fear of overt stuttering; this approach is typically referred to as stuttering modi cation or traditional stuttering therapy (Ratner & Guitar 2006).For all persons who stutter, an optimal outcome depends on the appropriate combination of education, training, and individualized interventions. 36
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