It is estimated
that over three million Americans stutter. Stuttering affects
individuals of all ages but occurs most frequently in young
children between the ages of 2 and 7 'who are developing
language.
What
is stuttering?
Stuttering is
a speech disorder in which the normal flow of speech is
disrupted by frequent repetitions or prolongations of speech
sounds, syllables or words or by an individual's inability
to start a word. The speech disruptions may be accompanied
by rapid eye blinks, tremors of the lips and/or jaw or other
struggle behaviors of the face or upper body that a person
who stutters may use in an attempt to speak. Certain situations,
such as speaking before a group of people or talking on
the telephone, tend to make stuttering more severe, whereas
other situations, such as singing or speaking alone, often
improve fluency.
Stuttering may
also be referred to as stammering, especially in England,
and by a broader term, disfluent speech. Stuttering is different
from two additional speech fluency disorders: cluttering,
characterized by a rapid, irregular speech, and spasmodic-dysphonia,
a voice disorder.
How
is speech normally produced?
Speech is normally
produced through a series of precisely coordinated muscle
movements involving respiration (the breathing mechanism),
phonation (the voicing mechanism) and articulation (throat,
palate, tongue, lips and teeth). These muscle movements
are initiated, coordinated and controlled by the brain and
monitored through the senses of hearing and touch.
Before speaking,
an individual takes a breath and the vocal folds (or vocal
cords), which are two bands of muscular tissue located in
the voice box directly above the trachea or windpipe, must
come together. The air that is held in the lungs is gradually
released, passing through the gently closed vocal folds
thus causing vibration and producing the voice. The sound
of the voice is passed through the throat and is directed
into the mouth for most speech sounds, or into the nose
for nasal sounds such as "m," "n" and
"ng." The palate, tongue, jaw and lips move in
precise ways to modify the sounds in order to make speech
sounds.
Who
stutters?
It is estimated
that over three million Americans stutter. Stuttering affects
individuals of all ages but occurs most frequently in young
children between the ages of 2 and 7who are developing language.
Boys are four times more likely to stutter than girls. Most
children, however, outgrow their stuttering, and it is estimated
that less approximately 1 percent of adults stutter.
Many individuals
who stutter have become successful in careers that require
public speaking. The list of individuals includes Winston
Churchill, actress Marilyn Monroe, actors James Earl Jones,
Bruce Willis and Jimmy Stewart, and singers Carly Simon
and Mel Tillis, to name only a few.
What
causes stuttering?
Scientists suspect
a variety of causes. There is reason to believe that many
forms of stuttering are genetically determined. The precise
mechanisms causing stuttering are not understood.
The most common
form of disfluency is thought to be developmental, that
is it is occurring in children who are in the process of
developing speech and language. This relaxed type of stuttering
is felt to occur when a child's speech and language abilities
are unable to meet his or her verbal demands. Stuttering
happens when the child searches for the correct word. Developmental
stuttering is usually outgrown and is referred to as "normal
nonfluency".
Another common
form of stuttering is neurogenic. Neurogenic disorders arise
from signal problems between the brain and nerves or muscles.
In neurogenic stuttering, the brain is unable to coordinate
adequately the different components of the speech mechanism.
Neurogenic stuttering may also occur following a stroke
or other type of brain injury.
Other forms of
stuttering are classified as psychogenic or originating
in the mind or mental activity of the brain such as thought
and reasoning. Whereas at one time the major cause of stuttering
was thought to be psychogenic, this type of stuttering is
now known to account for only a minority of the individuals
who stutter. Although individuals who stutter may develop
emotional problems such as fear of meeting new people or
speaking on the telephone, these problems often result from
stuttering rather than causing the stuttering. Psychogenic
stuttering occasionally occurs in individuals who have some
types of mental illness or individuals who have experienced
severe mental stress or anguish.
Scientists and
clinicians have long known that stuttering may run in families
and that there is a strong possibility that some forms of
stuttering are, in fact, hereditary. No gene or genes for
stuttering, however, have yet been found.
How
is stuttering diagnosed?
Stuttering is
generally diagnosed by a speech-language pathologist, a
professional who is specially trained to test and treat
individuals with voice, speech and language disorders. The
diagnosis is usually based on the history of the disorder,
such as when it was first noticed and under what circumstances,
as well as a complete evaluation of speech and language
abilities.
How
is stuttering treated?
There are a
variety of treatments available for stuttering. Any of the
methods may improve stuttering to some degree; however,
there is at present no cure for stuttering. Stuttering therapy,
however, may help prevent childhood stuttering from becoming
a lifelong problem. Therefore a speech evaluation is recommended
for children who stutter for longer than 6 months or for
those whose stuttering is accompanied by struggle behaviors.
-
Developmental
stuttering is often treated by educating parents about restructuring
the child's speaking environment to reduce the episodes
of stuttering. Parents are often urged to:
- provide a
relaxed home environment that provides ample opportunities
for the child to speak. Setting aside specific times when
the child and parent can speak free of distractions is
often helpful.
- refrain from
criticizing the child's speech or reacting negatively
to the child's disfluencies. Parents should avoid punishing
the child for any disfluencies or asking the child to
repeat stuttered words until they are spoken fluently.
- resist encouraging
the child to perform verbally for people.
- listen attentively
to the child when he or she speaks.
- speak slowly
and in a relaxed manner. If a parent speaks this way,
the child will often speak in the same slow, relaxed manner.
- avoid telling
the child to slow down or think of what he or she is going
to say before speaking.
- wait for
the child to say the intended word. Don't try to complete
the child's thoughts.
- talk openly
to the child about stuttering if he or she brings up the
subject. Many of the currently popular therapy programs
for persistent stuttering focus on relearning how to speak
or unlearning faulty ways of speaking. The psychological
side effects of stuttering that often occur, such as fear
of speaking to strangers or in public, are also addressed
in most of these programs.
Other forms of
therapy use interventions such as medications or electronic
devices. Medications or drugs that affect brain function
often have side effects that make them difficult to use
for long-term treatment. Electronic devices that help an
individual control fluency may be more of a bother than
a help in most speaking situations. and are often abandoned
by individuals who stutter.
Unconventional
methods of stuttering therapy also exist. It is always a
good policy to check the credentials, experience and goals
of the person offering treatment. Avoid working with anyone
who promises a "cure" for stuttering.
What
research is being done about stuttering?
Stuttering research
is exploring ways to improve the diagnosis and treatment
of stuttering as well as to identify its causes. Emphasis
is being placed on improving the ability to determine which
children will outgrow their stuttering and which children
will stutter the rest of their lives. Stuttering characteristics
are being examined to help identify groups of individuals
who have similar types of stuttering and therefore may have
a common cause. Research is also being conducted that will
help locate the possible genes for the types of stuttering
that tend to run in families. Modern medical tools such
as PET (positron emission tomography) scans and functional
MRI (magnetic resonance imaging) scans are offering insight
into the brain organization of individuals who stutter.
The effectiveness of different types of treatment
are also being examined, and new treatments are being developed.
'
Where
can I get additonal information?
American Speech-
Language- Hearing Association
10801 Rockville Pike Rockville, MD 20852
(301) 897-5700 (VoiceiTTY) (800) 638-8255 (Toll free) (301)
571-0457 (Fax) www.asha.orgj (Internet)
National Council
on Stuttering Counseling Center
1200 W Harrison Street, Suite 2010 MIC 333
Chicago, IL 60607-7110
(312) 996-3132 (Voice)
cdugan@vic.edu (E-mail)
Stuttering
Foundation of America
P.O. Box 11749
3100 Walnut Grove Road #603
Memphis, TN 38111
(800) 992-9392 (Toll free)
stuttersfa@aol.com(E-mail)
Source: April
1997 NIH Pub. No. 97-4232
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