Editor's note: This article was sponsored by Seattle Children's Hospital.
For people who stutter — and try to hide it — common daily interactions can be highly stressful, says Elyse Lambeth, MS, CCC-SLP, BCS-F, a speech-language pathologist at Seattle Children’s Hospital.
Lambeth once worked with a teenager who would avoid ordering a strawberry Frappuccino, her favorite drink, for fear of stumbling over the first sounds. In a school setting, kids who stutter may be reluctant to participate in class. Others might be hesitant to introduce themselves to potential friends because uttering their own name could result in a stammer.
“The cognitive load of scanning ahead and word switching is a lot,” says Lambeth. “You can hide it, but it takes a mental and emotional toll.”
Emerging research is offering useful approaches and strategies to help people who stutter. At the same time, the emphasis should be on communication, not concealment, speech pathologists say.
“We’re working on helping [those who stutter] speak and communicate in a way they want and go for the goals they have in life,” Lambeth explains. “We want them to feel comfortable and not use most of their mental energy on avoiding stuttering.”
What causes stuttering?
About 1 percent of Americans stutter (including one rather famous American), according to the National Institute on Deafness and Other Communication Disorders. Stuttering occurs most frequently in children ages 2–6. While many will outgrow the condition, about one in four will experience persistent developmental stuttering.
Stuttering originates from differences in how the brain is wired, Lambeth says. While genetics play a strong role in stuttering, other environmental factors can contribute, too. Some triggers are hard to pinpoint, especially in older children and adults.
For younger children, stuttering often occurs when they’re feeling overwhelmed. For example, parents might notice stuttering when a child is trying to urgently communicate information. Maybe they’re competing with a sibling for airtime, or they’re asking for something and fear the response will be “No.” In a classroom, a student might stutter when they’re feeling excited or nervous, or when they are struggling to organize a complicated story.
“It tends to come out more with big emotions,” says Lambeth. “But it’s caused by differences in how the brain works.”
Special time is a key strategy
A powerful tool for preschool stuttering is special time with parents, an approach that’s also frequently recommended to help improve behavioral challenges.
That’s because there is a common source in both cases: a small child’s system is overwhelmed. Spending that special time with a parent helps regulate their system. Lambeth uses the acronym TOPS to help parents remember the components: Ten minutes, One-on-one, Play and Specific praise.
First time you’ve heard of “special time”? Learn more.
This means playing whatever your child would like for those 10 minutes and following their lead. During that time, parents should try to notice and comment on specific things they’d like to see grow. A parent might point out times when something went awry, such as a block tower falling over, and comment on the child’s persistence.
“Focus on seeing them and what they’re saying, not just the way they’re talking,” says Lambeth.
Focus on the speaker’s experience
On a broader scale, there’s also movement to encourage someone to communicate freely, regardless of stuttering.
This is important because hiding or concealing one’s stuttering exacts an emotional toll. It can also negatively affect life choices. An adult might not apply for a certain job for fear that the pressure of the interview might provoke their stuttering.
The effort to mask stuttering can be all-consuming, influencing everything from word choice to deciding whether to speak at all. In fact, the very act of concealing stuttering had the strongest impact on someone’s quality of life, even more so than the severity of their stutter, according to research on adults who stutter published in 2021 in the Journal of Fluency Disorders.
Encouraging spontaneous speech
When Lambeth meets with the parents of children who stutter, she talks about creating spontaneous speech, that is, enjoyable communication that requires little effort and premeditation. Increasing this spontaneity can significantly reduce the psychological stress that often accompanies stuttering, according to findings published in the Journal of Speech, Language and Hearing.
Along with building up their child’s communication strengths, Lambeth also encourages parents to explore other possible stressors that might be overwhelming the child’s system. For example, how well does the child sleep?
Caregivers can also look at what steps can be taken to support improved communications, modeling good speech habits such as taking turns talking, slowing down their own speed when they speak, putting in more pauses between sentences and speaking in a relaxed manner. Lambeth also explores factors that might influence one’s emotional regulation, such as perfectionist tendencies or feeling overscheduled.
Focus on listening
It’s important to talk openly and positively about stuttering. After all, children know something is going on. A parent might say something like, “Some people do that, and it’s okay. Your body is getting tight when you’re trying to say the word.”
Telling someone to “calm down” often does just the opposite. Strategies such as taking a breath can backfire, too, since tension increases as one draws in a breath.
Instead, listen patiently as you would with any child who is trying to communicate an idea.
In therapy sessions, Lambeth works on active relaxation, encouraging children to visualize the muscles that are tightening. It can also be beneficial to work on reducing struggle when moving through tension on certain sounds and words.
More than anything, Lambeth tries to convey a message of acceptance.
“Each kid has their own journey,” she says. “Whatever journey they have, I want the core message to be: Your voice is beautiful and what you have to say is important.”
Find more information on fluency disorders and stuttering services on the Seattle Children’s Hospital website.