As an SLP, when do I recommend treatment for preschool stuttering?

Part 2.1

**NOTE** The information contained here is not meant to be used to diagnose or treat stuttering.  Only a licensed speech and language pathologist can evaluate and diagnose stuttering.

In case you haven’t already noticed, I love talking and writing about stuttering! So if you have a question about stuttering, don’t hesitate to drop me a line and you might even get a special mention in a blog post dedicated to your concern or query!

Recently I was asked by a colleague, “How do you help parents distinguish whether their preschooler is stuttering or whether it’s a developmental disfluency?”

This is Part 2.1 of my response (Part 2.2 is coming soon), geared towards SLPs.  In Part 1, we addressed the parent side of the question, When should a parent of a preschool child consult with an SLP experienced in working with stuttering? Now, we move onto:

As an SLP, how do I know when to recommend treatment for a preschool child?

Unfortunately there’s no simple and straight forward answer.  If you recall from your fluency course, there are many factors that are associated with the onset and persistence of stuttering.  In preschool aged children we need to take all of these factors into consideration in order to make the best recommendation.

I tend to err on the side of caution, in part because of my own childhood experiences with stuttering.  I also figure that even if a preschool child will recover without any intervention (and we don’t always know which kid that will be), providing indirect, parent focused training will never hurt.

In this post we will look at the roles that the warning flags discussed in Part 1 play.  In Part 3 (coming soon) we will consider the roles that different types of disfluencies play in determining when to recommend speech therapy.

Warning Flags

• Family history: This is an important consideration.  If there is a family history of stuttering, the likelihood that I will recommend speech therapy goes way, way up.  Remember that stuttering often, but not always, runs in families.  If a child is showing stuttering-like disfluencies, and has a family history, I will almost always recommend beginning speech therapy.  Family history can include siblings, parents, aunts/uncles, cousins, or grandparents.
• Child’s awareness or concern: This is another heavy hitter in my book.  If a child is showing concern, they may be starting to develop negative attitudes and feelings towards speaking.  This may lead to fear and avoidance, which later on can develop into struggle and tension.  In this situation, I definitely want to begin working with the family to support healthy communication attitudes.
• Time since onset >6 months: This is one of the factors that I am probably more cautious with compared to others.  Research has shown that the likelihood that stuttering will persist goes up after 12 months post onset, and continues to increase as time goes on.
• Temperament: Most kids and adults who stutter tend to have a more sensitive temperament. Put another way, they tend have stronger emotional responses which results in an increased physiological stress response.  Remember, fight, flight, or freeze?  It’s a stress response to danger and can impact the speech motor system.
• Delayed speech or language development:In the presence of other factors, delayed speech or language development would tip me in favor of recommending speech therapy.  If we think about it, preschool kids’ brains are working full time to learn new skills.  It’s like a computer with a maxed out CPU.  If a child has a speech or language delay, they may be using a lot of their cognitive processing power (CPU) to formulate speech.  This might mean that there is less CPU power available for the motor component of speech.  This could result in a breakdown in the motor plan, leading to disfluencies.  Again, it’s important to reiterate that stuttering is in some ways an imperfect storm.  That is, multiple factors work together in the onset of stuttering.
• Advanced language skills:Similarly, if a preschool child’s language is advanced for his or her age, it’s possible that their speech motor system is struggling to keep up.  It’s common for kids to have growth spurts in the language domain or the motor domain, but rarely in both domains at the same time.  Again, it is important to take other factors into consideration.  You will want to look at the big picture.
• Pattern of change: Have there been only one or two brief periods of disfluencies during times of language growth?  If so, it may only be typical disfluencies.  However, if there have been many periods of disfluencies, each lasting a few weeks, over the course of ~6 months, I would recommend beginning speech therapy.
• Parent Concern: If a parent is contacting you, they are concerned, and rightly so.  That’s one of their jobs.  One of our roles is working with parents to address and relieve their concerns.  With a strong grasp of the factors associated with stuttering we can help parents understand the disorder and that we are here to support them.  The initial phone call with a parent can be very powerful for them and can greatly reduce their fears.  If you are not feeling confident in discussing the complex interplay of factors associated with stuttering, you can have them reach out to me.  Even if you end up working with them, I’m happy to speak to them.

How do I know if it’s a stuttering disfluency or a typical disfluency? Click here to find out