Preschoolers who stutter: What and how? A talk with Norwegian SLT Gry Line Tokerud Bakke

While our EST-project team is busy working on systematic reviews, collecting literature, reading articles and preparing for our intervention study, we thought it would be fun to use our blog to learn about how other speech and language therapists, healthcare professionals and parents manage stuttering in preschool children here in Norway and around the world.

Our first guest was Norwegian speech and language therapist Gry Line Tokerud Bakke who works in public schools and preschools in south-east Norway.

Gry Line has been working with preschool children who stutter since 2013. She receives five new referrals for preschool children who stutter every year, from either kindergartens or parents. 

Here she shares some of her experiences.

What is a common question you get asked about stuttering by parents and/or kindergarten teachers?

«Do you think my child stutters a lot?» «Do you think this will pass?» «Is this normal?” and «Should I be worried?»

Does your service have a waitlist for services? If so, does your service have a protocol for determining who receives access to intervention?

No, I am the only SLT in our municipality and the child will be added to my caseload immediately. I always contact parents quickly (within two weeks of receiving a referral). In this initial contact, the parents and I plan a meeting to talk and assess the child.

What factors do you consider when deciding when to start treatment with a preschool child who stutters? 

I take into consideration how worried the parents are, if they want direct treatment for their child, and how motivated they are to work with the child. However, when it comes to assessment and counseling towards the preschool and parents - that is something I always do, if a child is referred because of stuttering.

What is the earliest age you provide stuttering treatment for preschool children?

Management approaches that could be labeled as indirect treatment, like changing the surroundings and language environment, and counseling parents and professionals around the child, are given to all children regardless of age. I start giving more structured and direct treatment from the child is 3 years of age.

How do you decide which treatment to use with preschool children who stutter?

It often depends on the parents. Some parents do not want their child to know they stutter, and want advice from me as an SLT on how to approach the stuttering in the right way. Others want their child to work with strategies like breathing, rate, soft and easy stuttering with a SLT, and follows up at home for a while, before they wait and see. Others wants to do something immediately. In that case I would provide more structural treatment that will demand a lot from the parents, like Lidcombe.  

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What stuttering managing approaches do you use the most with preschool children and why? Do you use any other management approaches and if so why? What is the main goal of each approach?

In addition to consulting parents and the preschool, I try to visualize some principles for the child. I usually start with raising the child’s awareness around breathing. I play with the child with different toys to blow through and we talk about the breath we use to shout and the one we use to talk. The shouting breath is powerful and is similar to the one we use when blowing a ball high up in the air with a toy. Talking breath is the smooth breath, which allows the ball to be almost kept calm in the air for a long time when we blow. Parents often say that the children can correct themselves after they have seen me and "forget to use talking-breath" and that they then manage to change to a slower speech by using the smooth breath.

In addition, I also work with rate reduction. I often use a car and make a racetrack on the floor. My goal is to show the child how the car will not crash or drive out of the way if we keep a slower pace. Then we try to transfer these "discoveries" to the speech and find that the slower speech makes it easier for others to understand us.

I have used the Lidcombe program with one child before and have just started treatment with a second child. Unlike the other approaches, I like that the program has a specific structure for the progress and the content of every session.

In all approaches, the goal is for the child to achieve better speech flow.

On a scale from 1 to 10, 1 being not confident at all and 10 being extremely confident, how confident do you feel about working with preschool children who stutter and their families?

7. Stuttering is generally one of the fields where I don’t feel so confident. This might be related to the fact that I like fixing things. Stuttering is challenging for myself as a therapist, because I have to find other goals than stutter free speech. With preschool children who stutter I often feel that my work is depending on that of the parents. I find it challenging when they are not following up what I do in therapy, or do not want to talk to their child about stuttering.

Do you have any formal training working with preschool children who stutter? If so, what type of training have you received?

In my formal training as a speech and language therapist, fluency disorders is included as a part of the education. I have attended different courses at Statped over the last years. I was recently counseled on how to use Lidcombe with a child, but do not have training in Lidcombe or any other stuttering management approaches.

Describe one thing you find rewarding and one thing you find challenging about working with preschool children who stutter?

After providing them with information, new knowledge and some advice, I can often see how parents experience their child’s stuttering to be less scary and overwhelming, and they feel in control of the situation. Seeing how parents meet their child with a new sense of confidence and calm when the child is stuttering in very rewarding and gratifying.  At the same time, I find it frustrating in cases where the parents are reluctant to get help because they don’t want their child to “know it stutters”.

In your country, are there national guidelines for treating stuttering in preschool children? If so, what are the key recommendations for working with preschool children who stutter?

On their homepage, The Norwegian Fluency Association describe the legal rights that people who stutter have on treatment, as well as facilitation of the workplace and at school. When it comes to preschoolers, I don’t know about any given recommendations for treatment.

In your opinion what’s the most important outcome of intervention when working with preschool children who stutter?

To provide the child with tools they are able to use if they feel they are stuck. In addition to giving parents tools to reduce their worry and anxiety around stuttering. 

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Thank you, Gry Line!