1. My Preschool Student is Stuttering! What do I do now?
Connie Haines, M.S., CCC-SLP, Speech Language Pathologist
Sumner School District
Mary Turcotte, M.S., Early Intervention Specialist
Olympia School District

2. Introductions
Kahoot
Go to kahoot.it

3. What is stuttering?
Stuttering involves the repetition, prolongation or blockage of a word or part of a word that a person is trying to say. It could be accompanied by tension or struggle and avoidance of sounds, words or speaking situations.

4. Stuttering Vocabulary
Fluency
Disfluency
Stuttering block
Repetition (sounds, syllables, word, phrases)
Prolongation

5. Stuttering Vocabulary
Hesitations
Interjections
Revisions
Secondary characteristics
Speaking on residual air
Avoidance behaviors

6. The stuttering iceberg
Confusion
Fear
Shame
Isolation
Guilt
Anxiety
Hopelessness
The stuttering iceberg

7. Myths About Stuttering
Nervousness causes stuttering
Stress causes stuttering
You should not talk about
stuttering with children
Children who hear a lot of stuttering will start to stutter
Stuttering always goes away on its own
Many persistent myths about stuttering! Many have been perpetuated for generations.

8. Experience Stuttering
Your assignment to stutter….
How did it feel?
What reactions did you have?

9. How does stuttering develop?
All of us exhibit disfluencies at times
Making mistakes in talking is normal for kids while learning to talk.

10. What causes stuttering?
It is widely accepted that there is no single cause of stuttering

11. Some factors that may contribute to stuttering:
Linguistic ability – the child’s ability to put words or sentences together
Motoric ability – the child’s ability to move
his/her mouth in the rapid and
exact manner needed for speaking
Personality or temperament – the ways a child
tends to react to events in his environment or within
him/herself
Environment – requirements placed on the child
for producing speech

12. Normal disfluencies and true stuttering
“Normal” Disfluencies “Stuttered” dysfluencies
Hesitations
Interjections
Revisions
Phrase Repetitions
Disfluencies occur more frequently
Reactions to disfluency increase
Tension or struggle increase
Duration of
disfluencies
increase
Repetitions of whole words
Tension during “normal”
disfluencies
Repetitions of sounds or syllables
Prolongations
Blocks

13. Video –If your child stutters

14. Stuttering Foundation of America, Stutteringhelp.org

15. Speaking Demands Intrapersonal Demands Temperament – frustration level
Attitudes toward speech
Fatigue
Anxiety / stress
Negative reaction toward disfluencies
Word Retrieval
Other speech/language deficits

16. Speaking Demands Interpersonal Demands Communication partner
Speaking expectations of partner
Time pressure
Interruptions
Fast rate
Loss of listener attention
Demand speech (“say ____”)

17. Speaking Demands Topic Stresses High linguistic load
Specific words / sounds
Asking questions
High cognitive load
High emotional load or topics
Unknown topics

18. Speaking Demands Environment Multiple vs. single partner
Hectic / unstructured routines
Competitive situations
Type of listener
High expectations imposed by others
New situation or changes

19. Speaking capacities Motor Skills Reaction time Coordination
Movement timing
Motor Programming

20. Speaking Demands Language Skills Word retrieval
Grammatical formulation
Pragmatics
Phonological skills (speech sounds)

21. Speaking capacities Emotional Maturity Confidence Social skills
Coping strategies

22. Speaking Capacities Cognitive Development
Supports all the other skill development

23. Stuttering Demands and Capacities Interpersonal Intrapersonal Demands
Environment
Topic Stresses
Capacities
Interpersonal
Stuttering
Intrapersonal
Adapted from
Starkweather

24. Development of stuttering
Normal Disfluency:
Less than 10% more typical disfluencies
No secondary behaviors
Not aware, no concerns
Adapted from Guitar

25. Development of stuttering
Borderline Stuttering
Over 11% disfluencies
Combination of both typical and
less typical disfluencies
No secondary behaviors
Generally not aware, occasional momentary
Surprise or mild frustration
Adapted from Guitar

26. Development of stuttering
Beginning stuttering
Repetitions are rapid, tense and irregular
May appear ‘stuck’
Developing escape behaviors
eye blinks
pitch increases
loudness increases
Aware of disfluency
May express frustration
Adapted from Guitar

27. Stuttering is like a pendulum
Stages of stuttering
Stuttering is like
a pendulum

28. Writing activity

29. Communicative/Interpersonal
Circle of stuttering
Stress
Communicative/Interpersonal
Subject
More Tension
And Disfluency
Tension
Increased Fear
Normal Disfluencies
Negative attention
Brought to speech
More disfluency
Increased Tension
Adapted from
Gregory

30. What contributes to stuttering?
Stressors
Evaluation of speaking performance/expectation of fluency
Time pressure to speak, including interruptions
Corrections to communication attempts
Advice that does not facilitate fluency
Negative comments
Adverse facial expressions or body language
Linguistic, high cognitive “load” or complexity
Fast-paced family speaking and lifestyle

31. When to get help Stuttering has been present for over 6 months
Stuttering has increased since it was first noticed
Family history of stuttering
Struggle and tension are evident
Other speech or language delays are present
Child has become less communicative or more withdrawn
There is a strong reaction to disfluent speech
Child has expressed concern

32. What kids tell us about stuttering:
I hope you understand.
It makes me completely exhausted every day.
Just because I stutter doesn’t mean I’m stupid.
Don’t finish what your kids are trying to say.
It’s hard to talk to multiple people because you get scared to speak.
If I had a choice between a million dollars or my stuttering to be gone, I would decide on my stuttering to be gone.

33. Where to get help Clinics Schools University Private practitioners
Referral list from Stuttering Foundation

34. Ways you can help the child who stutters.
Respond to communication attempts
Reduce pressure
Questions
Time pressure
Pause before responding
Model slower rate of speech
Treat the child the same as other children
Encourage all children to take turns talking

35. What fosters fluency reduce identified "demands" for that child
Limit the language load
Slow your rate; i.e. Fred Rogers
Use pausing in your speech
Be an accepting communication partner
Reduce speaking pressure
Types of questions
Time pressure
Clear communication turns
reduce identified "demands" for that child

37. How to react to disfluency
Maintain eye contact with the child while he is speaking
Respond as you might to fluent talking
Be accepting of the child’s efforts to talk
Have patience during especially disfluent periods
Verbally remind all children of these tenants of communication i.e. “We will all listen with our eyes and our ears.” “We will all have turns for talking” “We will take the time to hear what you have to say.”

38. How do we talk about stuttering?
Treat talking as you might any other developmental skill
Acknowledge the child’s efforts to communicate
1- We are all learning to run faster, talk, etc…
2- You stayed with it and told me your whole idea, thank you
3- If child expresses “I can’t talk, I’m stuck, etc..” can acknowledge “Sometimes talking is easy and sometimes it is hard.”
Listen to the child’s concerns about speaking

39. How do we talk about stuttering?
Use descriptive words to describe the stuttering: Repetition = “Going over a railroad”
Prolongation = going over a bridge
Block = hitting a brick wall

40. Educate others about stuttering

41. Famous People Who Stutter

42. Acknowledge the child's efforts to communicate