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.
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 an assessment, a Speech-Language Pathologist may recommend monitoring over a period if fluency seems to be increasing and will offer therapy later if stuttering persists. 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 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.
Parents need to consider that government-funded services may have wait lists that span months when deciding whether to initiate a referral or wait.
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.
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 list of Canadian Speech-Language Pathologists.
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.
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.
Should preschoolers be told that they stutter?
Stuttering is not usually discussed directly or in detail with a young child.
Unlike older school-aged children and adults, preschool children do not typically identify as persons who stutter, or as having a speech “problem.” They may at a moment in time become aware of being unable to talk during a stuttering block or of repeating multiple times before being able to finish a word or sentence and may comment about it. They may forget what they were saying because talking took too long. With the reassuring words and support of parents and other adults, children usually move on and don’t dwell on the incident. They are spontaneous in their communication and do not predict or expect that they will stutter.
Stuttering may be discussed openly, in a matter-of-fact way, in the presence of a child during therapy sessions. Descriptive words, such as “bumps” or “sticky words,” may be used when adults discuss and evaluate the child’s stuttering. Valuating words such as “good” or “really bad,” are avoided by using stuttering severity scales with numbers and supplemented by descriptive language that exclude valuating words. After hearing the adults discuss the scale on repeated occasions, some older preschoolers may offer comment, which the adults will acknowledge.
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 assigning severity ratings to the child’s speech, and for delivering effective therapy.
For preschoolers, therapy involves games, fun and positive feelings. The adults take responsibility for the therapy, as they play and have fun, too!
If a child is still stuttering by age 7-8, it will be a more persistent condition, perhaps into adulthood. A child can benefit greatly from speech therapy which may, at this stage, feature cognitive approaches and coping techniques, and encourage self-acceptance. In other words, fluency may not be the only goal of the therapy. Parents can initiate conversation and self-expression in the family setting, which will help a child deal with his stuttering and life in general. Finding ways for the child to be engaged in life, whether through sports, artistic endeavours or whatever interests him, can also help greatly.
There are many speech and language pathologists and specialist therapy for children and teens who stutter in Canada. Speech pathology is a broad field, ensure that your child’s therapist has had experience in treating stuttering in particular, and has worked with children. After an assessment, the therapist will discuss a treatment plan with you and realistic goal-setting.
The involvement and support of the whole family will provide valuable support and help to make the activities done in the therapy sessions feel like a part of life, not something done only once a week. Children of all ages can learn to reduce their stuttering and develop their ability to communicate well. Specialist help is available in three settings.
One-to-one sessions with a speech and language pathologist (SLP). Sessions are usually once per week or two, for several months. Therapy will be adapted to the age of your child and will help them to learn simple fluency techniques and manage their feelings and reactions when they stutter.
See our page on clinics for information on how to find a specialist speech and language therapist in Canada.
- Your school board. Specialist therapy might be available through the public school system in your area (coordinated through a school board). Each province and region is different, and availability varies. For primary and middle schools, speak with your child’s teacher to find out what help is available. In secondary school s, the guidance teacher or equivalent is the best person to contact for additional support.
- Intensive courses for one-two weeks during school holidays. These involve several hours a day working with a small team of therapists and other children who stutter. There are courses in Vancouver, Calgary, Toronto, Ottawa and Montreal.