Tripping over words

Moving overseas and a host of other issues can trigger stuttering in children.

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What is the link among the former UK Prime Minister Winston Churchill, the UK Pop Idol runner-up Gareth Gates and the US actor James Earl Jones? They all have, or had, a stutter. Anyone who saw Gates's initial audition in the first Pop Idol series will remember the strong, fluent singing that came from a boy who could barely say his own name. Stuttering, or stammering, affects approximately five per cent of children and one per cent of adults. As the statistics suggest, it is treated most effectively in children, provided it's caught early enough.

The most common form of stuttering is developmental, affecting children when they are learning their speech and language skills. Boys are statistically three times more likely to suffer from the condition than girls. While most stutterers will struggle with initial sound or syllable repetition, stuttering can take various forms, as Charlotte Stockwell, a speech and language consultant based in Abu Dhabi, explains. "You can also have whole word repetition or whole phrase repetition. There is prolongation, like 'Ssssssarah', not a stammer but a really long sound, or there may be 'blocking' when you are trying to say a word but it is not coming out, like it's stuck."

Despite a great deal of research, the precise cause of stuttering is not known. It is thought to be a combination of neurophysiological, genetic and environmental factors, and usually starts in children before the age of four, just before they are about to start school. Parental concern over a child's speech development may be compounded by the worry over how it will affect the child academically and socially at school.

A few years ago, Amanda Jones noticed that her son, Callum, then three years old, was starting to struggle with his speech, coinciding with the family's return to the UK after six years of living in Oman and Abu Dhabi. "His speech had been slow to develop but was within normal parameters. Then I noticed he was starting to struggle with the start of his sentences and when he was excited he would repeat things. I put it down to the change. It had been a massive move for him to leave Abu Dhabi."

Jones gave Callum some time to see if his speech would improve as he settled into their new life in the UK. But after a year, during which there had been periods of fluency and regression, Callum's stutter "came back with a vengeance" and Jones was referred to a speech therapist. Stockwell recommends seeking an assessment by a speech therapist if a child stutters for more than three months. The symptoms may come and go, which can make its duration hard to monitor. "Stuttering can be inconsistent and variable. Parents can be lulled into a false sense of security." She continues that while some children may simply grow out of it, others will not. "It is certainly better to get them checked out. By the time they get to school it could be more problematic. The younger the child is when you work with them, the more effective the therapy is. Pre-school is the optimum time because their brains are still so elastic."

There are many treatments a speech therapist can use, depending on the severity of the stammer and the developmental age of the child. The Lidcombe Programme, used by Jones and her son, is particularly effective for children under the age of five. Developed in the 1980s at the University of Sydney, it is now used internationally and has been scientifically researched across the world. Under the programme it is the parent who has the main role in encouraging their child's fluency, supported by weekly sessions with a speech therapist. During the first stage, which can last between 11 and 22 weeks, the parent will have set play sessions with the child every day, encouraging them to speak fluently and using praise to reinforce good speech. If the child is only capable of managing two-word utterances without stammering, the parent will, while playing, ask questions that only require a two-word answer. As the child's confidence and fluency increases, the sessions are altered accordingly. During the second stage, which normally lasts a year, the number of visits to the therapist and home treatment sessions is reduced.

Jones has been careful to create a home environment to encourage Callum's progress. "As soon as his speech went, I would clear the diary and make sure he was getting enough sleep." She put in place some family rules about talking, which her husband and their three-year-old daughter, Isabelle, have to adhere to as well. "As a family we have been doing a lot about not talking over each other. We take it in turns to speak so there is no pressure on him to get his words out fast. It's about giving him space."

When Callum started school, Jones was concerned how he would react, particularly as he would be spending most of the week in an environment that she had no control over. At first his speech deteriorated. "He was exhausted. There was no positive speech to reinforce." A few months on, they have just begun the second stage of the Lidcombe Programme and Jones is cautiously optimistic. "At the moment we are on a very good phase, his fluency is fantastic. He occasionally stumbles over words, but it is nothing like it was. I am really hopeful we have turned a corner. But I focus on wherever we are at the time."

Early warning signs of a stutter can be very subtle. "A child may exhibit trouble in their breath control. Not actually a word stammer, but an airflow disruption," explains Stockwell. "Another thing they might do is use fillers like 'um', which, if this presents itself with other signs, will make us question whether this is part of a stammer." Children may also use avoidance techniques to try and cover up the difficulty they are experiencing. "They might change and use another phrase or change the subject completely and come back to it."

Two years ago, Christel Vorster began to worry when her youngest son, Liam, then two years old, was much slower to start to talk than his older brother, Nicolas, then four. This was at a time when they were moving to Abu Dhabi from South Africa. "We all spoke Afrikaans at home, then we moved to Abu Dhabi and he heard English for the first time." Occasionally, Liam would become frustrated with his speech difficulties and become aggressive. Like Jones, Vorster decided to lay down some family rules to give him the space to improve. "His brother would finish his sentences, so I stopped him doing that. I told him to give Liam time to speak, don't interrupt him. And no teasing. We give him time to talk, show him we love him and that he has our full attention." Vorster admits it has been difficult at times with a busy family life. "You just have to take that five minutes or whatever it takes for him to finish. When you are busy you just have to stop, kneel down and listen. It was hard, but it did help."

Today, Liam's stutter is much better, at least, in English. In Afrikaans he still stutters occasionally. One of the strategies Vorster uses now is visual clues to remind him to focus on how he is speaking. She or her husband will raise a finger to gently remind him to concentrate. "As soon as he concentrates he is much better. We are really happy with his progress. I don't think it's a big problem now. We will overcome it."

As Stockwell explains: "Every single person is an individual. Older children are taught strategies - they learn how to manage their stammer so if it happens they know what to do. If we can deal with the stammer when the child is very young, it is unlikely to come back when they are older." She finds that parents often blame themselves for their child's stammer, but says: "it is not your fault, or your child's fault. Try not to get too frustrated. Be patient."