Counseling Parents

Counseling Parents of a Child with Normal Disfluencies

If a child appears to be normally disfluent, parents should be reassured that these disfluencies 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 disfluencies without any discernable reaction or comment.

Particularly concerned parents may find 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 disfluent word over again. Instead, they should concentrate on calmly listening to what their child is saying.

Counseling Parents of a 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 moderate and calm pace, especially when the child is going through a period of increased stuttering.

It is often difficult for busy, concerned parents to provide models of slow speech for the child to emulate. Therefore they are likely to need encouragement for continuing this practice after an initial trial. Most children, whether they stutter or not, will benefit from adults’ speech that is close to their own natural rate. Children who stutter may feel less need to hurry their speech if their parents speak slowly.

While parents may provide models of a slower, more relaxed way of speaking, they should refrain from criticizing, showing annoyance, or telling the child to “slow down.” This may create a power struggle that makes it more difficult for the child to slow his rate.

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.

These are times when the child has chosen the activity and can experience the feeling it’s a time to talk about anything he or she wants.

If the child asks about the problem, parents should talk about it matter of factly: “Everyone has difficulty learning to talk. It takes time, and lots of people get stuck. It’s okay; it’s a lot like learning to ride a bike. It’s a little bit tricky at first.”

The parent may mention casually that going slow can sometimes help or that the child need not hurry, if the child seems to be asking for help.

If the child’s stuttering persists for four to six weeks or more despite these efforts on the parents’ part, or if the parents are unable to follow these suggestions, the child should be referred to a speech-language pathologist (see later section on referral).

Treatment of the child with mild stuttering may be indirect and focused on creating an environment in which the child feels fairly relaxed about speaking, both at home and in the treatment setting.

If more direct treatment is needed, the speech-language pathologist may show the child how to produce speech more easily, without increased physical tension and struggle, so that stuttering gradually diminishes into something more like normal speech.10,11 Some speech-language pathologists may choose to train the parents to work more directly with the child.10

Counseling Parents of a Child with Severe Stuttering

The child with severe stuttering should be referred immediately to a qualified speech-language pathologist for an evaluation, further counseling, and direct treatment of the child if appropriate. 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 disfluencies in stride will be of benefit.

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. The speech-language pathologist working with the child might also encourage the parents to nod or comment on the child’s courage for “hanging in there,” when the child has a particularly hard time on a word. In addition, the child with severe stuttering would probably benefit from being able to share his or her frustration with his or her parents. This may be difficult in many families, and may be best handled with the help of a speech-language pathologist experienced with the management of stuttering.

Professional treatment of severe stuttering often consists of helping the child overcome the fear of stuttering and, at the same time, teaching the child to speak, regardless of stuttering, in a slower, more relaxed fashion. In addition, treatment is focused on helping the child’s family create an atmosphere of acceptance of stuttering and conducive to ease in speaking.7,10

As mentioned earlier, some speech-language pathologists may choose to train the parents to provide some aspects of therapy in the home. The clinician will ask the parents to keep careful records of the child’s responses to treatment and will closely monitor the therapy.7

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.

7. Fox, P.T., Ingham, R.J., Ingham, J.C., Zamarripa, F., Xiong, J.-H., and Lancaster, J.L. (2000).  Brain correlates of stuttering and syllable production: A PET performance-correlation analysis. Brain, 123:1985-2004.

10. Harrison, E. and Onslow, M. (1998), Early Intervention for Stuttering: The Lidcombe Program. In R. F. Curlee (Ed.), Stuttering and Related Disorders of Fluency, (2nd ed.). NY, NY.: Thieme.

11. Pellowski, M., Conture, E., Roos, J., Adkins, C. & Ask, J. (2000, November). A parent-child group approach to treating stuttering in young children: treatment outcome data. Paper presented to Annual Conference of American Speech-Language-Hearing Association, Washington, DC.

Guitar, B., & Conture, E. G. (Eds.) (2006). The child who stutters: To the pediatrician. Fourth edition, publication 0023. Memphis, TN: Stuttering Foundation of America.