A Child Stuttering

Autism Spectrum Disorder is a behavioral diagnosis that typically signals difficulties in socialization, behavior regulation and, you guessed it, communication.

In recognition of Stuttering Awareness Week, let’s take a look at communication: What it is, how verbal and vocal communication differ, and how we can best support children who may have difficulties with communication.

Communication in itself can be verbal without being vocal – in the field of Applied Behavioral Analysis, we utilize the works of BF Skinner. Skinner did a lot of work in the area of behaviorism, but dug deep into studies on verbal behavior and classified verbal operants. Verbal operant is a technical term for our modes of communication that we use toward a purpose. While Speech and Language Pathology heavily focuses on the mechanics of speech – as in, how to get the message from the brain to the muscles of the mouth to produce speech, ABA focuses heavily on the entire act of communication.

Most of our behavior IS communication. It’s attempting to produce an effect or a result on the environment or the people around us to have our needs or wants met, or perhaps, simply to produce an outcome that we desire. 

We tend to put the focus and emphasis on vocal communication, which is what we know as speech. The art of using our voices and words to communicate. For children on the spectrum, this proves to be more difficult than it does for most neurotypical children. This is in large part because the methods of learning are different. Most children who are born neurotypical learn new behaviors by watching others – they observe what their parents, siblings or peers are doing, mimic the actions, and then based on the results of those actions, repeat the behaviors or not. Children on the spectrum, however, typically learn from direct instruction. They don’t quite as easily observe the behavior patterns of other people.

This is where a lot of difficulties come in with vocal communication – if you don’t see it in action, you are not as likely to pick it up as fluently. This creates barriers such as speech delays, or delays in mechanics of speech, such as stuttering, repeating phrases, missing the underlying meaning of vocal speech, etc. 

When we know WHY these difficulties present themselves, we have a better understanding of how to help our kiddos who struggle with vocal communication strengthen their speech mechanics without getting frustrated or shutting down. 

Here are some helpful tips for you if your child struggles with speech delay or stuttering:

1.Work on speech mechanics during periods of low demand/frustration

Imagine you’re in a foreign country and you need to use the bathroom desperately. You wiggle around as you feel an embarrassing outcome becoming more and more certain. You can’t read signs for a restroom, so you will have to find someone who can guide you to the lavatory as soon as possible. Problem: No one speaks your language. In desperation, you try to get someone to understand what you’re telling them. You feel frustration and anxiety build as the need for relief gets stronger and your attempts to communicate aren’t getting you any closer. This is not the time for a language lesson. You’re not likely to be very receptive, because you have an immediate need that you want to have met. This is not when your brain is in its spongiest mode – you’re actually more in an emergency mentality. Such is the same with kiddos who struggle with stuttering or speech delays. The time of need is not the time to get technical about how a child is communicating. Rather, it’s in your best interest to accept VERBAL, without necessarily being vocal attempts of communication. Allow the child to point, gesture, or find a less demanding way of communicating the need in the moment. THEN, now that you know what the child is trying to communicate, work on this method during times where the child can be more receptive (practice runs, if you will). 

You could have pictures of the bathroom and work on speaking the word “bathroom”. Just as you wouldn’t do a full sprint without training, we can’t expect our children to execute perfect speech with a situation is high stakes. 

2.Accept approximations and slowly work on improving speech

Speech is a pretty complicated mixture of mechanics and cognitive function. You have to know what you want to say, then execute muscular function in order to produce sounds, then combine those sounds to make words, then combine those words to make phrases. Oh, and by the way, they have to line up in a contextual manner to make sense to a communicative partner. Now, for a child who can observe this and mimic it, it’s a pretty natural process. For a child who struggles with learning by observation (common in ASD), this is a learning process with a LOT of steps.

As your child begins to acquire speech, learn to accept approximations of speech, then slowly and gradually make the demand higher and closer to what you would expect to hear in a typical setting. 

Let’s go back to our bathroom scenario (my son is super into comics that talk about potty language and underpants, so this is probably my most relevant reference at this point). Words are broken into tiny sound chunks, or phonemes. These phonemes often bear meaning, then when put together, make the meaning of the word they compose. The word “bathroom” requires the musculature to produce “BA” “TH” “R” “OO” “M”. For a child with language difficulties or stuttering, there are a lot of opportunities within the framework of this one word for getting caught up. 

When first working on the mechanics of this word, maybe we accept “Ba”, then as the child becomes more fluent with that sound chunk, we coach the child to say “Bath”, then “bathoom” then “bathroom”. 

The idea of gradual approximations to an end goal is very familiar in the ABA world – it’s called shaping. We slowly make the demand a tiny bit higher but giving lots of opportunities for practice and reinforcement. 

Imagine you try to talk to someone, and you try to pronounce “bathroom”. They frown and you and say “Nope. Not how you say it”. You try several different ways and several different times with the same reaction. Or worse, you say your best version of it, only to be asked to practice it over and over again until you get it right. Your motivation to use vocal speech PLUMMETS. You don’t want to speak, because all you’ll be met with is the demand to practice. By slowly coaching along the way through approximations, you’re encouraging each step as it becomes closer and closer to the word being phonetically correct. 

3.Use visual supports

When I was a little younger than my son, I was tested for ADD. Later in life, I was diagnosed with OCD, which now seems to lend its way much closer to a high functioning autism diagnosis. I find that when I speak, I have to prepare what I want to say by envisioning pictures. Almost like a roadmap that shows me where I want to go with what I have to say. Otherwise, I get lost. This actually produces some stuttering on my behalf, because I trip over words until I can get back on track. When a child is developing speech, it’s important to provide supports to help them not lose their ideas within the demands of vocal speech. While a child may be working on the mechanics of producing speech, we want to ensure that their wants, needs and ideas are properly being communicated. I  LOVE visual supports to speaking – PECS (Picture Exchange Communication System) or an AAC (Augmented and Alternative Communication) device can be extremely helpful. They use pictures to help a child construct their words or phrases, then the vocal component can be added in. AACs often have a speech function, so a child can actually HEAR how the phrase will sound, then repeat it. This was MONUMENTAL for my son, who did not fluently speak until he was six. Currently, he is the most avid reader and communicator I know! His vocabulary extends well beyond his age range and no longer requires the AAC. He was able to practice communication with it until the point where he was able to speak without it.

Whether your child utilizes visual supports to begin speech, to help remediate difficulties such as as stutter, or permanently, the idea behind it is that we aren’t REPLACING vocal behavior, we’re ensuring that precious ideas do not get lost simply because a child may lack the mechanics of vocally representing them. There’s no shame in the visual game – one day a child may be like me and learn how to produce the visual supports internally. The main goal, of course, being that we don’t sacrifice brilliance for speech mechanical issues. 

4. Allow multiple modalities of verbal communication

We PUSH HARD on vocal speech. I get it, we want our children to be able to verbally communicate. Here’s where it gets super tricky, though. Speech is HARD. English changes a lot. Do you think anyone in 1901 would’ve responded to the word “bruh”? Likely not. It evolves. Cultural context evolves, which changes our framework for speech. If a child has difficulty in language acquisition, this makes it nearly impossible. Verbal communication is a beautiful thing, in that, it allows multiple modalities. Written communication, visual supports (like the ones mentioned in the previous bullet), gestures, body language – we have so many ways to get our ideas and needs across to a communicative partner. While, yes, we do want to highly encourage vocal speech, keep in mind that these other modalities are incredibly useful, and during periods of fatigue or high frustration, they may be all a child is currently capable of. Speech should be safe. No one ever really recovered from stuttering out of fear or anxiety, so ensure that if a child is having a particularly hard time producing vocal speech, he or she has less demanding modalities to rely on. 

5.Give advance preparation (when possible) for instances where vocal communication is a requirement.

I JUST tried to film a video talking through some of these ideas on verbal behavior and the encouragement of speech. Not like a TED talk, a 1-2 minute snippet of ONE of these tips that I’m writing about now. It took me 8 takes. I stuttered over words, I cussed at myself, I deleted 7 videos. I got extremely frustrated! How hard is it to talk for 1-2 minutes? Actually, it can be really hard. Part of my neurodivergence is having to practice HOW to say things. How to line up ideas, how to choose the right words. I don’t do particularly well on the spot. The magic touch for me was to film in tinier clips, about 10-20 seconds at a time. Just enough to get one thought out and then prepare the next thought. If you give me the floor and say “Melissa, GO”, I’m not going to have my most compelling speech experience. As I stated before, I like to have a roadmap in my mind of where I’m going.

If your child is going to be a position where vocal speech is going to be a must, try to give as MUCH preparation as possible. For my son, I would create pictures or visual reminders on some of the things he would likely need to remember to say. He had visual prompts to help remember “please” and “thank you”, prompts to remember how to construct sentences, etc. 

Without some of this preparation, stuttering or other barriers to vocal speech are far more likely, which could silence even the most brilliant of thoughts. Think about it – if you had solid gold ideas in your brain, you wouldn’t want to share them if you didn’t have a way to do so that made you feel confident. You wouldn’t feel as though you would be taken seriously. And how devastating for the world to miss out on those valuable thoughts.

You know your child better than anyone – including doctors, psychologists, therapists, ANYONE. Think about how your child learns and most successfully implements skills. Offer those up as much as you can ahead of time. It’s the same as providing them with a winter coat when you know it’s going to be cold outside.

6.Target speech mechanics in ways that lead toward positive outcomes.

Because, as I mentioned,  vocal speech is typically a pretty involved skill, I like to start working on it in ways that are going to end up with a positive outcome for the child. For instance, a young child probably isn’t going to be super motivated to learn how to label objects. That’s likely not where I would start out. We want to provide ample opportunities for the types of speech needed to get needs/wants met.

There’s a verbal operant (thanks, Skinner) call the mand. The mand is the request. Going back to phonemes (chunks that work together to make words), the mand is that part of words like “deMAND”, “comMAND” so on and so forth. We’re asking for something. In ABA this is typically our first target of communication. Why? Because it’s inherently reinforcing. You ask, you get. I say “Book”, and it results in me getting a book. Who wouldn’t want to work on that?! That’s way better than I say “book” and someone I barely know says “Wow, good job. You said ‘book’. That is a book”. 

If your child is struggling with speech, try to work on encourage and promoting (NOT forcing…but attempting to be engaging) speech through these same means. For instance, your child loves chips. Instead of giving her the whole bag, give them to her one by one and encouraging her to say “chip”. Remember, approximations are a good place to start. By doing this, you’re building in reinforcement. After years of being on a low carb diet, you can bet that I would LOVE to break my silence and say a word if it meant I’ll get a chip out of the deal. This is a very natural way to practice speech mechanics, it also teaches that vocal speech has immense value, which later then can be translated into more abstract methods of communication. If you learn that by uttering a vocalization, you get a highly wanted item, later on, you learn that by learning phrases, you can get information you need. “Where are the chips?”

The idea is to start small and basic.

How can I make this fun and motivating? The language barriers such as stuttering can put a damper on a child’s motivation to speak, so it’s on us to make sure that there’s plenty of encouragement and support along the way.

If your child has speech difficulties such as stuttering, you can look into immersive speech or ABA programs that are geared towards verbal behavior. It’s not just about producing words, it’s about creating a language-rich environment that ENCOURAGES communication and all the positive outcomes that go with it!