Speech therapy for preschool children

Stuttering often begins during the preschool years, between the ages of 2 and 5 years. It is estimated that approximately 80% of young children recover naturally from stuttering.

For some children stuttering is short-lived and transient, lasting a few days or weeks and then disappearing completely. For others, stuttering comes and goes over a period before it disappears. The severity of stuttering when it first shows up is not predictive of whether it will naturally disappear or continue.  

For about 20% of young children who stutter, stuttering continues to manifest. It can come and go over a longer period, or it can become more consistently present when the child speaks. The severity of stuttering and its impact on the child’s ability to communicate can also change over time.

Find tips on how to talk with preschoolers who stutter.

When to seek help

It is typically recommended that parents wait 6 months after stuttering is first noticed in a child’s speech, allowing time for natural recovery to begin or complete. This advice varies, however, depending on the age of the child when stuttering is first noticed. For older preschoolers, aged 4 and 5, it is prudent to seek a professional opinion immediately. For children who are 2 or 3, waiting 6 months is likely okay. Of course, if the child or parent is distressed in any way, the opinion of a Speech-Language Pathologist (SLP) should be sought immediately.

Several factors are taken into consideration by speech-language pathologists when deciding whether to begin therapy. Following assessment, a Speech-Language Pathologist may recommend monitoring over a period and offer therapy later if it is needed. Waiting to begin therapy does not affect the outcome in younger preschool children. In fact, children progress faster in direct therapy when they are closer to the age of 4.

For some children, the recommendation will be to begin speech therapy immediately following the assessment session. Speech-language pathologists consider risk factors such as the child’s age, a pattern of persistent stuttering, the presence of other communication challenges, child or parent distress, and family history of persistent stuttering when deciding on the timing of therapy. The severity of stuttering is also considered, not because it affects the outcome, but because therapy takes longer when stuttering is more severe.

The decision to seek help should not be based on the severity of a child’s stutter alone. A mild stutter, left untreated, may not resolve on its own, and could become a problem over time – stuttering can begin to happen more often; stuttering moments can become more severe or take more time; associated physical tension and behaviours can develop. Emotional and psychological aspects of stuttering can emerge during the school years or later, even when stuttering is mild. Treatment before the age of 6 years remains the best option for reducing, and even eliminating stuttering, preventing the long-term impacts of stuttering.

Where to get help for preschool children

Speech therapy for preschoolers can be accessed through government-funded services provided in settings such as hospitals or children’s treatment centres in most Canadian provinces. Many places accept referral directly from parents.

Parents need to consider that government-funded services may have wait lists that span months when deciding whether to initiate a referral or wait.

Some parents will seek the services of Speech-Language Pathologists in private practice. Extended health insurance benefits may cover part of the expense; however, because speech therapy may take several to many sessions over a long period, parents should be prepared to pay out of pocket.

How long does therapy take?

The number of sessions required will vary for each child. Some children will need periodic monitoring for several months. Others will need from a few to many weekly sessions of speech therapy over several months during which changes in speech are monitored.

Once a satisfactory level of speech fluency is achieved, the child transitions to the maintenance phase of therapy. During the maintenance phase sessions may be shorter in duration and scheduled at gradually longer intervals as progress is maintained. The maintenance phase of therapy is essential because stuttering is prone to relapse and steps need to be taken immediately to prevent a significant relapse. The complete therapy process can take over one year to complete.  

Is it okay to wait?

Stuttering is most responsive to speech therapy during the preschool years, so getting help before the age of 6 is highly recommended.

How is therapy done with a 3-year old?

Speech therapists use indirect and direct approaches to address stuttering in preschool-aged children.

Indirect approaches target environmental, communication and child-related factors that are thought to contribute to the development and persistence of stuttering. Change in the child’s speech is monitored as contributing factors are targeted more directly. Indirect approaches aim to reduce stuttering and also reduce parental concern and are preferred for younger preschoolers who stutter.

Two evidence-based indirect approaches are the Palin Parent-Child Interaction Therapy for Early Childhood Stuttering developed in the United Kingdom, and the RESTART-DCM developed in the Netherlands. Canadian Speech-Language Pathologists will be familiar with these programs, and some will have received professional training in the methodology of each approach.  

Direct approaches target speech more directly, specifically aiming to increase speech fluency and reduce stuttering severity. The Lidcombe Program for Early Stuttering Intervention is an evidence-based direct approach developed in Australia that uses behavioural principles to significantly reduce or eliminate stuttering in young children. Look for Speech-Language Pathologists who are trained in the Lidcombe Program and registered or licensed to practice in your province on this interactive map.

No matter the approach selected or recommended, parent involvement is essential to successful therapy for preschool-aged children. Speech-language pathologists train and support parents in how to do the therapy safely at home in natural communication environments. Parents, who know their children best, provide valuable information to speech-language pathologists who evaluate children’s progress at each visit, and make recommendations based on parent reports and direct observation. Through collaborate efforts, positive results can be achieved.

Introducing the SLP to a preschooler

A Speech-Language Pathologist can be introduced as a friend the family will visit at a special office or school that has toys, books, and games. The friend will play and talk with them, and they will have a fun time.

If the child asked for help, or if stuttering was discussed with the child, a parent can inform the child that they will be visiting someone who can help with bumps, or with words that get stuck. (Look in How to talk with preschoolers who stutter)

Speech-Language Pathologists will briefly introduce direct therapy to children in a simple way they can understand. This is usually done when parents are present.

Won't therapy make the child aware of stuttering?

Preschool children do not need to know, and are not required to know, when they stutter for therapy to be successful. The parent leading direct therapy at home is responsible for identifying moments of stuttering for the purposes of observation and for delivering effective therapy.

Some parents are surprised when stuttering is openly discussed in the presence of the child during therapy sessions. Discussion is usually between the adults. It is matter of fact in tone, and uses descriptive words, such as “bumps” or “sticky words.” The use of numerical stuttering severity scales reduces the use of valuating words such as good, better, really bad, or worse. After hearing adults discuss stuttering on repeated occasions, some older preschoolers will offer comment, which the adults comfortably acknowledge.

For preschoolers, therapy involves games, fun and positive feelings. The adults take responsibility for the therapy, as they play and have fun, too!

Find tips on how to talk with preschoolers who stutter.

Last updated: