As I watched my daughter whip up a delightful maelstrom of noise at her third birthday party on Sunday, I was listening with unusual attention to her speech patterns.
Daisy stutters. It varies from staccato speech patterns that pass undetected by the untrained ear, to an inappropriate, marked increase in the volume of her speech as she struggles to force out the initial sound of a word or phrase.
Stuttering is a disorder in which the repeated movements and fixed postures of the speech mechanism interrupt speech. Its cause is unknown, though it is thought to be the result of a problem with the neural processing of speech.
It usually begins when a child is two or three years old and is not associated with a child's intelligence.
Interestingly, Daisy does not stutter when singing or using her "play voice" while playing with dolls. Adults who stutter may not do so while talking in a sing-song voice to pets or babies.
There is evidence that it runs in the family and that anxiety or distress can exacerbate an existing stutter. There are stutterers in our family and we know that Daisy's stuttering became more prominent when her sister was born four months ago, turning her only-child world upside down.
Speech pathologist Ange Southwell, pictured right, from Bubbles Speech Pathology in Subiaco, is treating Daisy using the Lidcombe Program of Early Stuttering Intervention. It is designed for pre-school children and named after the suburb which is home to the University of Sydney's Australian Stuttering Research Centre.
Ms Southwell said research showed one in 13 children will have started stuttering by age three. It was important to treat children early to avoid the social problems that can accompany adolescent and adult stuttering, which can be harder to treat. The Lidcombe Program requires dedicated parental involvement and requires weekly visits to Ms Southwell's clinic. At this stage in therapy, Daisy and I have a daily session of controlled play which we call Smooth Words.
Daisy has well-developed language skills for her age and often speaks rapidly with a broad vocabulary and a vivid imagination.
It is a parent's natural inclination to allow children to keep speaking, prompting her to continue a story (And what did you do then) or to use their imagination (What do you think happened next). But during the 15-minute sessions, I try to structure the activity to help Daisy's fluent speech.
For example, when playing with animal blocks, I ask her precise and specific questions such as: "Which of these animals is green? Is it the lion or the crocodile?"
I am not trying to elicit a three-year-old's imaginative, detailed descriptions of what the crocodile might be thinking. I want the deliberate, stutter-free production of a word that she knows and has used many times before. "The crocodile," she replies.
Every time she speaks without a stutter, I praise her, saying something like: "Lovely smooth words, Daisy." This is vital, reinforcing stutter-free speaking patterns. Importantly, she is not penalised for stuttering.
"At home, the parent assumes the role of the therapist," Ms Southwell said. "As taught in the clinic, the parent responds to the child's speech with praise and occasional gentle correction. In the beginning, practice conversations are structured around books and games. As stuttering reduces, sessions become more like everyday conversation."
Stage one of the program aims to reduce stuttering until it almost or completely disappears. The amount of treatment varies according to the stuttering, the child's individual characteristics and parenting style. Stage two minimises chances of a relapse.
Ms Southwell, who treated her son Dominic for stuttering when he was three, said the Lidcombe Program was the "best practice" in stuttering treatment, with the most research evidence to support its use. But she warned that it was essential that a professional decide whether a child needed treatment.
Parents should not attempt the aspects of the Lidcombe Program without the ongoing treatment and oversight by a qualified speech pathologist, she said.
It may be difficult for a parent or teacher to determine. Children should be taken to a speech pathologist if you see or hear the following:
· long delays before sounds
· sounds or words being repeated
· sounds being stretched out
· your child looking uncomfortable when he speaks
· your child telling you his words are getting stuck
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