(USA Today) -- When Bobby Sanders' speech patterns suddenly changed between ages 2 and 3, parents Kathy and Bob Sanders immediately wondered: Could he be stuttering?
That's because dad Bob, age 33, is a lifelong stutterer, and Bobby was showing a classic sign - adding long sounds to the beginning of some words. Sure enough, when the Tallahassee family saw a speech therapist a few months later, she told them that a family history of persistent stuttering was a good reason to be concerned about what might be a passing case of "disfluency" in another child.
Bobby began once-a-week therapy, and his mom was trained to help him at home. Eighteen months later, "his speech is much improved" and he's going to formal therapy only once every eight weeks, Kathy Sanders says. Even if Bobby's speech might have improved on its own, his parents feel therapy was worthwhile.
The Sanders family's experience illustrates why some U.S. speech experts were concerned about recent headlines surrounding a study from Australia. The study, published in Pediatrics, followed more than 1,600 children up to age 4 and found that the 11% who stuttered at some point did not suffer any obvious short-term harm to social or emotional development. The stutterers even had better vocabularies, on average, than other children.
Since other studies show no more than 1% of children become lifelong stutterers, the authors saw these results as very good news: Stuttering could be seen both as passing and harmless. Though the study did not look at treatment, they wrote that the "best practice," based on other studies, is waiting at least 12 months to begin therapy. They did say therapy was in order if a child was distressed or parents were concerned - but the "wait and see" message got more attention.
But that message is at odds with the one favored by many U.S. speech experts, which might be summarized as "when in doubt, check it out."
Studies have long suggested that at least 5% of preschoolers will stutter for a while, and at least 80% will recover, with or without therapy, says Ehud Yairi, a speech-language pathologist and professor emeritus at the University of Illinois at Urbana-Champaign. It is possible, he says, that the numbers who stutter are closer to the 11% in the new study, meaning the recovery rate is higher, too.
But, he says, his own research shows that some children are at much higher risk for continued stuttering and the social and emotional fallout that eventually comes with it. The risk factors include having a family history of persistent stuttering, being a boy, starting to stutter after age 3½ or stuttering for more than six to 12 months, he says.
Those are exactly the factors speech-language pathologist Craig Coleman says he looks at when he sees a new patient. Coleman, an assistant professor at Marshall University, Huntington, W.V., says he also looks for signs that a child is becoming anxious about how he speaks - such as showing facial tension or raising his pitch as he tries to get out a sentence. He says the Australian study wasn't designed to pick up those signs. "Four-year-olds don't tell you, 'I'm concerned about my stuttering,' " he says.
After the initial evaluation, he and other therapists say they often divide patients into three groups: Those who can check back in a few months; those who might benefit from a few formal therapy sessions; and those at highest risk, who should start rigorous therapy right away.
In any case, Coleman says, he sends parents home with tips that would benefit any child - such as slowing down conversations, waiting patiently for children to speak and asking fewer direct questions (that takes some pressure off, he and other experts say).
While anxiety isn't a root cause of stuttering, it can make it worse, says Tommie L. Robinson Jr., a speech-language pathologist at Children's National Medical Center, Washington, D.C., and a past president of the American Speech-Language-Hearing Association. Continued stuttering can make children lose confidence, he says. Therapy works on both speech and confidence, he says, so that even children who continue to stutter can be effective communicators. And, he says, early therapy works best.
As for costs, initial evaluations usually are covered by insurers, including Medicaid, says Lisa Scott, the Florida State University speech-language pathologist who supervises the clinic Bobby Sanders attends. Ongoing therapy can cost more than $100 an hour in some communities, but lower- or no-cost options, including university clinics and public early intervention programs, are available, she says. Many insurers cover at least some of the sessions, she says.
Sheena Reilly, the lead author of the Australian study, says cost is a real concern, especially for therapy that may be unneeded. She also notes that most parents in her study were not concerned about their children's stuttering, so their children may differ from those who show up in clinics. Once parents are concerned or children become distressed or reluctant to communicate, the picture changes, she says. "We are not advocating ignoring stuttering in children. Our study in no way contradicts the need for intervention soon after the onset of stuttering, if this is judged to be necessary for an individual child."
Reilly, a professor at the Murdoch Children's Research Institute in Melbourne, is continuing to follow the children in her study to see how they fare over time.
Parents who are concerned that their own children might be stuttering can should look for these signs, according to Reilly's paper:
• Repetition of words and syllables ("Can - can - can - I go?)
• Prolonged sounds (Caaaaaaaaaan I go?)
• Speech stoppages or blocks where no sounds come out.
Parents who want to improve communication with a child who stutters can get advice in a new 16-minute video from the not-for-profit Stuttering Foundation and get more information at www.stutteringhelp.org.