What state do you live in? Unfortunately licensed SLPs are only allowed to provide consults other than the state they’re licensed in, but I’m happy to try and provide some information here as it might be helpful to others as well! However, my best recommendation would definitely be for you to find a SLP near you and see if setting up an evaluation and therapy would be the most appropriate for your child. If you need help finding a therapist, take a look at www.thespotcollaborative.com. ! There is definitely a lot to unpack here and with that stuttering they’re really is no unknown cause it’s often a combination of genetic and environmental factors. There are different characteristics that we might look at to determine if a child may continue to stutter. Some of these include being male, have a family history of stuttering, later stuttering onset (starting after age 3.5), stuttering not starting to decrease after 12 months, overall time since onset greater than 1 year, presence of an average of more than 3 rapid repetitions, presence of prolongations or blocks, poor phonological or articulation/speech sound abilities, sensitive temperament. There is one model called the demand capacity model that I think can be helpful when thinking about stuttering and children. As children’s brains develop it must share all the information in the space that has developed. When the brain needs to process increasing amounts of information it moves slower due to insufficient capacity. This is a natural part of brain development in all children. Stuttering can occur when the capacity of the child’s brain for fluency is not equal to the demands that I’ve been placed in the environment for speech . Sometimes I use this analogy called the bucket analogy. everyone starts with a bucket that’s already a little bit full of water, and these are child factors such as genetic predisposition, sensitive temperament, language/ motor mismatch, and other speech/language disorders, maybe co-occurring diagnoses such as adhd, asthma, etc. Then you have environmental factors and life experiences such as traumatic events, life changes, family/sibling conflicts, unrealistic demands, fast paced lifestyle etc. and then we have communication stressors such as rapid pace of conversation, competition for talking time, frequent interruption, negative reactions to stuttering, high communication demands, etc. we already start with the child factors in our bucket and then add some of these environmental factors or communication stressors, and the bucket starts to overflow and that’s when we might see stuttering. This relates to that demand capacity type model where increased demands reduces the brains capacity to perform. Some of those factors like genetic predisposition, we can’t change or modify however, there are things that we can modify. So with this beach therapist, they may help you to recognize and modify the environment and communication stressors in order to produce a more fluency enhancing environment to decrease the chance that a child may continue to stutter although no one can really know for sure if a child will continue to stutter. Connecting to the demands/bucket analogy- It sounds like language skills are developed which is great! Usually around age 4 children are starting to, like you said, develop more complex language not only in syntax, but also they’re beginning to tell narratives which can also require a lot of organization and formulation. Something like this can definitely increase dysfluencies. This can also happen if there’s a mismatch between language abilities, and motor abilities, so if your child has always had been a little bit more delayed in gross motor skills, his language abilities at this time might be growing more rapidly than his motor system is able to keep up with. Speech production is a very complex system, so if his language ability is greater than his motor demands, his motor system may not be quite as developed as his language abilities at this time. In regards to asthma, there isn’t a ton of research on asthma or medications as they relate to stuttering however there is some research that suggests that children with stutter often have other diagnoses - asthma may be one. Speech is complex and starts with our breathing system to produce speech so it’s possible asthma is adding to the demands/to his bucket. If the medication is new, it’s possible this is adding to that “bucket” as well! It could be a variety of factors that contribute so I think speaking to your doctor regarding best practices to help support asthma and what medication may work for him is best. Then speaking to a speech therapist near you who can dive more into your child’s specific scenario, case history etc and continue to monitor over the next six months could be what’s best! A speech therapist can help give you strategies to help modify the environment and communication stressors to help reduce the water in the bucket/reduce demands on the system. Sorry for such a long message of information but I hope this is helpful!