Overview
Speech-language pathologist have a wide scope of practice as responsibilities may vary depending upon what population is being served. Patients can range from pediatrics to geriatric and included in that wide set criteria are school-age children. This particular population can present with several disorders and delays, one of which includes disfluencies particularly stuttering. By definition, stuttering is a disruption in the fluency of verbal expression characterized by involuntary audible or silent repetitions, and prolongations of sounds and syllables (Sommer, 2004). These uncontrollable movements can be associated with fear, frustration, or embarrassment. The term stuttering refers to a symptom not a diagnosis (Sommers & Büchel, 2004). Sommers & Büchel (2004) states that there are three main types of stuttering that typically present in different settings and populations, these include developmental, neurogenic, and acquired (Sommers & Büchel, 2004). Developmental stuttering, which is typically related to school-age children, presents before puberty, between the ages of two and five years old or soon after language develops (Onslow & O'Brian, 2012; Sommers & Büchel, 2004). Patients may present with disfluencies on the beginning of a words or on content words/complex utterances (Sommers & Büchel, 2004). Neurogenic or acquired stuttering presents after significant brain damage, stroke, or head trauma (Sommers & Büchel, 2004). This form of stuttering may be present in school-age children; however, the occurrences are fewer.
Effects of Stuttering on School-Age Children
According to Furnham & Davis, (2004) stuttering currently affects about 5% of the population at some point in their life. People deal with many emotional and social consequences as a result of their disfluencies. Specifically, the school-age and adolescent years of development can present with several difficulties. One of the most prominent areas of frustration of all children is bullying, as it can have severe and long-lasting effects (Furnham & Davis, 2004). Unfortunately, low peer acceptance and peer rejection can influence personal perceptions leading to depression and later life struggles (Furnham & Davis, 2004). Research states that children with special educational needs are more likely to be bullied than others (Furnham & Davis, 2004). Studies show that 11% of adults who stutter said they had been bullied in school resulting in negative speech outcomes (Furnham & Davis, 2004). Not only is bulling a reoccurring issue that school-age children who stutter have to encounter, low self- esteem and anxiety are also critical factors (Furnham & Davis, 2004). Children who stutter may perceive themselves based upon their personality, demographic background, and the severity of their stutter (Furnham & Davis, 2004). Social perception and feelings can play a role significant role in the occurrences of disfluencies and the child's overall life (Furnham & Davis, 2004).
Research on School-Age Children who Stuttering
Stuttering in school-age population can vary depending upon the individual child and their particular diagnosis. Due to the large population of children in school-age ranging from kindergarten to high school grade it can be difficult to gather consistent evidence about the prevalence and occurrence of stuttering. Typically, as a child ages, given the appropriate treatment and intervention disfluency rates decrease (Boscolo et al, 2002). A study by Boscolo et al, (2002) examines school-age children ranging from kindergarten to high school fluency and disfluency rates. Indicating that overall disfluency rates continue to fall through the period of later language development (Boscolo et al, 2002). In fact, results stated that 7-8% disfluency rates were in kindergartners through 4th grade and 5-6% rate from 6th-12th grade (Boscolo et al, 2002). This concluded that there is a correlation between aging and the decrease in dysfluencies (Boscolo et al, 2002). Further because of the overt presence of language and articulation disorders in school-age children researchers have examined if there is any correlation between disfluencies and language delay or disorders. For example, Boscolo et al, (2002) discussed a study that included two school-age children with language disorders who demonstrated frequent part-word repetitions (Boscolo et al, 2002). This correlated directly to difficulty with acquisition of language. Another study by Miranda (1998) supported this idea, in that school-age children were more disfluent then their age, gender, and socoiecomnic status (Miranda, 1998). However, some research presents conflicting views stating that there is not direct correlation between language impairment and disfluencies. In fact, researchers state that the onset can be very sudden and unexpected after a period of normal speech development (Onslow & O'Brian, 2012). Specifically, it is estimated that half of the cases appear within a period of 1-3 days (Onslow & O'Brian, 2012). These evidences support the importance of screenings, evaluations and treatment of fluency in the school-age population.
Early Diagnosis and Intervention in School-Age Children
As previously mentioned, school-age population can range from kindergarten through high school. When serving school-age children who stutter professionals must also consider the importance of early diagnosis and treatment. If stuttering is not treated during the early childhood period it can become difficult to remediate and lead to psychological, social, educational, and occupation complications later in life (Onslow & O'Brian, 2012). Several studies support this idea as children who receive early intervention during their pre-school years are 7.7 times more likely to resolve their stutter (Onslow & O'Brian, 2012). Although early childhood is a critical time in the intervention period for children who stutter the effects of stuttering at any time can have lasting effects on children.
Assessment and Treatment of School-Age Children
When considering the evaluation of stuttering in the school-age population a variety of assessments and screening are used. Oral reading is a strategy that is used to commonly assess reading fluency as it examines a child's automaticity to produce fluent speech (Scott, 2015). An article by Howell (2013) discusses screening school-age children who are at risk of stuttering. There are effective screenings available to patients that could be used in clinics around the world (Howell, 2013). However, these screenings can present unrealistic for school intake as more information and work must be gathered to determine a diagnosis (Howell, 2013). Screenings in this population are most effective once comprehensive data is collected (Howell, 2013). Additionally, in examining stuttering in school-age population, treatment must be taken into consideration. There is an urgent need to conduct studies that examine the effectiveness of treating stuttering in school-age children (Yaruss, 2012). This is related to the idea that SLP's tend to be uncomfortable when working with children who stutter as there is limited support for SLP's providing treatment (Yaruss, 2012). Most clinicians have a "throw in the towel idea" on achieving fluent speech; however, experts are trying to approach treatment comprehensively (Yaruss, 2012). Stuttering is a multidimensional disorder and treatment plans should be individualized to match client's needs as this may improve fluency (Yaruss, 2012). Yaruss (2012) discusses how comprehensive approach to treatment should address the child's needs as a whole. This includes "increasing fluency, reducing negative reactions by the child and people in the child's environment, increasing functional communication abilities, and minimizing the impact of stuttering on quality of life" (Yaruss, 2012). Although this is the standard for treating school-age children it is imperative to consider the child's unique experiences when planning therapy. As previously mentioned, in providing treatment to school-age children who stutter it is important to consider their own personalities, anxieties and emotions. Aslam (2013) discuss the effects of stuttering on children stating that children feel a range of negative feelings and emotions including low confidence, frustration, shame, embarrassment, and poor self-image. Parents also reported the children speaking less, loss of confidence, higher anxiety, low moods, and frustration (Aslam, 2013). These truths must be taken into consideration when providing comprehensive treatment and creating goals specific to school-age children. Beyond the individuals own perception of the stutter clinicians must take into account the effects stuttering has on families and culture, as families may demonstrate hostility or criticism (Aslam, 2013). Moreover, parents are directly involved in the evaluation and treatment process as their emotions should also be taken into consideration in that they can directly affect the effectiveness of treatment.
Additionally, when considering the treatment of school-age children there is limited agreement on when to begin treatment and what treatment is most effective (Sidavi & Fabus, 2010). There are two main approaches to available including indirect and direct approaches (Sidavi & Fabus, 2010). Indirect includes modifying the child's environment and direct approaches target the child's individual speech behaviors (Sidavi & Fabus, 2010). Both approaches are effective in the school-age setting. Treatment should be centered around family and client values. Other intervention approaches include stuttering modification, fluency shaping, Lidcombe program, auditory feedback, regulated breathing, synergistic stuttering, and self-modeling (Sidavi & Fabus, 2010).
Conclusion
It is important for professionals working with school-age children to consider a variety of variables. To begin stuttering is a typically a symptom of a diagnosis. This particular population of children can encounter several emotional and social experiences that are not always positive and may lead to circumstances and issues that extend past this time in life. There are varying opinions about the correlation of stuttering or disfluencies to language disorder. However, the general consensus is that it could benefit the evaluation process to assess all areas of speech and language to ensure there are no outlying diagnosis or concerns. Additionally, early identification and diagnosis can benefit children as some cases of disfluencies dissipate after effective intervention and support. Lastly when working with school-age children it vital to provide clients with a comprehensive intervention process that addresses the families and child's individual concerns.