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How to deal with a stammer - Q and A with Norbert Lieckfeldt, Chief Executive of the British Stammering Association (BSA)

Learning to speak is a key stage in child development, and for most parents this is an enjoyable time as communication with their child grows. However, sometimes the pleasure can be marred when a child has problems with speech. If a child begins to stutter or stammer, parents may not be sure how seriously to take the problem and how best to deal with it. As October sees an International Stammering Awareness Day, we found out more about stammering and how parents can help if their child is affected by speaking to Norbert Lieckfeldt of the British Stammering Association.

How common is stammering?

Stammering is one of the most common speech and language impairments. About 5-7% of children will go through a stammering period when they learn to talk. Most of these will recover naturally, though about one in four will not without intervention by a speech and language therapist. It's therefore imperative that all children who go through a prolonged period of stammering be referred as soon as possible to a speech therapist for an assessment. There are about 720,000 people in the UK affected by stammering, of whom 300,000 are children.

How early can children start to develop a stammer?

The average onset is between 2.5 and 3 years, as the child's language becomes more complex. But of course it can happen at a younger age, or when a child is older. The important thing is to be alert, be supportive and if the stammer persists, or if the child becomes aware and/or visibly distressed by it, to seek an assessment by a speech and language therapist

Is there anything parents should look out for?

On the whole, parents will know once stammering has started. In many cases it can come on very suddenly, and usually for no apparent reason. Parents often blame themselves for 'causing' their child's stammer, but there is really no evidence for that and latest genetic and neurological research findings would put stammering amongst the developmental childhood disorders.

Do we know what causes stammering?

We still don't know why any individual child starts to stammer at any particular point. It isn't a question of a shock, or trauma at all - very often it's simply 'he came down for breakfast and he was stammering'. We do know there are risk factors, and there are genetic links that predisposes a child for stammering. Without the physical predisposition, a child would simply never start to stammer. But what triggers it in a specific child, what causes many of them to recover, and others not, is still unknown (although, as with all developmental problems, girls are more likely to recover). However, early intervention through speech therapy has a very high success rate - once stammering becomes established and chronic, it is usually a lifelong issue.

Can stammering just be a phase as children learn to talk, or is it usually a more long-term problem?

Most children who start to stammer will recover normally fluent speech - though stammering may potentially reoccur at any point in later life. This is why most health visitors or GPs when asked will tell parents to 'ignore it, it will go away'. However, making the diagnosis between those children who will recover and those who need more direct intervention to recover is not easy and requires specialist input from a speech and language therapist, which is why we at the BSA would always recommend an early referral. Once a child has stammered for more than a year, the chances of spontaneous recovery are very much reduced, and stammering can become a lifelong problem.

What can parents do to help if a child starts stammering?

The first thing we would say to parents is not to feel guilty. They did not cause their child to stammer, but through simple changes they can give their chiuld the best chance of recovery. We would certainly encourage them to seek the help and advice of a speech and language therapist as soon as they're concerned about their child's speech. It is also helpful NOT to draw attention to the child's speech by asking them to 'slow down' ore 'take a deep breath'. Listen to the child, be patient, focus on WHAT they say, not how they say it, and don't make them speak if they don't wish to. The BSA has a very helpful leaflet with things parents can do at home to help their child's speech during this phase at http://www.stammering.org/pre-school.html

Are these things sometimes all that's needed to get over a stammer?

In most cases, as the child's physical capacities for producing speech catches up with their desire to express themselves, their stammer will resolve. However, one in four children will require intervention. This is usually administered by the parents themselves with the support of the therapist and young children often have no idea that they are receiving intervention for their speech.

Is it always advisable to seek medical help?

It is not easy to distinguish between stammering that will resolve spontaneously and stammering that leaves the child at risk of developing a life-long stammer. Neither health visitors nor GPs are trained in this, therefore BSA would always advise you seek an assessment from your local NHS speech therapy department (the BSA helpline can put you in touch with your local NHS service which usually operates on a self-referral basis). Again, the assessment will be done in such a way that your child will be unaware that they're being assessed.

What is the BSA and how can you help?

The BSA is the UK's national organisation for everyone concerned about stammering. We offer information and support on our helpline (0845 603 2001) and our website (www.stammering.org). We will put parents in touch with their local NHS speech therapy service, highlight local specialists, listen to parents' worries (because we know that having a child who struggles to speak is very stressful) and offer reassurance.

With the right help and advice, is it nearly always possible for children to stop stammering by the time they grow up?

Early intervention does have a very high success rate, but a complete return to fluent speech cannot be guaranteed. We don't know why this is so - one suggestion is that the physical and neurological make up of a child simply militates against producing speech easily and fluently. We do know that, left unsupported, stammering can have a devastating impact on a child's personal, social and educational development. So even if fluency cannot be recovered, the support of the therapist will ensure that the child is given the best possible start in life, and in school, to ensure that stammering does not become an obstacle in later life.


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