If he is tired, poorly, worried, frightened or even excited for a happy reason such as a birthday.

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1 What factors will affect your child's fluency? Children do vary and their stammer will be differently affected by the situation. However these are some of the common factors that may contribute to your child's stammering. His feelings. If he is tired, poorly, worried, frightened or even excited for a happy reason such as a birthday. The situation. A place that he does not know very well, if at all, and is expected to talk to strangers, such as in a shop or at the doctor's surgery. In these circumstances he is particularly likely to stammer when he tries to give information such as saying his name. The room seems noisy and rushed and many people are talking at once and he is expected to join in. The adults and other children are talking quickly and turn to him for a reply. He is talking to an adult who is obviously distracted and is looking away, for example when the parent is driving. He is trying to explain something very complicated and is struggling with new or unfamiliar words. He has been put on the spot to answer a question or tell a story about an event and is very aware that other children and adults are listening. He is trying to describe an event that has upset him, or he needs to explain that he wants to do something urgently, such as go to the toilet. Simple tips to help your child Contact your local speech and language therapy service. Intervention at the pre-school age gives the best chance of recovery from stammering. Parents should contact their local speech and language therapy service as soon as possible after they notice the stammering, even if the stammer appears to be quite mild and does not trouble the child in any way. It used to be thought that it was best to wait and see how the child s speech developed before making this referral. We know now that a therapist should be consulted as soon as possible. Most services can be approached directly by parents without contacting a GP or health visitor. The BSA can provide the contact details of your local NHS service, or of the web site for private therapists should you choose to enquire there. Remember the simple tips Give him time to finish and do not interrupt or finish off words. Do not comment on his speech unless you notice that he is struggling to speak, or reacting to his stammering by making a comment, or a gesture: 'Do not ignore his distress.' Give him support, as you would for any ordinary difficulty like a fall, and comment gently, 'Well done, that was a hard word for you.' A hug might also be a good idea. Listen attentively and repeat back some part of what he said so that the child feels that what he said is more important than how he said it. Maintain normal eye contact and do not show any impatience. For example, avoid frequently nodding; looking at a watch or surreptitiously getting on with another task while the child is speaking.

2 Slow your own speech with natural pauses, demonstrating that there is no need to rush. Talk and play regularly with your child in a relaxed environment where you follow his lead as to what he wants to do. Aim to build his self-esteem by emphasising what he does well and using his name or family nickname regularly when you talk with him so he knows that he is unique and special to you. He is more likely then to develop the confidence to manage his speaking even when stammering severely. Try to make sure that the other children and adults he sees regularly also follow this simple advice. Talk with him on a daily basis one to one for at least fifteen minutes in a relaxed and quiet atmosphere with nothing else happening to distract him such as the television, or loud background noise. You may find that he is most comfortable sitting down in a special place that he likes, with a favourite toy, with you sitting at the same level. Help your child feel good about himself and his talking. Always listen attentively and keep normal eye contact and compliment him when he has explained something to you. 'Well, that was interesting.' If you do feel very anxious about your child s stammering then contact the BSA:Helpline so that you can talk about your fears with someone who understands. If your child makes a mistake with a word when talking do not criticise him, just repeat the word, as it should be said in your comment back to him, so he hears the correct version. When it is his turn to speak, give him time to finish what he is saying without interrupting. Do not finish off words or sentences for him. If he seems be tense and shows signs of distress as he struggles to speak just react calmly to the difficulty as you might with any other with a comment that acknowledges his efforts and yet does not appear to him to show you are worried about his speech. 'That was a bit hard for you, you did really well there', acknowledges and compliments him at the same time. With young children a hug might add to the reassurance. Spending time with your child Spend time together regularly - follow his lead by playing with what he wants to play with and talking about what he wants to talk about. This sense of being in charge helps to build his self-esteem and causes him to think a little about what he wants to play. During this time, encourage him by praising him for what he is good at (e.g.: 'You have a drawn a lovely picture' or 'That was a very helpful thing to do'. Make things relaxed rather then rushed. If he has been at nursery, for example, you may want to immediately ask about his day. However, he will have been stimulated during that day by play and social contacts and may just need a comforting environment with you where no demands are made on him. You could just sit quietly nearby as he plays, responding when he talks to you. Let him choose the moment for talking about how he had got on, even if it is much later on. How the family can help Happy talking Build talking together into all family routines: out walking, at mealtimes, when watching television, at bath times and bed times, for example. Make conversation part of the pattern of family life. This will build

3 up your child's confidence in talking because he is learning that his talking is valued even when he is stammering. Speaking and listening in the family Children who stammer can be very sensitive to the speaking and attitudes of other family members. They may feel harassed by a fast pace of talking by sisters and brothers particularly if they find it hard to keep up, or are being continually interrupted, as they struggle to have their say. It is good for all the children and adults in the family, as well as the child who stammers, to take their turns in speaking and to allow others to have their say without interrupting. These skills are important for learning. In any family, children may make upsetting comments about another child in the family behind the parents' back and it is important to find out if this is going on. The secretive undermining of one child by other children in the family is quite common. Parents need to be aware of this and act to prevent that and any thoughtless comments by children or adults about stammering. Television He is bound to watch this on his own sometimes as parents are busy people, but do make sure that the programmes are appropriate for his age and whenever you can sit down and watch the programme with him. Encourage him to make comments about the characters and the story and use the opportunity to build up his language by sharing ideas with him. Key adults Use the BSA-Leaflets so that all key adults and children in your child's family use simple strategies to support your child's speech. All family and friends who have contact with your child who stammers should be asked to follow the simple tips when speaking to him. Sometimes older people may take some convincing that they should not interrupt or finish off words when a child is stammering. When this happens pass on the BSA-Leaflets as they provide straightforward information from outside the family that is well presented and up-to-date. How to help your child while you wait to see a therapist While you are waiting for your child to see a speech and language therapist, there are some ways you can help him with his talking. You may find some of them easy, others will need practice. If for some reason a therapist is not available or you are not able to take him to see one, these ideas will help you to support your child's speaking and will not make his stammering worse. What helps? Talking with your child. Slowing down your own speech when you talk to your child will make it easier for him to follow what you are saying and help him feel less rushed. This can be more helpful then telling a child to slow down, start again or take a deep breath. Whenever you talk to your child, always try to be near enough to him to establish normal eye contact. Insist that if he wants to talk with you, he stops what he is doing and comes over to speak to you. It is best to avoid shouting across the room, or through the house, unless absolutely necessary, so that your child learns that speaking and listening are important events and understands that he needs to concentrate when doing so. By concentrating on his talking, the demands on him will be lowered and he should feel more relaxed. He might also talk more fluently, or at least talk without being upset by his stammering. Use his name frequently to reinforce his sense of identity as someone who is special to

4 you. Keep normal eye contact as you speak and expect him to show he is listening by looking at you. Speak in the same sort of sentences your child does - keep them short and simple but sometimes speak in sentences slightly longer than his to help build up his vocabulary. For instance if he looks at a picture and says that's a car, you could repeat his word and add an adjective such as red. When he is used to that you could introduce a word for size, such as big or small and gently introduce him to noticing details about what he sees. 'That is a big red car.' Concentrate on what your child is saying, rather than how he says it. This helps you to avoid common reactions like tensing when your child stammers, or even looking away for a split second. If your child senses that you feel worried about his speech he may start to feel that he has something wrong with him and begin to worry about speaking situations. Even very young children can react in this way so the stammer might become more pronounced, or in some instances the child might try to avoid talking. If you do feel very anxious about your child s stammering then contact the BSA:Helpline so that you can talk about your fears with someone who understands. Try to avoid showing anxiety or irritation when your child's speech is not fluent as he is likely to react to your feelings of tension and become more worried about his speech. Asking your child to do something When you have to ask your child to do something, attract his attention and ensure he is concentrating. Look at him and break down into sections the actions you want him to carry out. This is called 'chunking' your talking. Pause between the 'chunks', always addressing the child by his name, looking in his direction so that he is encouraged to look at you. In general it is always best to expect your child to look at you when talking, so that you do not speak until you have his complete attention This might mean saying something like this, 'John, please stop playing with your toys now.' (Pause for 30 seconds at least) Then comment supportively, 'That's a good boy.' Follow up with another simple instruction. 'Put each toy into the toy box please, John.' (Pause while he does that, offering ideas on how to do that if he is having difficulties, then complimenting him when it is completed). 'Please come over to Mummy now John, so we can talk about what we do next.' If you always use this method when you give instructions to your child, you will be giving him time to concentrate on what he is doing. This capacity to concentrate is a very useful skill. Also, focussing on a task lowers the demands on his thinking as he is clear about what he has to do. If he wants to reply in any way, as the demands on him are lowered, he will be more likely to be able to calmly reply and may be more fluent when he does so. It might also help with having your instructions carried out without the tantrums that can occur at critical periods such as bed- times. Questions and Answers It may help to pause for one second before you answer him or ask a question. This slow, less hurried way of speaking gives your child time before answering. Ask questions that require a yes or no answer if he is stammering severely. Go on to more open questions if he seems ready to talk, not questions with simple yes or no answers. More open questions will help him to develop his vocabulary. If you are busy doing something and cannot stop, tell your child that, although you are busy, you are still

5 listening, or explain why you cannot stop, but will give him your full attention later. Ways to improve your child's language Any child benefits from encouragement in the family to develop his language skills, as language is the basic tool for learning. However, this particularly helps a child who stammers as the better his language skills the more likely he is to recover from stammering. We know that one of the reasons that girls tend to recover from stammering more than boys at the pre-school stage is that they usually have more developed language skills. At the very least good language skills will help your child to be more confident about himself. He will make better progress academically and be able to express his ideas even when stammering. Word and memory games can help with boring car journeys for example; learning new words when out and about can all be fun and extend a child's vocabulary. Read to him to develop good listening skills and concentration and explain what is happening in the pictures so that he can join in as he wishes. Use a different voice for a character and encourage him to work out the personality of the character you are playing. For example speak in a loud angry voice if you are acting the part of a fierce character in a story. Explore with your child what he thinks about that character, perhaps to draw it and talk about it using words to describe the character's personality. This will help him to develop his skills of understanding non-verbal behaviours in other people and is helpful, as we know that children who continue to stammer can be slower to learn this skill than other children. Library visits to choose books and join in storytelling activities with other children will all encourage preschool children to improve their language. Encourage him to join in with rhymes and singalong songs. They are a good way for children to learn the pace of language and the repetition reinforces the meaning of words. As he is unlikely to stammer when joining in with a rhyme or a song, this helps to build his confidence in hearing his own voice working fluently. When you are busy on a task, if appropriate talk to him about what you are doing, so he is hearing language as you work. He will be absorbing the message that words can tell you interesting things that you want to know. He may copy the idea, perhaps by explaining what he is doing to another person or even a toy as he plays. Show your pride in your child by praising his achievements both to him and other family members. If he wants to talk about his speech listen with interest and explain how all children are different and their parents love them as they are, so that he does not sense any anxiety about his speech. When he is talking and shows frustration as he struggles to speak, just react calmly to the difficulty as you might with any other with a comment that acknowledges his efforts and yet does not appear to him to show you are worried about his speech. 'That was a bit hard for you, you did really well there', acknowledges and compliments him at the same time. A hug might help too! Making a record of your child's fluency for the therapist Gather information When you visit the therapist for your child's assessment it is useful to have available all the details of his medical history, development and any reports from the pre-school, particularly about his speech. It is helpful also to have kept a record about your child's fluency and give a score of 1 to 10 where 10 is the highest rate of stammering and 1 the lowest. You could do this in your diary once a day based on your average of the episodes of speaking you have observed, or you could print the chart shown below. Put a cross by the average fluency rating for the day. Click on the following link to open a PDF, use the back button on your browser to return to this resource. To save the handout to your computer, right click and choose 'Save as'.

6 Fluency Record How to use the diary or chart When you consider the average score for a day, review what your child has been doing then and record that very briefly. For example on Sunday you can see the score is low as his stammering was less severe. Perhaps that was a day when he was playing at home with people he knew and he was more relaxed. However, as every child is different the opposite may have been the case, and he may have been in an exciting situation where he was enjoying himself so much that he felt relaxed and confident. When you have completed a chart for a week you can start to work out what situations affect your child's speech. There are no rules about this as your child is unique and will be affected differently by situations than another child who stammers. How to use what you learn from the chart When you have information about the levels of your child's fluency in different situations you can try to increase the situations in which he is more fluent so as to help him build up his confidence about his speaking. It may be possible to reduce the situations that appear to affect his speech but if that cannot be done, at least you can help him to deal with them by talking with him beforehand. You can hear his worries, answer any questions he has, and then give him support. Take the chart to the therapist as a starting point for a discussion about your child's speech. Summary Contact your local speech and language therapy service. Speech and language therapy has a high success rate for pre-school children. Parents should contact their local speech and language therapy service as soon as possible after they notice the stammering, even if the stammer appears to be quite mild and does not trouble the child in any way. It used to be thought that it was best to wait and see how the child s speech developed before making this referral. We know now that a therapist should be consulted as soon as possible. Most services can be approached directly by parents without contacting a GP or health visitor. The BSA can provide the contact details of your local NHS service, or of the web site for private therapists should you choose to enquire there. Remember the simple tips Give him time to finish and do not interrupt or finish off words. Do not comment on his speech unless you notice that he is struggling to speak, or reacting to his stammering by making a comment, or a gesture: 'Do not ignore his distress.' Give him support, as you would for any ordinary difficulty like a fall, and comment gently, 'Well done, that was a hard word for you.' A hug might also be a good idea. Listen attentively and repeat back some part of what he said so that the child feels that what he said is more important than how he said it. Maintain normal eye contact and do not show any impatience. For example, avoid frequently nodding; looking at a watch or surreptitiously getting on with another task while the child is speaking.

7 Slow your own speech with natural pauses, demonstrating that there is no need to rush. Talk and play regularly with your child in a relaxed environment where you follow his lead as to what he wants to do. Aim to build his self-esteem by emphasising what he does well and using his name or family nickname regularly when you talk with him so he knows that he is unique and special to you. He is more likely then to develop the confidence to manage his speaking even when stammering severely. Try to make sure that the other children and adults he sees regularly also follow this simple advice. Talk with him on a daily basis one to one for at least fifteen minutes in a relaxed and quiet atmosphere with nothing else happening to distract him such as the television, or loud background noise. You may find that he is most comfortable sitting down in a special place that he likes, with a favourite toy, with you sitting at the same level. Help your child feel good about himself and his talking. Always listen attentively and keep normal eye contact and compliment him when he has explained something to you. 'Well, that was interesting.' If you do feel very anxious about your child's stammering, then contact the BSA:Helpline so that you can talk about your fears with someone who understands. (Telephone lo-call number )