It is difficult enough for young children to be faced with a significant speech impairment like stuttering. As discussed in this blog, the effects of stuttering are often co-morbid with other learning issues. Most children who develop a stutter in their pre-school years fortunately outgrow it. The National Institute on Deafness and Other Communication Disorders states that some 3 million Americans stutter. Stuttering usually develops between the ages of 2 and 6 while language skills are rapidly developing and a child’s linguistic, motor, and emotional capacities are lagging (the so-called Demands and Capacity Model). As a result, approximately 5 to 10% of children will stutter at some point in their lives. The American Speech-Language-Hearing Association reports reports of remission rates vary from 6.3% all the way up to 80%. (The large disparity may reflect the manner in which data was collected.) Boys are affected 2 to 3 times as frequently as girls. Some data that suggest that African American children may stutter more frequently than whites. For those persons whose fluency does not resolve, stuttering can interfere with school, employment, and social milieus and lead to frustration, embarrassment, or anxiety. The worst cases can result in the creation of self-doubt and bullying. People who stutter know what they want to say. They simply can’t always get past the repetition of sounds or syllables or blocks associated with the disorder. Thus, diagnosis and treatment are imperative.
One of the challenges of diagnosis is that very few people who stutter are “pure” stutterers. They have associated, or co-morbid diagnoses, that will affect the treatment. The number of concomitant diagnoses ranges widely, and many of the studies are not current. Blood and Seider (1981) surveyed 358 school-based speech language pathologists. Of the 1,060 students with stutters whom they treated, 68% had at least one other concomitant disorder, which included articulation disorders (16%), language disorders (10%), learning disabilities (7%), and reading disabilities (6%). In a more recent and larger 2003 report, Blood et al surveyed 1184 speech pathologists who were treating 2628 students with stutters. Of these children 62.8% had other co-occurring speech, language, or non-speech language disorders. Articulation disorders (33.5%) and phonology disorders (12.7%) were the commonest. Of the language disorders, 13.5% of children had expressive semantic disorders and another 12.1% had receptive semantic disorders. Of the non-speech disorders, 11.4% had learning disabilities, 8.2% had literacy disorders, and 5.9% had attention issues. Less than 5% of students had central auditory processing disorders (3.1%), neuropsycholgical disorders (2.9%), behavioral disorders (2.4%), sensory integration issues (2.1%), or an acquired physical condition (1.3%).
A different set of researchers, Arndt and Healey in 2001, offered more stringent guidelines to the SLPs they surveyed about the identification of concomitant disorders, and not surprisingly, they offered a lower number (44%) than the Blood et al group. Regardless of the actual numbers, it is clear that frequently other issues accompany a stuttering disorder and must be carefully assessed to ensure that all issues are being addressed appropriately. Otherwise, children with very real challenges in addition to stuttering will fall through cracks as the stutter may be masking a different disorder. According to the ASHA, it is important to distinguish stuttering from language formulation difficulties such as word finding, which might present like “cluttering”, a form of fluency disorder, or apraxia, which might be confused with a fluency disorder. Conversely, we must be careful that the disfluency disorder does not result in an unnecessary diagnosis. For instance, a child who has a fluency disorder may struggle on an oral reading measure, not because he or she cannot read the encoded word, but because of the fluency issues. Silent reading assessments may be better measures of that child’s reading ability. The results of a thorough assessment in all suspected areas will root out the nature of the disorder(s) and thus result in appropriate treatment.
Speech language pathologists are provide therapy in the school setting for fluency disorders; it is they who must demonstrate “adverse educational impact” to secure special educational services for a child. However, it can be difficult to quality a child for an IEP. According to the ASHA, the effects of stuttering are much more than a communication disorder. “. . . stuttering can affect all areas of academic competency, including academic learning, social emotional functioning, and independent living.” If the IEP team refuses an IEP, families should consider requesting a 504 Plan, which more broadly defines disability, including speech as a disability that substantially limits a major life activity, according to the Americans with Disability Act. Speech services can be provided as a related service under a 504 Plan. Such accommodations as increasing time for oral reading or presentations or even alternate assignments to oral reading can be provided in a 504 Plan.
We can all share the pain of a child with a stutter who is struggling to communicate. We can also share the child’s frustration and anger. But in addressing the stutter, we don’t want to miss other issues. I have an elderly family member with a pronounced stutter, and he very rarely will pick up reading material. I will never know if his lack of reading is by choice or if perhaps he has an untreated reading disorder. I don’t wish to fan unnecessarily parental worries about their children who stutter; I just want to make sure that this doesn't happen to their children.