Tara Says: Praise to “The King’s Speech” for depicting the struggles associated with stuttering as well as a realistic view about how this disorder can be positively impacted by trained professionals. 

Stuttering is considered a communication disorder in which a person repeats sounds, syllables or words. It is quite common for young children to repeat words, especially when they are stressed, tired, or really trying to get your attention, as in “M-Mommy, M-Mommy, M-Mommy, I want a cookie, cookie! (Come to think of it most children seem to have the word “Mommy” on auto-drive.) Stuttering usually involves the repetition of sounds especially the first sound or first syllable of a word (e.g.,  “M-M-M-Mommy, I s-s-s-s-see the d-d-d-dog”) or in prolonged pauses or consistent interjections “um, uh, you know” disrupting the normal flow of speech.  The medical term for this condition is disfluency. The term stuttering may refer to difficulty with the entire process of communication or the specific disfluency of unintended repetition or pauses. 

It is likely that what you are seeing in your daughter is developmental stuttering. Normal stuttering, which is associated with early childhood language development usually around ages 2-5, often appears sporadically and with decreasing frequency over time. There are several factors at play during these years which trigger developmental stuttering, including commencement of utilizing words and sentences to express more connected thinking.  There is also a demand for increased linguistic competency and proficiency in articulation, all of which requires increased cognitive processing. Alba Barraza, Speech and Language Specialist at Baby Steps Therapy in Rocklin, CA, says, ”Some of the children I work with have more difficulty when they are asked a ‘thinking’ type question that requires simultaneous processing to formulate the answer and get it out. The catch is that these kids are bright and want to be right, so there is some anxiety built up around speech.”

New research shows that developmental stuttering may, in fact, be genetic. So it is important to find out if there is any family history that may explain the speech challenges you are seeing your daughter exhibit. If there is a family history, the pattern of stuttering may give some insight to your daughter’s pattern. If a family member stuttered, determine if  they stuttered for a short period of time or if they continued to stutter, requiring professional intervention to develop strategies.

What parents can do: Take a deep breath. There is no evidence to suggest that stuttering is linked to psychological difficulties. Given that, a stressful or pressured environment can exasperate stuttering type behaviors for children who already struggle with fluent communication.

Continue to note what your daughter is doing or experiencing when she stutters—this may help to uncover a potential trigger. Your daughter’s stutter frequently occurs when she is asked a question, so have you noticed who is asking the question and what type of question it is? For example, does she stutter more when a teacher asks the question and it is a multi-processing question (“What did you do this weekend?”) versus one of rote recall (”What color is the chair?”)? A multi-processing question requires your daughter to organize the information and then speak. This process happens almost simultaneously; a color question or any rote question is a quick recall that doesn’t require formulation of information. Finally, note these important insights:

• If the stuttering increases when she appears to be nervous, anxious or tired, help her avoid those situations or prepare her in advance to help decrease her anxiety.
• Practice reciting information with your daughter. You can do this with nursery rhymes or familiar sayings.  Make this a fun game and not a focus of your child’s difficulty.
• When you or others ask your child a question, slow down your rate of speech and make sure your child is given enough time to answer the question.
• When your daughter is trying to speak, do not finish sentences for her even if you know exactly what she is saying.
• Sometimes, encouraging her to move or walk while talking can help. When I am working with a child that struggles getting the words out or repeating words, I will give her a ball to squeeze or encourage her to clap lightly while answering questions. 
• Don’t correct your daughter when she is stuttering, because that could increase her anxiety and make her reluctant to speak. Instead, you can acknowledge what she said by repeating it. For example, “Yes, you’re right–the moon is round and white.” In this manner, you are praising your daughter for her answer you are also repeating it so she hears her own words without disruption. 

Most children outgrow stuttering or developmental disfluencies. Approximately five percent of all children between the ages of 2 to 5 stutter. By the time children reach adulthood the numbers reduce significantly; less than one percent of adults stutter.  

If your daughter’s stuttering persists for longer than six months, each disruption lasts longer than a few seconds, or if she exhibits noticeable facial tension or secondary tendencies, i.e., slapping her leg, snapping her fingers, etc. while trying to talk, you should consider having your daughter evaluated by a speech and language pathologist, who will try to determine if the stuttering is developmental or related to processing difficulties. Early detection and intervention should be balanced with what is developmentally linked. A rule of thumb to consider: If something is impacting your child socially, it needs attention. 

Finally, stuttering is not an indication of weak cognitive abilities and, even if stuttering persists, therapy and specific strategies can help children or adults work through and learn strategies that will help them be successful, as it worked for King George VI.

TARA’S ANSWER: Breaks from the routine of school or work are essential to helping regroup. The key to regrouping is downtime that allows for play using both the brain and the body.  The hope for these breaks is that children get an opportunity to enjoy themselves in a way that also promotes creativity, and in a sense, rejuvenating the brain. However, in many cases even during short breaks from school, our kids have every moment scheduled negating the downtime aspect of the break.

Sensory Overload
The winter break is usually chock full of sensory bombardment like, for example, auditory stimulation from various sources including relatives, more TV than usual, music and party atmospheres. Visual stimulation changes from paying attention to what is on a white board or books to very stimulating visual information including TV (again) as well as the various holiday lights on display.

It becomes a matter of shifting gears. If the scheduled fun includes seeing family and friends (which alters their schedules significantly), but simultaneously does not allow for downtime to regroup, what happens is that children are scheduled for fun (our definition) and that may consist of later bed times, not sleeping in their own bed and a lot of over-stimulation including constant interaction with others, toys, TV and sweets. This type of stimulation may be fun for the child but is non-predictable and totally out of their control.

Get Back To It – NOW
Once it ends, we expect the child to transition into usual structured, scheduled environment of school. It is a jolt of sensory information. BOOM, now you must sit all day, take in information that doesn’t blink, pound or otherwise get your attention and you must not have your attention stray at all starting IMMEDIATELY. This is hard for anybody, much less a child.

What Parents Can Do
When your family travels, especially after holiday trips, it helps to return home in time for your child to go to sleep in his own bed and wake up at the usual school time to allow the body to adjust. To recoup from the holidays, declare a  “regroup” day.  This special down-time allows your child to organize his materials including school stuff, clothes, etc.

Also, infuse quiet cognitive activities throughout the day. Start with reflecting on, in sequential order, what he did during the holiday break. For kids that can write, have them list what they did, in 1-to-10 order. Pull out the book that they were reading and the math they were working before the break came and reintroduce it in a non-pressured way so that they have a segue into the first week of school. Another great strategy is to be sure the weekends in January have quite a bit of down-time. Just like us adults, it takes weeks, not days, for kids to adjust back to the normal schedule.

TARA: The holiday season is very challenging for a lot of children. They are expected to be “on” for long periods of time and often in the company of relatives who are unfamiliar or whom they don’t see on a regular basis.

Children are not always sure what to expect during the chaos of the holidays and, many times, are unclear on how to react or behave. Think about how traveling or changes in your schedule make your body feel! So, imagine how children may be experiencing this without knowing how to communicate what it is they are feeling.

From the child’s perspective, consider these points:

• It’s hard to be ”on” for long periods of time
• A change in routine and schedule can be tough
• Traveling can be disruptive to the body
• Your child may not know what to expect or how to behave in the way you hope or expect

What can parents do?

You can help your daughter cope during the holidays by preparing her for change. Show her photos of relatives she’ll meet and discuss what they may say to her. For instance, talk about how an aunt or uncle may comment on how much your daughter has grown or how they might ask her about school and what she likes to do. Relatives tend to ask children they see infrequently “How’s school?” But most children answer with one word: “Good.”  Rehearse with your child things they can mention about school, such as a performance they were in, a project they are currently working on, or a new friend they just met. This will help your child learn how to engage in a conversation. The next step is to have your child prepare a few questions she can ask relatives, such as how a favorite pet is doing.

If your child is young or has difficulty understanding information verbally, create a “Social Story”–a picture book of what she will see and hear during the holidays and ways she can react.

Also, if your child tends to get overwhelmed when there are a lot of people around,  make sure she can take a break from the social mania that surrounds the occasion. If you are going to friends’ or relatives’ homes, explain that your daughter has a hard time in these social settings, and ask if there is a place where she can take a break. If there are a lot of people staying in one home, consider staying in a hotel–this will help with providing privacy, quiet, and maintaining a more consistent sleep/awake schedule.

As parents, we too are overwhelmed during the holidays, which in turn, impacts our children’s behavior. Be mindful of this, take a deep breath, and remember–it’s normal!

Me, I am an occupational therapist (OT) specializing in pediatrics. I own a private clinic called Baby Steps, write books, and lecture all over the country. If you’d like the full bio, you can read it here.

The thing about pediatrics (or “peds” as we in the industry call it) is you never feel like you know enough, because there is always that one kid you can’t quite figure out. This is probably the part of being an OT that makes me want to keep doing it. (This is also the part of being an OT that makes me want to throw my hands up and say, “forget it!” Just when I think I know a lot, I don’t know the answer for the parent of a particular kiddo.)

A mystery can be a powerful motivator. But it’s the “parent part” that fuels my engine. As a mother of two, I understand that parents want answers—a glimpse into the future. What do we want to know as parents? That the future will be okay. I get that, because even with a lot of answers, I have a lot of questions about my own children. When my son, who just turned five, tells his occupational therapist mother—who insists he practice handwriting for a few minutes every day—“I am not a writer boy. I am a train boy and a baseball boy. I am not a writer boy,” I question whether I should be making him write at the age of five. Then I go deeper and question his visual perceptual and visual motor abilities, and then of course I question myself—not as an OT but as a mom.

But then I imagine Liam in 15 years. Liam the writer of great poetry, thanking me for making him practice handwriting. Writing beautiful poems about his mother who made him write, much like the concert pianist thanks his mother for making him practice every day. Then Liam yells, “Where’s my cookie? I did three pages!” I hand it to him and realize the idea of my kids thanking me for daily torture is a direct quote from my father: “someday you’ll thank me for this!” (for doing my homework, or for practicing playing the guitar.) Perhaps I should pick up the phone, thank my father, and let my son play with his trains.