In a previous post about selecting a treatment approach for a preschool child who stutters, I encouraged you to consider two questions: Is treatment necessary? and What treatment will be most closely matched to the child’s and family’s needs? In this post, I will address the question of whether therapy is needed.
Many young children go through a period of stuttering during their development. Research estimates that the incidence is about 5%, though some studies indicate even higher figures. Either way, that means that a lot of children exhibit some stuttering behavior at some point in their early lives. Importantly, the vast majority—at least 75% to 80%—of these children will actually recover from stuttering. That is, they will go on to develop typical speech fluency and not have a problem with stuttering in their lives.
This is great news—but it also represents a bit of a challenge: We don’t know for certain *which* children are likely to recover and which children are truly at risk for developing chronic stuttering.
When it comes to making treatment recommendations, we want to be sure that we are providing treatment for the children who are most in need of it—that is, the children who are at risk for continuing to stutter. The other children, the ones who are more likely to recover on their own, may not be as much in need of therapy (though in such cases, I would still want to provide support for the parents, who may be very concerned about their child’s speech).
Determining who needs therapy, then, involves evaluating the child’s risk for continuing to stutter. A significant body of researcher over the past couple of decades has been dedicated to trying to identify relevant risk factors for chronic stuttering. We can use these data to guide us in our evaluations of young children who stutter to determine who is most likely to need treatment.
Commonly identified risk factors include:
- A positive family history of stuttering (stuttering is genetic, so it runs in families)
- Being male (girls are more likely to recover than boys)
- A longer time since onset of stuttering (the longer the child stutters, the more at-risk he is to continue stuttering)
- Onset of stuttering at age 5 (children who start stuttering at a younger age are more likely to recover)
- Difficulties with general speech or language development
- A high degree of reactivity or concern about stuttering by the child
- Others (research is ongoing)
- The more of these risk factors a child shows, the more likely he is to need treatment.
Careful readers will note a commonly assessed aspect that is missing in this list of risk factors: the frequency or severity of stuttering! Oddly, how much a child stutters doesn't really tell us much about whether the child is at risk for continuing to stutter. Some children will stutter severely yet still make a full recovery; other children may not stutter much but be at high risk for persistence. This is particularly true for younger children, ages 3 and 4. For 5-year-olds, the severity of stuttering may play a bigger role, but for the little ones, it's basically not relevant. (That means that you really don't need to worry about how much a younger child stutters during an evaluation! You can make appropriate treatment recommendations even if you don't see a lot of stuttering!)
Ultimately, there is more to the decision that just counting risk factors. Sometimes, I will recommend therapy specifically because the child or the parent is very concerned, even if the apparent risk for continuing to stutter is somewhat lower. The reason is simple: I want to help the parents or the child work through their difficulties, including fears about stuttering. Doing so not only contributes to the likelihood of recovery; it also helps children and their parents feel better along the way.
The ultimate goal of this assessment is to ensure that the children who most are in need of help get it, without committing valuable resources to children who are more likely to recover on their own, without intervention.
For more information about how to assess these factors and make treatment recommendations, see Chapter 3 of Early Childhood Stuttering Therapy: A Practical Guide.