Stammering in young children - the wisdom of Ann Irwin

Though this blog is mainly about developmental chronic stuttering in adults and teens, I did write a chapter on stuttering children in my free online book Coping with Stuttering. I based that chapter to a large extent on Ann Irwin's very useful book Stammering in young children - a practical self-help programme for parents (1988), which was well known and received at the time but seems to have been somewhat forgotten.

Ann's book made a great deal of sense to me at the time - also because she is acutely aware of the huge impact of stress on stuttering - and I thought it a good idea to revive her thinking on the subject, particularly as the issue of how to best deal with stuttering children up to the age of about seven has always been particularly controversial.

This controversy is partially due to the fact that most children (about 3/4 of kids) anyway outgrow the disorder, with or without treatment. The question inevitably arises whether, in order to maximise the chances of outgrowing it, it is best to either treat the child as soon as possible, or rather not at all in the hope that they will outgrow it. The controversy rages to this day, but Ann Irwin is firmly on the side of those who feel that direct intervention could do more harm than good. In my book I summarised her ideas, and I reprint that section here:

Book summary

       

"In the book Stammering in young children – a practical self-help programme for parents (1988, Thorsons), Ann Irwin describes a systematic preventative programme developed to temporarily reduce the child’s speech-related tension levels and in the process put an end to their stuttering. The programme is suitable for children up to the age of seven. While the programme is in effect, the child is temporarily as it were protected from exposure to all kinds of speech-related stress. If he has been completely fluent for a period of nine months, the parents may assume that he is cured and return to a normal routine. This protection programme should be introduced gradually – too many changes can confuse children and make them insecure.

"The extent to which children’s base-level tension varies was mentioned before – they may not stutter for months due to low base-level tension. If a child does not stutter for several months, parents may draw the wrong conclusion and consider him cured. The fact is that he may only be experiencing a period of temporary fluency due to low stress levels. For this reason Ann Irwin uses a nine-month period of fluency as the criterion for determining if the child has in fact outgrown his stuttering.

Strategies

"Her programme includes the following strategies:

* Parents should identify the factors that improve or weaken their child’s speech. The next step would be to develop strategies to control the negative aspects and enhance the positive ones.

Parents may, for example, find that Johnny’s speech deteriorates when he is excited. The appropriate strategy would then be not to emphasise exciting events such as Christmas – do not ask him what present he wants six weeks in advance, but rather one week before the event. Also avoid exciting games, tickling, et cet. If, however, parents notice that Johnny’s speech improves when he plays with his brother, they should encourage it, e.g. by buying a game they can play together.

* If he is by nature a hurried and active child who speaks too fast, try to calm him down in general without pointing out that he must speak slower. One way of doing this is to play a game in which the child is given a small financial reward if he walks to school instead of running.

Reduce direct questions

* Reduce the number of direct questions that you ask the child. Direct questions have to be answered and place the child under a great deal of speaking pressure. Bear in mind that your aim is to make Johnny enjoy speaking – and since you want to encourage him to associate speech with pleasure, avoid unpleasant questions. Also, many direct questions can be asked in an indirect way, e.g. instead of asking: ‘Do you want to play with these toys?’ you could say: ‘I put these toys on the table in case you want to play with them.’ If a question cannot be avoided, try to ask questions that require a simple yes or no instead of a long explanation. A good idea is to inform outsiders, especially teachers, of what you are doing. 

* Parents should reduce their speech demands and eliminate sentences starting with ‘say’ and ‘tell’, e.g.: ‘Say hello to Uncle Pete’, ‘Say goodbye’, ‘Say please’, ‘Tell Granny that story’, ‘Tell Dad what happened today’. Other speech demands include: `Johnny, come and talk to Granddad on the phone’ or ‘I saw you pull the cat’s tail. You have to tell me why you did it and promise that you will never do it again.’ Requests to repeat a word or sentence also constitute speech demands.

* Avoid interrupting the child. It only causes frustration and self-doubt and will force him to increase his tempo so that he can have his say before he is interrupted again. However, parents must allow the child to interrupt them. This is to prevent the type of self-consciousness and speech consciousness that would make him hesitate before saying something. He should not be thinking: Is it okay if I say something now?

Pay attention

* Pay attention to him when he speaks, so that he finds speaking an enjoyable and rewarding experience. Be a good listener. If you look bored, you will undermine his self-confidence. In real life, however, it is sometimes difficult to respond to your child with good listening – if giving him your undivided attention is difficult at a given moment, you should say something like: ‘I’m feeding the baby, so it’s difficult for me to listen to you right now. Give me thirty minutes and then you can tell me everything you want to.’ Bear in mind that children are often talking to themselves rather than to you – one should learn to distinguish between the different types of conversations children indulge in.

* Try to protect the child from competing for an opportunity to talk. It often happens – especially in families – that the stuttering child is deprived of an opportunity to speak his mind due to a lack of pauses in the conversation. This can make him speech-conscious. Give each child a turn to speak.

* Do not correct the child if his pronunciation or grammar is incorrect. If you make him aware of his language, he will also become aware of his stutter.

* Relax all discipline, criticism and punishment.

"Keep in mind that all these dos and don'ts are temporary. If the child remains fluent for nine months, you may resume the normal routine. The normal routine should be introduced gradually and in a step by step manner. If this process results in renewed stuttering, apply the relevant protective measure until the stuttering disappears.

If the stuttering persists

"If the stuttering persists in spite of the above guidelines, Ann Irwin has the following additional advice:

* Parents should not expect too much of their child. Avoid parental perfectionism.

* Is there something in the child’s life of which he is excessively afraid? Watch out for scary movies – try to reduce his fears and other negative emotions. If he fears something and wants to talk about it, he may stutter badly – it may then be better to express those fears on his behalf. Loneliness and sorrow also increase stress. Children have been known to recover after receiving a present such as a pet, or after going fishing with their father.

* A warm and loving home atmosphere allowing conversation, emotional outbursts and spontaneity will be of benefit. Comments such as: ‘Don’t ask so many questions’, ‘Don’t talk so much’ and too much discipline, criticism and punishment can be harmful. However, too little discipline or inconsistent discipline can lead to insecurity, resulting in ‘the stress of uncertainty’ and stuttering. Find the golden mean. Discipline should be fair.

Relapses

"After months of fluency a child may resume his stuttering due to a sudden frightening experience or stressful event, such as changing schools or going on a special holiday. This is unfortunate, but under normal circumstances the child’s fluency should return after a few weeks or months provided that he receives adequate protection against stress. However if he has a traumatic experience during this recovery period, the stuttering may increase in severity and last longer before improving. A third traumatic experience during this period may lead to chronic stuttering. One reason for this is that the child is growing up – and it is more difficult to treat older children. It is even possible that a single traumatic event, such as a car accident, may induce enough stress to cause continued stuttering due to high base-level tension."

The above summary can actually be condensed further in a single sentence: Try to keep the child's "speech tension" below his "stuttering threshold", in order to increase the chances that he will outgrow it. For more information on "speech tension", "base-level tension" and "stuttering threshold", read this chapter of my book. Also check out the remainder of the chapter on stuttering children here. You may also want to try the thiamine protocol. If you have a child who stutters, I wish you the very best of luck!