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