Stuttering
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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.
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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.
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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 6 who are developing language. Boys are
three times more likely to stutter than girls. Most children, however,
outgrow their stuttering, and it is estimated that less than 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.
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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 stuttering 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.
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.
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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.
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There are a variety of treatments available for stuttering. Any of the
methods may improve stuttering to some degree, but there is at present no
cure for stuttering. Stuttering therapy, however, may help prevent
developmental stuttering from becoming a life-long problem. Therefore a
speech evaluation is recommended for children who stutter for longer than
six 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 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.
- 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 utilize interventions such as medications or
electronic devices. Medications or drugs which affect brain function often
have side effects that make them difficult to use for long-term treatment.
Electronic devices which 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.
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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.
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American Speech-Language-Hearing Association
National Stuttering Association
Stuttering Foundation of America
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