Stuttering affects individuals of all ages but occurs most frequently in young children between the ages of 2 and 6 who are
developing language. The average age of stuttering in children is 2 ½ years old. Stuttering rarely begins after age six; 65% of
preschoolers who stutter spontaneously recover, in their first two years of stuttering. These children grow up to have normal
speech. However, children who stutter longer are less likely to recover without treatment. Only 18% of children who stutter up to
five years recover suddenly. The peak age of recovery is three and a half years old. By age six, a child is unlikely to recover
without speech therapy.

Among preschoolers, boys who stutter outnumber girls who stutter about three boys for one girl. The majority of girls recover
fluent speech, while the boys don’t. By fifth grade the ratio is about four boys who stutter to one girl who stutters. This ratio
remains into adulthood. Some pediatricians tell parents to “wait and see” if a child outgrows stuttering on his own.

Children who stutter should see a speech-language pathologist as soon as possible. To find a speech-language pathologist for your
child, start by calling your local elementary school. The board of education provides free speech therapy to children as young as
three years old. If your child stutters at two or three and you get the child into speech therapy right away, many see a full
recovery, within months, without relapses. A small push may get the child back onto the normal development path. If your child
is in grade school and has stuttered for five years, he or she will need additional speech therapy to get back onto the normal
development track.

Normal Pauses in Speech is not Stuttering

At two or three years old, children are quickly developing communication skills. Their brains are growing rapidly. A child’s
language skills may develop faster than his/her verbal skills. The child wants to communicate but can’t easily and freely produce
speech. All children have normal pauses in speech as they learn words and vocal communication. Normal pauses are not
stuttering, and don’t need to be treated by a speech-language pathologist. Normal interruptions and repetitions that tend to be
single, for instances “That my-my ball.

A child who does not noticeably struggle or show signs of visible pressure, frustration or embarrassment is normal. These errors
happen when the child is planning a long or complex sentence. Brief silent pauses are considered normal, such as when directing
another person’s attention, when concerned about the listener’s reaction, and when interrupting or being interrupted. Normal
imperfections may occur when the child’s language skills exceed his speech motor skills. Changes in the child’s environment may
also cause temporary normal flaws; this could involve parents’ divorce, the birth of a sibling, or moving to a new home.

Early signs of Stuttering

• Part-word repetitions (not whole-word repetitions). Repetitions become rapid, tense, and irregular. A sound or word is repeated
three or more times.

• Pauses and flaws on more than 10% of words.

• The child stutters for weeks or months, between periods of fluency. Stuttering for more than six months is a sign of a risk.

• Stuttering when excited or upset, when having a great deal to say, or under high environmental demands.

• Length of time creating speech. Sounds are delayed at least a half-second.

• Struggle and speech-production muscle tension, such as a rise in vocal pitch (caused by tensing the larynx), blocking airflow
and stopping vocal sounds, wide mouth opening or tongue swelling, or irregular breathing patterns.

• Stuttering only on the first word of a sentence or phrase.

• Stuttering on both content and purpose words (“like,” “but,” “and,” or “so”).

• Secondary or flight behaviors, such as eye blinking, nodding, facial frowning, quivering lip, raising eye brows, flaring nostrils.

• Fear or avoidance of certain sounds or words. Word substitution begins.

• Halts become common, in addition to repetitions and delays.

• Stuttering becomes persistent, without periods of smoothness.

• Stuttering occurs on content words—major nouns, verbs, and adjectives.

• Stuttering varies among situations, such as talking on the telephone, speaking to strangers, or when excited.

Stuttering often gets worse when the child is excited, tired or distressed, or when feeling self-conscious, rushed or pressured.
Speaking in front of a group or talking on the telephone can be particularly difficult for this group of children. While reasons are
unclear, most people who stutter can speak without stuttering when they talk to themselves and when they sing.

Causes of Stuttering

Scientists suspect a combination of motives causing stuttering in children. The exact structure that makes up stuttering is
unknown. Researchers don't know precisely the causes of stuttering, but the fact that stuttering tends to run in families gives
reason to believe that many forms of stuttering are genetic in origin.
The most common form of stuttering is thought to be developmental, occurring in children who are in the process of developing
speech and language. This casual type of stuttering occurs when a child's speech and language abilities exceed his/her verbal
demands. Stuttering happens when the child searches for the correct word. Developmental stuttering is usually outgrown.

Another common form of stuttering is neurogenic (originating in the nerves). Neurogenic disorders result from signal problems
between the brain and nerves or muscles. In neurogenic stuttering, the brain is unable to coordinate effectively the different
components of the speech system. Neurogenic stuttering may also occur following a stroke or other type of brain injury.

Other forms of stuttering are classified as psychogenic or originating in the mind or mental activity of the brain such as thought
and reasoning. Whereas at one time the major cause of stuttering was thought to be psychogenic (mental or emotional processes),
this type of stuttering is now known to report for only a minority of the individuals who stutter. Although individuals who stutter
may develop emotional problems such as fear of meeting new people or speaking on the telephone, these problems often are a
consequence of stuttering rather than causes of stuttering.

Expert statements that stuttering develops gradually in stages seems controversial. Some parents report that their children woke up
one morning stuttering severely. These children went from normal pauses to severe stuttering overnight. The children appear to
have skipped the developmental stages in between. Could a child’s immune system instead attack brain cells in the left caudate
nucleus (speech motor control area), and the child wakes up from an infection with severe stuttering? Scientists and clinicians
have long known that stuttering may run in families and that there is a strong possibility that some forms of stuttering are, in fact,
hereditary. No gene or genes for stuttering, however, have yet been found.

Treatment

Most children outgrow stuttering on their own, and no stuttering treatment is needed. If your child's stuttering last longer than six
months, or beyond age 5, speech therapy may be useful to help decrease stuttering.

There are a variety of treatments available for stuttering. Any of the methods may improve stuttering to some degree, but there is
at present no cure for stuttering. Stuttering therapy, however, may help prevent developmental stuttering from becoming a life-
long problem. Therefore a speech evaluation is recommended for children who stutter for longer than six months or for the child
who’s stuttering is accompanied by challenging behaviors.

Presently many accepted therapy programs for persistent stuttering focus on regaining speech skills or adjusting flawed ways of
speaking. The psychological side effects of stuttering that often occur, such as fear of speaking to strangers or in public, are also
addressed in most of these programs.
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