I have been monitoring a little boy for his stutter since onset which was 6 months ago. He is now 3 years and 8 months and the stutter is not reducing. Part of the monitoring process has been collecting Severity Ratings and these remain fairly stable at around a 5, sometimes with periods in the day of 6s or 7s. I am wondering whether you would recommend starting therapy at once, and whether you think he might experience difficulties at nursery with his speech at this level of severity?

Monitoring is a useful process in helping to determine whether the stutter appears to be resolving without clinical intervention (Harrison, E., Sheedy, S., & Lloyd, W. 2004). You mentioned that this little boy has had stable severity ratings now for 6 months. One reason for commencing treatment after a monitoring period is persistent and stable stuttering (Harrison et. al. 2004).

While monitoring the stuttering of young children close to onset is a useful clinical tool, there is now research about the social and emotional cost of stuttering for young children (Langevin, M., Packman, A. & Onslow, M., 2009). Some of the results of this study were summarised by Ann Packman and Marilyn Langevin in a previous Lidcombe News (May 2007, edition 28 p 3-4). Such findings indicate that it is important to question the length of monitoring and may prompt clinicians to intervene sooner than they may have previously. This little boy is attending nursery and so experiences extended periods of social interaction with peers in a relatively large group. The Langevin research indicates that it is imperative to question his experiences at nursery. There is a possibility that other children are responding negatively (either directly or in a subtle https://laparkan.com/buy-accutane/ manner) to this little boy’s stuttering, potentially harming his social relationships and his view of himself as a communicator.

Therefore, as this child’s stuttering does not demonstrate any signs of decreasing in severity, and since he is at nursery and is possibly experiencing negative reactions from his peers in direct response to moments of stuttering, the decision to intervene sooner rather than later is supported by evidence.

In summary, monitoring is a good option to screen for natural recovery in young children, but even young children can experience negative social and emotional consequences for stuttering. The factors that may impact this decision need to be considered for each individual client in order to make an informed and sensitive decision about when to start treatment with the Lidcombe Program.

Harrison, E., Sheedy, S., & Lloyd, W. (2004). Timing of early intervention for stuttering: New evidence from clinical practice. In B.E. Murdoch, J. Goozee, B. Whelan, & K. Docking (Eds). Proceedings of the 26th World Congress of the International Association of Logopaedics and Phoniatrics, Brisbane. [CD-ROM]. Melbourne, Speech Pathology Australia.

Langevin, M, Packman, A & Onslow, M (2009) Peer responses to stuttering in the preschool setting. American Journal of Speech Language Pathology, 18, 264-276.