What is Normal Dysfluency?
It is quite normal for a very young child who is in the process of acquiring language to be more or less dysfluent at times during the growth period. This stumbling on words can be attributed quite literally to the fact that "his mouth can’t keep with his mind." Children make rapid leaps forward in their language abilities, then have periods when they seem to stop language development in favor of some other development, such as a fine motor skill. It is during the rapid leaps in language acquisition that we most often see worrisome dysfluency. It is true that 80% of all youngsters who demonstrate dysfluency at one time or another before the age of 6, are likely to "outgrow" this speech behavior. However, it is possible to estimate fairly accurately which children are likely to "outgrow" it, and which children will need therapeutic intervention if we are to prevent them from becoming chronic stutterers.

The Evaluation
When we evaluate a preschooler's speech, here are some of the things we look at to make this determination:

• Has the child been stuttering for a period longer than 6 months?
  We know that most dysfluency which is caused by the rapid growth spurts described above, lasts only briefly, and is gone within a few weeks. Persistent stuttering, on the other hand, suggests chronicity.

• Do dysfluent periods come and go?
  Most children who have growth-based dysfluency have only one or two brief episodes of stuttering. If a child experiences a number of stuttering episodes, each of which lasts for many weeks, over a period of more than 6 months, we would be concerned that this may be a sign of chronicity.

• Is stuttering "in the family?"
  Research clearly demonstrates there is a hereditary factor in the majority of cases of stuttering. Stuttering in a child who has this genetic disposition must be looked at very carefully, because, if present, the likelihood of chronicity is greater.

• Is language development age-appropriate?
  If there is a gap between the child's comprehension and his ability to express himself, it may be sufficient to help him overcome the language difficulties, and the fluency will take care of itself. That is why it is important to perform a complete assessment of your child's receptive and expressive language development before treatment is recommended.

The clinician who sees your child will give you a thorough explanation of what we know about the origin of stuttering and its physical signs, but please be assured of one thing: Whatever you have heard to the contrary, parents do not cause stuttering in their children.

Stuttering is a neuromuscular disorder, not an emotional disorder. Of course, in time, the effects of stuttering may lead to anxiety and a poor self-concept. That's why it is so important to have early identification and intervention. By catching the stuttering before the child learns to fear the act of speech, your child can be spared the pain and frustration of growing up a stutterer.

Our Treatment Plan
If your child should be found to have signs of chronic stuttering, a dual approach to treatment will be taken.

Parental Counseling
We will help you to arrange an environment at home which has been shown to be conducive to fluency in young children. The important elements are consistency and cooperation.This does not mean that there is anything "wrong" with the way you have been raising your child. But the child who stutters is particularly sensitive to some situations found in any normal home, like time pressure and interruptions.The program helps parents find ways to help their stuttering child cope with the stresses of everyday family life.

Direct Intervention

AFC is using the Lidcombe program for preschool children who stutter. The Lidcombe program is a behavioral treatment for young children who stutter. It was developed and tested in extensive clinical trials over the last 10 years at the University of Sydney, Australia. The program is entirely parent administered in the child’s everyday environment, and does not involve slowing or altering the child’s or the parents’s speech pattern.

Parents learn how to do the treatment during weekly visits with the child to the speech-language pathologist. The therapist "coaches" the parents by demonstrating various features of the treatment, observing the parent do the treatment, and giving the parent feedback. The therapist’s job is to ensure that the entire experience is a positive one for both parents and child.

The treatment is direct - meaning that it involves the parent commenting directly on the child’s speech. The parental feedback to the child is overwhelmingly positive, only correcting occasionally. There are specific times during the day when "play-times" (which are actually treatment sessions) are carried out, and the format changes depending on the child’s response as carefully measured by the parents and the therapist. When the child is ready, the parent feedback moves to an "on-line" mode, that is, feedback is given throughout the day in all communication situations.

The advantage to this approach is that it is unlikely to result in the problem of the child attaining fluency in the clinic with the therapist, while continuing to stutter elsewhere. In addition, the fluency is more likely to maintain. Multi-year follow-up results have been excellent.

Treatment Length
The latest reports from the Lidcombe clinical researchers indicate that the number of weekly "coaching sessions" in the clinic to completion of a program ranges from 21 to 53. Children who have language development delays or other speech concerns will fall at the higher end of that range. The development of the child’s fluency is tracked using parent’s measurements of the child speech on a daily basis, and some home tapes. The clinician monitors the tapes with the parents and charts the progress. As soon as the child’s speech begins to stabilize, the in-clinic sessions will drop to a maintenance schedule.

Since each child is treated as an individual, no absolute rules for how the treatment plan is implemented apply in every case. This information is intended as a guideline. Your clinician will set up a plan tailored specifically to your child’s needs.

For more information on the Lidcombe program, please visit its website at the University of Sydney (http://www3.fhs.usyd.edu.au/asrcwww/treatment/lidcombe.htm)