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Kyle was an attractive eight year old with a sturdy build and big brown eyes. You wouldn?t know he had a problem unless you spoke to him. Kyle avoided eye contact and said as little as possible. His rapid speech was punctuated with awkward stops and starts. At times, his face grimaced and flushed as he struggled to speak. Saying simple things like ?hello? and ?Kyle? were agonizingly difficult. He was becoming increasingly withdrawn prior to his referral for therapy.

What causes children like Kyle to stutter? What do we know about incidence rates and treatment? What are the hallmarks of effective therapy? What can you do as a physician to help children like Kyle? These questions will be addressed in the following article, in order to help you better understand and manage stuttering disorders in your practice.

Stuttering is defined as ?A complex multidimensional condition in which the flow of speech or fluency is disrupted by involuntary speech motor events?. Overt stuttering behaviours are the sound blockages, prolongations and repetitions that you actually hear. Secondary behaviours are abnormal head, body or facial movements that accompany stuttering as the patient attempts to free himself from stuttered blocks. Covert stuttering is the unseen disabler. These are the constant mental backflips patients make to prevent stuttering, such as avoiding feared words, sounds, situations and people.

Stuttering can radically alter a patient?s life and deeply impact psychological and emotional well-being. Many adults who stutter report that they did not receive post-secondary education or pursue a particular vocation route because of their speaking difficulties. Early intervention is key.

The incidence of chronic stuttering in the general population is approximately 1 percent. In a typical practice of 3000 patients, 30 of your patients will suffer with this disorder. Most of your patients will have started to stutter prior to adolescence, most commonly around 18 months of age when attempting to say their first sentences. You will encounter more male than female stutterers (ratio is between 2:1 and 5:1).

We also know that a whopping 25% of preschoolers experience periods of dysfluency, with many experiencing spontaneous remission in symptoms. In fact, studies indicate between 32% to 80% of these children will recover spontaneously. How do you know when to be concerned? Richard Curlee, researcher from the University of Arizona reported that children were more likely to spontaneously recover if they : a) were girls, b) did not have relatives who stuttered, c) were less than 3 yrs of age when stuttering began. He also discovered a family history of stuttering remissions among children who spontaneously recover from stuttering. Consult a speech-language pathologist for an expert opinion whenever possible.

What do we know about the causes of stuttering? Many recent studies suggest neurophysiology. Dr. Robert Kroll, from the Stuttering Center in Toronto, used Positive Emission Tomography to demonstrate atypical brain activation patterns during speech. Stutterers demonstrated a pattern of bilateral brain activation with more extensive temporparietal involvement, which Dr. Kroll used to explain why stuttering is so resistant to change.

Even with therapy, patients often experience problems with regression and relapse. Speech-language pathologists must address this issue in their programs.

Speech-language pathologists have a variety of techniques that can create dramatic improvements in speech fluency within a relatively short period of time. The ultimate test of any clinician, is whether or not they can help patients maintain fluency gains over time.

In Kyle?s treatment program he learned to slow down, and to identify and reverse tension patterns in his speech. He practiced these new speech patterns in a variety of settings including school, home and community. After six months, Kyle could speak with very few dysfluencies and was no longer fearful of speaking. Treatment sessions will now be gradually decreased. Eventually Kyle will be seen for yearly check-up appointments. Or more often if needed, to evaluate and address maintenance. Issues.

As a physician, you can help by referring patients early. Speech-language pathologists work in private practices, schools and hospitals. Encourage families to check into their insurance coverage for speech and language services. Many have insurance funds that they are not aware of. Private clinics can often provide more intensive services without a waiting time.

Families are also invited to attend ?The Tangled Tongue? workshop held at London Speech and Language Centre designed to provide parents with information on how to help a child who stutters. These workshops are offered each month and are free. Please feel free to call London Speech and Language Centre for more information.

Kerry Erle, M.Cl.Sc.
Speech-Language Pathologist, Director
CCC-Sp, Reg. CASLPO, S-LP(C)

Kerry invites your questions and comments on this article or on other issues. Feel free to contact her at London Speech and Language Centre, 642-7370.

About the Writer: Kerry founded London Speech and Language Centre in 1987. She holds a Master?s of Clinical Science in Communication Disorders from the University of Western Ontario, and is currently and Adjunct Professor in the University?s Department of Communication Science and Disorders. She is licensed with the College of Audiologists and Speech-Language Pathologists of Ontario, and is Certified in Canada and the U.S.