Speech Therapy for Children Who Stutter: A Systematic Review

Introduction

Stuttering is defined as the disturbance or interruption in the effortless flow of speech. The core features of stuttering as described by Van Riper (1971, 1982) include: (a) sound or syllable repetitions, (b) sound prolongations, and (c) blocks. These core behaviours seem to be involuntary for a person, unlike secondary behaviours that are learned or acquired, often an individual’s response or reaction to his or her stuttering. Secondary behaviours can further be classified as either escape or avoidance behaviours. Escape behaviours are said to occur when a person tries to terminate the stutter. These include eye blinks, head nods and interjections like “uh”. Avoidance behaviours are a result of anticipating the stutter and recalling associated negative experiences. To avoid the stutter the person may resort to behaviours which he or she used earlier as escape mechanism (Guitar, 2014).

As suggested in the literature, stuttering is considered to be a highly prevalent disorder both in children and adults. Yairi and Ambrose (2013) in their review reported significantly higher prevalence of stuttering in preschool children (3.46%) when compared to school-age and high-school children (0.84%). It is also observed that in majority of the individuals, the onset of stuttering is during the preschool period i.e., between 2 to 5 years of age (Andrews and Harris, 1964; Bernstein-Ratner and Silverman, 2000; Geetha, Mahesh, and Swathy, 2015; Guitar, 2014; Johnson and Associates, 1959; Yairi and Ambrose, 1992a, 2005) and the risk of developing stuttering reduces with increase in age (Craig, Hancock, Tran, Craig, and Peters, 2002). This decline in prevalence rate with advancing age is attributed to two factors: first, the low incidence rate after the age of 4 years and second, spontaneous recovery in a significant group of children (Yairi and Seery, 2015). The natural, spontaneous, or recovery without any treatment in young children is considered to be one of the remarkable aspects of stuttering (Yairi and Seery, 2015). A wide range of recovery rates from 30 to 89% have been reported in the literature (Bryngelson, 1938; Craig et al., 2002; Johnson and Associates, 1959; Wingate, 1976; Yairi and Ambrose, 1992b).

Though a large group of these children recover on their own, there still remains a significant number who continue to stutter and these children are at an increased risk of psycho-social problems. Children who stutter (CWS) are reported to be more sensitive, anxious, fearful, introverted and withdrawn (Embrechts, Ebben, Franke, and van de Poel, 2000; Fowlie and Cooper, 1978; Oyler, 1996). They are also known to have more negative quality of mood (Howell et al., 2004; Johnson, Walden, Conture, and Karrass, 2010) and a negative attitude towards communication (Guttormsen, Kefalianos, and Næss, 2015; Kawai, Healey, Nagasawa, and Vanryckeghem, 2012; Vanryckeghem, Hylebos, Brutten, and Peleman, 2001). Moreover, this negative attitude is noticed as early as the preschool age (Clark, Conture, Frankel, and Walden, 2012; Vanryckeghem and Brutten, 2007; Vanryckeghem, Vanrobayes, and De Niels, 2015). The negative attitude towards communication is said to diminish with age in children who do not stutter (CWNS) (Clark et al., 2012; Vanryckeghem and Brutten, 1996) unlike CWS where this relation is strengthened with increase in age (Clark et al., 2012; Kawai et al., 2012; Vanryckeghem et al., 2001). In addition, a direct relation is reported between the severity of stuttering and negative communication attitude (Kawai et al., 2012; Vanryckeghem et al., 2001; Vanryckeghem and Brutten, 1996). Clark et al. (2012) proposed that the early onset of such negative attitude towards communication negatively influences the child’s “ability to establish normally fluent speech-language planning and production”.