About six months ago, Karugire’s son, who is making three years this week, started stammering. At first, the parents thought he was being playful and let him be until it became more serious.
“We did not see a therapist but our parents and other older people suggested it will go when he begins school and starts spending more time with other children,” says Karugire (not real name).
Once in a while, he says, the boy will speak well, then fidget with words when he is nervous, anxious or angry. “He seems to get grumpy when you ‘finish’ his sentences so we give him time to let the words out,” he says.
But Karugire wonders what could have caused the disorder “because we do not have any history of stammering in the family,” he adds.
According to Mayo Clinic, a non-profit American academic medical centre focused on integrated health care, education, and research, stuttering is a speech disorder that involves frequent and significant problems with normal fluency and flow of speech.
Stuttering or stammering is a state in which one faces difficulty in fluently saying what they want to say.
This may manifest in repeating or prolonging a word, letter or sound in word or pause during speech because of a “problematic” word or sound.
According to WebMD, an American online publisher of news and information pertaining to human health and well-being, Karugire’s son could be among the normal language dysfluency cases common among babies aged between 18 months and two years and may go up to the age of five, as the child learns to form words into sentences.
The website also reports that about one in five children at some point have a dysfluency that seems severe enough to cause concern. One such case is of a five-year-old boy in Uganda who started stammering recently, yet, according to his mother, he had started speaking very fluently as early as two years old.
“Is it a medical disorder that needs attention?” she wonders in a letter to Health Living, “or will it go away naturally?”
Gerald Ssemaganda is a speech and language therapist at Let the Children Hear (LTCH) in Kisenyi, Mengo and Mulago Speech and Language Clinic, the only hospitals that treat speech and hearing disorders among children free of charge.
In his six-year experience, Ssemaganda says stuttering that starts at five is a genuine cause for concern.
Ssemaganda classifies the stuttering signs and symptoms as primary and secondary. The primary ones include difficulty starting a word, phrase, or sentence; prolonging a word or sound in a word. For example: “sssssound” instead of “sound”; repeating a sound, syllable, word or pausing within a word, missing a word or syllable.
Ever noticed that sometimes even your favourite news anchor or presenter smuggles “um” between words? Medics say that too is a stuttering symptom.
Excess tension, tightness, or movement of the face or upper body to produce a word; rapid blinking; anxiety about talking; tremouring of the lips or jaws; clenching one’s fists, head twitching or stroking one’s outer thighs, are some of the secondary symptoms.
Stammering may be normal up to four years. Other children, medics say, outgrow the disorder by puberty. But Ssemaganda warns that if it occurs or recurs above five years, without proper interventions, stuttering might become a lifelong problem.
But is it worth the worry?
Medics warn that chronic stammering, can affect a person’s self-esteem and interactions with other people.
Other complications listed by Mayo Clinic, include anxiety about speaking, avoiding speaking in situations that require speaking; loss of social, school, or work participation and success and vulnerability to bullying or teasing.
How therapists help
Karugire* has not taken the child to any therapist. But even if he sought medical attention, only therapy from a Speech-Language Pathologist can help because no medication has so far been proven to cure stuttering.
Ssemaganda says as soon as a parent or caretaker realises the stammering, he or she should study the child’s case to identify whether the trigger factors are genetic or environmental before seeking medical review.
Ssemaganda says the earlier the problem is detected the easier the treatment, adding that the most complex cases involve teenagers or adolescents who have tendencies of noncompliance. As a therapist, Ssemaganda must study the child’s environment, history and form of stammering to identify the possible causes and necessary measures.
After assessment, the pathologist designs the treatment programme accordingly. If the symptoms are mild, the pathologist might engage the child once a week for two to three months, ensuring the child does not realise that they have a speech problem.
But if symptoms are severe, Ssemaganda says, the therapist might need three to five sessions a week and the package might last for up to a year or two. (the longest session lasts an hour). “Here, the aim is not necessarily to correct the stammering but gradual improvement in the fluency,” he says.
Ssemaganda says therapy might not help without the parents’ input. He, therefore, advises that the best therapy is one done early and within the child’s environment, where parents or caregivers are involved.
He adds that parents or caretakers should avoid demanding a stammering child to speak fluently because that can worsen the problem.
Studies show that some people who stutter have receptive disorders and having trouble understanding and processing what others say.
“Parents should also speak slowly to allow the child to listen to words and sentences so that they improve gradually without pressure,” Ssemaganda advises. He adds that there is still a low turn up because parents and caregivers lack knowledge of therapy services, while others cannot afford them.
Causes and risk factors
Scientists agree that family history of stuttering can manifest itself in subsequent generations. Gerald Ssemaganda, a speech and language therapist, says genetic stuttering usually begins at the child’s earliest stages of speech development. But stuttering can also be acquired from the child’s environment.
“For instance, if a child starts talking in an environment of mixed languages, the risks of stammering are high as that child tries to imitate the different languages or words,” he says.
Or if the child relocates to an environment that speaks a different language, Ssemaganda adds, the child is likely to stammer. A child can also learn stuttering from peers “if they feel it is okay, or fashionable.”
Parental pressure can also trigger stuttering. “Phonological errors are normal during a child’s speech development. For example, saying “kipoko” instead of “kikopo” but if a parent exerts pressure on the chid to perfect the words, it might cause stammering,” Ssemaganda says.