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Identification and Treatment of
Childhood StutteringJ. Scott Yaruss, Ph.D., CCC-
SLPStuttering Center of Western
PennsylvaniaUniversity of Pittsburgh
Children’s Hospital of Pittsburgh
Pediatric Grand RoundsMercy Hospital Continuing Education Program
September 14, 1999
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What Is Stuttering?
An impairment of speech and
language production, typically
characterized by interruptions
in the forward flow of speech
(“speech disfluencies”)
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What are the PrimarySymptoms of Stuttering?
Speech disfluencies come in many formsSome disfluencies are considered
“normal”(if they occur relatively infrequently) Interjections (“um,” “er,” “like,” “you
know”) Revisions (“I want- I need that”)
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How Does Stuttering Develop?
Typically begins between ages 3 and 5
As the disorder progresses, children are likely to develop reactions to stuttering... Tension and struggle in their speech
musculature More advanced types of speech disfluencies Concern or anxiety about their speaking
abilities
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What Kinds of Consequences?
Affective, Behavioral, Emotional Reactions:Anxiety about speaking, avoidance of speaking situations (reading in class, talking to friends), embarrassment, shame, guilt, low self-esteem, frustration, fear
Disability
Reactions
EnvironmentalInfluences andOther Factors
Behavioral
Affective
Cognitive
HandicapImpairmentPresumedEtiology
After Yaruss (1998)
Click for larger picture
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What Causes Stuttering?
NO single factor has been shown to beTHE cause stuttering Stuttering is not caused by
children’s parents Stuttering is not caused by drawing
attention to a child’s normal disfluencies
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Okay, so…What Does Cause
Stuttering?Current theories point to a complicated
interaction between children’s language
development and their motoric abilities for
producing speech, combined with the
multiple influences of the child’s personality
and the child’s communicative and social
environment
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Isn’t Stuttering “Genetic”?
Yes, stuttering tends to runs in families... If one family member stutters, there
is an increased chance that another family member will also stutter
The few twin studies that have been conducted show only 50% concordance for MZ twins, suggesting that there are also environmental influences
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Doesn’t EverybodyStutter Sometimes?
Yes. Speech disfluencies are a normal part of children’s speech/language development All children go through a period of
producing speech disfluencies when learning to speak
Some children, however, will continue producing disfluencies and develop a fluency disorder
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Don’t Most ChildrenOutgrow Stuttering?
Yes. Most children who exhibit disfluencies or even stuttering early in their speech/language development will recover without intervention Prevalence = 1% Incidence of Stuttering = 5% Incidence of Increased Disfluencies: 15-
25%
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A Critical Period forRecovery from
Stuttering If children do not recover by age 6
or 7, they are likely to develop chronic stuttering Older children rarely achieve normal
fluency, and the negative consequences increase over time
Negative social and emotional consequences can be minimized with appropriate early intervention
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Who Is At Riskfor Chronic Stuttering?
No single behavior categorically differentiates children who stutter from children who do not All children exhibit all types of
speech disfluencies Sometimes stuttering begins very
gradually, but persists for a long time before the family notices
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So...Who Is At Risk? Certain risk factors can provide some
clues: Number, nature, and types of speech
disfluencies Length of time the child has been
stuttering Family history of stuttering Child’s reactions to stuttering Family’s reactions to stuttering (parent’s
level of concern and attempts to help)
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Who Should Be Referredfor Evaluation?
It is impossible to determine whether a disfluent child is at risk for developing a chronic stuttering disorder throughinformal or casual observation
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Referral Guidelines
I evaluate if any of the following are true: The child produces 3 or more
disfluencies during a brief spontaneous conversational interaction
There is tension or struggle during disfluencies (even if the disfluencies are infrequent)
The child’s ability to communicate is affected
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Speech-language pathologists (SLPs), licensed and certified by the American Speech-Language-Hearing Association (ASHA)
Not all SLPs are comfortable with stuttering, so there has been a move toward specialization
Who Should Evaluateand Treat Stuttering?
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How Is Stuttering Treated?
Helping children learn to speak more fluently Changing the timing and tension of
speech production
Helping parents learn to facilitate children’s fluency in everyday speaking situations Parents can change their own speech
and manage children’s speaking situations to help them speak fluently
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Summary Early stuttering can be difficult to distinguish
from normal “developmental” disfluency
Early intervention is critical for preventing the development of chronic stuttering and its negative social and emotional consequences
The safest practice is to refer children for evaluation by a stuttering specialist, especially if the parents or child are concerned about the child’s speech
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Questions? Comments?Please contact me!
J. Scott Yaruss, Ph.D., CCC-SLP
Stuttering Center of Western PA
University of Pittsburgh4033 Forbes TowerPittsburgh, PA 15260
Phone: (412) 647-1367Fax: (412) 647-1370Email
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Mission of the Stuttering Center
Provide effective client-centered treatment for individuals who stutter
Conduct meaningful research on the nature and treatment of stuttering
Provide on-going education for student clinicians as well as practicing SLPs
Provide support for individuals who stutter, their families, and their clinicians
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