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.

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: http://www.audiology.org/.

American Speech-Language Hearing Association. 10801 Rockville Pike, Rockville, MD 20852. Web site: http://www.asha.org/.

WEB SITES

"Stuttering." National Institute on Deafness and Other Communication Disorders , May 2002. Available online at http://www.nidcd.nih.gov/health/voice/stutter.asp (accessed January 9, 2005).

"Stuttering." National Library if Medicine. Available online at http://www.nlm.nih.gov/medlineplus/stuttering.html (accessed January 9, 2005).

"Stuttering Information." Stuttering Foundation of America. Available online at http://www.stutteringhelp.org/ (accessed January 9, 2005).

"Stuttering Support." The National Center For Stuttering. Available online at http://www.stuttering.com/(accessed January 9, 2005)..

"Stuttering Support." The National Stuttering Association. Available online at http://www.nsastutter.org/ (accessed January 9, 2005).

L. Fleming Fallon, Jr., MD, DrPH