Treatment

There are different treatments available for stammering, depending on a person's age and their circumstances.

A speech and language therapist (SLT) will work with you, your child, and educational staff to come up with a suitable treatment plan for your child.

An SLT can also work with adults who stammer to help find ways to improve the fluency of their speechand reduce the impact stammering has on their lives.

You may be able to access psychological therapy to help with any emotional problems linked to your speech difficulties.

Speech and language therapy is widely available on the NHS for people who stammer, althoughthe level of service and waiting times vary across the country. Some treatments, such as feedback devices, may not be funded.

Some of the most commonly used treatments for stammering are described below.

Indirect therapy

Indirect therapy is where parents make changes to the way they communicate and the homeenvironment, rather than focusing directly on the child's talking.

If your child is under five, this is probably the approach your therapist will suggest you try first.

However, if a young child has been stammering for several months and it seems to be getting more severe, it may be best to start direct therapy straight away.

Indirect approaches are often basedon the concept that children start to stammer when they can't keep up with the demands made on their language skills.

These "demands" may come from other people around them or from the child's own enthusiasm and determination to communicate.

The goal of indirect therapy is to create an environment where the child feels less pressure when speaking.

This may involve:

• speaking slowly and calmly to the child
• encouraging turn-taking and listening within the family
• doing more of what seems to help the child's fluency for example, chatting about what you and your child are doing together, such as playing, cooking, walking to pre-school, or looking at favourite books
• avoiding interrupting or criticisingthe child
• making the family environment as relaxing and calm as possible

Direct therapy

Younger children

The Lidcombe Program is a widely used direct behavioural therapy for the treatment of stammering in young children.

It's designed to be carried out by the child's parents under the guidance of a speech and language therapist.

The programme is based on the principle of providing consistent feedback to the child about their speech in a friendly, non-judgemental and supportive way.

The British Stammering Association and the Australian Stuttering Research Centre have more information about the Lidcombe Program and stammering in children younger than six .

Older children

Stammering that persists beyond the age of six or has lasted for more than three years is significantly more challenging to treat.

As time passes, the effects of stammering become an additional part of the problem. These include anxiety about speaking, fear of stammering, and feelings of embarrassment.

Therapy with older children and adults will often take account of both the speaking behaviours and the social, emotional and psychological aspects of stammering.

With school-age children, direct therapy is often used to:

• help improve fluency
• help the child understand more about stammering
• share experiences with others who stammer
• work on feelings associated with stammering, such as fear and anxiety
• improve communication skills
• develop self-confidence and positive attitudes

Other treatment options

In addition to direct and indirect therapy, there are other options that can help people who stammer, particularly older children and adults with persistent stammering and those who develop stammering later in life (acquired or late-onset stammering).

Psychological therapies

These include solution-focused brief therapy (SFBT), personal construct therapy, neurolinguistic programming (NLP) and cognitive behavioural therapy (CBT) .

These therapies don't treat stammering directly, but can be helpful if you experience negative feelings as a result of your stammering.

Feedback devices

Feedback devices alter the way you hear your own voice. They include:

• delayed auditory feedback (DAF) these play your voice back to you a fraction of a second after speaking
• frequency-shifted auditory feedback (FSAF) these play your voice back to you at a lower or higher frequency
• combined DAF/FSAF devices these use a combination of both methods mentioned above

These devices are often fitted inside or around the ear, similar to a hearing aid , and can help improve the fluency of some people's speech. There are also apps for smartphones and computers that work in a similar way.

These techniques don't work for everyone and can be difficult to use in some speaking situations. The devices aren't generally available on the NHS.

However, the British Stammering Association (BSA), the main support organisation in the UK for people who stammer, can provide a device on loan for two weeks to BSA members.

You can read more about electronic devices and apps on the BSA website.