Stuttering is a speech disorder
in which sounds, syllables, or words are repeated or last longer than
normal. These problems cause a break in the flow of speech (called
disfluency). Symptoms: Stuttering may start with repeating...
Causes, incidence, and risk factors
About 5% of children (1 out of every 20 children) aged 2 - 5 will
develop some stuttering during their childhood. It may last for
several weeks to several years.
For a small number of children (less than 1%), stuttering does
not go away and it may get worse. This is called developmental
stuttering, and it is the most common type of stuttering.
Stuttering tends to run in families. Genes that cause stuttering
have been identified.
There is also evidence that stuttering may be a result of some
brain injuries, such as stroke or traumatic brain injuries.
Stuttering may rarely be caused by emotional trauma (called
psychogenic stuttering).
Stuttering is more common in boys than girls. It also tends to
persist into adulthood more often in boys than in girls.
Symptoms
Stuttering may start with repeating consonants (k, g, t). If
stuttering becomes worse, words and phrases are repeated.
Later, vocal spasms develop. There is a forced, almost explosive
sound to speech. The person may appear to be struggling to speak.
Stressful social situations and anxiety can make symptoms worse.
Symptoms of stuttering may include:
- Feeling frustrated when trying to communicate
- Pausing or hesitating when starting or during sentences,
phrases, or words, often with the lips together
- Putting in (interjecting) extra sounds or words ("We
went to the...uh...store")
- Repeating sounds, words, parts of words, or phrases ("I
want...I want my doll," "I...I see you," or
"Ca-ca-ca-can")
- Tension in the voice
- Very long sounds within words ("I am Booooobbbby Jones"
or "Llllllllike")
Other symptoms that might be seen with stuttering include:
- Eye blinking
- Jerking of the head or other body parts
- Jaw jerking
Children with mild stuttering are often unaware of their
stuttering. In more severe cases, children may be more aware. Facial
movements, anxiety, and increased stuttering may occur when they are
asked to speak.
Some people who stutter find that they don't stutter when they
read aloud or sing.
Signs and tests
No testing is usually necessary. The diagnosis of stuttering may
require consultation with a speech pathologist.
Treatment
There is no one best treatment for stuttering. Most early cases
are short-term and resolve on their own.
Speech therapy may be helpful if:
- Stuttering has lasted more than 3 - 6 months, or the
"blocked" speech lasts several seconds
- The child appears to be struggling when stuttering, or is
embarrassed
- There is a family history of stuttering
Speech therapy can help make the speech more fluent or smooth,
and can help the child feel better about the stuttering.
Parents are encouraged to:
- Avoid expressing too much concern about the stuttering,
which can actually make matters worse by making the child more
self-conscious
- Avoid stressful social situations whenever possible
- Listen patiently to the child, make eye contact, don't
interrupt, and show love and acceptance. Avoid finishing sentences
for them.
- Set aside time for talking
- Talk openly about stuttering when the child brings it up,
letting them know you understand their frustration
- Talk with the speech therapist about when to gently correct
the stuttering
Drug therapy has NOT been shown to be helpful for stuttering.
It is not clear whether electronic devices help with stuttering.
Self-help groups are often helpful for both the child and family.
Expectations (prognosis)
In most children who stutter, the phase passes and speech returns
to normal within 3 or 4 years. Stuttering that begins after a child
is 8 - 10 years old is more likely to last into adulthood.
Complications
Possible complications of stuttering include social problems
caused by the fear of ridicule, which may make a child avoid
speaking entirely.
Calling your health care provider
Call your provider if:
- Stuttering is interfering with your child's school work or
emotional development
- The child seems anxious or embarrassed about speaking
- The symptoms last for more than 3 - 6 months
Prevention
There is no known way to prevent stuttering.
Stammering and
stuttering
have the same meaning - it is a speech disorder in which the person
repeats or prolongs words, syllables or phrases. The person with a
stutter (or stammer) may also stop during speech and make no sound
for certain syllables. People who stutter often find that
stress
and
fatigue
make it harder for them to talk flowingly, as well as situations in
which they become self-conscious about speaking, such as public
speaking or teaching. Most people who stutter find that their problem
eases if they are relaxed.
According to Medilexicon's
medical
dictionary, to stammer is
"To hesitate in speech, halt,
repeat, and mispronounce, by reason of embarrassment, agitation,
unfamiliarity with the topic, or as yet unidentified physiologic
causes. To mispronounce or transpose certain consonants in
speech."We all have the capacity to stutter if
pushed far enough. This may happen during a very stressful
interrogation in a police station, talking to emergency services on
the telephone, or trying to respond to a particularly agile and
aggressive lawyer while on the witness stand in court.
Famous people who
stammered
Stammering does not reflect a person's
intelligence or personality. Here is a list of famous people who
stammer/stammered:
Aesop - Greek storyteller
Alan Turing - Computer science
founder
Aneurin Bevan - Labour Party MP
and Minister
Anthony Quinn - Actor (Zorba the
Greek)
Aristotle - Philosopher
Arnold Bennett - British
writer/journalist
Bruce Oldfield - British fashion
designer
Carly Simon - Singer (You're so
vain)
Charles Darwin -
Scientist/Naturalist
Claudius Cesar - Roman Emperor.
Demosthenes - Greek orator
Sir Jonathan Miller - British
theatre/opera director
Elizabeth Bowen - Author
Erasmus Darwin - Scientist/Doctor,
grandfather of Charles Darwin
Field Marshall Lord Carver -
British military leader/author
Gareth Gates - English pop star
George Washington - American
President
Harvey Keitel - Actor (Life on
Mars)
Isaac Newton - Scientist
Jack Harold Paar - US comedian &
TV host
James Stewart - Actor (It's a
wonderful life)
John Montague - Poet/Author
Joseph Priestley - Scientist
(discovered oxygen)
Kenneth Tynan - British theatre
critic, writer
Kim Philby - British double agent
for the Soviets
King Charles I - England 1625-1649
King George VI - UK 1937-1952
Lenin - Russian revolutionary
Lewis Carroll - Author (Alice in
Wonderland)
Louis II the Stammerer, King of
France, 877-879
Marion Davies - Famous
silent-movie actress
Michael Bentine - British
comedian, script-writer and TV star
Michael Ramsey - Archbishop of
Canterbury 1961-1974
Miguel de Cervantes Saavedra -
Author
Nevil Shute (1900-1960) - Author
Philip Larkin - Poet, author,
critic
Raymond Massey - Actor (High
treason)
Richard Condon - Author
Robert Boyle (1627-1691) -
Scientist
Robert Heinlein - Author
Rowan Atkinson - Actor (Mr. Bean)
Sam Neill - Actor (Jurassic Park)
Samuel L. Jackson - (Pulp Fiction)
Somerset Maugham - Author
Theodore Roosevelt - American
President
Thomas Becket - Archbishop of
Canterbury 1162-1170
Thomas Jefferson - American
President
Walter H. Annenberg - Publisher,
diplomat, philanthropist
John Updike - Author
- Bill Withers - Singer, songwriter (Ain't no sunshine)
Stuttering is common when children are learning to speak. However,
the majority of kids grow out of this stage of initial stuttering.
For some, however, the problem persists and requires some kind of
professional help, such as speech therapy. It is important that
parents do not add to a child's stress by drawing too much attention
to the problem when they are trying to communicate verbally. The
calmer a child feels the less acute the symptoms tend to become.
What are the signs and symptoms of stuttering?
Problems starting a word, phrase
or sentence
Hesitation before certain sounds
have to be uttered
Repeating a sound, word or
syllable
Certain speech sounds may be
prolonged
Speech may come out in spurts
Words with certain sounds are
substituted for others (circumlocution)
Rapid blinking (when trying to
talk)
Trembling lips (when trying to
talk)
Foot may tap (when trying to talk)
Trembling jaw (when trying to
talk)
Face and/or upper body tighten up
(when trying to talk)
Some may appear out of breath when
talking
- Interjection, such as "uhm" used more frequently
before attempting to utter certain sounds
What causes stuttering?
Experts are not completely sure. We do know that somebody with a
stutter is much more likely to have a close family member who also
has one, compared to other people. The following factors may also
trigger/cause stuttering:
Developmental stuttering -
as children learn to speak they often stutter, especially early on
when their speech and language skills are not developed enough to
race along at the same speed as what they want to say. The majority
of children experience fewer and fewer symptoms as this
developmental stage progresses until they can speak flowingly.
b>Neurogenic stuttering - when
the signals between the brain and speech nerves and muscles are not
working properly. This may affect children, but may also affect
adults after a
stroke
or some brain injury. In rare cases neurogenic stuttering results in
lesions (abnormal tissue) in the motor speech area of the brain.
- Psychological factors - it used to be believed that
the main reasons for long-term stuttering were psychological.
Fortunately, this is not the case anymore. Psychological factors may
make stuttering worse for people who stutter, such as stress,
embarrassment, etc., but they are not generally seen as underlying
long-term factors. In other words, anxiety,
low self-esteem, nervousness, and stress therefore do not cause
stuttering per se. Rather, they are the result of living with a
stigmatized speech problem which can sometimes make symptoms worse.
What are the risk factors?
Family history -
approximately half of all children who have a stutter that persists
beyond the developmental stage of language have a close family
member who stutters. If a young child has a stutter and also a close
family member who stutters, his/her chances of that stutter
continuing are much greater.
Age when stutter starts - a
child who starts stuttering before 3.5 years of age is less likely
to be stuttering later on in life. The earlier the stuttering starts
the less likely it is to continue long-term.
Time since stuttering started
- about three-quarters of all young children who stutter will stop
doing so with one or two years without speech therapy. The longer
the stuttering continues the more likely it is that the problem will
become long-term without professional help (and even with
professional help).
- Sex of the person - long-term stuttering is four times
more common among boys than girls. Experts believe there may be
neurological reasons for this, while others blame the way family
members react to little boys' stuttering compared to little girls'
stuttering. However, nobody is really sure what the reason is.
When to seek professional help
Experts say that parents should consider visiting their GP
(general practitioner, primary care physician) when:
The child's stuttering has
persisted for over six months
When the stuttering occurs more
frequently
When it is accompanied with
tightness of the facial and upper body muscles
When it interferes with the
child's schoolwork
When it causes emotional
difficulties, such as fear of places or situations
- When it persists after the child is 5 years old
How is stuttering diagnosed?
Some aspects of stuttering are obvious to everyone, while others
are not. To have a comprehensive and reliable diagnosis the patient
should be examined by a well-qualified Speech-Language Pathologist
(SLP).
The SLP will note how many speech disfluencies the person produces
in various situations, as well as the types of disfluencies. How the
person copes with disfluencies will also be assessed, how the person
reacts to such factors as teasing, which can exacerbate their
problems. The SLP may perform some other assessments, such as speech
rate and language skills - this will depend on the patient's age and
history. The SLP will analyze all the data and determine whether
there is a fluency disorder. If there is one, the SLP will determine
to what extent the disorder affects the patient's ability to function
and take part in daily activities.
It is vital to try to
predict whether a young child's stutter will become long-term. This
can be fairly accurately done with the help of a series of tests,
observations and interviews. Predicting whether an older child or an
adult is likely to have continued stuttering over the long-term is
less important because most likely the problem has been around long
enough for the person to seek help. Assessments for older children
and adults are aimed at gauging the severity of the disorder, and
what impact it has on the person's ability to communicate and
function appropriately in daily activities.
What is the treatment for stuttering?
A good evaluation (diagnosis) is vital as this determines what the
best treatment might be.
Treatments for people who stutter
tend to be aimed at teaching the person skills, strategies, and
behaviors that help oral communication. This may include:
- Fluency shaping therapy
Controlling monitoring speech
rate - this may involve practicing smooth, fluent speech at
very slow speed, using short sentences and phrases. The person is
taught to stretch vowels and consonants, while trying to secure
continuous airflow. With practice the person gradually utters
smooth speech at higher speed, and with longer sentences and
phrases. Patients have higher long-term success rates if the
sessions with the SLP are followed up regularly - this helps
prevent relapses.
Breathing control - as the
patient practices prolonged speech he/she also learns how to
regulate breathing. Added to this is operant conditioning
(controlling breathing, as well as phonation, and articulation
(lips, jaw and tongue).
Stuttering modification
therapy
The aim here is to modify the stuttering so that
it is easier and requires less of an effort, rather than eliminating
it. This therapy works on the principle that if anxiety exacerbates
stuttering, using easier stuttering with less avoidance and fear
will alleviate the stuttering. Charles Van Riper developed Block
Modification Therapy in 1973; it includes four stages:
Stage 1 (Identification) -
the therapist and the patient identify the core behaviors,
secondary behaviors, and feelings and attitudes that accompany the
stuttering.
Stage 2 (Desensitization) -
the patient freezes stuttering behavior in an attempt to reduce
fear and anxiety - this involves confronting difficult sounds,
words and situations (rather than avoiding them), and stuttering
intentionally (voluntary stuttering).
Stage 3 (Modification) -
the patient learns easy stuttering. He/she learns how to
apply: a) 'cancellations' - stopping a dysfluency, pausing for a
moment, and then repeating the word, b) 'pull-outs'- pulling out of
a dysfluency into fluent speech, c) and 'preparatory sets' -
anticipating words that cause stuttering and using 'easy
stuttering' on those words.
Stage 4 (Stabilization) -
the patient prepares practice assignments, makes preparatory sets
and pull-outs automatic, and changes the way he/she sees
himself/herself from being a stutterer to being a person who speaks
fluently most of the time, but stutters mildly occasionally.
- Electronic fluency devices
Some patients have
responded well to this type of treatment, while others have not. The
patients hear their voice differently. Altered auditory feedback
effect can be done by speaking in unison with another person (as
groups of people do when they are praying or singing), and blocking
out the stutterer's voice while talking - this is called masking.
Some ear-pieces can echo the speaker's voice so that they feel they
are talking in unison with someone else. Most stutterers can sing
flowingly without stuttering - it seems that talking in unison with
someone else often has the same effect as singing on a stutterer.
How to behave when you are talking with somebody who stutters
People who are not used to talking to somebody with a stutter may
be unsure about how to respond. This can make the listener to look
away whenever the stutterer stutters, or try to help out by
completing his/her missing words or phrases - or simply to try to
avoid people who stutter altogether.
It is important to
remember that a person who stutters is interested in communicating
just like everybody else, and would like to be treated just like any
other person. Focus should be on the theme of the speaker, the
information he/she is conveying, rather than how it is coming across.
A stutterer is only too aware of what his/her speech is like
and that it can take longer to utter phrases. In fact, this awareness
can sometimes make the stuttering worse. The stress of knowing that
it takes longer to say something may make the stutterer try to speed
up, which often makes things worse. It is important that the listener
gives out a feeling (vibes) of patience, calm and peace. An impatient
listener, or a listener who seems impatient, may make it harder for a
stutterer to speak. Attempting to fill in the gaps (saying the
missing words) is often an attempt to help out, but can come over to
the stutterer as impatience.
Telling the stutterer to relax,
or to take a deep breath, may have helpful intentions, but could
stress the stutterer more (it may help some, though). Stuttering is
not simple to overcome, and cannot usually be easily sorted out with
a few deep breaths.
If you are really not sure how to behave,
and you are talking to a person who stutters and nobody else is
around, it may be helpful to ask them what would be the most best way
to respond to his/her stuttering.
Put simply - focus on the
content of the speaker's message, not how it is being delivered. Emit
a sensation (vibes) of matter-of-fact patience, calm and peace.
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