Is My Child’s Speech Fluency Normal?

It is very often that I receive calls from parents & caregivers who are concerned with their child’s speech fluency.  Differential Diagnosis between developmental disfluent speech patterns and early signs of stuttering can be difficult to distinguish between, but through parent/caregiver observation, there are definitely things to look for to help weed out between the two.  

Per the Stuttering Foundation website, here are helpful tips for parents/caregivers to determine if they should seek the guidance of a speech-language pathologist to assist with the differential diagnosis.

Normal Disfluency

• Between the ages of 18 months and 7 years, many children pass through stages of speech disfluency associated with their attempts to learn how to talk. Children with normal disfluencies between 18 months and 3 years will exhibit repetitions of sounds, syllables, and words, especially at the beginning of sentences. These occur usually about once in every ten sentences.
• After 3 years of age, children with normal disfluencies are less likely to repeat sounds or syllables, but will instead repeat whole words (I-I-I can’t) and phrases (I want…I want…I want to go). They will also commonly use fillers such as “uh” or “um” and sometimes switch topics in the middle of a sentence, revising and leaving sentences unfinished.
• Typically, children may be disfluent at any time but are likely to increase their disfluencies when they are tired, excited, upset, or being rushed to speak. They also may be more disfluent when they ask questions or when someone asks them questions. Their disfluencies may increase in frequency for several days or weeks and then be hardly noticeable for weeks or months, only to return again.
• Children with normal disfluencies often appear to be unaware of them, showing no signs of surprise or frustration. Parents’ reactions to normal disfluencies show a wider range of reactions than their children do. Most parents will not notice their child’s disfluencies or will treat them as normal. Some parents, however, may be extremely sensitive to speech development and will become unnecessarily concerned about normal disfluencies. These overly concerned parents often benefit from a referral to a speech-language pathologist for an evaluation and continued reassurance.

Mild Stuttering

• Mild stuttering may begin at any time between the ages of 18 months and 7 years, but most frequently begins between 3 and 5 years, when language development is particularly rapid. Some children’s stuttering first appears under conditions of normal stress, such as when a new sibling is born or when the family moves to a new home.
• Children who stutter mildly may show the same sound, syllable, and word repetitions as children with normal disfluencies but may have a higher frequency of repetitions overall as well as more repetitions each time. For example, instead of one or two repetitions of a syllable, they may repeat it four or five times, as in “Ca-ca-ca-ca-can I have that?” They may also occasionally prolong sounds, as in “MMMMMMMommy, it’s mmmmmy ball.” In addition to these speech behaviors, children with mild stuttering may show signs of reacting to their disfluency. For example, they may blink or close their eyes, look to the side, or tense their mouths when they stutter.
• Another sign of mild stuttering is the increasing persistence of disfluencies. As suggested earlier, normal disfluencies will appear for a few days and then disappear. Mild stuttering, on the other hand, tends to appear more regularly. It may occur only in specific situations, but it is more likely to occur in these situations, day after day.
• Also, a sign associated with mild stuttering is that the child may not be deeply concerned about the problem, but may be temporarily embarrassed or frustrated by it. Children at this stage of the disorder may even ask their parents why they have trouble talking.

How to Help Right Away 

1. Try to model slow and relaxed speech when talking with your child, and encourage other family members to do the same. Don’t speak so slowly that it sounds abnormal, but keep it unhurried, with many pauses. Television’s Mr. Rogers is a good example of this style of speech. Slow and relaxed speech can be the most effective when combined with some time each day for the child to have one parent’s undivided attention. 
2. Set aside a few minutes at a regular time when you are doing nothing else but listening to your child talk about whatever is on their mind. When your child talks to you or asks you a question, try to pause a second or so before you answer. This will help make talking less hurried, more relaxed. 
3. Try not to be upset or annoyed when stuttering increases. Your child is doing his best they can with learning many new skills all at the same time. Your patient, accepting attitude will help them. If your child is frustrated or upset at times when the stuttering is worse, reassure them. 
4. Some children respond well to hearing, “I know it’s hard to talk at times…but lots of people get stuck on words…it’s okay.” Other children are most reassured by a touch or a hug when they seem frustrated.

Reference:  The Stuttering Foundation (https://www.stutteringhelp.org/differential-diagnosis)

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