This leaflet should be read in conjunction with either the BSA leaflet Does Your Young Child Stammer (for parents of pre-school children) or the BSA leaflet The Child who Stammers - Information for Parents (for parents of school-age children).
Speech and language therapy for children who stammer is available under the NHS. In most parts of the UK, you can refer your child to the local speech and language therapy department yourself (the BSA can provide contact details), although in a few areas you will need your GP or Health Visitor to make the referral. Some private speech and language therapists also work with children who stammer.
Speech and language therapists work with children both individually and in groups. They can also refer your child to a specialist centre or intensive course.
Whether you see an NHS or a private therapist, it is entirely acceptable for you to ask if the therapist specialises in stammering and what you can expect from therapy. It is important, if possible, to see a specialist who works regularly with stammering and keeps up to date with the latest approaches to therapy. If there is no specialist available in your local NHS speech and language therapy department, it may be worth asking if you can be referred to another department nearby - or contact BSA for details of NHS regional centres of expertise. If you are told to wait and see, as your child will probably grow out of it, the person is unlikely to be experienced in stammering. It is true that the majority of children do recover naturally from stammering, but you should still be given guidance on how to support your child, and the dysfluency should be actively monitored.
As it is not known exactly what causes stammering, therapists take a holistic approach, examining all the factors which may be contributing to dysfluency.
The therapist will begin by taking a detailed case history. Stammering tends to run in families, so if you are aware of a grandparent or other relative who stammered, let the therapist know. Part of the assessment may be carried out while your child is not present, so that issues can be discussed openly.
The therapist will then assess your child's speech and language skills. With young children the therapist will do this through playing and talking informally with your child, to ensure that they don't get unduly concerned or worried about their speech. The therapist may wish to discuss with you how you respond to any episodes of stammering. Through informal discussion, the therapist will aim to identify factors which might make it more difficult for your child to talk, and explore with you some specific steps that you can take to help your child talk more easily (such as slowing down your own speaking rate by using more pauses).
With pre-school children, indirect therapy is the method more commonly used, and is carried out through you as parents. You may be asked to attend appointments without your child, to discuss ways in which you can best provide support at home. Sometimes arrangements are made for parents to work together in small groups.
Indirect therapy tends to be based on the demands and capacities model of stammering. According to this model, most children trip up over words, get stuck and repeat words or sounds when they first begin to talk. Usually, they work through this phase, although some may need extra help. At the same time as speech and language skills are developing, there are increasing demands on the child to communicate - these can include both external demands and internal demands (for example, to answer questions, express themselves, compete with siblings, etc). When a child's skills keep pace with the demands, any difficulties are overcome fairly soon. However, when the demands are greater than the skills a child has acquired, difficulties can persist. The aim of indirect therapy is to achieve a better balance between the demands on the child to communicate and his or her developing capacities. The therapist will explore ways in which you can help reduce some of the pressures your child may be experiencing, as well as ways in which you can help increase their skills.
With school-age children, the therapist is more likely to choose direct therapy, which is likely to include:
- Helping the child understand more about stammering;
- Sharing experiences with others who stammer;
- Working on feelings associated with stammering, such as fear and anxiety;
- Improving communication skills; and
- Developing self-confidence and positive attitudes.
For younger children (generally, those under 7 years of age), a specific form of direct therapy, the Lidcombe Programme, may be available in some areas. Since the late 1990s, an increasing number of NHS and private speech and language therapists have trained in this form of therapy, which was developed in Australia. It is a structured programme that takes a behavioural approach to the modification of a child's speech, the main 'therapist' being the parent. The therapist teaches you how to work directly with your child. You learn to recognize stammering and to measure its severity. For short periods each day, you will praise stammer-free speech, gently request that your child self-corrects stammered speech, and provide support. In the first instance, weekly sessions at the clinic are needed to guide you through the programme. Research indicates that this form of therapy is more effective than relying on natural recovery, but it will not be suitable for everyone. Please note that you should not attempt to use Lidcombe Programme techniques unless you have been trained in them by a speech therapist and have the therapist's on-going support, as this could be harmful to your child's speech.
For younger children, both indirect and direct therapy techniques can be equally successful, and different approaches suit different children. However, with the Lidcombe Programme, the therapist may wish to wait for some time before starting treatment, as there is evidence that children respond to this approach better, and go through the programme more quickly, at around four years of age than when they are younger. This does not alter the fact that children should be seen by a speech therapist as soon as possible after stammering starts, so that they can be assessed and actively monitored.
The Association of Speech and Language Therapists in Independent Practice (ASLTIP) provides information about independent speech and language therapists throughout the UK. All therapists are Registered Members of The Royal College of Speech and Language Therapists and registered with the Health Professions Council. You can search online for a therapist via the Association's website at www.helpwithtalking.com or email them at firstname.lastname@example.org or phone on 01494 488306. This is an answerphone service and is not staffed by therapists. When contacting ASLTIP, you will need to specify that you are looking for a therapist who deals with fluency problems or stammering, as many therapists do not work in this area of expertise. Rates for private therapy vary widely depending on the service offered. However, the average fee for an initial, straightforward assessment is in the region of £85 to £120 per session. On-going therapy sessions are likely to be in the region of £50 to £70 per session. The therapist will advise you of their fees.
Specialist centres and Intensive courses
Once you have made contact with a local speech and language therapist, they may be able to refer your child to one of the specialist centres or courses listed below. This may be appropriate either if there is no specialist service available in your area, or if a local therapist feels your child could benefit from extra help. Please note that these centres are all 'tertiary' centres working within the NHS, so they are unable to accept referrals direct from parents - the referral must be made by a therapist or a doctor. Some centres may be able to accept a referral from a therapist working privately, provided that on-going therapy support will be available for the child after the completion of the course.
The Michael Palin Centre for Stammering Children
Provides a free specialist assessment service for children. Referrals may be made by the GP or local speech and language therapist from any part of the UK where no specialist service exists. Parents living in the London Boroughs of Camden and Islington may refer direct. Following the assessment, a programme of specialist therapy will be set up as appropriate, and may be carried out by the local speech and language therapist, with support from the Centre where necessary.
Therapy may be offered at the Centre on an individual or group basis, where this is not available locally. Funding for this is usually obtained through the local Primary Care Trust. Two-week intensive courses are run during the Easter and summer holidays for children aged 9 - 14 and their parents, and a two-week course for young adults aged 16 - 18 is held in the summer holidays. An assessment will be required before attendance.
Contact: The Michael Palin Centre for Stammering Children
13-15 Pine Street
London EC1R 0JH.
Tel 020 3316 8100
Stammering Support Centre, Leeds
Opened in April 2011, this Centre offers highly specialist speech and language therapy assessment and support for children, young people and adults who stammer. Stammering Support Centre website.
The Fluency Trust
Residential course for children and teenagers who stammer, age 10-17, combining intensive therapy with outdoor pursuits. It includes an assessment day in Swindon, a five day residential course based in an outward bound activity centre in Devon, and a follow-up day later in the year and report and liaison with professionals. Therapy aims to increase confidence in communication, develop a positive attitude to speaking and decrease sensitivity to stammering.
The residential element is funded by the Fluency Trust Charity. There is a cost for the therapy side, which may be paid by an NHS Trust or your local provider. If you find your local provider unable to fund the course, please contact the course organisers for a discussion about alternative funding.
Contact: visit www.thefluencytrust.org.uk which includes dates and referral forms. Claire McNeil, Alex Ford, Sarah Taylor or Beth Loveday (SLTs) at Saltway Centre, Pearl Rd, Swindon SN5 5TD, tel: 01793 466790.
City University, London
Week-long intensive courses are run during school holiday periods in April and July, and sometimes in January, with follow-up days at half-term. Up to 24 people are accepted on each course and are divided into two groups: approximately 8 - 11 years and 12 - 18 plus.
Contact: Sue Swinbank, Division Administrator
Department for Language and Communication Science
London EC1V 0HB
Tel 020 7040 0150