Stuttering In Young Kids: When To Be Concerned

When you see your child all-of-a-sudden struggling to get words out, it can be concerning.  This is especially true if your child, who previously had no difficulty speaking, is now stuttering out of the blue.  Fortunately, about 75% of children who show signs of early stuttering will recover by late childhood.

As a parent, how do you know when to accept stuttering as a normal part of development and when to be more concerned?

When children are learning how to communicate, some will exhibit developmental disfluency, or normal interruptions in speech, between ages 2-5. This stage happens when children are acquiring the skills to talk.  It is thought that they are having difficulty coordinating their muscles for speaking as their language skills are blossoming and they begin talking in longer, more complex utterances.   The child’s speech system may also be stressed from the development of other skills, such as walking or potty training.

When determining when to be concerned about your child’s speech, knowing the difference between typical/developmental disfluency and true stuttering can be helpful.

Examples of typical/developmental disfluency:

  • Hesitations between words (“I want some …. milk”)
  • Interjections, such as “um,”“uh,” “well,  or “like”
  • Revisions within utterances (“The dog is – the dogs are playing”)
  • Repetitions of phrases (“I want to … I want to go”)

Examples of stuttering, or atypical disfluency, which can fall into the more concerning category:

  • Repetitions of words (“I I I … I want a banana”)
  • Repetitions of sounds (“M-my”) or syllables (“Ba-baby”)
  • Sound prolongations (“I— (prolonging sound) I live in C—-Cincinnati.”)
  • Vocal blocks in which no sound comes out (“M {block} my name is {block} … M Max.”)

Emotional Reactions to Stuttering:

In addition to taking note of how atypical disfluencies sound, it is also very important to be aware of any emotional reactions that your child may demonstrate in response to his or her stuttering.  The following reactions may be a cause for concern:

  • Awareness of difficulty with speaking (saying, “I can’t say it.”)
  • Frustration from stuttering
  • Shame or embarrassment with talking
  • Refusal to talk to strangers due to a fear of stuttering
  • Escape or avoidance behaviors (e.g. abnormal movements during speech such as jerking or forceful eye blinking, head nodding, or using of many filler words, such as “um”)

When Stuttering Persists

Although many children do tend to recover from stuttering, other children may persist.  Some children who begin with typical developmental disfluency may evolve into children who stutter.  Determining the difference between a child who is truly stuttering and a child who is simply passing through the developmental disfluency stage can be confusing. Here are some factors, which may indicate your child is at-risk for continued stuttering:

  • Family history of stuttering
  • Age at onset (if your child began stuttering after age 3 ½ years)
  • Time since onset (if you child has stuttered for longer than 1 year)
  • Gender (males are 3 to 4 times more likely than females to persist in stuttering)
  • Speech is difficult to understand with many speech sound errors
  • High frequency of disfluencies (more than 10 stutters per 100 words)
  • Higher percentage of atypical stuttering-like disfluencies (atypical stutters comprise more than 50% of total disfluencies); these include:
    • Repetitions of sounds, syllables, and one syllable words
    • Tense pauses accompanied by muscular tension in the jaw and/or mouth
    • Prolongations (elongating a sound or syllable)
    • Silent blocks (voice stops)
    • Higher number of times a word or sound is repeated – often more than two times
    • Increased degree of tension during speech
    • Higher sensitivity to stress

Variability in Stuttering

It is important to remember that stuttering is highly variable in its nature and frequency among children and even within the same child.  A common saying is, “The only constant with stuttering is its variability.”  Furthermore, stuttering is not black and white.  There is actually much overlap between a young child who is truly stuttering and one that is passing through the developmental disfluency period.  One area of overlap is the impact of environmental influences on fluency.

Both children with developmental disfluency and children who persist in stuttering are more likely to have difficulty speaking smoothly when they are: interrupting; commanding or directing another person; responding to a request to change their own activity.

Also, children often exhibit more disfluency due to excitement, such as during vacations, holidays, and visits from relatives.  Similarly, disfluency increases when the child is exposed to psychological stress such as a birth of a sibling, moving homes, divorce, or other events that disrupt the normal life routine.

When to Seek Help

Your child should be evaluated by a speech-language pathologist who specializes in stuttering if you have a concern about your child’s speech and he or she:

  • Stutters for longer than 6 months and it occurs frequently during the day
  • Shows tension, facial grimaces, or struggle behaviors during talking
  • Avoids situations in which he or she will have to talk
  • Expresses concerns about speech
  • Avoids saying certain words or sounds

Getting Your Child Help

Diagnosing stuttering can be difficult as stuttering is a complex disorder and no one child stutters in the same way.  For children that do continue to stutter, early treatment can substantially reduce and sometimes eliminate their stuttering.

Speech therapy is the most effective treatment, and there are different kinds available, depending on each child and family.  In addition to working on a child’s speech skills, therapy can also help build the child’s confidence in communicating.  Families and patients are counseled and given support throughout the therapy process.

To learn more about our division of Speech-Language Pathology, call 513-636-4341 or email speech.pathology@cchmc.org.

Katrina Zeit Purcell

About the Author: Katrina Zeit Purcell

Katrina Zeit Purcell, MHA, MA, CCC-SLP, is a speech-language pathologist at Cincinnati Children's and coordinates the speech pathology division’s public relations projects. Katrina is a member of the fluency team, specializing in evaluating and treating preschool, school-age, and adolescent stuttering. Additionally, she served as a final editor for Language in My Life, an interactive guide for caregivers that offers practical, easy-to-follow and fun suggestions for stimulating a child’s speech and language development at home.

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Comments

  1. Mokwena Sbongile February 26, 12:59
    Hey Katrina, hope to find you well. Can I briefly ask if you understand the concept of Atypical dysfluencies vs atypical fluencies. Thank you. Sbongile Mokwena, South africa
    • Katrina Zeit Purcell
      Katrina Zeit Purcell Author March 05, 10:26
      Hi Mokwena, I think what you might be asking is “What is the difference between atypical and typical disfluencies?” As children learn to communicate, some will exhibit developmental disfluency, or normal interruptions in speech, typically between the ages of 2-5 years. However, as children get older, they may develop atypical disfluencies. Additionally, some young children may produce atypical disfluencies from onset. Examples of atypical disfluencies are described in the paragraph above and are defined as repetition of words, repetition of sounds, sound prolongations and vocal blocks.
  2. Cassie December 31, 15:52
    Hey Katrina, I have a question, My son is almost 11 and has had a continuous stuttering issue. And in the past 4 months it has gotten extremely bad. There is no family history of it, and he had no issues growing up til now. Is it typical for late childhood on set of stuttering?
    • Katrina Zeit Purcell
      Katrina Zeit Purcell Author January 11, 15:43
      Hi Cassie, The short answer is that onset of stuttering in late childhood is more rare, however, it does occur. Stuttering is a complex issue and I would need more background information, such as how long he's been stuttering, when you first noticed it, any medications he's started/stopped, and if the stuttering is impacting his interactions with others.
  3. Kel September 04, 03:30
    I have been reading and reading. After 6 months of treatment from my 4 year old i see no changes and it breaks my heart. I am waiting for him to “grow out of it” but i feel this is unrealistic. Any advise for a distraught mother? I get so frustrated at his lack of progress.
    • Katrina Zeit Purcell
      Katrina Zeit Purcell Author September 06, 13:23
      Hi Kel, I am sorry to hear about your frustrations related to your son’s stuttering, a situation which can be difficult and stressful for the entire family. It would be hard for me to offer you advice in this format, without knowing your child’s history, treatment plan, and any incremental progress. If you haven’t already, I recommend relaying your thoughts to your child’s speech pathologist, and if you’re still having concerns, a second opinion is never a bad idea.
  4. Rob Schneider February 27, 06:36
    This is very clever and very helpful.
  5. Dr.Brian March 02, 17:56
    great article full of helpful information Dr.Brian McKay
  6. Bobby March 15, 21:38
    Respectfully I think title to this article puts an unnecessary negative twist on stuttering. I do believe that some good points are made and I encourage you to all that you can to help your child with this challenge. As someone that has dealt with a stutter their entire life, the impactful people that influenced me were people that didn't acknowledge but accepted my stutter as apart of me. Instead of being ashamed, I embraced it and worked thru it. Not seeing it as a weakness, but just part of me. I used it as a character builder. I was a leader in my high school, I have done public speaking, lead as manager of 300 people, currently operate a small business, and succeed in many ways of my life. Yes, I sometimes get aggravated, sometimes I have to start over, but I never let this get the best of me. I'm sure we all have hurdles that we must overcome. I consider myself a successful extroverted, talkative person. I don't even use Stutting to define any part of me and I'm sure most people who know me wouldn't either. Children that have a speech impediment are very tuned into "special treatment" and it shapes them. Allow your children to define their speech impediment or any struggle, don't make it define them. Let them tell you what they need help with and stand behind them and support them. Give them the information and let them make decisions as it makes sense to. I am a product of defining the stutter and not letting it define me. You can find peace with any struggle if you look at other areas of your life it improves. I realize that in some ways I am the opposite of a normal Stuttering person, but I believe with the correct influences and support that I could be the norm. Reguardless on if there is a "cure" or not, you can have a life that is not defined by a stutter even if it stays with you. Never be concerned about your child having a stutter, simply know that just as with other children, you are helping them shape who they are! Help them just as you would other kids, don't coddle them and protect them from life. Instead prepare them and give them the confidence to be Great!