After so many years of research to the contrary, I’m still surprised this myth continues to live on in the speech community. “Three years old is too young to work on fluency” is a myth that has been dispelled time and time again with the use of various treatment programs, family education and community-based services. So why does the myth remain alive and well? My personal opinion is that we, as SLPs must get better at determining WHEN a client of a young age is appropriate for therapy.
Speech therapy is not appropriate for every child that walks through our therapy room door with a fluency concern, so how do we make this determination?
Frequency of Dysfluencies:
The first thing I know I was taught in graduate school about fluency disorders is how to label the “severity” of the disorder by the frequency with which dysfluencies present themselves. For anyone with fluency issues, frequency of use of dysfluencies can range quite a bit. This is especially true for young children who are learning and beginning to master the grammatical rules of their native language. So why do we put so much stock in frequency? Is there a better way to measure dysfluencies? I think so.
Types of Dysfluencies:
Types of dysfluencies can be a greater indicator of need than simply frequency of dysfluencies. Why is this so? Because we ALL have dysfluent moments. In addition, young children do exhibit a period of typical development when dysfluencies seem to present themselves due to the large burst of language being learned at this time. However, you might be surprised to learn this typical age of dysfluencies actually occur PRIOR to the age of 3. The typical dysfluent period of development occurs between 2-3 years of age and does not persist longer than 6 months. So if you are already evaluating a 3 year old, who does not have a history of delayed language development, you must keep in mind persistent dysfluencies at this age and beyond are already atypical in nature.
Are there specific types of dysfluencies that are red flags? The short answer is yes! Word, phrase, and sentence repetitions are the least worrisome in that they are typically used as a means to delay the message while a child is attempting to correct his/her grammar. However, if a child typically uses initial sound repetitions, prolongations or blockages, we as SLPs should be much more concerned about the child’s fluency in general and should be taking this into account when determining eligibility of speech therapy services.
Secondary characteristics, simply stated, are body movements (i.e. shakes, tics, muscular tension, etc.), that accompany dysfluent moments in a subconscious effort to “get the word(s) out”. If we are seeing ANY use of secondary characteristics, we as SLPs should be highly concerned knowing that secondary characteristics not only do not cease on their own, but typically increase in frequency and severity over the course of time.
Family Dynamic and Family Concerns:
Family concerns and the dynamic in the child’s home should be another factor we must take into account when assessing a child and determining eligibility of therapy services. A child whose parents seem to present with guilt, possibly feeling as if they had a hand in their child’s development of dyslfuencies is a family that could most definitely benefit from education about fluency disorders. If you are evaluating a child that seems to experience much transition, change, or instability, this too can be a red flag for us as evaluators. We may find our services of family education, training of fluency strategies, and teaching the child to intentionally stutter may be extremely helpful for a child in this situation. A good example of this type of family that I have encountered in the past are children from military families, who not only move often but also experience deployments of one or both parents. So much transition can increase anxiety and fear in all types of situations, including communication. Therefore, it is imperative we take these aspects into account when determining eligibility of services.
So this is a very basic overview of the aspects we should be taking into account when evaluating our young clients/students with fluency concerns. It is my hope, we can keep these indicators in mind rather than just writing off our clients based on age.
Have you had experience with other additional indicators that aid in your determination of clinical services for young children with fluency issues? Feel free to share in the comments below!