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Research perspective

Roberta Lees, Reader (retired), Speech and Language Therapy Division, Department of Educational and Professional Studies, The University of Strathclyde, in Glasgow, discusses issues connected with stammering:

Strategies for teachers

How does the teacher react to the child who stammers in the classroom? The teacher may feel very anxious, the teacher may find that he or she is holding their breath, because this can be a natural reaction to someone stammering, they may try to finish the sentence for the child. These are all normal reactions of people to someone who stammers.

The teacher may have perceptions that the child is shy, tense, anxious, and again, this is a normal or common perception of people towards the child who stammers. In fact, the child who stammers is no more anxious, tense or nervous than any other child, but it's a perception that has been built up.

However, the teacher can be of enormous help to the child who stammers. If the teacher can listen to the child and listen to the content of what the child is saying and try to ignore the dysfluency, that is enormously helpful. If the teacher can also provide a good speech model to the child, and this often means an unhurried model, so that if the teacher gives the impression there's plenty time this creates a more relaxed atmosphere for the child and helps the child who stammers to speak more fluently or at least, more easily.

The teacher can also help by trying to improve the child's self-esteem, find something the child is good at and praise the child, if the child can develop a good self esteem the child will go on to be able to communicate a bit more effectively, and if the teacher can also create a good speech environment where every child has their turn of speaking and they're not constantly interrupted in the classroom, this is also very helpful.

On a more day-to-day basis, it's useful not to ask the child to read or to answer questions very early on. If the teacher is going round the classroom asking the child to read or answer questions, the child is sitting there becoming more and more anxious as his turn is approaching, so that for the child who stammers it's very helpful to give them a turn very early on.

Also, if the child can take part in all activities but with an opt-out being available so that if the child, the child should not feel different in any way, and feel 'oh, I can't take part in that', the child should have an option of taking part in everything.

And if the child gives a long answer to a question, sometimes that long answer gets lost with all the child's dysfluency, it's very helpful if the teacher will then paraphrase what the child has said, and this adds great meaning and great import to what the child has been saying, and of course it's very important that the teacher remains calm, tries to speak a little more slowly and the whole atmosphere is calm.

If the child is aware of the stammer it is very useful if the teacher will speak to the child about it, on their own, but show the child that the child has an ally in the teacher, because if the teacher doesn't mention the stammer and sometimes the parents don't mention the stammer, a conspiracy of silence develops and the child begins to think that stammering must be something absolutely awful because no-one will talk about it. But if the child feels that he or she has an ally in the teacher and someone they can talk to, and talk to about the stammer and the problems in the classroom because of the stammer this helps the child enormously.

The role of the speech and language therapist

The speech and language therapist has an important role with the child who stammers. The therapist will want to intervene with the stammering child as early as possible so that if diagnosis is made at age 3, the therapist will want to intervene at age 3 before the child develops all the fears and anxieties about speaking that often do develop in stammering.

What is the therapists role? The therapist will assess the child, and assess the child from a holistic view point so that the therapist will speak to the parents. The therapist will speak to the teacher if relevant, that is, if the child is of school age, or to the nursery teacher if not, or whoever.

The therapist is trying to build up a holistic picture of the child not just the stammer. And based on this picture of the child, the therapist will then produce a management programme for that child.

The management program may indeed be aimed at increasing the fluency of the child, or it may be aimed at increasing the self esteem and confidence of the child because the two are interrelated, if the child is more confident and has a higher self esteem, the child is more likely to speak more fluently. Or, the therapist's program may be aimed at trying to prevent the child developing all the fears and anxiety and, indeed, avoidance behaviour. Some children sitting in the classroom will just avoid speaking at all costs.The therapist will try to reduce the amount of avoidance that the child has.

One thing is very important, when the therapist is working with the child, the therapist sees the child once or twice a week but the parents see the child seven days a week, the teacher sees the child five days a week and it's very important that all of them collaborate together to work towards the end of producing a more confident child, who can say what he or she likes when they like.

This collaboration can be very effective, particularly in the primary school, but sometimes the service can be differential, that is, some parts of the country will have many more speech and language therapists than others, and it sometimes happens that the teacher does not have access to a speech and language therapist who has specialised in stammering or does not have direct access, but, I would hope that for all teachers they will have access by means of telephone to therapists that can help them and give them information, indeed work with them in the treatment of any child.

The research

Stammering occurs in about 5% of school children. There is a very considerable amount of research going on into stammering and there has been for many many years. One of the major areas of research is that of genetics, and we've known for a long time that stammering runs in families.

We know we can expect that if any child in the classroom has a stammer, there's a 42% chance that someone in that child's immediate family will have a stammer and a 71% chance that someone in the child's extended family will have a stammer. So, if you have a child in your class with a stammer, there is a very high chance that that child will have a relative who stammers.

The greatest risk in stammering is when we have a male relative of a female who stammers, so if the mother stammers and has a son, that is the greatest risk of transmission of stammering. However, although we say that up to 70% of children will have a relative who stammers, we're still left with about 30% where we can trace no family history of stammering what-so-ever, for those children there has been a considerable amount of research again, and many of those children have a history of birth injury, illness or various traumatic events, but this still does require much more research.

Current research is also looking at how the brain functions when someone stammers, and we do know that when the person stammers they have much more activation in one part of the brain and much less activation in another part of the brain.

What is perhaps particularly interesting is that when these people have therapy and undergo a means of teaching them to speak more fluently the brain returns to normal functioning, in other words, there's some type of rewiring but we don't fully understand exactly how that happens.

Roberta Lees discusses issues connected with stammering