Stuttering
Stuttering
Definition
There is no standard definition of stuttering, but most attempt to define stuttering as the blockages, discoordination, or fragmentations of the forward flow of speech (fluency). These stoppages, referred to as disfluencies, are often excessive and characterized by specific types of disfluency. These types of disfluencies include repetitions of sounds and syllables, prolongation of sounds, and blockages of airflow. Individuals who stutter are often aware of their stuttering and feel a loss of control when they are
disfluent. Both children and adults stutterers expend an excessive amount of physical and mental energy when speaking. Older children and adults who stutter show myriad negative reactive behaviors, feelings, and attitudes. These behaviors, referred to as “secondary behaviors,” make the disorder more severe and difficult.
Description
Stuttering is a confusing and often misunderstood developmental speech and language disorder. Before discussing stuttering, it is important to understand the concepts of speech fluency and disfluency. Fluency is generally described as the forward flow of speech. For most speakers, fluent speech is easy and effortless. Fluent speech is free of any interruptions, blockages, or fragmentations. Disfluency is defined as a breakdown or blockage in the forward flow of speech, or fluency. For all speakers, some occurrence of disfluency is normal. For example, people may insert short sounds or words, referred to as “interjections,” when speaking; examples of such are “um,” “like,” or “uh.” Also, speakers might repeat phrases, revise words or phrases, or sometimes repeat whole words for the purpose of clarification. For young children, disfluency is a part of the normal development of speech and language, especially during the preschool years (between the ages of two and five years).
The occurrence of disfluency is not the same as stuttering, though stuttered speech is characterized by an excessive amount of disfluency. The disfluencies produced by people who stutter will often be similar to those in the speech of individuals who do not stutter; however, certain types of disfluent behavior are likely to appear only in the speech of people who stutter. These disfluencies are sound and syllable repetitions (i.e., ca-ca-ca-cat), sound prolongations (“sssss-salad,” “ffffff-fish”), and complete blockages of airflow. These behaviors, often referred to as stuttering type disfluencies, distinguish stuttered speech from nonstuttered speech.
Unlike speakers who do not stutter, most people who stutter react negatively to their disfluencies. A person may develop a number of physical reactions, including tension of the muscles involved in speech (tongue, jaw, lips, or chest, for example) and tension in muscles not related to speech (such as shoulders, limbs, and forehead). In addition to these physiological reactions, people who stutter will often have negative emotional reactions to the disorder. Among the emotions that people who stutter report are embarrassment, guilt, and frustration.
Finally, many people who stutter will develop a number of negative attitudes and beliefs regarding themselves and speaking—because of their stuttering. These may be negative attitudes and beliefs in certain speaking situations, with people with whom they interact, and in their own abilities. These physiological, emotional, and attitudinal (cognitive) reactions to stuttering, described as secondary stuttering behaviors, are often very disruptive to the communication process and the person’s life.
Stuttering behaviors can develop and vary throughout the life span. Sometimes, children will experience periods when the stuttering appears to “go away,” only to return in a more severe pattern. Many children, (estimates range between 50 and 80%) will develop normal fluency after periods of stuttering. For those who continue to stutter during late childhood, adolescence, and into adulthood, stuttering can become a chronic problem. Lifelong efforts will be needed to cope successfully with the behavior.
Due to the effect that stuttering has on communication, the person who stutters may experience certain difficulties in various parts of his/her life. These problems might be secondary to factors inside the person (symptoms of stuttering) and outside the person (society’s attitudes toward stuttering and other barriers). For example, many people who stutter report difficulties in social settings. Children who stutter often experience teasing and other social penalties. Adolescents and adults also report a variety of social problems. Academic settings may be difficult for children who stutter because of the emphasis schools place on verbal performance.
Finally, there appears to be some evidence that people who stutter might confront barriers in employment. These barriers might take the form of inability to do certain tasks easily (talking on the phone, for example), limitations in job choices, and discrimination in the hiring and promotion processes.
Causes and symptoms
Though research has not identified a single cause, there appears to be several factors that are viewed as being important to the onset and development of stuttering. Therefore, stuttering is often described as being related to multiple factors and having possibly multiple causes. First, there is a genetic predisposition to stutter, as evidenced by studies of families and twins. A second important factor in stuttering the onset of stuttering is the physiological makeup of people who stutter. Research suggests that the brains of people who stutter may function abnormally during speech
production. These differences in functioning may lead to breakdowns in speech production and to the development of disfluent speech.
Third, there is some evidence that speech and language development is an important issue in understanding the development of stuttering. Studies have found some evidence that children who are showing stuttering type behaviors may also have other difficulties with speech-language. Additionally, children with speech-language delays will often show stuttering type behaviors. Finally, environmental issues have a significant impact on the development of stuttering behaviors. An environment that is overly stressful or demanding, may cause children to have difficulties developing fluent speech. Though the environment, in particular parental behaviors, does not cause stuttering, it is an important factor that might adversely affect a child who is operating at a reduced capacity for developing fluent speech.
There is no evidence that stuttering is secondary to a psychological disturbance. It is reasonable to assume that stuttering might have some effect on psychological adjustment and a person’s ability to cope with speaking situations. People who stutter might experience a lower self-esteem and some might report feeling depressed. These feelings and difficulties with coping are most likely the result and not the cause of stuttering. In addition, several research studies have reported that many people who stutter report high levels of anxiety and stress when they are talking and stuttering. These feelings, psychological states, and difficulties with coping are most likely the result and not the cause of stuttering.
Generally, children begin to stutter between the ages of two and five years. Nevertheless, there are instances when individuals begin to show stuttering type behaviors in late childhood or as adults. These instances are often related to specific causes such as a stroke or a degenerative neurological disease. This type of stuttering, stuttering secondary to a specific neurological process, is referred to as neurogenic stuttering. In other cases, stuttering may be secondary to a psychological conversion disorder due to a psychologically traumatic event. When stuttering has abrupt onset secondary to a psychological trauma, it is described as psychogenic stuttering.
As stated earlier, the primary symptoms of stuttering include excessive disfluency, both stuttering and normal types (core behaviors), as well as physical, emotional, and cognitive reactions to the problem. These behaviors will vary in severity across people who stutter from very mild to very severe. Additionally, the behaviors will vary considerably across different speaking situations. There are specific situations when people tend to experience more stuttering (such as talking on the phone or with an authority figure) or less stuttering (speaking with a pet or to themselves, for example). It is likely that this variability might even extend to people having periods (days and even weeks) when they can maintain normally fluent or nonstut-tered speech.
Demographics
Stuttering is a relatively low-prevalence disorder. Across all cultures, roughly 1% of people currently has a stuttering disorder. This differs from incidence, or number of individuals who have been diagnosed with stuttering at some point in their lives. Research suggests that roughly 5% of the population has ever been diagnosed with a stuttering disorder. This difference suggests that a significant number of individuals who stutter will someday develop through or “grow out of” the problem. Research suggests that roughly 50-80% of all children who begin to stutter will stop stuttering. In addition, approximately three times as many men stutter as women. This ratio seems to be lower early in childhood, with a similar number of girls and boys stuttering. The ratio of boys to girls appears to get larger as children become older. This phenomenon suggests that males are more likely to continue to stutter than females.
Diagnosis
Speech-language pathologists are responsible for making the diagnosis and managing the treatment of adults and children who stutter. Preferably, a board-certified speech-language pathologist board should be sought for direct intervention or consulting. Diagnosis of stuttering, or identifying children at risk for stuttering, is difficult because most children will show excessive disfluencies in their speech. With children, diagnostic procedures include the collection and analysis of speech and disfluent behaviors in a variety of situations. In addition, the child’s general speech-language abilities will be evaluated.
Finally, the speech-language pathologist will interview parents and teachers regarding the child’s general developmental, speech-language development, and their perceptions of the child’s stuttering behaviors. For adults and older children, the diagnostic procedures will also include gathering and analyzing speech samples from a variety of settings. In addition, the speech-language pathologist will conduct a lengthy interview with the person about their
stuttering and history of their stuttering problem. Finally, the person who stutters might be asked to report his/her attitudes and feelings related to stuttering, either while being interviewed or by completing a series of questionnaires.
Treatments
General considerations
It is generally accepted that conducting interventions with children and families early in childhood (preschool) is the most effective means of total recovery from stuttering. The chances for a person to fully recover from stuttering by obtaining near-normal fluency are reduced as the person ages. This is why early intervention is critical. For older children and adults for which stuttering has become a chronic disorder, the focus of therapy is on developing positive coping mechanisms for dealing with the problem. This therapy varies in success based on the individual.
Treatment options for young children
Treatment of young children generally follows one of two basic approaches. These approaches may also be combined into a single treatment program. The first type of approach, often referred to as indirect therapy, focuses on altering the environment to allow the child opportunities to develop fluent speech. With this approach, counseling parents regarding the alteration of behaviors that affect fluency is the focus. For example, parents may be taught to reduce the amount of household stress or in the level of speech-language demands being placed on the child. In addition, parents may be advised to change characteristics of their speech, such as their speech rate and turn-taking style; this is done to help their children develop more fluent speech.
The other basic approach in treatment with young children targets the development of fluent speech. This type of approach, often referred to as direct therapy, teaches children to use skills that will help them improve fluency and they are sometimes given verbal rewards for producing fluent speech.
Treatment options for older children and adults
Treatment approaches for older children and adults usually take one of two forms. These approaches target either helping the person to modify his/her stuttering or modify his/her fluency. Approaches that focus on modifying stuttering will usually teach individuals to reduce the severity of their stuttering behaviors by identifying and eliminating all of the secondary or reactive behaviors. Individuals will also work to reduce the amount of emotional reaction toward stuttering.
KEY TERMS
Disfluency —Disruptions, breakage, or blockages in the forward flow of speech.
Secondary behaviors —Negative behavioral, emotional, or cognitive reactions to stuttering.
Speech-language pathologist —Specialists trained in assessment and diagnosis of communication disorders.
Finally, the speech-language pathologist will help the individual to learn techniques that allow them to stutter in an easier manner. Therapy does not focus on helping the individual to speak fluently, though most individuals will attain higher levels of fluency if this approach is successful. The other groups of approaches will focus on assisting adults and children who stutter to speak more fluently. This type of therapy, which focuses less on changing secondary and emotional reactions, helps the person to modify their speech movements in a specific manner that allows for fluent sounding speech. These procedures require the individual to focus on developing new speech patterns. This often requires a significant amount of practice and skill. The successful outcome of these approaches is nonstuttered, fluent sounding speech. Many therapists will integrate stuttering modification and fluency shaping approaches into more complete treatment programs. In addition, psychological counseling may be used to supplement traditional speech therapy.
Prognosis
Complete alleviation of recovery from stuttering is most likely possible when children and their families receive treatment close to the time of onset. Thus, early identification and treatment of stuttering is critical. For older children and adults, stuttering becomes a chronic problem that requires a lifetime of formal and self-directed therapy. For individuals who show this more chronic form of the disorder, internal motivation for change and support from significant others is going to be an important part of recovery.
Resources
BOOKS
Bloodstein, O. A Handbook on Stuttering. 5th ed., revised. San Diego, CA. Singular Publishing, 1995.
Guitar, B. Stuttering: An Integrated Approach to Its Nature and treatment. 2nd edition, text revision. Baltimore, MD: Lippincott Williams and Willkins, 1998.
Manning, W. H. Clinical Decision Making in Fluency Disorders. 2nd. ed., revised. San Diego, CA. Singular Publishing, 2001.
ORGANIZATIONS
National Stuttering Association. 5100 East La Palma, Suite #208, Anaheim Hills, CA 92807. http://www.nsastutter.org
Stuttering Foundation of America. 3100 Walnut Grove Road, Suite 603, P.O. Box 11749, Memphis, TN 38111-0749. http://www.stuttersfa.org
Rodney Gabel, Ph.D.
Stuttering
Stuttering
Definition
There is no standard definition of stuttering, but most attempt to define stuttering as the blockages, discoordination, or fragmentations of the forward flow of speech (fluency). These stoppages, referred to as disfluencies, are often excessive and characterized by specific types of disfluency. These types of disfluencies include repetitions of sounds and syllables, prolongation of sounds, and blockages of airflow. Individuals who stutter are often aware of their stuttering and feel a loss of control when they are disfluent. Both children and adults stutterers expend an excessive amount of physical and mental energy when speaking. Older children and adults who stutter show myriad negative reactive behaviors, feelings, and attitudes. These behaviors, referred to as "secondary behaviors," make the disorder more severe and difficult.
Description
Stuttering is a confusing and often misunderstood developmental speech and language disorder. Before discussing stuttering, it is important to understand the concepts of speech fluency and disfluency. Fluency is generally described as the forward flow of speech. For most speakers, fluent speech is easy and effortless. Fluent speech is free of any interruptions, blockages, or fragmentations. Disfluency is defined as a breakdown or blockage in the forward flow of speech, or fluency. For all speakers, some occurrence of disfluency is normal. For example, people may insert short sounds or words, referred to as "interjections," when speaking; examples of such are "um," "like," or "uh." Also, speakers might repeat phrases, revise words or phrases, or sometimes repeat whole words for the purpose of clarification. For young children, disfluency is a part of the normal development of speech and language, especially during the preschool years (between the ages of two and five years).
The occurrence of disfluency is not the same as stuttering, though stuttered speech is characterized by an excessive amount of disfluency. The disfluencies produced by people who stutter will often be similar to those in the speech of individuals who do not stutter; however, certain types of disfluent behavior are likely to appear only in the speech of people who stutter. These disfluencies are sound and syllable repetitions (i.e., ca-ca-ca-cat), sound prolongations ("sssss-salad," "ffffff-fish"), and complete blockages of airflow. These behaviors, often referred to as stuttering type disfluencies, distinguish stuttered speech from nonstuttered speech.
Unlike speakers who do not stutter, most people who stutter react negatively to their disfluencies. A person may develop a number of physical reactions, including tension of the muscles involved in speech (tongue, jaw, lips, or chest, for example) and tension in muscles not related to speech (such as shoulders, limbs, and forehead). In addition to these physiological reactions, people who stutter will often have negative emotional reactions to the disorder. Among the emotions that people who stutter report are embarrassment, guilt, and frustration.
Finally, many people who stutter will develop a number of negative attitudes and beliefs regarding themselves and speaking—because of their stuttering. These may be negative attitudes and beliefs in certain speaking situations, with people with whom they interact, and in their own abilities. These physiological, emotional, and attitudinal (cognitive) reactions to stuttering, described as secondary stuttering behaviors, are often very disruptive to the communication process and the person's life.
Stuttering behaviors can develop and vary throughout the life span. Sometimes, children will experience periods when the stuttering appears to "go away," only to return in a more severe pattern. Many children, (estimates range between 50 and 80%) will develop normal fluency after periods of stuttering. For those who continue to stutter during late childhood, adolescence, and into adulthood, stuttering can become a chronic problem. Lifelong efforts will be needed to cope successfully with the behavior.
Due to the effect that stuttering has on communication, the person who stutters may experience certain difficulties in various parts of his/her life. These problems might be secondary to factors inside the person (symptoms of stuttering) and outside the person (society's attitudes toward stuttering and other barriers). For example, many people who stutter report difficulties in social settings. Children who stutter often experience teasing and other social penalties. Adolescents and adults also report a variety of social problems. Academic settings may be difficult for children who stutter because of the emphasis schools place on verbal performance.
Finally, there appears to be some evidence that people who stutter might confront barriers in employment. These barriers might take the form of inability to do certain tasks easily (talking on the phone, for example), limitations in job choices, and discrimination in the hiring and promotion processes.
Causes and symptoms
Though research has not identified a single cause, there appears to be several factors that are viewed as being important to the onset and development of stuttering. Therefore, stuttering is often described as being related to multiple factors and having possibly multiple causes. First, there is a genetic predisposition to stutter, as evidenced by studies of families and twins. A second important factor in the onset of stuttering is the physiological makeup of people who stutter. Research suggests that the brains of people who stutter may function abnormally during speech production. These differences in functioning may lead to breakdowns in speech production and to the development of disfluent speech.
Third, there is some evidence that speech and language development is an important issue in understanding the development of stuttering. Studies have found some evidence that children who are showing stuttering type behaviors may also have other difficulties with speech-language. Additionally, children with speech-language delays will often show stuttering type behaviors. Finally, environmental issues have a significant impact on the development of stuttering behaviors. An environment that is overly stressful or demanding, may cause children to have difficulties developing fluent speech. Though the environment, in particular parental behaviors, does not cause stuttering, it is an important factor that might adversely affect a child who is operating at a reduced capacity for developing fluent speech.
There is no evidence that stuttering is secondary to a psychological disturbance. It is reasonable to assume that stuttering might have some effect on psychological adjustment and a person's ability to cope with speaking situations. People who stutter might experience a lower self-esteem and some might report feeling depressed. These feelings and difficulties with coping are most likely the result and not the cause of stuttering. In addition, several research studies have reported that many people who stutter report high levels of anxiety and stress when they are talking and stuttering. These feelings, psychological states, and difficulties with coping are most likely the result and not the cause of stuttering.
Generally, children begin to stutter between the ages of two and five years. Nevertheless, there are instances when individuals begin to show stuttering type behaviors in late childhood or as adults. These instances are often related to specific causes such as a stroke or a degenerative neurological disease. This type of stuttering, stuttering secondary to a specific neurological process, is referred to as neurogenic stuttering. In other cases, stuttering may be secondary to a psychological conversion disorder due to a psychologically traumatic event. When stuttering has abrupt onset secondary to a psychological trauma, it is described as psychogenic stuttering.
As stated earlier, the primary symptoms of stuttering include excessive disfluency, both stuttering and normal types (core behaviors), as well as physical, emotional, and cognitive reactions to the problem. These behaviors will vary in severity across people who stutter from very mild to very severe. Additionally, the behaviors will vary considerably across different speaking situations. There are specific situations when people tend to experience more stuttering (such as talking on the phone or with an authority figure) or less stuttering (speaking with a pet or to themselves, for example). It is likely that this variability might even extend to people having periods (days and even weeks) when they can maintain normally fluent or nonstuttered speech.
Demographics
Stuttering is a relatively low-prevalence disorder. Across all cultures, roughly 1% of people currently has a stuttering disorder. This differs from incidence, or number of individuals who have been diagnosed with stuttering at some point in their lives. Research suggests that roughly 5% of the population has ever been diagnosed with a stuttering disorder. This difference suggests that a significant number of individuals who stutter will someday develop through or ""grow out of" the problem. Research suggests that roughly 50-80% of all children who begin to stutter will stop stuttering. In addition, approximately three times as many men stutter as women. This ratio seems to be lower early in childhood, with a similar number of girls and boys stuttering. The ratio of boys to girls appears to get larger as children become older. This phenomenon suggests that males are more likely to continue to stutter than females.
Diagnosis
Speech-language pathologists are responsible for making the diagnosis and managing the treatment of adults and children who stutter. Preferably, a board-certified speech-language pathologist board should be sought for direct intervention or consulting. Diagnosis of stuttering, or identifying children at risk for stuttering, is difficult because most children will show excessive disfluencies in their speech. With children, diagnostic procedures include the collection and analysis of speech and disfluent behaviors in a variety of situations. In addition, the child's general speech-language abilities will be evaluated.
Finally, the speech-language pathologist will interview parents and teachers regarding the child's general developmental, speech-language development, and their perceptions of the child's stuttering behaviors. For adults and older children, the diagnostic procedures will also include gathering and analyzing speech samples from a variety of settings. In addition, the speech-language pathologist will conduct a lengthy interview with the person about their stuttering and history of their stuttering problem. Finally, the person who stutters might be asked to report his/her attitudes and feelings related to stuttering, either while being interviewed or by completing a series of questionnaires.
Treatments
General considerations
It is generally accepted that conducting interventions with children and families early in childhood (preschool) is the most effective means of total recovery from stuttering. The chances for a person to fully recover from stuttering by obtaining near-normal fluency are reduced as the person ages. This is why early intervention is critical. For older children and adults for which stuttering has become a chronic disorder, the focus of therapy is on developing positive coping mechanisms for dealing with the problem. This therapy varies in success based on the individual.
Treatment options for young children
Treatment of young children generally follows one of two basic approaches. These approaches may also be combined into a single treatment program. The first type of approach, often referred to as indirect therapy, focuses on altering the environment to allow the child opportunities to develop fluent speech. With this approach, counseling parents regarding the alteration of behaviors that affect fluency is the focus. For example, parents may be taught to reduce the amount of household stress or in the level of speech-language demands being placed on the child. In addition, parents may be advised to change characteristics of their speech, such as their speech rate and turn-taking style; this is done to help their children develop more fluent speech.
The other basic approach in treatment with young children targets the development of fluent speech. This type of approach, often referred to as direct therapy, teaches children to use skills that will help them improve fluency and they are sometimes given verbal rewards for producing fluent speech.
Treatment options for older children and adults
Treatment approaches for older children and adults usually take one of two forms. These approaches target either helping the person to modify his/her stuttering or modify his/her fluency. Approaches that focus on modifying stuttering will usually teach individuals to reduce the severity of their stuttering behaviors by identifying and eliminating all of the secondary or reactive behaviors. Individuals will also work to reduce the amount of emotional reaction toward stuttering.
Finally, the speech-language pathologist will help the individual to learn techniques that allow them to stutter in an easier manner. Therapy does not focus on helping the individual to speak fluently, though most individuals will attain higher levels of fluency if this approach is successful. The other groups of approaches will focus on assisting adults and children who stutter to speak more fluently. This type of therapy, which focuses less on changing secondary and emotional reactions, helps the person to modify their speech movements in a specific manner that allows for fluent sounding speech. These procedures require the individual to focus on developing new speech patterns. This often requires a significant amount of practice and skill. The successful outcome of these approaches is nonstuttered, fluent sounding speech. Many therapists will integrate stuttering modification and fluency shaping approaches into more complete treatment programs. In addition, psychological counseling may be used to supplement traditional speech therapy.
Prognosis
Complete alleviation of recovery from stuttering is most likely possible when children and their families receive treatment close to the time of onset. Thus, early identification and treatment of stuttering is critical. For older children and adults, stuttering becomes a chronic problem that requires a lifetime of formal and self-directed therapy. For individuals who show this more chronic form of the disorder, internal motivation for change and support from significant others is an important part of recovery.
Resources
BOOKS
Bloodstein, O. A Handbook on Stuttering. 5th ed., revised. San Diego, CA. Singular Publishing, 1995.
Guitar, B. Stuttering: An Integrated Approach to Its Nature and treatment. 2nd edition, text revision. Baltimore, MD: Lippincott Williams and Willkins, 1998.
Manning, W. H. Clinical Decision Making in Fluency Disorders. 2nd. ed., revised. San Diego, CA. Singular Publishing, 2001.
ORGANIZATIONS
National Stuttering Association. 5100 East La Palma, Suite #208, Anaheim Hills, CA 92807. <http://www.nsastutter.org>.
Stuttering Foundation of America. 3100 Walnut Grove Road, Suite 603, P.O. Box 11749, Memphis, TN 38111-0749. <http://www.stuttersfa.org>.
See also Speech-language pathology
Rodney Gabel, Ph.D.
Stuttering
Stuttering
Definition
Stuttering has no absolute definition that encompasses all the aspects of the disorder. In general, it is a condition in which a person trying to speak has difficulty in expressing words normally. Morphemes (actual individual sounds such as "mm" or the explosive "p") are not easily articulated. Two common symptoms of stuttering are the drawing out of the morpheme as in "mmmmmore" or the repetitious "l-l-l-look" of seemingly simple words.
Stuttering is not to be confused with another speech disorder called cluttering. Cluttering has a much more definitive cause and clearer symptoms. Its neurogenic link has been more thoroughly established, while the roots of stuttering have not. Cluttering involves a rapid speech pattern, while stuttering can take on a variety of levels of complexity.
Description
In the past, researchers and speech therapists assumed that stuttering was a developmental disorder. Increasing evidence points to a genetic cause in many patients, especially males. The results are far from clear and studies are conflicting in their data and conclusions. Many studies are focused on the fact that monozygotic (one egg) twins both seem to stutter when the disorder is present.
Stuttering is usually identified in children. Unless the situation is extremely stressful, such as speaking in front of a large group of people, or an equally distressing condition is present, very few adults begin to stutter later in life. Stress and anxiety about the inability to easily express thoughts and words is very distressing for the child who stutters and can prolong recovery or even prevent it.
The social anxiety accompanying stuttering is one of the reasons researchers have historically cited the lack of emotional well-being or the production of high anxiety as the root cause of the disorder. While at an early age, when peer pressure and social acceptance is extraordinarily important, the lack of understanding by other children can be very difficult to overcome. At this point, stuttering does become an emotional as well as physical challenge.
Demographics
More than 1% of the population stutters. However, if every person who has, at some time, found themselves stuttering when anxious were included, the condition would be considered a great deal more common. Males are four times more likely than females to stutter. Stuttering is also more common in children than adults.
The Stuttering Foundation of America has provided facts on who is likely to stutter. They describe four of the most common factors that lead to stuttering. The first is genetics. Clinical results indicate that around 60% of those who stutter have a family member who also stutters. A second possible cause for stuttering involves developmental delays. Researchers claim that children with other speech and language problems are more likely to stutter than those who do not.
The third proposed reason for stuttering involves the physiology of the brain. With magnetic resonance imaging (MRI) and other such examinations, it appears that some people process speech and language in different regions of the brain than those who do not stutter. Early language acquisition occurs in the Broca's area of the brain, but this ability lasts only for a short time during childhood. After initial speech is acquired, language is learned in other regions of the brain. This may have an influence on those who stutter.
Finally, family dynamics are implicated as reasons for stuttering. Parents with high expectations and little patience may push a child to speak before he or she is ready. Without proper education, some parents may push their children to achieve certain goals by a particular age. If the goal is not, met a child may experience anxiety and it is possible this could result in stuttering.
Causes and symptoms
The actual physiological cause of stuttering is not conclusive.
Neurogenic stutterers are those people who have developed the disorder as a result of some sort of head injury or trauma. Their speech may be repetitious, prolonged, and they may even experience a mental block on certain words or phrases. However, they seem to lack the fears and anxieties of those who are designated as developmental stutterers. The severity of neurogenic stuttering is directly correlated with the degree of brain injury and degree of healing.
Diagnosis
A health professional or speech therapist trained in identifying varying speech disorders makes the diagnosis of stuttering. Stuttering must be isolated from anxious stammering, brain-related cluttering, and a variety of additional speech disorders.
Treatment team
The treatment team for a stutterer is multidisciplinary. Initially, a child's parent or teacher may identify a problem in communication and reading aloud. The pediatrician usually identifies and makes the diagnosis of stuttering as opposed to other vocal disturbances. A neurological consultation may be sought. Occurrences such as head trauma or lesions of the brain must be ruled out as a contributing factor.
Many speech and language pathologists have been trained and licensed to work with stutterers. They can provide exercises, vocal awareness, and support that the stutterer needs to begin a path to recovery. Many schools offer these types of support and are free to the students.
One of the best teams for the treatment of stuttering is the family and friends of the person who stutters. It is likely the stutterer feels embarrassment or guilt over the condition. Family and friends who take the time to understand the condition and show their patience and acceptance can help the person who stutters. Reading books about the condition and aiding in home therapies is a proven method of making the stutterer feel less shame and embarrassment. In turn, the benefits of therapy can be reached more quickly.
Treatment
Most clinicians recommend a holistic approach in which patients are allowed to find their own most useful therapy. A good rapport should exist between the speech therapist and patient.
Significantly, often when the person who stutters focuses on a related task such as singing, the individual fails to show any symptoms. When a prescribed set of words and additional distraction are employed, it appears the stutterer has fewer problems speaking clearly. Singing and rhyming are strategies used by speech therapists as confidence boosters to illustrate that the person has the ability to express language in a natural, easily flowing manner.
Recently, some electrical devices for the treatment of stuttering have come onto the market, but their success is still not well documented. The Delayed Auditory Feedback (DAF) and Frequency-Shifting Auditory Feedback (FAF) are electronic devices that pick up a voice from a microphone, delay the sound for a fraction of a second, and feed the voice back through earphones. Some clinicians claim the feedback machines can significantly reduce or eliminate stuttering.
Recovery and rehabilitation
Recovery from stuttering is unpredictable for several reasons. Many people must come to the aid of the stutterer. Family and friends, the therapist, schoolmates, and a variety of additional environmental conditions must be in place for the stutterer to gain control over the disorder. If all is in place, the chance of significant improvement is excellent.
Clinical trials
As of early 2004, the National Institute on Deafness and Other Communication Disorders and the National Institute of Neurological Diseases and Stroke were sponsoring several clinical trials on the nature and treatment of stuttering. Information about the studies can be found at the National Institutes of Health clinical trials website: <http://www.clinicaltrials.gov/ct/search?term=stuttering&submit=Search>.
Prognosis
The prognosis for people who stutter can be very good. The American Society of Stuttering lists some famous people who stutter and have proceeded to make careers in which their voice is an asset. The list includes James Earl Jones, Mel Tillis, Winston Churchill, Marilyn Monroe, Carly Simon, and many more celebrities who make their living by announcing, acting, or singing.
Special concerns
Many childhood stutterers are not receiving adequate treatment because of poverty or financially stretched school resources. The American Institute for Stuttering offers information on seeking financial resources for the treatment of stuttering, training of professionals to treat those who stutter, and additional information about stuttering.
Resources
BOOKS
Guitar, Barry, and Theodore Peters. Stuttering: An Integrated Approach to Its Nature and Treatment, 2nd ed. Philadelphia: Lippincott, Williams & Wilkins, 1998.
Kehoe, Thomas. Multifactoral Stuttering Therapy: A Guide for Persons Who Stutter, Parents, and Speech-Language Pathologists. Boulder, CO: Casa Futura Technologies, 2002.
Logan, Robert. The Three Dimensions of Stuttering: Neurology, Behavior, and Emotion. London: Whurr Publishers, 1998.
OTHER
"How to React When Speaking with Someone Who Stutters." Stuttering Foundation of America. April 4, 2004 (June 3, 2004). <http://206.104.238.56/brochures/br_htr.htm>.
"Stuttering." University of Maryland Medicine. April 4, 2004 (June 3, 2004). <http://www.umm.edu/ent/stutter.htm>.
ORGANIZATIONS
American Speech-Language-Hearing Association. 10801 Rockville Pike, Rockville, MD 20852. (301) 897-5700 or (800) 638-8255; (301) 571-0457. [email protected]. <http://www.nsastutter.org>.
National Stuttering Association. 471 East La Palma Avenue, Suite A, Anaheim Hills, CA 92807. (714) 693-7480 or (800) 364-1677; (714) 630-7707. [email protected]. <http://www.nsastutter.org>.
Brook Ellen Hall, PhD
Stuttering
Stuttering
Definition
Stuttering is a speech problem characterized by repetitions; pauses; or drawn-out syllables, words, and phrases. Stutterers are different than people experiencing normal fluency problems because a stutterer's disfluency is more severe and consistent than that of people who do not stutter.
Description
Normal language development in a child usually includes a period of disfluency. Children might repeat syllables or words once or twice. Sometimes, children experiencing normal disfluencies hesitate during speech or use fillers, including "um," with frequency. These developmental problems usually happen between one and five years of age. Often, parents are concerned about the disfluency they hear in their children.
A child with mild stuttering, however, will repeat sounds more than twice. Parents and teachers often notice the child's facial muscles become tense and he or she might struggle to speak. The child's voice pitch might rise with repetitions, and some children experience occasional periods when airflow or voice stops for seconds at a time. Children with more severe stuttering stutter through more than 10 percent of their speech. This child exhibits considerable tension and tries to avoid stuttering by using different words. In these children, complete blocks of speech are more common than repetitions or prolongations, during which children lengthen syllables or words.
Stuttering does not affect intelligence . Teens often experience more noticeable problems with stuttering as they enter the dating scene and increase their social interactions. Stuttering can severely affect one's life. Often, adults who are concerned about stuttering choose their careers based on the disability.
The degree of stuttering is often inconsistent. Stutterers can be fluent in some situations. Many find that they stop stuttering when singing or doing other activities involving speech. Some have good and bad days when it comes to stuttering. On good days, a stutterer might be able to talk fluently using words that usually cause him to repeat, pause or prolong sounds, syllables, parts of words, entire words, or phrases.
Demographics
More than 3 million Americans stutter and four times more males are affected than females. Stuttering usually begins in childhood when the child is developing language skills, and it rarely develops in adulthood with only 1 percent of the population affected by the disorder. Approximately 25 percent of all children experience speech disfluencies during development that concern their parents because of their severity.
Causes and symptoms
There is no known cause of stuttering. Some believe that it has a physical cause and that it might be related to a breakdown in the neurological system. Stuttering starts early in life and often is inherited. Brain scan research has revealed that there might be abnormalities in the brains of stutterers, while they are stuttering. Myths about why stuttering occurs abound. Some cultures believe that stuttering is caused by emotional problems, tickling an infant too much, or because a mother ate improperly during breastfeeding. None has been proven to be true. It is believed that some drugs might induce stuttering-like conditions. These include antidepressants , antihistamines , tranquilizers, and selective serotonin reuptake inhibitors.
When to call the doctor
The child's doctor should be contacted if parents have concerns about the speech patterns of their child. The doctor may refer parents to a speech-language specialist for evaluation if needed.
Diagnosis
Speech and language therapists diagnose stuttering by asking stutterers to read out loud, pronounce specific words, and talk. Some also order hearing tests. The tests will determine whether a person needs speech therapy.
Treatment
As of 2004, researchers did not understand what causes stuttering. However, progress has been made regarding what contributes to the development of the disability; therefore, in some cases it can be prevented in childhood with the help of therapy early on. Therapy can help people of all ages suffering from the speech disability. While not an overnight cure, therapy can offer positive results and more fluent speech patterns. The goals of therapy are for the stutterer to reduce stuttering frequency, decrease the tension and struggle of stuttering, become educated about stuttering, and learn effective communications skills, such as making eye contact, to further enhance speech. The therapy focuses on helping stutterers to discover easier and different ways of producing sounds and expressing thoughts. The success of therapy depends largely on the stutterer's willingness to work at getting better.
The duration of stuttering therapy needed varies among stutterers. Sometimes, stutterers find intermittent therapy useful throughout their lives.
Parents, teachers and others can help ease stuttering. These include: talking slowly, but normally, clearly, and in a relaxed manner to a stutterer; answering questions after a pause to encourage a relaxed transaction; trying not to make stuttering worse by getting annoyed by a person's stuttering; giving stutterers reassurance about their stuttering; and encourage the stutterer to talk about his or her stuttering.
Electronic fluency aids help some stutterers when used as an adjunct to therapy. Medications, such as antipsychotics and neuroleptics, have been used to treat stuttering with limited success.
Some people use relaxation techniques to help their stuttering.
Prognosis
As of the early 2000s no answers had been found to explain the causes of stuttering; still, much has been learned about what contributes to stuttering's development and how to prevent it in children. People who stutter can get better through therapy. Winston Churchill, Marilyn Monroe, Carly Simon, James Earl Jones, and King George VI were childhood stutterers who went on to live successful professional lives.
Prevention
The location of some genes appears to predispose people to stuttering. While genetic factors do not explain all stuttering, genetics may help to uncover the disability's causes. Speech therapy, especially that performed at a young age, can stop the progression of stuttering.
Parental concerns
Many children experience brief episodes of stuttering. In many cases, these are transitory and disappear without treatment. Parents should be aware that some stuttering is quite normal when a child feels under pressure to talk. Thus, parents should wait to allow the child to communicate at his or her own speed, and not pressure the child to talk or make fun of the stutter.
KEY TERMS
Antipsychotic drug —A class of drugs used to control psychotic symptoms in patients with psychotic disorders such as schizophrenia and delusional disorder. Antipsychotics include risperidone (Risperdal), haloperidol (Haldol), and chlorpromazine (Thorazine).
Disfluency —An interruption in speech flow.
Neuroleptics —Antipsychotic drugs that affect psychomotor activity.
Resources
BOOKS
Boethe, Anne K. Evidence-Based Treatment of Stuttering: Empirical Bases, Clinical Applications, and Remaining Needs. Mahwah, NJ: Lawrence Erlbaum Associates, 2004.
Hulit, Lloyd M. Straight Talk on Stuttering: Information, Encouragement, and Counsel for Stutterers, Caregivers, and Speech-Language Clinicians. Springfield, IL: Charles C. Thomas, 2004.
Kent, Susan. Let's Talk about Stuttering. New York: Rosen Publishing Group, 2003.
Ramig, Peter R., and Darrell Dodge. The Child and Adolescent Stuttering Treatment and Activity Resource Guide. Albany, NY: Delmar, 2005.
PERIODICALS
Altholz, S., and M. Golensky. "Counseling, support, and advocacy for clients who stutter." Health and Social Work 29, no. 3 (2004): 197–205.
Maguire, G. A., et al. "Alleviating stuttering with pharmacological interventions." Expert Opinion on Pharmacotherapy 5, no. 7 (2004): 1565–71.
Messenger, M., et al. "Social anxiety in stuttering: measuring negative social expectancies." Journal of Fluency Disorders 29, no. 3 (2004): 201–12.
Michel, V., et al. "Stuttering or reflex seizure?" Epileptic Disorders 6, no. 3 (2004): 193–215.
Viswanath, N., et al. "Evidence for a major gene influence on persistent developmental stuttering." Human Biology 76, no. 3 (2004): 401–12.
ORGANIZATIONS
American Academy of Audiology. 8300 Greensboro Dr., Suite 750, McLean, VA 22102. Web site: <www.audiology.org/>.
American Speech-Language Hearing Association. 10801 Rockville Pike, Rockville, MD 20852. Web site: <www.asha.org/>.
WEB SITES
"Stuttering." National Institute on Deafness and Other Communication Disorders, May 2002. Available online at <www.nidcd.nih.gov/health/voice/stutter.asp> (accessed January 9, 2005).
"Stuttering." National Library if Medicine. Available online at <www.nlm.nih.gov/medlineplus/stuttering.html> (accessed January 9, 2005).
"Stuttering Information." Stuttering Foundation of America. Available online at <www.stutteringhelp.org/> (accessed January 9, 2005).
"Stuttering Support." The National Center For Stuttering. Available online at <www.stuttering.com/>(accessed January 9, 2005)..
"Stuttering Support." The National Stuttering Association. Available online at <www.nsastutter.org/> (accessed January 9, 2005).
L. Fleming Fallon, Jr., MD, DrPH
Stuttering
Stuttering
Definition
Stuttering is a speech problem characterized by repetitions, pauses, or drawn out syllables, words, and phrases. Stutterers are different than people experiencing normal fluency problems because a stutterer's disfluency is more severe and consistent than that of people who do not stutter.
Description
Normal language development in a child can include a period of disfluency. Children might repeat syllables or words once or twice. Sometimes, children experiencing normal disfluencies hesitate during speech or use fillers, including "um," with frequency. These developmental problems usually happen between one and five years of age. Often, parents are concerned about the disfluency they hear in their children. In fact, about 25% of all children experience speech disfluencies during development concern their parents because of their severity.
A child with mild stuttering, however, will repeat sounds more than twice. Parents and teachers often notice the child's facial muscles become tense and he or she might struggle to speak. The child's voice pitch might rise with repetitions, and some children experience occasional periods when airflow or voice stops for seconds at a time. Children with more severe stuttering stutter through more than 10% of their speech. This child exhibits considerable tension and tries to avoid stuttering by using different words. In these children, complete blocks of speech are more common than repetitions or prolongations, during which children lengthen syllables or words.
Stuttering usually begins in childhood when the child is developing language skills, and it rarely develops in adulthood with only 1% of the population affected by the disorder. Stuttering does not affect intelligence. Teens often experience more noticeable problems with stuttering as they enter the dating scene and increase their social interactions. Stuttering can severely affect one's life. Often, adults who are concerned about stuttering choose their careers based on the disability.
The degree of stuttering is often inconsistent. Stutterers can be fluent in some situations. Many find that they stop stuttering when singing or doing other activities involving speech. Some have good and bad days when it comes to stuttering. On good days, a stutterer might be able to talk fluently using words that usually cause him to repeat, pause or prolongate sounds, syllables, parts of words, entire words, or phrases.
Causes and symptoms
There is no known cause of stuttering. Some believe that it has a physical cause and that it might be related to a breakdown in the neurological system. Stuttering starts early in life and often is inherited. Brain scan research has revealed that there might be abnormalities in the brains of stutterers, while they are stuttering. Myths about why stuttering occurs abound. Some cultures believe that stuttering is caused by emotional problems, tickling an infant too much or because a mother ate improperly during breastfeeding. None have been proven to be true. It is believed that some drugs might induce stuttering-like conditions. These include antidepressants, antihistamines, tranquilizers and selective serotonin reuptake inhibitors.
Diagnosis
Speech and language therapists diagnose stuttering by asking stutterers to read out loud, pronounce specific words, and talk. Some also order hearing tests. The tests will determine whether or not a person needs speech therapy.
Treatment
Researchers don't understand what causes stuttering. However, progress has been made into what contributes to the development of the disability and, therefore, in some cases it can be prevented in childhood with the help of therapy early on. Therapy can help people of all ages suffering from the speech disability. While not an overnight cure, therapy can offer positive results and more fluent speech patterns. The goals of therapy are to reduce stuttering frequency, decrease the tension and struggle of stuttering, become educated about stuttering, and learn to use effective communications skills, such as making eye contact, to further enhance speech. The therapy focuses on helping stutterers to discover easier and different ways of producing sounds and expressing thoughts. The success of therapy depends largely on the stutterer's willingness to work at getting better.
The duration of stuttering therapy needed varies among stutterers. Sometimes, it helps stutterers if they have therapy intermittently throughout their lives.
Parents, teachers and others can do things to help ease stuttering. These include: talking slowly, but normally, clearly, and in a relaxed manner to a stutterer: answering questions after a pause to encourage a relaxed transaction; trying not to make stuttering worse by getting annoyed by a person's stuttering; giving stutterers reassurance about their stuttering; and encourage the stutterer to talk about his or her stuttering.
Electronic fluency aids help some stutterers when used as an adjunct to therapy. Medications, such as antipsychotics and neuroleptics, have been used to treat stuttering with limited success.
Alternative treatment
Some use relaxation techniques to help their stuttering.
KEY TERMS
Antipsychotics— A class of drugs used to treat psychotic or neurotic behavior.
Disfluency— An interruption in speech flow.
Neuroleptics— Antipsychotic drugs that affect psychomotor activity.
Prognosis
More than three million Americans stutter and four times more males are affected than females. Winston Churchill, Marilyn Monroe, Carly Simon, James Earl Jones and King George VI are among the many people who stuttered but went on to live successful professional lives. Decades of research have yielded no answers to the causes of stuttering; still much has been learned about what contributes to stuttering's development and how to prevent it in children. People who stutter can get better through therapy.
Prevention
New and exciting developments are occurring in researchers' understanding of the genetics of stuttering. Researchers are finding the locations of genes that predispose people to stuttering. While genetic factors will not explain all stuttering, genetics will help to uncover the disability's causes. Speech therapy, especially that performed at a young age, can stop the progression of stuttering.
Resources
ORGANIZATIONS
National Stuttering Foundation of America. 1-(800) 992-9392. 〈http://www.stutteringhelp.org〉.
OTHER
The Stuttering Home Page. Minnesota State University, Mankato. 〈http://www.mandato.msus.edu/deprt/comdis/kuster/stutter.html〉.
"Stuttering." The Nemours Foundation, KidsHealth.org. 〈http://kidshealth.org〉.
"What is Stuttering?" Robert W. Quesal, PhD, Professor and Program Director. Communications Sciences and Disorders. Western Illinois University. 〈http://www.wiu.edu〉.
Stuttering
Stuttering
How Is Stuttering Linked to Fear?
Stuttering is a speech disorder in which the normal flow of speech is broken by sounds that are repeated or held longer than normal, or by problems with starting a word.
KEYWORDS
for searching the Internet and other reference sources
Communication disorders
People who stutter may repeat a speech sound over and over (st-st-stuttering), or they may hold a sound longer than normal (sssssstuttering). In some cases, they may have trouble starting a word, leading to abnormal stops in their speech (no sound). Yet many people who stutter learn to control the problem. The list of famous people in history who overcame stuttering includes Isaac Newton, Charles Darwin, Clara Barton, King George VI of England, Winston Churchill, and Marilyn Monroe.
What Is Stuttering?
Stuttering is a speech disorder in which the normal flow of speech is broken. Along with the effort to speak, some people who stutter also make unusual face or body movements, such as rapid eye blinking or trembling of the lips. Certain situations, such as speaking on the phone, tend to make stuttering worse. On the other hand, people usually do not stutter when they sing, whisper, or speak as part of a group, or when they do not hear their own voices. No one is sure why this is so.
Most children go through a stage of choppy speech when they are first learning to talk. In addition, teenagers and adults often add extra sounds (for example,“uh”and“um”) to their speech, and they occasionally repeat sounds. This is perfectly normal. Such problems are considered a disorder only when they last past the age when most children outgrow them and get in the way of communicating clearly. Treating stuttering even in young children may help prevent a lifelong problem. Treatment may be considered for children who stutter longer than 6 months or for those who seem to struggle when they speak. Sometimes, however, no treatment is the best treatment, especially in the case of children whose stuttering worsens when attention is focused on the problem.
What Causes Stuttering?
Stuttering usually begins between the ages of 2 and 6 years. About 1 percent of children stutter, and boys are three times more likely to do so than girls. The most common form of stuttering is thought to arise when children’s developing speech and language abilities are not yet able to keep up with their needs. Stuttering occurs when they search for the right word. This kind of stuttering usually is outgrown.
Being a Good Listener
When talking to someone who stutters, you should:
- Be patient. Do not finish sentences or fill in words for the person. This might be taken as an insult, or you might guess the wrong words.
- Make normal eye contact. Try not to look embarrassed or concerned.
- Be understanding. Do not make remarks such as“slow down”or“relax.”The person probably has tried this already, so your comments will not help.
- Set a relaxed pace. Try to keep your own speech at a medium speed.
- Be sensible. If you do not understand what someone says, politely ask the person to repeat it. This is better than risking a misunderstanding.
Another form of stuttering is caused by signal problems between the brain and the nerves or muscles involved in speech. The brain is unable to control all the different parts of the speech system. This kind of stuttering sometimes is seen in people who have had a stroke or brain injury. Yet another, less common form of the disorder is caused by severe stress or some types of mental illness. Some kinds of stuttering seem to run in families, and it is likely that stuttering is genetic* (je-NE-tik) in some cases, although no gene for stuttering has been found yet.
- * genetic
- means having to do with genes, which are chemical substances that help determine a person’s characteristics such as hair or eye color, and also determine some health conditions. Genes are contained in the chromosomes, threadlike structures found in the cells of the body. A person’s genes are inherited from his or her parents.
How Is Stuttering Linked to Fear?
Contrary to popular belief, there is no evidence that stuttering is caused by anxiety (ang-ZY-e-tee), an intense, long-lasting feeling of fear, worry, or nervousness. Yet people who stutter may become fearful of meeting new people, speaking in public, or talking on the phone. In such cases, it is the stuttering that causes the fear, not the reverse.
How Is Stuttering Diagnosed?
Stuttering usually is diagnosed by a speech-language pathologist (paTHAH-lo-jist), a professional who is specially trained to test and treat people with speech, language, and voice disorders. The speech pathologist will ask questions about the problem, such as when it first started and when it is most and least noticeable. The speech pathologist also will test speech and language abilities. In addition, some people may be sent to other professionals for hearing tests and medical tests of the nervous system.
How Is Stuttering Treated?
There are several treatments that may improve stuttering, although none is an instant cure. With young children, the focus often is on teaching parents how to help the child at home. Parents typically are told to have a relaxed attitude and give their children plenty of chances to speak. They may be warned not to criticize their children’s speech problems or even not to pay attention to them at all. Instead, they can be good role models, speaking in a slow, relaxed manner themselves and listening patiently when their children talk.
With older children, teenagers, and adults, speech therapy can help them relearn how to speak or unlearn faulty ways of speaking. Some people who stutter have fears related to the disorder, such as a fear of speaking in public. Such problems caused by the stuttering can be helped with psychotherapy (sy-ko-THER-a-pea), in which people talk about their feelings, beliefs, and experiences with a mental health professional who can help them work out issues that play a part in their speech problems.
See also
Anxiety and Anxiety Disorders
Selective Mutism
Social Anxiety Disorder
Resources
Books
De Geus, Eelco. Sometimes I Just Stutter. Mempis, TN: Stuttering Foundation of America, 1999. This book tells young people about the causes of stuttering and discusses the fears and embarrassment of people who stutter. It is available to buy or to read at the foundation’s website: http://www.stuttersfa.org.
Sugarman, Michael, and Kim C. Swain. The Adventures of Phil Carrot: The Forest of Discord. Anaheim, CA: National Stuttering Association, 1995. This is the story of an unusual day in the life of a boy who stutters and his classmates.
Organizations
American Speech-Language-Hearing Association, 10801 Rockville Pike, Rockville, MD 20852. This professional association for speech-language pathologists offers reliable information on stuttering. Telephone 800-638-TALK http://www.asha.org
National Stuttering Association, 5100 East La Palma, Suite 208, Anaheim, CA 92807. This organization is the largest self-help and support group in the United States for people who stutter. Telephone 800-364-1677 http://www.nsastutter.org
Stuttering Foundation of America, 3100 Walnut Grove Road, Suite 603, P.O. Box 11749, Memphis, TN 38111-0749. This nonprofit group works toward the prevention and improved treatment of stuttering. Telephone 800-992-9392 http://www.stuttersfa.org
U.S. National Institute on Deafness and Other Communication Disorders, 31 Center Drive, MSC 2320, Bethesda, MD 20892-2320. This government institute is a source of facts and figures on stuttering.
Phone 301-496-7243 http://www.nih.gov/nidcd
Stuttering
Stuttering
Definition
Stuttering is a speech disorder in which there is a disruption in the normal flow of speech (disfluency). Disfluencies include repetitions of a sound, syllable, or word; silent blocks (drawing out a sound silently); and prolongations (drawing out a voiced sound). Certain behaviors such as eye blinks, facial twitches, or body movements may also accompany stuttering. Stuttering may become worse under stressful situations (such as speaking in front of a group) but may improve when speaking, reading aloud, or singing while alone.
Description
It is estimated that approximately three million Americans are affected by some form of stuttering. The disorder most often affects children between the ages of two and five, usually resolving before puberty. Boys are three times as likely to be stutterers than girls. Less than 1% of adults in the United States suffer from stuttering.
Developmental stuttering (DS) most often occurs in children during the age at which they are developing their language and speech. The onset of DS is gradual, typically occurring before the age of 12. Persistent developmental stuttering (PDS) is defined as stuttering that does not resolve spontaneously or with treatment over time.
Acquired stuttering (AS) occurs in individuals who have been previously fluent. There is no gradual onset of disordered speech in persons with AS; disfluency occurs rather abruptly. AS may be neurogenic or psychogenic. Neurogenic stuttering is caused by problems in the signaling between the brain and the various muscles and nerves used in generating speech. This may occur after a stroke or damage to the brain. Psychogenic stuttering tends to occur after a trauma or period of extreme stress, or in individuals suffering from mental illness.
Causes and symptoms
Although the exact cause of stuttering is not known, there are three leading theories that propose how stuttering develops. The learning theory proposes that stuttering is a learned behavior and that most children are occasionally disfluent (i.e. speaking rapidly, searching for the right words, etc.) when at the age at which speech and language develop. If a child is criticized or punished for this, he or she may develop anxiety about the disfluencies, causing increased stuttering and increased anxiety.
The second theory suggests that stuttering is a psychological problem—that stuttering is an underlying problem that can be treated with psychotherapy. The third theory proposes that the cause of stuttering is organic, that neurological differences exist between the brains of those who stutter and those who do not.
There is also some indication that genetic factors are involved in the development of stuttering and subsequent recovery, as shown by various studies done on families and twins. It is not known to what degree stuttering is dependent on genetic factors, on environmental factors, or on both.
Symptoms
A certain measure of disfluency is expected in small children as they learn to speak a language. Some symptoms of normal disfluency are the following:
- less than 10 disfluencies per 100 spoken words
- whole-word repetitions ("She-she-she")
- part-word repetitions ("M-milk")
- phrase repetition ("I don't want-I don't want to go")
- interjections ("Um," "ah," "uh")
The child would also not normally appear visibly tense or anxious while communicating.
There are some basic characteristics that differentiate stuttering from normal childhood disfluencies. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) describes those characteristics as follows:
- sound and syllable repetitions
- sound prolongations
- interjections
- broken words (for example, pauses within a word)
- audible or silent blocking (filled or unfilled pauses in speech)
- circumlocutions (word substitutions to avoid problematic words)
- words produced with an excess of physical tension
- monosyllabic whole-word repetitions ("I-I-I-I see him").
The DSM-IV also indicates that such disfluency "interferes with academic or occupational achievement or with social communication."
Diagnosis
A diagnosis of stuttering typically includes a complete medical history, a physical examination, a complete history of the speech disorder, and an evaluation of speech and language by a speech-language pathologist. An important function of the speech evaluation is to distinguish between normal disfluency and stuttering.
Treatment
Treatment for stuttering varies according to the patient's age and type and severity of stuttering. Speech therapy is a popular method of treatment that involves learning new speech techniques (such as speaking syllable-by-syllable) and modifying current ways of speaking (such as reducing the rate of speech). It may also include psychological counseling as a way of boosting self-esteem and reducing the tendency of avoiding fearful situations such as speaking in front of a group.
Studies have looked into the potential of treating stuttering with medications. Haloperidol has been the most widely studied antistuttering medication and the only drug to show improvement in fluency. The side effects of haloperidol, however, are not well-tolerated and so the drug is often discontinued.
Prognosis
Nearly 80% of children with DS will recover by puberty, spontaneously or with treatment. One study looking at the recovery rate for stutterers ages nine to 14 who had undergone speech therapy noted that over 70% remained nonstutterers for one year after treatment. Five years after treatment, that rate remained approximately the same. The recovery rate among adult stutterers is not as high, in part because of extensive social phobias and depression.
Health care team roles
Common health care professionals involved in the care of an individual with a stuttering problem include:
- speech-language pathologists
- pediatricians and primary care physicians
- psychiatrists or psychologists
- neurologists
KEY TERMS
Disfluency— An interruption in the normal flow of speech.
Prevention
There is no cure for stuttering, but parents can do a number of things to help their child recover from DS, thereby preventing a life-long stutter. These include:
- speaking slowly and fluently in front of the child, but avoiding criticizing or punishing his or her rate of speech or disfluencies
- questioning the child less and commenting on his or her activities more
- refraining from having the child speak in front of large groups
- listening carefully to what the child has to say
- resisting from completing the child's words or sentences
Resources
PERIODICALS
Costa, Daniel and Robert Kroll. "Stuttering: An Update for Physicians." Canadian Medical Association Journal 162 (27 June 2000): 1849-55.
Lawrence, Michael, and David M. Barclay. "Stuttering: A Brief Review." American Family Physician 57 (1 May 1998): 2175-80.
ORGANIZATIONS
American Speech-Language-Hearing Association (ASHA). 10801 Rockville Pike, Rockville, MD 20852. (888) 321-ASHA. 〈http://www.asha.org〉.
National Institute on Deafness and Other Communication Disorders (NIDCD) Information Clearinghouse. 1 Communication Ave., Bethesda, MD 20892-3456. (800) 241-1044. 〈http://www.nidcd.nih.gov〉.
National Stuttering Association. 5100 E. La Palma, Suite 208, Anaheim Hills, CA 92807. (800) 364-1677. 〈http://www.nsastutter.org〉.
Stuttering Foundation of America. 3100 Walnut Grove Rd., Suite 603, PO Box 11749, Memphis TN 38111-0749. (800) 992-9392. 〈http://www.stuttersfa.org〉.
OTHER
"Diagnostic Criteria for 307.0 Stuttering." Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Psychiatric Association, 1994. 6 July 2001. 8 August 2001 〈http://www.behavenet.com/capsules/disorders/stutter.htm.
"Stuttering." National Institute on Deafness and Other Communication Disorders. 25 June 2001. 8 August 2001 〈http://www.nidcd.nih.gov/health/pubs_vsl/stutter.htm〉.
"Stuttering." Roger Knapp Website. 6 July 2001. 8 August 2001 〈http://www.rogerknapp.com/medical/stutter.htm〉.
stuttering
Chronic stuttering usually begins in early childhood (development stuttering), although occasionally the disorder starts in adulthood (acquired stuttering), usually as a result of brain damage. Stuttering seems to occur in all nationalities with a prevalence of approximately 1% and an incidence of 4% to 5%. Approximately 40% to 80% of children with the disorder recover, for various reasons, by the time they reach adolescence or adulthood. More males than females stutter: the ratio of males to female stutterers ranges from 2–3:1 in childhood, up to 4–5:1 by adulthood. The incidence of the disorder is much higher among other members of the family of a stutterer than in the general population: in other words, there is probably a genetic factor in this condition.
Stuttering may vary greatly in its frequency and severity in different situations. It is, for instance, dramatically reduced when speaking alone or reading aloud in chorus with an accompanist. Wearing headphones that alter the feedback of one's own voice can also reduce stuttering, and so too can the use of certain regular speech patterns (e.g. singing, unusual accents, speaking in rhythm). The reliability with which such techniques for inducing fluency can reduce or even abolish stuttering is considered a key to understanding the disorder — they also form the basis of some treatments.
The social and vocational effects of chronic stuttering may be quite devastating, perhaps because of the suspicion that it is the outward sign of a personality disorder. However, there is remarkably little evidence that stuttering is related to any unusual personality characteristics or neuroses; and there is little support for the claim that stuttering is associated with anxiety. Many prominent individuals, including well-known actors and politicians, have managed to control their stuttering and achieve successful careers. Nevertheless, the handicapping effects of the disorder in children and adults are undeniable.
There is currently no accepted theory that offers a satisfactory explanation for all the features of stuttering. At different times, psychoanalytic or organic theories have held sway over research and/or therapy. Traditional, formal learning has been blamed; so too have errors in control systems in the brain. Most current researchers consider developmental stuttering to be a disorder of motor control, with strong genetic underpinnings, influenced by environmental factors. This position has gained support with evidence that signs of severe stuttering may appear almost as soon as a child starts to produce connected speech.
Recent studies of right-handed adult stutterers, using techniques for imaging activity in the brain, have revealed unusual patterns of activation and inhibition during stuttered speech, particularly in parts of the right hemisphere involved in hearing and the control of movement, and especially exaggerated in the cerebellum. The unusual activity in these regions, which appears to occur only during speech, is very different when stuttering is reduced or absent as a result of strategies for improving fluency. These findings have intensified the search for a neurological system or systems that might be specifically related to stuttering.
The treatment of stuttering is an area of controversy. There is no evidence that any drug treatment is effective in removing stuttering in children or adults. The most convincing effects have been reported for behavioural treatments, although there is much debate about the evaluation of such therapy. Other forms of treatment emphasize learning to adjust to the disorder rather than removing the problematic behaviour.
Probably the most dramatic change to therapy for stuttering in the last decade is the use of mild verbal corrections for each occasion of stuttering, and verbal praise for periods of fluency, which has beneficial effects in treating young children. Recovery commonly occurs without treatment in the first year after onset, but this becomes less likely without intervention if the disorder persists. Indeed, there is an urgent need to correct the widely-held belief that children will recover from stuttering if their problem is merely ignored. Currently, the preferred therapies for older stutterers involve a combination of behavioural techniques and methods for training speech–motor strategies. However, there is no convincing evidence that these therapies result in complete recovery.
The most successful therapeutic approaches for adults and children involve three general features: first, a method that establishes reduced stuttering or stutter-free speech under relatively controlled conditions; then a procedure for transferring that improvement beyond the treatment setting; and finally, strategies for maintaining that improvement. The most favoured techniques for establishing control over stuttering fall into three categories: behavioural methods based on rewarding performance; teaching stutterers to prolong their speech; and mechanical aids. These techniques are also often used in conjunction with control of the rate of speaking. Once improvement has been produced in the controlled conditions, ‘transfer’ procedures are used, which systematically introduce increasingly demanding speaking situations. The most successful maintenance procedures require intermittent management over periods lasting up to two or three years. Given the variability of stuttering across situations, over time, and with relatively slight alterations to the manner of speech production, stuttering therapy evaluation presents considerable challenges, which are now occupying the attention of clinical researchers.
Roger J. Ingham
Bibliography
Bloodstein, O. (1995). A handbook on stuttering. Singular, San Diego, CA.
Fox, P. T.,, Ingham, R. J.,, and Ingham, J. C., et al. (1996). A PET study of the neural systems of stuttering. Nature, 382, 158–62.
Stammering
STAMMERING
Stammering is a disorder in the rate of speech delivery. It appears in the communication patterns of children aged between two and five and is characterized by repetitions or blockages that lead to ruptures in the rhythm and melody of speech. Three out of four children are destined to overcome it before adolescence. Stammering is a universal complaint and has been documented in the most ancient cultures.
Sigmund Freud associated this type of disorder with hysteria, but classified it separately as a fixation neurosis (on an organ [of speech]). Otto Fenichel located this functional speech disorder in the group of pregenital conversion neuroses. The patient's mental structure was the same as that of an obsessive, whereas the symptomatology was of the conversion type. Speech had acquired an unconscious significance related either to its verbal content or to the general meaning of the function of "speaking" itself, as in severe cases of stammering in which the speech act represents a reprehensible drive.
Bernard Barrau draws attention to the frequent presence of situations of oral violence in these cases, and fantasies of "forcible introduction," whether in relation to forced food or its metaphorical equivalents (the voice and speech of the mother). Ivan Fonagy stresses the fact that speech is capable of absorbing narcissistic, oral, anal, or genital libido, and reports observations of parallel strategies in the anal and glottal sphincter (stammering when establishing sphincter control), and upward transfers of anal libdinal cathexis (one of Charlotte Balkany's patients identified resonant air with air emitted by the anal sphincter). René Diatkine points to the absence of a psychic structure specific to stammering subjects, whose symptom, as a disorder in verbal communication, modifies their relational system, particularly the balance between narcissistic- and object-cathexes.
Annie Anzieu traces the elements in the neurotic dynamics of stammering subjects. An anal-sadistic relation is often established between the (grasping and abusive) mother and the child, with the child fixating on a dual, merging relation with the mother, excluding all connections to a third object, unless it takes part in the mother-child whole. Stammerers thus have difficulty in engaging oedipal problems. Supervisions must be redoubled in order to integrate oedipal prohibtions into the ego, because what enters the body or comes out of it assumes a new erotic meaning. The speech act permanently alludes to castration anxiety. This relational mode leads to the persistence of what Melanie Klein calls the paranoid-schizoid position. Indeed the stammerer is persecuted by a particularly demanding father and mother. All verbal emissions are problematic. Like feces, words are experienced as aggressive objects whose true intentions may be to wound or kill. They become the concrete symbols of interiorized aggressive objects. These paranoid characteristics entail a considerable obsessional element as well. Stammerers exhaust their discourse to the point of fragmentation; they remain haunted by the specific words they should be saying. Obsessional cathexis of discourse can be understood in the process of neurotic construction as a superegoic symptom in relation to the hysterical symptom stammering constitutes. The phonetic dysfunction and suffering caused by verbal emission are a form of hysterical conversion, a conversion that lends genital significance to an originally anal-sadistic symptom. The stammerer expresses the conflict he has always experienced through his symptom; the subject hides behind it. The act of speaking conceals what is said. The psychotherapy or psychoanalysis of stammerers always evinces these hysterical, obsessional, and paranoid contents in a more or less typical fashion depending on the moment in treatment and patient in question. For Nicole Fabre, stammering is an archaic difficulty shot through with oral aggressivity and anal sadism, from which the subject has not yet been able to break free in order to fully accede to oedipal triangulation.
Although psychoanalytic treament is rarely indicated initially, especially with children, this approach does provide an understanding of the disorder that does not exclude its meaning from the outset.
The etiology of stammering is unknown. Constitutional factors interact with environmental ones in addition to factors linked to the personal dynamics of the child in varying proportions depending on the subject in question, thus illustrating the uniqueness of the trouble each stammerer faces.
Christian Payan
See also: Tics.
Bibliography
Anzieu, Annie. (1989). De la chair au verbe. In Psychanalyse et langage: Du corpsà la parole (pp. 103-127). Paris: Dunod. (Original work published 1977)
Barrau, Bernard. (1989). Begaiement et violence orale. In Psychanalyse et langage: Du corps à la parole. Paris: Dunod. (Original work published 1977)
Fabre, Nicole. (1986). Des cailloux plein la bouche. Paris: Fleurus.
Fenichel, Otto. (1953). Respiratory introjection. In The collected papers, first series. New York, W.W. Norton.
Fonagy, Ivan. (1983). La Vive Voix: essais de psycho-phonétique. Paris: Payot.
Freud, Sigmund, and Breuer, Josef. (1895d). Studies on hysteria. SE, 2: 48-106.
stammering
—stammerer n.