What is the recommended treatment for stuttering in children?

Treatment for Stuttering in Children

The recommended treatment for childhood stuttering involves a comprehensive approach combining speech restructuring techniques, muscle tension reduction, and psychological interventions to address both the physical symptoms and psychological aspects of stuttering. 1

Core Treatment Components

Speech Restructuring Techniques

• Speech restructuring and fluency shaping techniques have the strongest evidence base for treating childhood stuttering 1
• These techniques include:
  • Slowing rate of speech
  • Easy, gentle onset of sounds
  • Elongating vowels and producing prolonged speech
  • Linking words together with controlled phrasing
  • Emphasizing speech naturalness 2
• Specific programs like the Camperdown Program and La Trobe Smooth Speech Clinic Programme have demonstrated effectiveness 2, 1

Muscle Tension Reduction

• Reducing excessive musculoskeletal tension in both speech and non-speech muscles:
  • Target high-frequency abnormal behaviors associated with dysfluencies
  • Manipulate facial muscles or lower the larynx to reduce tension
  • Reduce muscular tension in head, neck, shoulders and improve postural alignment 2
• Elimination of secondary movements through distraction techniques:
  • Speaking while lying on their back
  • Squeezing a ball while speaking
  • Sorting blocks into patterns while speaking
  • Finger tapping while speaking
  • Speaking while listening to music through headphones 2

Psychological Interventions

• Address psychological aspects through:
  • Communication counseling for predisposing, precipitating, and perpetuating factors
  • Addressing abnormal illness beliefs and excessive attention to bodily sensations
  • Teaching adaptive responses to moments of stuttering
  • Cognitive-behavioral therapy (CBT) for anxiety related to stuttering 2, 1
• Recognition of psychosocial factors allows therapists to appreciate the lived experience of stuttering and guide appropriate therapy 2

Treatment Approach

Progressive Treatment Structure

1. Initial phase: Focus on tension reduction and education

   • Provide reassurance about prognosis
   • Explain that dysfluencies reflect excessive muscle tension but can be controlled
   • Highlight importance of forward airflow during speech 2

2. Middle phase: Implement speech restructuring techniques

   • Once excessive tension is reduced, introduce speech restructuring techniques
   • Focus on slowing speech rate, gentle onset, and prolonged speech 2, 1

3. Advanced phase: Practice in progressively challenging situations

   • Develop hierarchy of speaking situations with desensitization tasks
   • Practice techniques in increasingly difficult contexts 1

Important Considerations

Early Intervention

• Treatment success is highest when stuttering is treated before age 6, before it develops into persistent stuttering 3
• The Lidcombe Program has shown effectiveness for preschool children who stutter 4

Identity Development

• For school-age children, consider approaches that help develop positive stuttering identities
• Stutter-affirming therapy can help reduce speaking effort and social stigma 5

Monitoring Progress

• Evaluate treatment response during first 1-2 sessions to determine effectiveness
• Many patients show rapid improvements with appropriate speech and language therapy 1

Caution About Recovery Claims

• Be aware that spontaneous recovery occurs in 60-80% of children who display incipient stuttering behaviors
• Therapy may provide symptomatic relief and decrease stuttering severity but may not "cure" stuttering 6

Referral Considerations

• Clinicians should perform diagnostic laryngoscopy before prescribing voice therapy and communicate results to the speech-language pathologist 2
• Speech-language pathologists play a central role in patient education and delivery of therapy 2

By implementing this evidence-based approach to stuttering treatment in children, clinicians can help minimize the adverse impact of stuttering on children's educational endeavors and overall quality of life.