What is Stuttering?

Fluency

What is stuttering?

It is a complex interaction between the child’s inherent abilities and his/her internal/external environment.

There is a lot of new research out there about stuttering and with the age of technology, some information can be overwhelming and some information may be incorrect. New research shows that stuttering does not have an adverse affect on one’s life if it is left untreated. Research has  also shown a link between stuttering and language, stuttering and pragmatics (social use of language), stuttering and phonology (speech sound patterns), and stuttering and language complexity; however there is no consensus on the exact effects stuttering has on these areas. Additionally, research has concluded that the onset of developmental stuttering is usually observed at the same time of their child’s language spurt.  Children who stutter might experience increased anxiety levels and decreased self-esteem. Some physicians might tell you that stuttering is of no concern  and that your child will “grow out of it”. A speech/language referral is the first step to take to help your child.

In every day speech, we all display many types of disfluencies. These disfluencies are considered ‘normal’ because they are heard in normally fluent speakers as well as those who stutter. They are:

     1.       Whole word repetitions 

     2.       Phrase repetitions

     3.       Interjections

     4.       Revisions

9 Types of Disfluencies:

    1.       Sound repetitions ( i-i-it was me)

    2.       Syllable repetitions ( Bi-bi-bicycle)

    3.       Whole word repetitions ( I-I-I want to go too)

    4.       Phrase repetitions ( I don't I don't I don't like it)

    5.       Interjections (um, like, uh)

    6.       Prolongations (W-------------e will play later)

    7.       Blocks (Mmmmmmmmore please)

    8.       Incomplete phrases/revisions "I want mi-mi-mi" (milk), "I want water"

    9.       Broken words

Types of stuttering:

    1.       Developmental-onset between 2-5 years of age

    2.       Neurogenic stuttering associated with acquired neurogenic disorder (e.g. stroke, head trauma)

    3.       Psychogenic stuttering- may occur in people with mental illness or who have experienced mental stress. It is very rare

    4.       Cluttering-fluency disorder that is not stuttering

Fast Facts:

·         More males than females

·         About 1% of the population stutters

·         A large genetic component

Treatment:

An in-depth speech and language evaluation should be conducted. The evaluation is comprised of an interview, assessment, counseling, case history, and audio and video recording. After the evaluation, there are 4 possible situations:

   1.       The child is fine, no stuttering behaviors, no at risk behaviors
   2.       We aren't quite sure, not totally concerned, but more red flags than in situation one. 
   3.      The child is at risk. They aren't actually stuttering yet, but there are red flags, family history, and disfluencies 
   4.       The child stutters

Treatment goals would include:

•      Reducing/eliminating the disfluencies
•      Master modification skills so the child can say what they want, when they want to say it, at any time, any place, and with any listener
•       Teaching self-evaluation skills
•      Teaching modification skills
•     Teaching self-correction skills
•     Building in generalization tasks

According to Bloodstein (1949), stuttering is reduced or eliminated when speaking:

    1.       Alone

    2.       In unison with another speaker 

    3.       To an animal

    4.       To an infant

    5.       In time to a rhythmic stimulus

    6.       When relaxed

    7.       In a different dialect

    8.      While simultaneously writing

If you have a concern about a child in your life who is stuttering, contact a speech-language pathologist in your area.

Additional resources can be found at:

The American Speech-Language-Hearing Association http://www.asha.org

The National Stuttering Association

The Stuttering Foundation of America http://www.stutteringhelp.org

Sensory Processing Disorder: What's That?

As a child, I hated walking in the grass. It felt like needles on my feet, my legs, my hands. Today, I can tolerate it. It still hurts; but I tolerate it. All of us have "quirks" that bother and annoy us. Maybe its a loud toilet flushing or the feel of chalk. Some children feel, smell, taste, hear, and see everything WAY too much.

This month, Parent's magazine has done it again with a comprehensive article, "Kids Who Feel Too Much"; an article featuring Sensory Processing Disorder (SPD). Although SPD is not recognized as a medical diagnosis, ask any parent of a child experiencing SPD and they will tell you just how real it is.

Sensory Processing Disorder affects the way a child's brain processes messages sent to his body. This causes signals to be very severely misinterpreted or just slightly. A child may be tapped on the shoulder and his brain could tell him that he was hit, or not even register the touch at all. Many children with SPD have times of both over and under sensitivity; therefore, behaviors are hard to predict.

One of the biggest markers of SPD manifests as extreme behaviors; therefore,  many children suffering from SPD are mis-diagnoised with Autism. Another mis-diagnosis, Attention Deficit Disorder, stems from a continual need to stimulate the sensory system by moving muscles. The child looks too busy and over-reactive. 

Children with SPD typically have strong transitioning objections. It takes the child much longer to become comfortable in a new task so they’d just assume continue with the task they have already learned to handle. When asked to move to a new task, with new people, the child feels out of control and demonstrates objective behaviors. 

Children with SPD may appear clumsy, aggressive, hyperactive, or anti-social. They may love swinging, but hate the feel of squishy play bugs, etc.. However, it is important for these children to learn fine motor tasks in order to develop the coordination it takes to cut, hold a pencil, and eventually write.

Symptoms:

1)Sincerely bothered by certain sensations (hair cutting, loud noises, messy hands, walking barefoot on grass/sand, hugs, tags on clothing, etc…).

2) Does not seem to notice being touched. Prefers “quiet” play, may not seem to feel heat/cold/pain/hunger.

3) Uses too much or too little force with a pencil or when touching someone.

4) Passive, quiet, to respond to directions

5) Overly careful and fearful of new activities/group activities

6) May love spinning or swinging (more than typical)

7) Accident prone; may not be coordinated with learning new motor skills.

9) May have significant eating difficulties or aversions to certain “types” of foods (mushy, crunchy, etc.).

10) May have a language delay (generally will avoid contact with other kids due to unpredictability and dislike of being touched).

Treatment consists of practicing a variety of sensory activities at once to train the sensory system to handle sensory input and build positive neural connections with appropriate responses to the information coming in.

The goal is for the connections to become automatic.

Unfortunately, many insurances do not recognize SPD as a medical diagnosis; therefore, the child will need to receive related services (feeding, ADHD, etc.). Children with SPD may also need to be accommodated in school (wiggle seats, something to feel or fidget with at seat).

If you have a concern about a child in your life who may be suffering from SPD,  contact a child development specialist in your area. 

Age for Speech Sounds

I've had several parents wondering what age that their child should have certain sounds. Here is a general chart demonstrating the age range that of 90% children master the sounds by! 

*Smit (1990), Shriberg (1993) and Grunwell (1997)

Keep it simple

During my time serving on our district's Child Find team, I had the joy of "experimenting" with  variety of therapy techniques and tools.

One of the greatest things I picked up on while working with so many disabilities and individualism was to  teach children language the way that we naturally learn language. Seems simple; just like Rosetta Stone...right? *note the sarcasm

Children always learn best in their natural environment with engaging toys and activities. If you've ever tried to sit down with a one year old and practice flashcards with the goal of them sitting with an attention span of a three year old; than you can picture how a three year old with a developmental level of a one year old would responds to this same task.

The point is, we must always keep in mind where the child is it in their development and shift our therapy/play to their level.

Multiple research studies have proven that therapy tasks that don't account for developmental learning are useless. Practices including non-speech oral motor exercises, weighted vests, auditory integration therapy, and other developmentally inadequate approaches.

Follow the child's lead. If the want to play cars, play cars. If they want to rock a baby, rock a baby and shower that child with pretend play, natural language, and engaging therapy.


SarahV

Media vs Life As We Knew It.

At the beginning of every year, I do a "get to know you" activity with all of the kids that I see in the public schools. Most of the kids grumble and complain a little about this seemingly meaningless task; but, generously comply with a little prompting. One of the questions on their worksheet reads, " what is your favorite after school activity?". To my surprise ( I don't know why this was a surprise, it just was), at least 75% of the kids mentioned using some form of media as their favorite activity ( Xbox, Wii, computer games, World of Warcraft...whatever that is, etc.). More boys than girls answered this way,  even Kindergarten aged children.

Here's what I've noticed in my own life....I have an obscure view of the world through the lens of the media .I see these perfect and  happy family bogs, our nation in chaos over an election, STUFF that I cannot afford, updates that are meaningless yet necessary to read, and so many daily emails that I browse through the ones that don't take brain power and forget to reply to the important individuals that I say I love. All of this input coming at the speed of light so frequently that it becomes a drug. Literally, an addiction. Media is a legal drug ...for all of us. All other drugs are off limits for children because they are drastically unhealthy and young individuals are not able to always make safe choices.  If you knew that this media drug was altering the chemistry of your child's brain, would you allow it? If you knew it was hindering their ability to interact, in person with others, would you allow it?



Please note that I am neither condoning or condemning media use. Even now as I write this, my one-year-old is pining for my attention. I think there is a time and place for everything, even gaming (ask my husband). I simply think that it is a great idea for us to take a look at a few of these changes that have been taking place in our routines in the past 10-20 years. Then, take a look at other changes that have been taking place.  Learning disabilities are on the rise, 1/6 children; ADHD on the rise,  1/12 children; obesity on the rise,1/3 children. Who's to say whether there are correlations to our recent shift in lifestyle or not.

I share Jen Hatmaker's thoughts, which she sums up passionately in her book Seven.

  "I don't want my kids to be more comfortable interacting with a computer screen than a human   being. It's easier to bypass relational snags with convenient distractions forfeiting the chance to improve problem solving and listening skills....we stay the course until we resolve an issue. This is harder and requires more time, but my kids will marry people and have bosses and children. Learning healthy relational skills in now or never."

Do the world a favor and let's put a limit on the whole media thing. Let's go outside and play again. Let's read a book, no not an e-book, a BOOK. Let's eat dinner together and have conversations. Let's get out the board games and fight over who won at scrabble. Let's talk, laugh, argue, listen, and understand each other better. Who's with me?!?


Let me know if you have any questions, I'm not going anywhere.
SarahV

The missing "S"

" I daw a nake over there and it melled like a kunk!".  What's missing???  Hmmmmm, yep, you guessed it. This sentence is missing the important phoneme that most of us know as the /s/ sound.

The phoneme /s/ is the second most commonly used sound in the English language. So, when a child has difficulty with their /s/ sound, it can be REALLY difficult to understand them. Most of us are able to remember hearing someone speak with a lisp, and many of us have children who  have been known to have difficulty with this letter sound. So, let's explore how to help them find that /s/ again!

For purposes of this post not taking until Christmas to read (or write for that matter), I will focus on one specific difficulty with the /s/ sound. That is, the /s/ in a consonant blend.

A blend of consonants is two or more consonant sounds in a sequence within a word. For example sn---as in 'snake', sp---as in 'spider', and even ts---as in 'hats'.  When a child has difficulty with their consonant blends, the general rule is that they will leave off or delete the more difficult of  the two consonants. In /s/ blends, the /s/ is almost always more difficulty than it's adjoining consonant. Therefore, it gets the boot!

Spider is renamed a "bider"
Snow becomes a very excited "NO!"
Smile is now a unit of length, a "mile".

Confusing, right?  Imagine if you were the one trying to be understood!

Now that you know what is missing, how can you help? Let's start with the physiology...
The /s/ sound is produced with:

1) Your tongue tip slightly hovering behind your top teeth. 
2)The sides of your tongue lightly touching your upper set of molars. 
3)Your teeth remaining closed.


Now, let air out of the front of your mouth like a leaking balloon. Right over your tongue and out your front teeth.

Since this is a constant stream of air, I like to have the kids visualize the sound as a slithering snake, or a long string, even run a finger up or down their arm.

If the s-blend is at the beginning of a word, we have to define a stopping place for the next consonant. So, if you are using the "arm" technique make sure you help the child visualize where the /s/ ends and the next consonant is articulated.

For example, to teach the word "star", start at your hand and run  your finger (while making the /s/ sound) all the way up your arm to your face, and then tap your teeth when you get to the /t/ sound...to show where the /s/ ends and the next consonant is produced. You may also start at the shoulder or elbow and work your way down to the hand. Once you get to the hand, the second consonant sound is produced, followed immediately by the rest of the word.

It is important to remember that we are multi-sensory learners, children even more so. The more senses (sight, sound, touch, etc..) that you can incorporate, the easier it will be to learn!

This, again is a very visual sound and fairly easy to elicit...let me know if you have any questions/comment. I'm not going anywhere:)

Sarahv

Ixnay Screen Time

Before I go into my rant on television and young children, let me be very clear that I write this with ZERO condemnation. I am a parent who allows my 14 month old to watch a half-hour program almost every day. This post is intended to be purely informative and educational.

I am, however, going to clearly stress that if your child has more TV time than interactive language time with real live individuals, they WILL have a language delay.That's just the way it goes. So, yes, I am very passionate about this subject.

Let's play this out.  Your excitable 10 month old is running around, getting into cupboards, and screaming for your attention. You need to shower, do five loads of laundry, make breakfast, clean up the dishes, and finish your Facebook stalking. So, you turn on the TV. What happens to your baby....they become the poster child for the newest baby ZOMBIE movie. They immediately get sucked into the lights and sound, yet are unable to process the fast pace of what is actually happening in the program. 

How much screen time is your child exposed to each day? This includes both shows geared towards children and shows that you have on for your own enjoyment...be honest.  You'd be surprised how many families don't realize how much television/computer/iPhone time  their baby/toddler is exposed to during the day. Most families understand,even less, how little children are able to pick up from TV shows before two years of age.

Within the first year of life, children's brains TRIPPLE in mass! 3Xs! The majority of that growth comes from  the building of their language. What we know, is that children can learn little to nothing from watching television prior to the age of two. Yet, surveys show that between 40-60% of families have the television on most of the day.

So how do they learn language if not from television? The only way they learn is from the world around them, from play, from interactions with live people playing out life circumstance, from YOU. Not from Elmo, Backyardigans, YoGabbaGabba, Dora, or Cat in the Hat; from YOU.

What about attention? Studies have also shown that children who have consistent screen time also have difficulty with attention later in life. Has anyone heard of a rise in ADD/ADHD lately? I have!

"Well, the TV is only on for background noise". Studies also show that for every hour that a child under two years is exposed to screen time, they spend 50 minutes less interaction time with a parent. In our busy world, that is a sad realization.

There is no problem solving going on while watching TV, no creative play, no talking with others, no cause and effect (aside from turning the TV on and off), and no opportunity to watch your child grow. So press the off button. And if you MUST have it on sometimes, talk to your child about the program as they watch it. Name the characters, talk about what they are doing, what they are saying, what they are learning.

We all want to raise intelligent, patient, kind, social, and mindful children. So, do your part as the parent and lead by example.

Thank You.

Sarahv