How do we treat school-age kids who stutter?
First, a few sobering facts:
1. Stuttering gets harder to treat with age. Academics say it becomes “less tractable”, with “the chances of natural recovery diminishing significantly”. In plain English, this means stuttering gets harder to control; and full recovery is less likely.
2. School-age kids who stutter are at risk of being bullied and teased. One study showed that more than 80% of children who stutter were bullied about their speech during primary school (Ezrati-Vinacour et al., 2001). Another showed that kids as young as 4 years of age start to experience negative reactions from their peers (Langevin et al., 2009). Not surprisingly, school-aged children who stutter often develop negative attitudes to speech and communication, which gets worse over time and may include actively avoiding situations requiring them to speak (e.g. reading out loud and giving talks to the class).
3. We now know that the effects of all this negativity can have effects that outlast high-school, potentially affecting further education and job opportunities (Yaruss, 2001). We also know that adults who stutter have 7 times the odds of having an anxiety disorder than people who don’t (Iverach et al., 2009).
So what can be done to help school-aged kids who stutter?
The first thing we can do is provide advice to teachers and others working with children who stutter, highlighting the heightened risk of bullying, teasing, anxiety and avoidance.
Obviously, the next thing we can do is try to treat the stuttering. But, unlike with pre-schoolers, the evidence-base for treating school-aged kids successfully is limited and fairly low in quality. To date, the best contenders for school-age stuttering treatments are:
- speech restructuring, like the Camperdown Program;
- verbal response contingent treatments like the Lidcombe Program and Time Out;
- video-self modelling; and
- syllable-timed speech, like the Westmead Program (also known as “Robot Talking”).
Of these treatments, speech restructuring is probably the least desirable for school-aged kids. Many children don’t like using the speech pattern, and relapse is common.
For younger and less mature school-age children, the Lidcombe Program has some evidence to support its use (e.g. Koushik et al., 2009). But parents and the child (and their speech pathologist!) need to get creative and work hard to keep the child motivated, and the treatment doesn’t seem to work nearly as well as it does with pre-schoolers.
Video-self modelling has been studied with children as young as 8 years old, with some low level evidence to supports its use (e.g. Bray & Kehle, 1998). The treatment is safe and not hard to do in the age of smart phones and tablets. It doesn’t work for everyone. But it’s certainly worth a try – especially if some of the other treatments haven’t worked or as an addition to another treatment.
Recently, there has been some promising (but preliminary) research conducted treating school-aged children with syllable-timed speech therapy very similar to the Westmead Program. In 2012, Cheryl Andrews and her colleagues from the Australian Stuttering Research Centre (ASRC) and Macquarie University published the results of a clinical trial using the program to treat 10 children who stutter, aged 6-11 years. Nine months after commencing treatment:
- 1 child was almost free of stuttering;
- 8 of the 10 children reduced their stuttering;
- stuttering decreased by more than 50% for half the children, (more than 80% for two of these children); and
- reduced stuttering outcomes were supported by measures showing reduced situation avoidance and increased quality of life for the children.
The positive results of this trial need to be read with some caution. The study was a preliminary “Phase I” trial only: the sample size was small, and there was no control group, meaning the results appear more positive than they truly are. There was a lot of variation. The treatment did not eliminate stuttering completely for any participant. Children who had never been treated and who had no family history of stuttering seemed to do better than others who had received previous treatment. Kids with severe stuttering before treatment seemed to do better than kids with mild stuttering. 90% of the participants showed a significant and immediate improvement within 6 weeks. And some of kids showed mixed results – with an increase in syllables stuttered (an objective measure), but a decrease in self-reported severity levels and an increased quality of life. Importantly, the results only tracked 9 months of treatment results – the longer-term effects of the treatment are unknown.
Nonetheless, the results are encouraging. They warrant a large randomised controlled trial. They also warrant further exploratory studies experimenting with additional elements to the program, e.g. systematic rewards, which might increase the treatment’s effectiveness.
Treating school-aged children who stutter is very challenging. Evidence-based treatment is essential. But the current treatments all have significant limitations.
We need more and better treatment options. We need more research. The researchers need more funding to run quality trials. We need good researchers (like the ASRC) to keep publishing their results with detailed treatment instructions and consideration of “real world” clinical issues. In private and public practice we need to read the studies carefully to deliver the treatments correctly. We need to monitor outcomes and benchmark the results against the clinical trial results.
Those of us who treat school-aged children who stutter continue to watch this space like hawks.
**September 2016 update: Cheryl Andrews and her colleagues from the ASRC, have just published the results of their Phase II trial of a syllable-timed speech treatment for school-aged children who stutter. Read about it here.
Principal Source: Andrews. C., O’Brian, S., Harrison, E., Onslow, M., Packman, A., & Menzies, R. (2012). Syllable-Timed Speech Treatment for School-Age Children Who Stutter: A Phase I Trial. Language, Speech, and Hearing Services in Schools, 43, 359-369.
- The Westmead Program for children who stutter
- School-age stuttering research update: mixing and matching treatments to get results
- 5 ways for teachers to help children who stutter – tips from people who stutter themselves
- The Lidcombe Program for children who stutter
- The Camperdown Program for stuttering
- My child stutters. Is it because he’s shy? sensitive? hyper?
- Stuttering treatments: what works for whom? An evidence update