The key to treating stuttering effectively is early detection and intervention.
Barry Guitar, chairman of the Department of Communication Sciences at the University of Vermont, knows exactly what it’s like to be a stutterer. He began to stutter at the age of 3, and like most kids with a speech disorder, he was often teased by other children when he began going to school. In addition to the frustration that comes with a speech disorder, Guitar’s stuttering began to take a greater emotional toll. Soon he became reluctant to speak at all.
Despite his difficulty in speaking, Guitar became an excellent student. In the 11th grade, his classmates selected him to represent his high school at a state academic conference. However, a teacher intervened and selected another student to go in his place. Guitar was crushed. It was an opportunity denied to him because of his stutter.
Guitar sought professional treatment for his stuttering when he was in his 20’s, and the positive effects of the therapy were profound. Before long, he was able to effectively manage his stuttering. Today, any lingering trace of stuttering is barely noticeable. Perhaps not surprisingly, his life’s work has been devoted to helping others who stutter. “Every person who stutters can be helped,” he says.
What is stuttering?
Stuttering is a speech disorder in which the fluency (normal flow) of speech is impaired. The World Health Organization defines stuttering as “a disorder in the rhythm of speech in which the individual knows precisely what he or she wishes to say, but may have difficulty saying it because of an involuntary repetition, prolongation, or cessation of sound.” Repetition usually involves syllables (“fa-fa-fa-father”) or one-syllable words (“and-and-and”). Prolongation involves elongated sounds (“waaaater”). Cessation is the complete blockage of speech during which the person is unable to utter a sound at all.
More than 3 million Americans stutter, and male stutterers outnumber females 4 to 1. Stuttering is much more common in children than adults, affecting about 3 to 5 percent of preschoolers at one time or another. Almost 80 percent of children who stutter recover fluency by age 16. Some people develop stuttering for the first time as adolescents or adults, but such cases are rare.
People with a mild stutter sometimes learn to control or conceal their condition on their own, but more severe cases require speech therapy by a trained professional. The key to treating stuttering effectively is early detection and intervention.
Stuttering occurs in all cultures and races, all educational levels and social classes. However, many experts believe that cultures such as those in the United States and Japan, which are thought to be more stressful in terms of demanding high performance and efficiency, have a greater percentage of stutterers. Some famous people who experienced a stuttering disorder include former British Prime Minister Winston Churchill, King George VI of the United Kingdom, English physicist Sir Isaac Newton, actors James Earl Jones, Bruce Willis, and Marilyn Monroe, and writers Somerset Maugham, John Updike, and Lewis Carroll.
Through the ages, many theories about the causes of stuttering have been proposed, usually with an associated “cure.” The ancient Greek physician Hippocrates (460?-380? B.C.), believed that stuttering was caused by dryness of the tongue. In the 1600’s, the English philosopher and statesman Francis Bacon insisted that a “refrigerated tongue” needed to be warmed with hot wine in order to cure stuttering. In the 1800’s, many doctors attributed stuttering to a supposed anatomical problem of the mouth or tongue. In the 1840’s, a Prussian surgeon attempted to cure the problem by surgically removing portions of patients’ tongues.
By the early 1900’s, most experts had come to believe that stuttering was caused by psychological and emotional factors. As a result, many stutterers sought psychotherapy (treatment of mental and emotional problems by psychological methods) in hopes of resolving the condition. Since the 1930’s and 1940’s, this approach has slowly fallen out of favor. Physicians determined that psychological treatments were ineffective. A growing body of research indicated that people who stutter are no more likely to have a psychiatric disorder than anyone else. In fact, by 2000, most doctors believed that stuttering was caused by physical—and not psychological—factors. Psychological factors, however, may make the condition worse. Although the exact cause of stuttering remains a mystery, research in the late 1900’s indicated that several factors may play a role in the disorder, including neurological (the brain and nervous system), genetic, and environmental influences.
The speech process
Speaking is a complicated process. To produce fluent speech, the brain must direct the fine and complex movements of more than 100 muscles of the chest, neck, mouth, and face with precise coordination and timing. This fact prompted many researchers to theorize that neurological factors play a significant role in stuttering, and many studies have supported this view.
For instance, research has shown that the brain functions of people who stutter are organized a bit differently than the brain functions of those who don’t. In one study, led by Peter T. Fox, director of the Research Imaging Center in San Antonio, Texas, researchers employed a medical imaging technique known as positron emission tomography (PET) to identify which areas of the brain are most active while handling tasks involving processing language and producing speech. In most people, the brain’s speech and language centers are located in the left hemisphere. However, Fox’s PET scans revealed that the speech and language functions of many stutterers were controlled by the right hemisphere, which may not be as well suited to handle the complexities of producing speech. This study and others like it suggest that stuttering is a fundamental disorder of the way the brain processes language and speech.
Researchers have also explored the role that genetics plays in stuttering. Statistics show that a person with a parent or other close relative who stutters is more than three times more likely than the average person to develop a stuttering problem, according to researchers. Researchers found that stuttering was more than twice as likely to occur in both identical twins (who share the same genetic information) as in both fraternal twins (who are genetically no more alike than any other siblings). By 2000, experts agreed that stuttering involves an inherited genetic trait, much like dyslexia (a reading and writing disorder), attention deficit hyperactive disorder, and similar disorders that involve the brain.
Is it really stuttering?
Many children experience some normal loss of fluency at one time or another, particularly when they try to speak too rapidly, when they are upset or excited, or when they have trouble thinking of the word they want to say. Experts agree that in most cases, this is merely the result of “developmental dysfluency” and is not characterized as stuttering.
Developmental dysfluency is a normal part of childhood development. About 25 percent of all children go through a period of development in which they experience some loss of fluency. From the ages of 18 months to 5 years, youngsters may repeat sounds or pause between words. This developmental dysfluency may persist for weeks or months, but it eventually disappears on its own as the child’s nervous system matures. Many experts believe developmental dysfluency occurs because a child’s thought processes develop more rapidly than the mastery of speech. When learning to talk, it is common for children to utter statements like, “Mommy, I saw, I saw, um, um, I saw. . . .” Instances like this simply indicate the child is learning to use language in a new way.
There are signs to look for that can help make the distinction between developmental dysfluency and a stuttering disorder. Children who are developmentally dysfluent usually repeat sounds or one-syllable words once or twice. They may also hesitate and use filler sounds such as “um,” or “uh.” Children with a stuttering disorder, on the other hand, are likely to repeat sounds or one-syllable words three or more times or prolong sounds for two or more seconds. A stuttering child also may experience a momentary blockage of speech. As this happens, the child may exhibit tension in the facial muscles, particularly around the mouth. The pitch of his or her voice may also rise in the struggle to get words spoken.
Signs of stuttering usually begin to appear between the ages of 3 and 6, and the problem develops gradually. Children with developmental dysfluency tend to have fluency difficulties that come and go, generally during the preschool years. The problem may subside for a few weeks only to return, but it usually ceases altogether by the time a child begins going to school.
Stuttering can be an extremely frustrating condition. The individual is unable to speak words fluently and, because each sentence is spoken with such difficulty, the level of frustration increases. Some-times, a word seems to become “stuck,” and the person may grimace, jerk the head or neck, or roll the eyes as he or she struggles to overcome the stutter. Stuttering can also be frustrating for other people as they watch the individual labor to be understood. At its worst, the disorder can interfere with a person’s ability to communicate with others, and its impact on self-esteem can be severe.
Experts agree that emotional or stressful situations can trigger stuttering. For example, stuttering typically worsens when the child becomes anxious, upset, or excited. All children feel anxiety and pressure from time to time, such as when a baby brother or sister is born or when value is placed on giving short speeches or reciting poems at the dinner table. According to Guitar, this kind of stress can trigger childhood stuttering. Children usually try to stop stuttering on their own, but when they are unsuccessful they may become self-conscious or anxious, or lose self-esteem, which can make their stuttering even worse. Teasing by other children further amplifies the problem. Some children become socially and emotionally withdrawn, and they may avoid verbal interactions in school, such as class participation, presentations, and reading aloud.
In later years, if left untreated, stuttering can have a large impact on a person’s life. For example, a stutterer may choose a job because little or no speaking or personal interaction is expected or turn down a promotion that would involve more personal interaction.
Fortunately, in at least 50 percent of cases, stuttering children will spontaneously recover fluency, even without formal treatment, according to researchers. This may be due to the maturing of the nervous system or to learned adaptations, such as talking more slowly. Girls are more likely to experience a natural resolution of their stuttering than boys. However, there is no way to identify which youngsters will outgrow their speech problem.
Treatment for stuttering
While there is no known cure for stuttering, just about everyone who stutters can be helped to some degree. Treatment for stuttering is often multi-tiered, combining speech therapy for the stuttering itself with psychological counseling to manage self-esteem issues often associated with this condition. Parents may be counseled as well to help them avoid any inappropriate behavior—such as criticism or showing frustration—that they may direct at their child over his or her stuttering.
The earlier a child begins treatment, the better the chances for success. The reason for this is that the developing brain and nervous system of a young child are more receptive to learning—and relearning. During the critical period of speech development—between 2 and 12 years of age—the still-growing brain is much more adaptable for speech development than it is after puberty. In a sense, it is easier to reprogram the brains of younger children. As the stuttering behavior becomes more entrenched with time, it is harder to resolve.
As a rule, a child who has been stuttering for more than a year should be considered a candidate for speech therapy. Speech therapy is usually administered by a speech-language pathologist, a health care professional educated and trained to evaluate and treat children and adults with speech or language problems. A speech-language pathologist should have both a license from the state and certification by the American Speech-Language-Hearing Association (ASHA), the national professional, scientific, and accrediting organization responsible for certifying speech-language pathologists. Most schools, particularly elementary schools, employ a speech-language pathologist. The ASHA also maintains a list of certified speech-language pathologists for referral.
The role of speech therapy
During an initial assessment of a stuttering child, the speech therapist will ask about any family history of stuttering and evaluate the severity of the child’s condition. Some experts believe that a child who exhibits five or more breaks in speech per 100 words is a candidate for treatment. In addition, a child who shows physical signs of speech-related anxiety (such as grimaces and facial twitches) or substitutes words to avoid stuttering should receive professional help. After evaluating the child, the therapist will create a suitable treatment plan.
The two most common treatment approaches for stuttering are fluency shaping, which attempts to help the child speak more easily and fluently, and stuttering modification, which teaches the child how to reduce the anxiety associated with stuttering. Fluency shaping usually begins with extremely slow, deliberate speech (also called turtle talk). The child is guided to speak in a carefully controlled way, one syllable after another, stressing each syllable evenly and allowing for a better coordinated transition between vowel sounds and other sounds. The therapist gradually increases the speaking rate until the speech rate sounds normal.
Stuttering modification seeks to reduce the fear of stuttering and eliminate the avoidance behaviors associated with this fear. It teaches stutterers to be aware of what they do when they stutter. By examining their stuttering behavior, individuals learn to be less afraid and anxious about stuttering and begin to feel a sense of control over their speech. Eventually, the stuttering becomes less evident.
Speech therapy also employs various devices to help the child learn to speak more normally. One method is known as delayed auditory feedback (DAF). In DAF, children use headphones to listen to their own voice, which a tape recorder delays by several milliseconds. Speaking and then listening to the delayed voice somehow causes a marked reduction in stuttering. Why this occurs is not well understood, but researchers suggest that the delayed sound forces the child to speak more slowly. However, the improvement made by people who undergo DAF therapy often disappears over time. As a result, researchers in 2000 were seeking a better understanding of auditory feedback and attempting to develop therapies that would result in more permanent speech improvement.
Children in speech therapy are often encouraged to play with computer programs designed to help them become more fluent. The programs give feedback on children’s speech patterns, which can guide them in making subtle adaptations toward greater fluency.
Medication for stuttering
In some cases, a physician may prescribe medications that have been shown to help some people with a stuttering problem. These drugs include certain benzodiazepines, calcium channel blockers, phenothiazines, and anticonvulsants. A medication called haloperidol (sold as Haldol) improves stuttering in some individuals, but the side effects are often difficult to tolerate. The major side effect of haloperidol is a disorder called tardive dyskinesia, which involves involuntary movements of the mouth, tongue, cheeks, jaw, or arms and legs. Most of these medications temporarily reduce the anxiety associated with stuttered speech, but they don’t provide a cure for stuttering. By 2000, no drug had yet produced consistently positive results in the treatment of stuttering.
Some stutterers try several kinds of therapy without significant improvement, which often results in feelings of failure and frustration. People who stutter can therefore become vulnerable to scams that claim to improve or even cure the problem. Two common but ineffective methods that claim to cure stuttering include teaching the person to speak with a sing-song inflection or while rhythmically tapping a finger.
Supporting the stutterer
The most effective thing that parents and other family members can do to help a child with a stuttering problem, experts say, is to minimize the child’s frustration level and self-consciousness about stuttering. Make sure everyone in the family understands the importance of acceptance, being a good listener, and refraining from interrupting the child. Don’t correct the child or finish sentences for him or her. Don’t say things like “Stop and start over” or “Think before you talk,” which imply that the child is doing something wrong. Instead, experts counsel parents to listen patiently as the child talks and to not become annoyed. Reassure the child with statements such as, “Lots of people find certain words hard. You’re doing just fine.” Encourage the child to speak at home and at school. Discourage siblings and playmates from teasing the child and intervene when necessary. Listen for signs of improvement and encourage any progress the child makes in his or her speech behavior.
It is also helpful to slow your own rate of speech, experts say, talking calmly and comfortably. Young children especially have problems when others speak too rapidly. Devote a block of time each day to talking quietly with your child in a stress-free setting, when you can give your undivided attention. Reading bedtime stories together may also be helpful, according to experts.
Stuttering can be a frustrating problem that can have significant emotional and sociological effects. However, stuttering is by no means a roadblock to a normal, fulfilling life. With proper education, early intervention, and support, virtually everyone who stutters can learn to either speak with greater fluency or at least without undue anxiety or embarrassment about his or her stuttering, even if the problem is never completely conquered.
Jezer, Marty. Stuttering: A Life Bound Up in Words. Basic Books, 1997.
Hulit, Lloyd M. Straight Talk on Stuttering: Information, Encouragement, and Counsel for Stutterers, Caregivers, and Speech-Language Clinicians. Charles C. Thomas Pub Ltd., 1996.
For additional information: Web sites
American Speech-Language-Hearing Association—www.asha.org
National Stuttering Association—www.nsastutter.org
Sometimes I Just Stutter (online version of the children’s book)—https://www.stutteringhelp.org/sometimes-i-just-stutter
The Stuttering Foundation of America—https://www.stutteringhelp.org/
The Stuttering Home Page, Minnesota State University, Mankato— http://www.mnsu.edu/comdis/kuster/stutter.html