Many parents first notice it around the preschool years: a sudden stretch of "I-I-I want" or "Can can can I go?" It can be worrying to hear, especially when it seems to come out of nowhere. The good news is that there's a lot of published guidance on what's typical, what the risk factors are, and how to respond at home. Here's a summary.
What is stuttering?
The National Institute on Deafness and Other Communication Disorders (NIDCD) describes stuttering as "a speech disorder characterized by repetition of sounds, syllables, or words; prolongation of sounds; and interruptions in speech known as blocks."[3] NIDCD adds that a person who stutters knows what they want to say but has trouble producing a smooth flow of speech.[3]
The American Speech-Language-Hearing Association (ASHA) points out that "all speakers are disfluent at times," and notes that "some people consider stuttering to be a neurodivergent communication variation."[1]
At what age does stuttering usually start?
Stuttering usually begins in early childhood. According to ASHA, "approximately 95% of children who stutter start to do so before the age of 4 years, and the average age of onset is approximately 33 months." ASHA also notes that onset can be gradual or sudden, and that it's "not unusual for disfluencies to first be apparent and then to seem to go away for a period of weeks or months—only to return thereafter."[1]
NIDCD reports that stuttering "occurs most often in children between the ages of 2 and 6 as they are developing their language skills," and that approximately 5 to 10 percent of all children will stutter for some period of time.[3]
Normal disfluency vs. stuttering: what's the difference?
ASHA notes that people may hesitate, use filler words like "uh," or repeat a word or phrase, and calls these typical disfluencies.[1] The Communication Health Support Association (CHSA) notes that "many children go through normal periods of disfluency lasting less than 6 months."[6] ASHA's comparison of typical disfluency and stuttering highlights some differences speech-language pathologists (SLPs) look for:[2]
| More typical of normal disfluency | More typical of stuttering | |
|---|---|---|
| What it sounds like | Repeating whole words or phrases ("I want, I want that"), fillers like "um," and revising a sentence | Repeating sounds or syllables ("b-b-ball"), stretching sounds ("sssun"), or getting stuck with no sound coming out (a block) |
| Physical tension | No physical tension or struggle | Physical tension or struggle |
| Other behaviors | None | Secondary behaviors, such as eye blinks, facial grimacing, or changes in pitch or loudness |
| How the child feels | No negative reaction or frustration | Negative reaction or frustration |
| Avoidance | None | Avoiding certain words or speaking situations, or talking less |
ASHA notes that telling these patterns apart is an important part of assessing preschoolers.[2] If you're noticing more of the right-hand column, that's a reasonable prompt to ask a speech-language pathologist.
Will my child outgrow stuttering?
Many children do, though published estimates vary depending on how recovery is measured:
- NIDCD states that "approximately 75 percent of children recover from stuttering."[3]
- The Stuttering Foundation reports that "between 75% and 80% of all children who begin stuttering will begin to show improvement within 12 to 24 months without speech therapy."[4]
- ASHA cites research estimating recovery rates, with or without intervention, of about 88% to 91%, while noting that rates may be lower (about 60%) when children's own reports are counted alongside parent and clinician reports.[1]
Because it's hard to predict which children will keep stuttering, speech-language pathologists look at risk factors, such as family history, how long a child has been stuttering, and whether there are other speech or language concerns.[3]
What are the risk factors for ongoing stuttering?
The Stuttering Foundation and ASHA describe several factors linked with a higher likelihood that stuttering will continue:
- Family history. "Almost half of all children who stutter have a family member who stutters," according to the Stuttering Foundation.[4] ASHA cites research estimating that children with a family history of stuttering are 1.89 times more likely to keep stuttering.[1]
- Age at onset. "Children who begin stuttering before age 3 1/2 are more likely to outgrow stuttering."[4]
- Time since onset. "If your child has been stuttering longer than 6 months, or if the stuttering has worsened, he may be less likely to outgrow it on his own."[4]
- Sex. "Girls are more likely than boys to outgrow stuttering."[4]
- Other speech and language factors. A child who speaks clearly with few speech errors is more likely to outgrow stuttering than a child whose speech errors make them hard to understand.[4]
On causes, CHSA says, "There is no 'one cause' of stuttering," and lists family history and small differences in how the brain works among the possibilities.[6] NIDCD notes that genetic factors contribute to developmental stuttering and that brain imaging studies have shown consistent differences in people who stutter.[3]
When should I get my child evaluated for stuttering?
NIDCD reports that health professionals generally recommend an evaluation if a child "has stuttered for 3 to 6 months, exhibits struggle behaviors associated with stuttering, or has a family history of stuttering or related communication disorders."[3] CHSA suggests seeing an SLP if your child:[6]
- Has been stuttering for 6–12 months or more
- Starts to stutter late (after 3½ years old)
- Starts to stutter more often
- Tenses up or struggles when talking
- Avoids talking or says it is too hard to talk
An evaluation doesn't automatically mean therapy. ASHA notes that one decision point after assessment is whether monitoring or treatment is recommended.[1] For preschoolers, ASHA describes "indirect" approaches that focus on coaching families, and states that "parent and family involvement in the treatment process is essential."[1] You can read more about our speech therapy and parent coaching services, or learn about evaluations.
How can I help my child who stutters at home?
NIDCD and the Stuttering Foundation offer similar suggestions for parents:[3, 5]
- Give your child time. The Stuttering Foundation advises, "Keep eye contact and give your child enough time to finish speaking. Try not to fill in words or sentences."[5]
- Focus on what they say, not how. Let your child know "by your manner and actions that you are listening to what she says-not how she says it."[5]
- Slow your own pace. NIDCD suggests speaking "in a slightly slowed and relaxed manner," and the Stuttering Foundation suggests waiting about two seconds before answering a question.[3, 5]
- Skip "slow down" and "take a breath." The Stuttering Foundation says this kind of advice "is simply not helpful to someone who stutters."[5]
- Make talking time relaxed. NIDCD suggests a relaxed home environment with many chances to talk, including time set aside to talk together.[3]
- Be open about it. NIDCD suggests talking openly and honestly with your child about stuttering if they bring it up, and letting them know it's okay for some disruptions to occur.[3]
A helpful reminder from NIDCD: help your child learn "that a person can communicate successfully even when stuttering occurs."[3]
The bottom line
Bumpy speech is common in the preschool years, and many children who stutter stop on their own. Risk factors like family history, stuttering that lasts more than several months, or signs of tension and frustration are reasons to get an expert opinion sooner. If you have questions about your child's speech, a speech-language pathologist can help you understand what you're hearing and whether monitoring or support makes sense for your family.
Sources
- American Speech-Language-Hearing Association (n.d.). Stuttering, Cluttering, and Fluency (Practice Portal). ASHA.
- American Speech-Language-Hearing Association (n.d.). Characteristics of Typical Disfluency and Stuttering. ASHA Practice Portal.
- National Institute on Deafness and Other Communication Disorders (n.d.). What Is Stuttering? Diagnosis & Treatment. NIDCD, National Institutes of Health.
- Stuttering Foundation (n.d.). Risk Factors. Stuttering Foundation of America.
- Stuttering Foundation (n.d.). FAQ's for Parents. Stuttering Foundation of America.
- Communication Health Support Association (n.d.). Stuttering and Cluttering. CHSA (HelpingYouCommunicate.org).
Articles from Speech Me Therapy, a pediatric speech-language therapy practice in North Phoenix serving Scottsdale, Paradise Valley, and families across Arizona by telehealth. Our posts summarize published guidance from professional and public health organizations; sources are listed at the end of every article.