Stuttering in Children and Adolescents

The disorder is characterized by disturbances in normal fluency and time patterning of speech that are inappropriate for the individual’s age and language skills, persist over time, and are characterized by frequent and marked occurrences of the following symptoms:

• Sound and syllable repetitions
• Sound prolongations of consonants and vowels
• Broken words (pauses within a word)
• Audible or silent blocking (filled or unfilled pauses in speech)
• Circumlocutions (word substitutions to avoid problematic words)
• Words produced with an excess of physical tension
• Monosyllabic whole-word repetitions (e.g., “I-I-I-I see him”)

These disturbances cause anxiety about speaking or limitations in effective communication, social participation, or academic performance. Children who stutter may also exhibit secondary, or avoidance, behaviors that may impact their fluent communication. These may include:  

• Distracting sounds (e.g., throat clearing, insertion of unintended sound)
• Facial grimaces (e.g., eye blinking, jaw tightening)
• Reduced verbal output due to speaking avoidance
• Head or body movements (e.g., head nodding, leg tapping, fist clenching)
• Avoidance of social situations
• Fillers to mask moments of stuttering

Children who stutter may also experience stress and anxiety in anticipation of their stuttering. This associated fear of speech can elevate to the levels that will affect several aspects of learning, quality of life, and the engagement in everyday activities.  Children who stutter are also stigmatized by other children and may experience bullying or be ostracized by their peers. Stuttering children are stereotyped as being nervous, shy, passive, and introverted. There is a promising trajectory for children who stutter. Many preschool age children who stutter naturally recover from their dysfluencies. Approximately 70% of children recover from stuttering during the first 15 months of treatment post-onset.

The risk of stuttering among first-degree biological relatives of individuals who also stutter is more than three times the risk than the normative population. Studies have identified three gene mutations linked to stuttering. Mutations to genes GNPTAB, GNPTG and NAGPA have been found to disrupt the signal that directs enzymes to their target location in the lysosome of the cell. These gene mutations were present in close to 10% of cases of familial stuttering.  However, having a genetic predisposition to stuttering does not necessarily mean that someone will develop stuttering.

Clinical research suggests the following treatments are indicated for the treatment of children and adolescents with language disorder:

• Speech-Language Services: highly individualized language intervention services facilitated by speech-language pathologists (SLPs). Treatment is based on an assessment of speech fluency, language factors, emotional/attitudinal components, and life impact. Direct treatment targets speech modification (fluency shaping) and reducing word avoidance. Indirect treatment focuses on counseling families about how to make changes to their own speech and how to make changes to the child’s environment.

• Psychological Therapy:  helps children improve their quality of life by minimizing the burden of their communication disorder. Counseling includes increasing acceptance of stuttering, reducing secondary behaviors, minimizing avoidance, improving communication skills, increasing self-confidence, managing bullying effectively, and minimizing any other adverse impacts.
• Behavioral Strategies: utilizes a response contingency to reinforce the child for fluent speech and redirect dysfluent speech

In addition, research suggests the following interventions are promising:

• Technology Aided Intervention- delayed auditory feedback
• Desensitization to environments that provoke anxiety and stuttering
• Cognitive restructuring around stuttering
• Support groups
• Generalization activities