How do we work with children who stammer?

How does Cardiff and Vale Children’s Speech and Language Therapy Service work with children who stammer?

In Cardiff and Vale we offer a telephone appointment (or sometimes face to face especially if an interpreter is required) with the main caregiver so that we can discuss your individual concerns and have a chat about what support would be most helpful for you and your child at that time. You may like to prepare any questions and information about how stammering is or isn’t affecting your child and those close to them.

A further appointment may be arranged to have a face to face or video assessment which would include some informal/formal speech and language assessment. Alternatively families may first of all be encouraged to follow telephone advice for a certain period of time before reviewing progress. During this time a parent can contact the service for clarification of what they should be doing.

Some of the therapy we provide involves you and your child being videoed on your own device so that you can comment on play based interaction patterns (if we use a work device, secure storage of any video will be agreed with you first for a certain period of time if that material is to form part of confidential case note records. Material only required for that session can be deleted after use). Including both parents in sessions is most effective as it will enable differences between conversation styles to be identified.

You will see that you are already doing so much to naturally help your child to communicate. Video allows you to highlight where your child may temporarily benefit from some adaptations to conversation styles. You and your therapist can talk about these possibilities together, remembering that nothing you are already doing is different to any other parents but that a child who stammers may require something extra for a while. Parents do not cause stammering.

We are trying to reduce stigma about stammering to guard against children developing negative self-image. We are trying to change the words we use to describe a stammer so try saying ‘stammers more when’ rather than ‘had a bad day’ or ‘getting worse’.

There are many ways a speech and language therapist can support you and your child. These include the following:

  • Helping you to recognise what you are already doing that is helpful for your child.
  • Suggesting activities and ways of interaction which can help a child to enjoy communicating.
  • Helping you understand more about stammering so that it feels less worrying. Many children do not continue to stammer into later life so if adults are feeling more relaxed, a child will develop a positive feeling about their ability to communicate.
  • Explaining and jointly agreeing therapy approaches that are specifically designed for pre-school children who stammer. Therapy is mostly conducted in clinic based sessions and initially these sessions can be weekly or fortnightly with daily practice for families to do at home. They are fun and play based.
  • Answering queries you have about any advice given and making adaptations for individual circumstances where appropriate.
  • Helping you and your child deal with any difficult thoughts and feelings you may have around stammering. This may include your personal experience of having a stammer.
  • Giving advice for other family members or staff in early years settings, such as nurseries or child-minders.
  • Working with you on ways to keep your child chatting and developing their language and communication skills whether they are stammering or not.
  • Finding out what affects your child’s stammering. This could be struggling with speech and language skills or developing these suddenly, needing time to speak, tiredness, going through other development stages, being excited, worry, change, trying to compete for attention or a child’s temperament meaning that they are trying hard to ‘get things right’.
  • Working on speech patterns that can help your child say what they want to say more easily. This is likely to start with adults modelling a way of talking which is slower or calmer in that their phrases are shorter and followed by adequate pauses. A child is likely to mirror the way their conversation partner speaks.
  • There may be some direct work with your child later in the process where the therapist explores ‘different’ (not better) ways of talking so that a child feels that they are able to say any word they want to. It may seem strange but we may even practice stammering together, again to show that we can choose to use our voices in different ways. This really helps to desensitise a child to stammering so that they do not feel nervous about someone hearing them stammer and they keep talking.

Every child and every family is different. Your therapist will work closely with you to agree upon the goals of any therapy, and then tailor the support they offer to you and your child.

For older children, therapy priorities will vary at different stages of a young person’s life. We include the child and help them to make informed decisions about therapy goals.

We aim for therapy to help them to manage their speech and feel confident and competent to speak. Young people are often involved in educating listeners about their own stammer, with the speech and language therapist there to facilitate.

The therapist will plan therapy to suit your child’s needs; this may involve working directly with your child, either one-to-one or in a group.

It is likely to combine some of the following elements:

  • Liaising with your child’s school: ensuring that there is a positive environment in the classroom and the schoolyard where your child’s speech is accepted, whether it is stammered or fluent.
  • Supporting parents: helping you to feel confident in supporting your child at home, at school and socially.
  • Understanding speaking and stammering: your child will learn how speech is produced and what happens when they stammer.
  • Reducing avoidance: the therapist will encourage your child to try some of the words or situations they may have avoided due to a fear of stammering. This will happen at your child’s pace gradually moving through a hierarchy of speaking situations that start with the easiest that they have identified.
  • General communication skills: your child will learn that good communication depends on more than fluency and includes skills such as listening, making eye-contact, taking turns and how to start and end conversations. We will start with identifying your child’s present strengths.
  • Addressing the emotional side to stammering: you and your child may learn ways to work with unhelpful thoughts and feelings and discuss strategies to cope with any bullying or teasing.
  • Encouraging openness about stammering: often a young person wants to hide their stammer and they want to be accepted by peers and not to stand out. Adults who stammer advise young people not to apologise for stammering but instead to say that they stammer or I stammer in certain situations but that there is nothing wrong; it just means that others should wait a few more seconds to see if their friend has finished. It takes the pressure off a young person if they are not anticipating someone’s reaction. In fact lots of people are not fluent all the time. People who stammer exist in all areas of life and we encourage young people to listen to videos of adults and young people who stammer in different ways but who don’t let it hold them back. (e.g. Joe Biden, Emily Blunt, Ed Sheeran)
  • Making speech changes: if appropriate, the therapist may help your child explore different ways of speaking. Or your child might learn how to ease through tense stammers more easily.

Group sessions: young people are sometimes nervous when I mention these but I assure you that once people start coming they rarely want to stop attending as it is a fun, relaxed environment where focus is on what the young people want to achieve. This could be just meeting others that stammer. We prepare a young person for hearing different types of stammer. It does not mean that they will start to sound similar to those they hear.

Therapy is likely to also include some work with parents or the family as a whole. Making changes to how the family communicates (for example, working on taking turns to talk and reducing interruptions) may be helpful for the child who stammers.

If your child is focusing on different ways of talking they will be asked to practice at home to see if this works for them. Without practice we will accept that new ways of talking are not going to become easier, so ensuring that the child is motivated and supported at home will be key to this aspect of therapy being agreed. Motivation levels can fluctuate for any aspect of therapy. If your child is not happy please talk to the therapist to see if they have any other suggestions as it is not ‘one size fits all’. Don’t lose contact thinking one approach was all that was on offer.

If a child still stammers but they are really happy with the way they sound at that time that is ok. Young people can be discharged if no support is needed at that point in time and they can return to the service if they wish to revisit therapy.

The therapist may also contact your child’s school and give teachers advice to help support your child in class. They might even support teachers to talk to the rest of the class about stammering, particularly if your child is being teased or has experienced unhelpful responses at school.

We regularly contact secondary schools at transition time of year in order to facilitate a meeting or be the spokesperson for a young person who stammers. This will be an opportunity to inform school about any reasonable adjustments they need…or don’t need, as we don’t assume they need help.

If you have read all the information on this page, that is amazing! You will be well on the way to supporting your child effectively.

We also want to highlight that there is growing acceptance and awareness of differences in all walks of life. People are increasingly open about disabilities, mental health, dyslexia and the list goes on. There are awareness campaigns to explain that people who stammer are not nervous and weak and can be inspiring communicators with great empathy. Some people choose to work on sounding different whilst others want listeners to accept their stammer. The stammering community is very friendly and their talks and conferences are full of opportunities for people to meet and become inspired by speakers who happen to have a stammer. Whilst many children stop stammering when they have gone through developmental stages, a stammer does not have to define someone who continues to stammer. The more young people are given recognition and start to recognise their positive qualities, the less they will struggle.

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