CHAPTER I

INTRODUCTION

A.      Background of the Problem

Have you ever watched tv drama “Upin Ipin”? Do you know what is the character of “Ijat”? Ijat is a classmate of Upin and Ipin. He is rarely speaking to his friends. He often communicates by using body gestures. If he agrees, he will show his thumbs; if he admires or likes something, he will give big applause, of course, it will be accompanied by his face expressions; if he speaks, he will speak slowly, word by word; if he reads, he will try to read letter by letter to join it as a word, very slowly.

That is an example of stuttering suffered by a child.  It is not uncommon for young children to have disfluencies (pauses, repetitions, additions, or prolongations of words/sounds/phrases) in their speech. In fact, about 5% of all children are likely to stutter at some point in their development, usually during the preschool years. It is also very normal for a child to go back and forth between periods of fluency and disfluency. Sometimes, this can occur for no apparent reason, but often this happens when a child is excited, tired, or feels rushed to speak. The number of disfluencies present in a child’s speech is an important factor in determining if a child is stuttering. Generally speaking, stuttering on more than 10 words out of 100 may indicate that the child is having a problem.

            Nevertheless, some of parents do not realize that their children suffer stuttering. They do not know the characters (signs) shown by the children. They think that their children get late on language development; something naturally occurs on every children, it just needs time to cover it. Because of that, many children must struggle on how to solve their stuttering by themselves. When the parents start realizing that their children have problems with the language development, the children have already need much help from every body around them, even from the therapists. Thus, the parents should know earlier about what happen to their children, and they know how to give help to the children who get stuttering. They should know that there are many solutions for stuttering. Therefore, the writer tries to write this term paper entitle “Stuttering in Children”.

B.       Objectives and Significances of The Paper

1.      The Objectives of the Paper

The objectives of the paper are recognized as follows:

a.       To find out nature of stuttering.

b.      To find out types of stuttering.

c.       To identify causing of stuttering.

d.      To identify stuttering in children.

e.       To find out solutions for stuttering in children.

2.      Significances of the paper

Related to the objectives above, the significances of the paper are recognized as follows:

1. The paper is intended to give the valuable input to the parents especially who have children suffered stuttering and all people who have great concern on stuttering and language development.

b.      The paper is expected to provide both theoretical and practical benefits for development of psycholinguistic.

CHAPTER II

STUTTERING IN CHILDREN

A.  Nature of Stuttering

Many people who do not understand well about stuttering, suppose it as speech error, but actually it is a part of speech disorder. Stuttering is a disruption in the fluency of verbal expression characterized by involuntary, audible or silent, repetitions or prolongations of sounds or syllables. These are not readily controllable and may be accompanied by other movements and by emotions of negative nature such as fear, embarrassment, or irritation.[1] Strictly speaking, stuttering is a symptom, not a disease, but mostly the term stuttering usually refers to both disorder and symptom. Similarly, point of view given by Marc Shell, he defines[2] that stuttering is initially involuntary, the flow of speech is broken (or breaks that flow) in the form of repetition, prolongations, or cessation of sound. Simply, the speaker knows what he wants to say, but he cannot say it.

Stuttering affects people of all ages. It occurs most often in children between the ages of 2 and 5 as they are developing their language skills. In effect, the suttering itself can be indentified since the age of 18-24 months. Approximately 5 percent of all children will stutter for some period in their life, lasting from a few weeks to several years. Boys are twice as likely to stutter as girls; as they get older, however, the number of boys who continue to stutter is three to four times larger than the number of girls. Most children outgrow stuttering. About 1 percent or less of adults stutter.[3]

B.  Types of Stuttering

Stuttering can be indicated differently through its signs. According to Campbell and Hill (1987), there are several types of stuttering, as follows:[4]

1.        Hesitation (of one second or longer).

2.        Interjection (such as “um” and “er”).

3.        Phrase/sentence revision (where a speaker goes back to rephrase the sentence or phrase).

4.        Unfinished word.

5.        Phrase/sentence repetition.

6.        Word repetition.

7.        Part-word repetition (which can be either sound, syllable or multisyllabic repetitions).

8.        Prolongations (the unnatural stretching of a sound).

9.        Block (a session of sound, which can either be momentary or lasting, arising from an occlusion in the vocal tract which is either at an inappropriate location; at an appropriate location, but mistimed; or both). Blocks are usually accompanied by increased localized tension.

10.    Other (amongst other possibilities, this may include inappropriate breathing patterns).

Differently, Martin divides stuttering into four types, as follows:[5]

1.        Type I is considered the most common. Stress leads to a locking of the vocal cords which shortly precedes the stutter which coincides in time with speech. The struggle with speech consists of hesitations, repetitions and prolongations of sounds, syllables or words. When the average non-stuttering individual thinks of stuttering, it is Type I.

2.        The second category is Type II. Again stress leads to the locking of the vocal cords which reflexively triggers a struggle, but in this instance the struggle is not part of speech but precedes it. The struggling may be violent but the stutterer has elected to delay speech until after the struggle - so the speech, when it occurs, is fluent. Type II stutterers are very interesting to observe as they speak on the telephone. Their head may be thrust back in some violent gesture, their jaw may shake, eyes clench, hands thrust - while the person at the other end hears nothing, just a pause followed by normal-sounding speech. If the listener knew the magnitude of the titanic struggle ensuing at the other end of the line, he would be amazed and appalled. The Type II stutterer demonstrates that the struggle to release the vocal cord spasm is clearly independent of speech. The fact that for most stutterers the struggle appears in the speech (Type I) is simply an expression of their inability to wait and complete their struggles before starting to speak.

3.        In Type III stuttering, the stress also provokes the locking of the vocal cords, but the patient has elected not to struggle but to pause and wait until the locked cords release. This may be accomplished by several means: he may distract himself in some appropriate manner, he may passively wait for his stress to drop, he may quietly inhale to open his vocal cords, or he may swallow to achieve the same end. The patient will cough gently during such pauses to blow his vocal cords apart.  

4.        Finally, in Type IV stuttering, the stuttering chain is aborted before it starts. The stutterer uses an avoidance behavior when his conscious habit of scanning informs him of the presence of "trouble ahead." This type is referred to as the hidden or "closet" stutterer.  These patients avoid words, sounds, and speaking situations. No one knows they stutter, but the price they pay for their fluency is constant vigilance.

From four types categorized above, there are some points should be bear in mind that type I stuttering is the "typical" form, seen most often in stutterers. The struggles are part of speech. Type II stuttering, though less frequent, is also recognized as stuttering even though the speech is unimpaired. Type III and Type IV stuttering are socially acceptable; they are not recognized as forms of stuttering. Stutterers in these two categories rarely seek professional help even though these forms of the disorder often take a considerable emotional toll.

C.  Causing of Stuttering

There is still a lot that is unknown about the cause of stuttering, but experts agree that it is probably caused by a combination of factors.[6] First, genetics is believed to play a part because stuttering tends to run in families. Most children that stutter have a family member that also stutters or stuttered as a child.

Second, developmental factors are believed to be a contributing factor. During the preschool years, a child’s physical, cognitive, social/emotional, and speech/language skills are developing at a very rapid rate. This rapid development can lead to stuttering in children who are intended to it. This is why stuttering often begins during the preschool years.

Third, environmental factors can have an influence. Some examples of these factors include parental attitudes and expectations, the child’s speech and language environment, and stressful life events. This does not mean that parents are doing anything wrong. Often these things are not harmful to a child that doesn’t stutter, but can worst stuttering in a child that has a tendency to stutter. Finally, the child’s fear and anxiety of stuttering can cause it to continue and even worsen.

In addition, there are other factors that also cause stuttering[7]. Fourth, Neurogenic stuttering can be one of the factors of stuttering. Neurogenic stuttering may occur after a stroke, head trauma, or other type of brain injury. With neurogenic stuttering, the brain has difficulty coordinating the different components involved in speaking because of signaling problems between the brain and nerves or muscles. Fifth, Psychogenic Stuttering is also believed can be a part of stuttering factors. Psychogenic stuttering can be caused by emotional trauma or problems with thought or reasoning. At one time, all stuttering was believed to be psychogenic, but today we know that psychogenic stuttering is rare. David Ward discusses[8] that neurogenic and psychogenic are categorized into acquired stuttering.

It has been explained about several causes of stuttering, thus, we can identify who get risk of stuttering. According to Barry & Edward[9], there are several points show who get risk of stuttering.

1.      Family history

There is now strong evidence that almost half of all children who stutter have a family member who stutters. The risk that the child is actually stuttering instead of just having normal disfluencies increases if that family member is still stuttering. There is less risk if the family member outgrew stuttering as a child.

2.      Age at onset

Children who begin stuttering before age 3 1/2 are more likely to outgrow stuttering; if the child begins stuttering before age 3, there is a much better chance she will outgrow it within 6 months.

3.      Time since onset

Between 75% and 80% of all children who begin stuttering will stop within 12 to 24 months without speech therapy. If the child has been stuttering longer than 6 months, he may be less likely to outgrow it on his own. If he has been stuttering longer than 12 months, there is an even smaller likelihood he will outgrow it on his own.

4.      Gender

Girls are more likely than boys to outgrow stuttering. In fact, three to four boys continue to stutter for every girl who stutters. Why this difference? First, it appears that during early childhood, there are innate differences between boys' and girls' speech and language abilities. Second, during this same period, parents, family members, and others often react to boys somewhat differently than girls.

Therefore, it may be that more boys stutter than girls because of basic differences in boys' speech and language abilities and differences in their interactions with others.

5.      Other speech and language factors

A child who speaks clearly with few, if any, speech errors would be more likely to outgrow stuttering than a child whose speech errors make him difficult to understand. If the child makes frequent speech errors such as substituting one sound for another or leaving sounds out of words, or has trouble following directions, there should be more concern.

The chart below figures out about the risk factors of stuttering.

Risk Factor	More likely in Beginning Stuttering	True Stuttering
Family history of stuttering	A parent, sibling, or other family member who still stutters
Age at onset	After age 31/2
Time since onset	Stuttering 6–12 months or longer
Gender	Male
Other-speech language concerns	Speech sound errors, trouble being understood, difficulty following directions

Chart 2.1 The risk of stuttering

From the explanation above, the process of stuttering in children can be seen in the following diagram:[10]

 

Diagram 2.1 Understanding Different Types of Speech Disfluencies

D.  Stuttering in Children

Many toddlers and preschool age children stutter as they are learning to talk, and although many parents worry about it, most of these children will outgrow the stuttering and will have normal speech as they get older. Since most of these children don't stutter as adults, this normal stage of speech development is usually referred to as psuedostuttering or as a normal dysfluency[11].

As children learn to talk, they may repeat certain sounds, stumble on or mispronounce words, hesitate between words, substitute sounds for each other, and be unable to express some sounds. Children with a normal dysfluency usually have brief repetitions of certain sounds, syllables or short words. The stuttering usually comes and goes and is most noticeable when a child is excited, stressed or overly tired.

Stuttering is usually not a concern, as long as it doesn't persist for more than five or six months or at least gradually improve during that time period. Until it does go away by itself. If the stuttering is ignored, it will usually resolve without any intervention. Parents will need to be supportive though if the stuttering is bothering their child.

True stuttering is much less common than psuedostuttering. Unlike children with pseudostuttering, children with true stuttering are more likely to have long repetitions of some sounds, syllables or short words. While it may also come and go, true stuttering occurs more often than pseudostuttering and occurs more consistently. Children with true stuttering are also more likely to notice the stuttering and to be anxious or embarrassed by it and may develop a fear of speaking.

For children with pseudostuttering, if the stuttering does persist more than five or six months, or is making your child anxious or self-consciousness, then he may benefit from a speech evaluation and treatment with speech therapy. Children with true stuttering, especially if it is making them anxious or embarrassed, should be evaluated by a speech pathologist, who can begin speech therapy.

Children who suffer stuttering can be detected through several signs; it can be from the types of stuttering, or the causing of stuttering. If adult people are late in detecting the stuttering in children, possibly, the children may meet some risks.  Speech behaviors indicate risks of becoming a stutterer, as follows:[12]

1. Facial tremors caused by excessive tension.

2. Speaks cautiously.

3. Speaks very rapidly, almost compulsively

4. Speaks too loudly or softly.

5. Evidences of struggle and tension while speaking.

6. Blocks the airflow.

7. Raises the pitch or volume during disfluencies.

8. Accompanying body movements during disfluencies.

9. Signs of embarrassment while speaking.

10. Uneven repetitions

11. Use of the schwa vowel on his repetitions.

12. Many repetitions (5 or more) during a word.

13. Stops in the middle of a word, backs up and starts over.

14. Evidence of avoiding certain words.

15. More than one disfluency during a sentence.

  Non-speech behavior indicates risk of becoming a stutterer, as follows:

1. Shyness, looks away especially when he is disfluent.

2. Low self-concept.

3. Other nervous habits, e.g. nail biting, bed-wetting, hyperactivity.

4. Poor socialization skills.

5. Evidences of depression and sadness.

6. Worry.

The discussion above does not mean that a child who displays one or more of these behaviors can be called stutterers, but it may help us with confirmation. It is hard to put a stutterer in a box because there are so many kinds of stuttering and ways to stutter. Besides, a child may stutter only occasionally. If attention can be given to the child, we can see the child stutters in a variety of speaking situations such as when conversing with parents or friends, in relaxation, in aggressive or excited play, when talking to strangers or on the phone, in a crowd or only one-on-one.

Many parents and speech therapists are worried about working with a stuttering child because they have noticed that a child who stutters may become embarrassed or uncomfortable when encouraged to "try" harder. They fear that drawing attention to the stuttering itself may worsen or make a child really sad. Believe it or not, directly confronting stuttering in a positive way is a good way to begin therapy.

E.  Solution for Stuttering in Children

There are many solutions actually can be given to the child stutterer. One of them is promoted by British Stammering Association (BSA).[13]

1.        Language Every Day

Children do not learn language just by hearing it around them. They have to communicate and interact for that to happen. Parents should regularly set aside time for talking with their child in a quiet place with no distractions or interruptions. Both the parent and the child should focus on the conversation, for example about what is happening in the child's life: listening to each other, keeping normal eye contact, with the child having plenty of time to think about answers. Parents should resist the temptation to correct any of the child's comments but can echo back the correct version of what the child said. So, if the child says "play teddy" a parent can model good speaking by saying "Oh, you play with teddy". "You play with teddy" for "play teddy". New words should be introduced, supported by pictures or photographs that are interesting to look at and talk about.

Busy parents can also use the times when they are carrying out other tasks and talk to their child as they do so, explaining what they are doing or what is happening at the time. This chatting encourages the child to think about what he sees and to make comments himself. Messages about language use, prepositions for example, may be conveyed as objects are picked up, described and put away in cupboards, on tables etc. You can also notice sounds made by everyday activities like pans simmering, a hammer on metal, and the difference between loud and quiet sounds heard.

It is always helpful to involve as many other key adults in this talking as you can, as long as they keep to the same rules. Talking with different people helps the child to learn naturally about social language. Grandparents may have different expectations about social language and vocabulary and give the child another experience that widens his understanding of language and relationships

By the time, he is ready for nursery, the child should have learned about concentrating, listening quietly, answering at his own pace, understanding and following simple instructions and expressing his own simple needs. Having these skills will lower the demands on the child who stammers so that he is more relaxed about speaking.

2.        Extending language skills

Parents can also help their child who stammers to achieve their potential in academic work. They should provide a diet of varied language at home that goes beyond the everyday and functional. They should read with their child regularly so he enjoys sounds, words and stories. Acting as a favorite character in a story helps the child to understand the signals behind language. A cross voice for a fierce story character, and a meek tone for a quieter character, can convey quite sophisticated messages about tone of voice and the variations of mood possible. This will help understanding of social language and therefore interaction with other children and adults. This particularly helps a child who stammers who may be concentrating so much on his own speaking that he needs help with picking up social signals of mood and tone in conversation.

3.        Listening to your child

An important part is also played by listening in language development: we know that many adults including teachers have a tendency to dominate the conversation when talking with a child and to ask too many questions too quickly. Sensible pausing by the adult who is talking, the breaking down of longer sentences into simpler ones, giving opportunities for the child to just sit quietly and think before talking, will all help the quality of language used. The child should be encouraged to use words as he chooses, perhaps playing with rhymes and sounds and even inventing new words and phrases of his own.

If the child stutterers need more help in the form of therapy, the parents can meet the therapist. The therapist will give certain treatments. The treatment often focuses on having children produce fluent speech as they learn to self-monitor. This can be done by first having the child say single words in a slow, relaxed way. The number of words the child says may be slowly increased until the child is saying sentences. For example, “ball,” “red ball,” “a big red ball,” “I have a big red ball.” This process can take anywhere from a few weeks to six months or more. Another stuttering treatment technique focuses on helping children decrease secondary characteristics like twitching, blinking, and a closed or clamped jaw.

There are many things that parents can do (and avoid doing) that will help the child stutterer. The most important thing that parents can do is to use a smooth, relaxed rate when talking to him/her. Speak to the child in simple, short sentences, pausing slightly before responding. While parents are talking, be sure to listen to what the child is saying without interrupting or finishing sentences for him/her. It is very important that the child knows that he/she is being understood. Try to slow the pace of household, minimizing the level of excitement. When he/she has difficulty speaking, it’s OK to acknowledge it by saying, “You had a little trouble getting that out.”

In addition, there are several practical instructions can be conducted by the parents as guidance to help the children.

1.        Parents should speak with the child in an unhurried way, pausing frequently. Wait a few seconds after the child finishes speaking before parents begin to speak. Parents’ own slow, relaxed speech will be far more effective than any criticism or advice such as "slow down" or "try it again slowly."

2.        Reduce the number of questions parents ask to the child. Children speak more freely if they are expressing their own ideas rather than answering an adult's questions. Instead of asking questions, simply comment on what the child has said, thereby letting him know the parents heard him.

3.        Use facial expressions and other body language to convey the infromation to the child that parents are listening to the content of her message and not to see how she's talking.

4.        Help all members of the family learn to take turns talking and listening. Children, especially those who stutter, find it much easier to talk when there are few interruptions and they have the listeners' attention.

CHAPTER III

CONCLUSION

A.      Conclusion

Stuttering is a disorder that affects the fluency of speech. People who stutter know what they want to say, but have trouble saying it because the flow their speech is disrupted by repeating sounds, words or phrases, prolonging or stretching out sounds, blocking (moments where no sounds come out when the person is trying to speak). A child can be identified as a stutterer at the age between 2 and 5 years old. There are several factors why children get stutter; genetic, development, environment, neurogenic, and psychogenic. Therefore, to help children recover from stuttering, parents and people around him are suggested not to drawing attention to the child’s speech in front of others, interrupt his speech or complete his sentences, critisize his speech, and tease him about his stuttering. Then, if parents need more help for his child, they are suggested to go to therapist.

B.           Suggestion

There are several suggestions related to stuttering in children, as follows:

1.        Parents and educators, are suggested to find out more information about stutterer. Thus, they can identify earlier whether their child or student a stutterer or not. Then, they can anlyze how to help them, so the child can be safed from becoming a true stutterer.

2.         Parents are suggested to spend much time together with the child stutterer in order to help and facilitate them to learn speaking in relaxed way.

3.        Parents and people around the child stutterer can accept him as he is.

 

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[1]Christian Buchel and Martin Sommer. 2004.  “Unsolved Mystery: What Causes Stuttering?”, (Retrieved on 29 December 2012), http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.0020046

[2]Marc Shell. Stutter. (United States of America: President and Fellows of Harvard College, 2005), p. 7

[3]MedicineNet.Inc. 2012. “ Stuttering”. (Retrieved on 28 December 2012), http://www.medicinenet.com/script/main/art.asp?articlekey=83202&page=1

[4]David Ward. Stuttering and Cluttering: Framework for Understanding and Treatment. (New York: Psychology Press, 2006), p. 5

[5]Martin F. Schwartz. “Stutter No More”. (Retrieved on 30 December 2012), http://www.stutter-No-More.com/chapter_05.Html

[6] Ducworth, Dule. 2012. “Causes and Treatment of Stuttering in Young Children”. (Retrieved on 29 December, 2012), http://www.superduperinc.com/handouts/pdf/65_Cause_and_Treatment_of%20Stuttering.pdf

[7]MedicineNet.Inc. 2012. “ Stuttering”. (Retrieved on 28 December 2012), http://www.medicinenet.com/script/main/art.asp?articlekey=83202&page=2

[8]David Ward. Op.cit, p. 4

[9] Barry Guitar & Edward G. Conture. The Child Who Stutter: to the Pediatrician. Fourth Ed. (Tennessee: Stuttering Foundation of America, 2007), p. 4

[10] Yaruss & Reardon. 2006. “Understanding different types of Speech Disfluencies”. (Retrieved on 29 December 2012), http://www.stutteringcenter.org/Forms/2009-stuttering-center-disfluency-types.pdf

[11]Normal Disfluencies include hesitation (pause), interjections(um, uh, er), revisions (I want-I need that), and repetitions (I want-want that) 

[12]Tom and Sherry Bushnell. 2011. “How a Parent Can Help Their Child With Stuttering”. (Retrieved on 29 December 2012), http://www.nathhan.com/stuttering.htm

[13] British Stammering Association. 2008. “Developing your young child's language skills”. (Retrieved on 28 December 2012), http://www.stammering.org/devlangskills.html