I have been getting a lot of questions from SLPs and parents that all seem to center around the question “Is this stuttering” or “Does this warrant speech services?”

Question:
I am a school based SLP. I just screened a 7 year old girl. Her teacher was concerned that she might be stuttering. She is repeating whole words and phrases quite often. 

She also used some interjections such as “um”. Her teacher has never heard her repeat or prolong sounds. Is this really considered stuttering if a child is only repeating words and phrases? I have been looking on the internet, but most children either repeat syllables or sounds as well as words or else they don’t repeat whole words as often as this student.

Answer:
You’re correct in thinking that whole word and phrase repetitions are considered “typical disfluencies”, however, if done excessively (both in frequency and in number of repetitions per word or “iterations”) they aren’t so “typical” anymore. Considering a teacher came to you about this, I’d say this is most likely occurring enough to interfere with the normal flow of communication and therefore warrants attention.

You also have to consider that she may be using interjections (ex. um) to mask stuttering. The question is if she omitted “um” would she then present with sound repetitions, blocks or prolongations? Sometimes interjections are used as “tricks” or “starters” and although initially they seem helpful, they cause children to have to do a lot of “mental gymnastics” to get a message across. This is exhausting/frustrating and has the potential to result in word/situational avoidances as the effort to mask stuttering exceeds the motivation to speak. It is so important to look at other aspects of communication, in addition to the frequency/type of stuttering, when deciding if therapy is warranted. Percent stuttered syllables simply doesn’t give us the full picture, especially as children get older! I recommend assessing for secondary behaviors(physical tension and struggle associated with a stuttering moment), word/situational avoidances, impact on participation in social/academic settings, feelings associated with stuttering/speech and overall communication abilities. I also suggest looking at the child’s rate of speech and articulation of multisyllabic words. Is she aware of her disfluencies? Excessive “typical” disfluencies is sometimes a sign of the fluency disorder, cluttering.

Once you look at all these other aspects of communication, the decision to qualify for services should become clear! As a parent, if you have any concerns it is best to follow your gut and seek advice from a speech pathologist!

Does anyone else have a similar situation with their child or a child on their caseload? What has helped you determine if the child does, in fact, have a fluency disorder and furthermore decide whether therapy is necessary?