Journal of Family and Child Health - Stammering in children

Abstract

Amy Noakes looks at how health visitors can support children and families with timely and effective therapy strategies beneficial to children who stammer

Stammering, also known as stuttering, is a difference in the manner in which an individual speaks. This can vary from person to person and the severity is dependent on the individual affected. A stammer can happen at any point of a sentence and may encompass one or more of the following (NHS, 2023; STAMMA, 2024):

Repetition of a sound or word for example ‘My name is J-J-J-J-John’

Stretching of a prolonged sound; for example, ‘MMMMummy’

A word gets stuck, meaning there is a silent block.

Approximately 1 in 50 adults are affected by stammering and 1 in 12 young people will go through a phase of stammering (NHS, 2023). Stammering is a neurodevelopmental issue in which there is a difference in brain activity, interfering with the production of speech (National Stuttering Association, 2024).

There are two types of stammer (NHS, 2023):

Developmental stammering first emerges between 2 and 3 years of age as speech and language skills are developing. Interestingly, the same number of boys and girls will start to stammer but girls are more likely to stop stammering (Michael Palin Centre for Stammering (MPC), 2024)

Acquired or late-onset stammering is quite rare but is usually connected with a stroke, head injury or progressive neurological condition.

It is recognised that many individuals who stammer have greater levels of empathy and compassion for others, strength of character and resilience «

The exact cause of stammering is unknown. However, it is influenced (but not completely explained) by genetics, and other factors in relation to the child and their environment (MPC, 2024).

Families and professionals can adopt indirect therapy strategies beneficial to children who stammer. These include (Action for Stammering Children, 2023):

Patience through not interrupting or trying to finish the child's sentence

Not correcting the stammer Taking turns in conversation

Encouraging good general wellbeing with adequate sleep and eating habits, as children can stammer more when overtired

Building the child's confidence with activities that take the focus away from the stammer

Endorsing behaviours that may reduce the stammer; for example, walking side by side rather than speaking face to face, or talking while drawing as a form of distraction

Asking the child what can assist them with their stammer (although it should be noted that not all children have awareness or want to discuss their stammer).

If a child's stammer persists for several months or it appears to be worsening, direct therapy will be offered by a speech and language therapist. In younger children, this includes the Lidcombe programme to provide direct behavioural therapy (Jones et al, 2005).

If a stammer continues until a child attends school, therapy will focus on both the speaking behaviour and the social, emotional and psychological aspects of stammering (NHS, 2023). Other options may be available, including feedback devices fitted inside or around the ear to improve fluency of speech; however, these do not work for everyone and are not available on the NHS.

Stammering can be associated with negative reactions from others, including bullying, which can have an impact on the child's attitude towards themselves and their mental heath (Tudor et al, 2013). Stammering can also have a negative effect on employment prospects, with the potential to lead to discrimination at work, which could affect an individual's quality of life (Craig et al, 2009; Butler, 2014).

Despite this potential for adversity, it is recognised that many individuals who stammer have greater levels of empathy and compassion for others, strength of character and resilience (Hughes and Strugella, 2013).

It is important that health visitors provide advice and information for children and families as soon as possible so that therapy strategies can be put in place and assist carers in appropriately supporting children.