Stuttering Health Article

Stuttering

A speech disorder characterized by a lack of normal fluency.

A person who stutters repeats words and parts of words, prolongs sounds, has difficulty producing sounds (usually at the beginning of words or groups of words), and generally speaks in fragmented phrases. ("Stuttering" and "stammering" are synonymous. The former is used more frequently in the United States, while the latter is the preferred term in Britain.) Due to the frustration and embarrassment caused by this problem, stuttering is usually accompanied by anxiety about speaking. It is estimated that stuttering affects about one percent of the general population in the world's industrialized nations—2.5 million people in the United States alone. It is much more common in males than females: the ratio is generally thought to be about four to one (and according to some estimates may even be as high as nine to one). About four-fifths of children who stutter outgrow the problem by adulthood, in some cases spontaneously and in others with treatment. Stuttering usually begins between the ages of two and seven; it is very rare for it to occur in an adolescent or adult who has no history—even a brief one—of childhood stuttering. Except for cases where it results from brain damage, no physical basis can normally be found for the disorder.

Stuttering was long regarded as an emotional disorder (or as a symptom of one), but this view has been largely abandoned by today's researchers and speech pathologists. It is known that the condition has a genetic component. Children whose parents have a childhood history of stuttering, even if they have outgrown it, are more likely than other children to stutter. If one identical twin stutters, there is a 77% likelihood that the other one will, too. Experts have speculated that the timing of the three functions involved in speech—respiration, articulation, and use of the larynx (or voice box) to produce sound—may be different in stutterers than in persons who speak normally. Through the use of brain scans, neurologists have been able to contribute valuable information to what is known about the physiological basis of stuttering. It has been found that when people stutter, the areas of the brain that control physical movement go into overdrive while parts of the cortex (the brain's outer layer) that are instrumental in controlling the content and organization of speech remain abnormally inactive.

In addition to a better understanding of the physical aspects of stuttering, there have also been advances in analyzing the environmental influences that lead a child to stutter. Foremost among these is parental behavior in relation to children's speech. When children are first learning to communicate verbally, their speech is very far from the normal fluency of adults (and even older children). It is common for their speech to be punctuated by many of the same types of interruptions that characterize stuttering: hesitation, repetition or prolongation of sounds, and a generally fragmented flow of speech. A major difference, however, between this normal lack of fluency (called dysfluency) and stuttering is that very young children do not know there is anything wrong with their speech. When a parent corrects the child's speech or attempts to speak for him, the possible feelings of failure and parental disapproval can create anxiety that worsens this transient dysfluency and causes it to become chronic.

Parents of young children who show dysfluency in their speech are advised to avoid any action that will make the child think there is something wrong, such as showing disapproval or concern over the child's speech, mentioning the term "stuttering," or asking him to slow down or say something again the correct way (which usually backfires because the child becomes anxious and the speech actually worsens). On the other hand, it can be helpful to note if there are particular situations associated with the dysfluency and to refrain from asking or expecting the child to speak in these or any other situations that seem likely to produce unusual anxiety. Other positive actions that parents can take at this stage include being patient and calm when listening to their children speak and speaking in an unhurried manner themselves. It is especially helpful to make sure the pause before answering after the child speaks is long enough so that the conversation has an unhurried pace, and the child feels he doesn't have to rush to answer. By grade school, it is often too late to prevent stuttering. However, there are still ways that parents can still help a child who stutters. In general, a relaxed parenting style can help reduce stuttering, while inflexibility and perfectionism can exacerbate it, as can conflicts within the family. As with younger children, awareness of the situations that either exacerbate and reduce stuttering is helpful. Perhaps the most intriguing aspect of stuttering, in both children and adults, is the fact that under certain circumstances it disappears. Children who stutter should be encouraged to participate in activities that generally tend to eliminate the problem, including group singing, reciting from memory, and play-acting.

There are two basic methods of treating stuttering. One is fluency training, which attempts to totally eradicate the stutter and replace it with normal speech, using exercises that help coordinate speech and breathing, slow down the rate of speech, and prolong syllables. One technique used with children is a method that involves saying a single word fluently and then gradually adding words to slowly increase the length and complexity of speech that can be mastered without stuttering. Often, more challenging speaking situations are gradually introduced as well. For example, a child may progress from speaking together with the speech pathologist to speaking alone, followed by speaking to other people individually and, finally, to a group. A technological aid that has been effective in fluency training is the use of delayed auditory feedback (DAF), in which the stutterer hears an echo of his own speech sounds. For some reason, this disruption, which would make it harder for most people to speak, tends to produce fluent speech in stutterers. Once DAF has been used to get the stutterer accustomed to what it feels like to speak normally, the speech pathologist gradually reduces the amount of feedback delay until it is eliminated and the stutterer is still speaking fluently.

Fluency training generally works best with young children. Older children and adolescents may be more successful with another treatment method, in which true fluency is not attained but the impulse to stutter is controlled in ways that makes speech much clearer and less hesitant. A "hard stutter" is replaced with an "easy stutter" in which, for example, the first sound of a word may be prolonged or repeated very softly. The speech produced this way may sound somewhat halting or deliberate but it will not sound like stuttering, and it is considered a great improvement by those stutterers who master it. As with fluency training, this method requires diligent practice under the guidance of a qualified speech pathologist.

Speech language pathology, commonly referred to as speech therapy, is offered in a variety of settings. Speech impairment is considered a disability under Public Law 94-142, the federal law governing education for the handicapped. Most communities have school speech pathologists who can assess and work with children who stutter. In addition to the obvious financial advantages, therapy in public school has the advantage of convenience. The child may be able to work in a group with other children who have the same problem, and it is easy for the speech therapist to consult with the child's classroom teacher. However, some mild cases of stuttering may not qualify for school treatment, and parents may need to seek private treatment, often at a speech and hearing clinic. The early intervention that private treatment makes possible for children under school age can also be an advantage, as can the opportunity for parents to work more closely with the speech therapist than they could ordinarily do under a school program.