Stuttering & Autism Spectrum Disorder: Diagnosis & Treatment in Children

by Team Stamurai

Autism, it is a term we have been hearing often in our social circles, and even on the screen. TV series like Atypical have done justice to portray the life of someone who a little different from the masses and how life transpires for those around them.

Despite several controversial publications, opinions and judgements, we can proudly say that people who fall in the autism spectrum may not be neurotypical, but they are gifted and incredibly special in their own ways.

Are Stuttering and Autism Related?

Autism is not a disease. It is a spectrum disorder. Even today, neuroscientists, psychologists and psychiatrists know little about the causes of autism. It is not hereditary or does not happen due to external injuries during childhood. Researchers classify autism spectrum disorder (ASD) as a pervasive developmental disorder (PDD).

Autism spectrum disorder comes with a myriad of signs and effects – as you have possibly understood by now, these effects are usually a mix of good and bad. Some children and adults with ASD may be excellent in mathematics, arts, and creativity. While at the same time they may have trouble communicating, maintaining relationships and observing social norms.

Similarly, many who are in the spectrum also have fluency disorders. Such fluency disorders include stuttering. Stuttering manifests in the form of repetitions, blocks and prolongations. For example, a word like “cup” may sound like “c-c-up” due to repetitions or “cuuuup” due to prolongations.

Stuttering in people with autism is typically restricted to the beginning of the first syllable of a single-syllable word or the second syllable of a longer word. End letter repetitions are not common for this type of stuttering.

How Many Children With Autism Stammer?

Autism and stuttering may have a long-standing relationship. Sadly, there is no objective data that quantifies the incidence of stuttering among the population with ASD. Modern research is providing the scientific community with evidence of an intricate relationship between autism and stuttering, cluttering and/or word-final disfluencies.

According to studies published by Kathleen Scaler Scott (2013), stuttering like disfluencies are common in those with Asperger’s Syndrome. Shriberg et. al. (2001) states that 67 out of 100 males with Asperger’s syndrome exhibit disfluent speech as compared to 40 out of 100 with high functioning autism. However, right now, no study can conclusively state how many children with ASD also stutter.

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Is Stuttering A Sign or Symptom Of autism?

Quite a number of children and adults with ASD have speech disfluencies such as stammering. It is important to remember that neither is stuttering a form of autism, nor is it a sign of autism in the case of most individuals.

People falling in the spectrum may also have a disorganized speech due to more than one disfluencies, revision of thoughts and interjections in speech. Each individual has a different combination of these symptoms and a varying level of awareness of the same.

Diagnosing Stuttering in Children With ASD

Only a professional, who specializes in paediatric development can diagnose ASD. Since it is a complex disorder that has widely varying signs and symptoms, diagnosis can occur between the ages of 2 and 8 years. There can be a sudden onset of stuttering in children with autism due to emotional stress, changing environment and/or social challenges.

Children with ASD have multiple issues with communication and social interactions. Hence it is challenging to notice speech disfluencies like stuttering until they reach school-age. The interaction between ASD and speech fluency disorders is a nascent area of research.

Speech-language pathologists, who are also familiar with ASD in children are the ideal candidates for the diagnosis and therapy of speech disfluency in children with ASD. Their experience and knowledge-based evaluation should help in distinguishing between the other childhood fluency disorders that may affect those with ASD from stuttering.

The evaluation of the SLP can help in determining whether the speech problem lies in the production of speech or the organization of language and the likes. Understanding the root of the problem will determine the course of therapy. After several sessions of conversation or storytelling with the child, the SLP may decide to go forward with word-finding, storytelling or narrative language activities to find the language deficits.

What You Should Know About Your Child With ASD and Stuttering

For a child with autism getting the right words out even without stuttering can be difficult. The presence of a speech disfluency like stuttering makes communication dreadful for many children as well as adults with ASD. Even the most brilliant minds may take more than a minute to get a single word out. It is like “the words keep getting stuck on a sticky tape in my brain,” as stated by a 6-year old with ASD and stuttering speech.

Children with ASD and stuttering may have difficulty in expressing themselves, but they are in no way deserving of one’s frustration, impatience, irritation or anger. In most cases, the child knows exactly what to say, but he or she has difficultly in minting the words or processing speech.

Stammering is a disability indeed but coupled with ASD it can take a debilitating form which may hinder the emotional growth of an individual. It hinders their social life and the ability to form and maintain meaningful relationships later on. Misperceptions about ASD and stuttering disorder can cause children to become further withdrawn and it can affect their quality of life as a whole.

Stuttering Treatment for those with ASD and Stuttering

The treatment for stuttering depends on the needs of the client, which is especially true in the case of those with ASDs. Stuttering further impacts communication and social skills of those with ASD. Therefore, therapy is crucial. Since self-monitoring and social interaction can be incredibly difficult for those with ASD, therapists often focus on fluency tools during social interactions.

  1. Traditional stuttering tools – The child’s age and level of comprehension will determine how the therapist introduces these tools into practice. Children with a higher level of comprehension may benefit more from the techniques in a picture or written format. Those with lower comprehension levels can utilize less descriptive methods with more imagination of therapist models. For example, many child therapists use playdough or stretchy slime to represent prolonged speech. Visualization of their speech disfluencies playfully and tangibly may aid them to overcome the symptoms of stuttering to a great extent. Repeated practice is the key for children with ASD and stuttering to acquire greater fluency in speech.
  2. An aide for organizing thoughts – Visual cues and organizers like online visual mapping programs can help children collate and express their thoughts. The newly acquired skills should be evident in daily communication. Once again, practice is the only way to maintain the child’s ability to structure their thoughts and sentences.
  3. Introducing increasing pausing – The increase in pausing can allow additional time for the child to –
    a. Gather their thoughts
    b. Practice controlled breathing
    c. Apply the fluency tools (easy starts, easy onsets or prolonged speech)
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What Parents of Children With Autism and Stuttering Should Remember

The parents of a child with both ASD and stuttering has an important role to play in their emotional development. The way you support your child during his or her daily conversations and activities will determine their level of confidence while dealing with the outer world.

Here are a few points you must remember while speaking to your child –

  1. Do not complete a word or sentence for your child
  2. Keep positive and encouraging facial expressions
  3. Listen patiently and respond at the appropriate places
  4. Do not show impatience or frustration
  5. Do not rush your child to finish speaking
  6. Do not assume that he or she lacks the capability to understand what he or she is trying to convey
  7. Do not overwhelm your child with too many bits of information at one go
  8. Practice taking turns while talking

Not interrupting someone while they are talking is a basic social skill every adult should possess. It shows respect for the speaker.

What I Wish Everyone Knew

Listening to a child with a speech disability should be no different. ASD makes the diagnosis of an already withdrawn child more difficult than a neurotypical individual. However, that does not mean there is no scope for the child to speak with more fluency in the future.

We must remember that autism spectrum disorder is very common. 222 out of 10,000 children in the US, 106 out of 10,000 in Canada, and 23 out of 10,000 in India have ASD. Autism is neither good nor bad. It is simply a disorder that makes a person unique!

Speech therapy for those with autism and stammering can help these individuals break free from their speech impediments, and help create a more inclusive world.

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