Stuttering
Stuttering is a neurologically based condition which impairs an individual’s ability to time and sequence the underlying movements necessary for fluent speech. More than 70 million people worldwide stutter, which is about 1% of the population. People who stutter often exhibit overt stuttering characteristics where sounds and words are repeated or stretched, or words get “stuck” where no sound can be heard. These behaviours can be described as the “physical” aspects of stuttering and can be seen and heard by those around the speaker. Covert features or less visible characteristics of stuttering can include feelings of shame or embarrassment and negative attitudes towards communication. These less visible characteristics of stuttering are often described as the “cognitive” and “social-emotional” aspects of stuttering and play a role in maintaining the problem of stuttering where the urge to conceal stuttered speech may dominates a person’s life. People who stutter often report a sense of “losing control” when stuttering. This “loss of control” can lead to increased tension, struggling or pushing during a moment of stuttering and an anticipatory effect of predicting and fearing future speech breakdowns. Avoidance behaviours may build up slowly over time and therapy can help individuals “unlearn” these unhelpful coping behaviours to speak in an easier and more forward moving manner (with less associated anxiety or fear).
In preschoolers who begin to stutter, intervention is focused on helping children regain fluent speech as well as developing and maintaining positive communication attitudes towards talking. Intervention is conducted through parent coaching and counselling to support a child’s fluency. An attitude of acceptance towards stuttered speech in the preschool years is key as some children continue to stutter despite early intervention. For older children, teens and adults who stutter, intervention is focused on improving the quality of life of the individual by increasing their ability to talk and desire to talk. This may include having the skills to adjust moments of stuttering to reduce struggle and fear, being more open about stuttering, increasing one’s comfort and confidence when talking, and seeing value in living authentically as a person who stutters. Community support and connecting with other people who stutter is strongly encouraged at Skill Builders to complement individual therapy to reduce feelings of isolation.
Speech
A child’s ability to speak clearly is crucial to communicating with family members, peers and other people in his/her world. Even though children vary in their development of when they have mastered a sound, there are certain ‘milestones’ that can be used as a rough guide for normal development. In the first 3 years of life, children’s speech does not sound like adult speech because they make typical child-like ‘sound replacements’. By 4-5 years, children can say most sounds correctly and anyone (including unfamiliar listeners) should be able to understand the child’s speech in conversation 90-100% of the time. Some sounds develop after a child’s fifth birthday and it is not uncommon for children to have difficulty with “r” (e.g., saying “wed” for red, with “r” usually present by 5 and a half years of age) and “th” (e.g. saying “fink” for think, with “th” usually present by 8 years). Children who are unclear or hard to understand should be seen by a speech language therapist. Speech language therapists help children acquire sounds which have not developed or to correct sounds which are being mispronounced.
Speech sound difficulties should be addressed as errors in speech production have been associated with literacy difficulties.
Language
A child’s ability to understand what is being said and his/her ability to use words and sentences to communicate is partly innate and partly learned. Similar to the way children develop sounds, language acquisition varies greatly. Language learning occurs gradually through interaction with people and the environment. By 12 months or so, most children have their ‘first words’ and are able to understand simple questions or requests (e.g. “Come here”). Rapid language development occurs between 18 months and 4 years and children’s vocabulary (knowledge of words) expands dramatically and their speech evolves from simple, short phrases to more complex, longer sentences. During this period, a child’s ability to understand concepts and follow instructions (e.g. “Point to the big dog and little cat”) is also developing and he/she is also able to provide the correct answer to more abstract questions (e.g. “What’s different about a mum’s shoes and the little girl’s shoes?"). By the time children are 5, they can communicate by using long and detailed sentences, construct a story with “adult-like” grammar and engage in conversations with people. Some children have difficulties progressing through these stages of language development and they need assistance from a speech language therapist to develop their language skills.
Language difficulties should be addressed because the development of literacy depends on oral language skills; if you can’t say it, you can’t write it! Furthermore, weak language skills can affect a person’s ability to understand written texts.
Literacy
Reading and writing are critical skills for children to acquire during the early school years. Being literate means that people can understand and follow written instructions, find out information online or in books, write letters and emails, and send text messages. It also means that a child or adult is able to participate fully in their education and learning. The way reading is taught can vary from school to school, however, by about Year 3, most children are expected to have “cracked the code” to reading and have the ability to read fluently and understand the text they have just read. Some children have a specific learning disorder (e.g. dyslexia) which makes reading difficult for them despite high quality teaching. For these children, extra support is required by a speech language therapist to help him/her learn the skills to be able to read fluently and to comprehend the message in the text.
Whilst learning to read, children also learn spelling and writing conventions which allow them to become effective writers. By the time a child is in Year 3 and 4, he/she will reach levels of spelling automaticity that allow them to write without too much conscious control over their spelling. Children who struggle with reading often also struggle with spelling as a student’s ability in one is intricately related with the other (however, spelling is considered a more difficult task compared to reading). Speech language therapists can help children become competent spellers by systematically teaching spelling patterns and by increasing their repertoire of spelling strategies.
Children who are at-risk of having literacy difficulties can be identified as young as 4 to 5 years of age (before starting school!). Once at school, students who are struggling to read in the first year of schooling should be assessed by a speech language therapist as soon as possible. At risk readers should not be left to “catch-up” as inevitably, this does not occur and the reading 'gap' steadily widens between those who can read and those who continue to struggle. Early identification of children who are at-risk of literacy difficulties combined with direct, explicit instruction ensures that every child has every chance of literacy success.
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