Stammering is a low incidence, high need speech, language and communication problem that disrupts the forward flow of speech. It usually develops at the pre-school stage in 5% of children, and is most responsive then to early intervention by a speech and language therapist.
One important researcher in the field has suggested that its occurrence is actually about 8% at the pre-school stage but this is not generally accepted. Stammering has no single cause, although there may be a genetic link. There is no single or definite cure and there is no single best strategy for supporting pupils. Current research indicates that the cause of stammering has a physiological basis in the brain structure.
Over time a number of misconceptions about this complex communication problem have arisen. The stereotyping of people who stammer as shy, nervous, anxious individuals is frequently found and yet there is no evidence to support this.
Certainly, the stammering experience itself can lead to worry and anxiety, which will exacerbate the dysfluency. Parents cannot cause stammering, although there may be a genetic link. Small modifications in the speaking and listening environment at home and in school, which make the child feel supported, can lower these anxiety levels, and may help with fluency.
Other myths that it is caused by being forced to use the right hand when left handed, or that it is linked with intelligence are equally untrue. People who stammer generally show the same spread of intelligence as the rest of the population.
Stammering can emerge at any childhood stage, but most commonly between the ages of two and five when about one in twenty children may stammer. This of course coincides with a period of the rapid development of language skills. It affects both boys and girls equally at first but later boys outnumber girls by as much as 5 to1. It can emerge gradually, but sometimes develops very suddenly. Early intervention at this age gives the best chance of recovery.
Stammering is not common after the pre-school age, affecting about one in eighty children of school age. It is complex, unpredictable and variable and there are different factors contributing to each child's problem and to the development of the stammer. Thus it is impossible to give prescriptive strategies for its management by teachers but there do seem to be some helpful methods of support that are worth trying. These methods are likely to be useful in the management of the whole class, particularly if there are other pupils with communication difficulties.
Ideally, the child will be receiving support from a speech and language therapist who will be able to offer advice to the staff on managing the child in class. If this is not the case, the school should encourage the parents to consent to referral. In some areas therapists are able to visit the classroom and, after observing the child, give the teacher specific advice. However, it is still useful for staff to be aware of the complexities of the problem so that they feel more confident in their approach to pupils and parents.
Often younger children are not aware of their speech and if there is a stammer present staff should not comment on it, but continue to encourage the child to talk and develop language skills. However, some quite young children may be aware, at a particular moment, that they are having a problem with their speaking. A supportive comment, showing understanding at the time, can be helpful:
"That was a hard word to say, wasn't it?"
If the child is obviously aware all the time of their stammering and seems anxious about it, the teacher should speak with the parents on how to offer the child support. A gentle discussion with the child, that shows that the difficulty is acknowledged, lowers the pressure on the child and allows him to feel that his difficulty is understood.
It's believed that when the demands made on a child who stammers are greater than his capacities then fluency may break down in that situation. In the classroom it is helpful to lower demands during periods of severe stammering. The demands made by other people, the situation, or the language demands of vocabulary, grammar and level of questions should be kept as simple as possible. Liaising with parents allows the teacher to take account of changes in family circumstances that may add to the demands that are affecting the child's fluency.
Occasionally a stammer goes undetected in school, as the child hides it by avoiding talking, or generally getting out of situations where that is called for, perhaps by appearing to be very shy and quiet, playing the clown, disrupting the work, or simply by missing a lesson. This covert stammering is very damaging, as so much energy goes into avoidance strategies that the real needs are misunderstood. Girls are more likely to be quiet and withdrawn and the busy teacher may be happy to assume that they are getting on with their work, in their own way. In reality, the girl may feel very lost and alone with the problem, building up a sense of shame, as it is never acknowledged. Boys are more likely to challenge the teacher and present as uncaring and disinterested in an effort to deny their real problem. Teachers may be moving into disciplinary strategies that label the child, when it is possible that a stammer lies behind the behaviour.
|Awareness||Child unaware / unconcerned|
||Dysfluencies - mild, unhurried, lacking tension or struggle and usually consists of repetitions of phrases and whole words|
|Avoidance||Child does not avoid words or situations|
|Awareness||Child has some awareness/some concern, usually when stammering|
||Stammers may be tense, hurried. May be prolongations or blocks as well as repetitions of phrases and sounds|
|Avoidance||Child may occasionally avoid words or situations|
|Awareness||Child is aware and may think about stammering a lot of the time|
||Stammers may be very tense, hard attack on words and last several seconds - or may be hidden so that there is less actual stammering and the symptoms may 'go underground' affecting behaviour|
|Avoidance||Child may avoid a great deal- change words, avoid situations e.g. the phone, groups, may not make friends, may choose non-speaking subjects at school|