Question
A 3 year old blocks on the initial consonant in the beginning of a sentence and throws his head back as a secondary characteristic. He is not aware of his dysfluencies yet. What is the best method to treat him besides parent counseling? Air flow or slow
Answer
The age of 3 is a very typical time for children to begin easy repetitions of sounds, syllables, words and/or phrases. Generally, blocks are not part of this developmental stuttering that the child is unaware of. Parents may become concerned, but certainly not the child at this stage. At some level it seems this child must be 'aware' if indeed what you call a "secondary characteristic" is PART of the stuttering (part of the struggle with stuttering!). If it is not and he is truly unaware, then I'd be concerned about that particular behavior with his head: where does it fit in the scheme of things; what is causing this; is it something entirely separate from speech but only occurs during speech? In other words, you need to begin a differential diagnosis! Create a team of professionals who may help in differentiating; it need not be large, expensive or cumbersome.
Do NOT 'help' him struggle by introducing 'techniques' intended for those who are indeed persistent stutterers (neurophysiological...differentiate from any possible neurogenic or psychogenic stuttering!). It could backfire on you and this child. Get to know him by being an active listener. Once you feel you are trusted by him, don't be afraid to directly ask him how his speech sounds to him and how he thinks it sounds to others (using HIS vocabulary, of course!). His first open response is your breakthrough. His parents should also open doors of communication and sharing. While sharing the day's activities the parents can talk about difficult events, letting the child know "it's OK to talk about difficulties" with my mom and dad. At this point, it is important, in my opinion, that parents provide their unconditional love and a safe environment and not be therapists. Yes, they should understand the process and read about stuttering, but also they should be observers ( not reactors....children read nonverbal reactions or phoney "it's OK's"). They should be a part of empowering the child and maintaining his self-esteem, as should every parent! Certainly, I'd get a good history of the child and of the extended family in terms of stuttering, cluttering, OCD, ADHD, AD, Tourette's syndrome, dyslexia, articulation and language problems because many of these are on the same chromosome as stuttering and may help in this process of differential diagnosis.
As to length of time...this is jumping the gun since we don't know exactly what this child is demonstrating besides by observation. I advise SLP's, parents, and those who stutter never to get caught up in the 'how long' question---for example, how long for what outcome or even what diagnosis or diagnoses and treatment by whom (perhaps more than one professional!). Be patient and your outcomes will be more satisfactory and the process more pleasant.
Janet Skotko, M.Ed., has been a Speech/Language Pathologist for approximately 30 years and was distinguished by being one of the first named to be among the Board Recognized Fluency Specialists. She maintains a private practice in Tampa, Florida but sees clients world-wide. For further information , please visit: www.thevoiceinstitute.com
