stuttering adj : unable to speak freely and easily [syn: stammering(a), stuttering(a)]

English

Noun

1. A speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words or phrases, and by involuntary silent pauses or blocks in which the stutterer is unable to produce sounds.
2. An instance of stuttering.

Synonyms

• stammering

Translations

• Czech: koktání
• French: bégaiement

Verb

stuttering

1. present participle of stutter

Stuttering, also known as stammering in the United Kingdom, is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words or phrases, and involuntary silent pauses or blocks in which the stutterer is unable to produce sounds. 'Verbal non-fluency' is the accepted umbrella term for such speech impediments. The term stuttering is most commonly associated with involuntary sound repetition, but it also encompasses the abnormal hesitation or pausing before speech, referred to by stutterers as blocks, and the prolongation of certain sounds, usually vowels. Much of what constitutes "stuttering" cannot be noted by the listener; this includes such things as sound and word fears, situational fears, anxiety, tension, self-pity, stress, shame, and a feeling of "loss of control" during speech. The emotional state of the individual who stutters in response to the stuttering often constitutes the most difficult aspect of the disorder. The term "stuttering", as popularly used, covers a wide spectrum of severity: it may encompass individuals with barely perceptible impediments, for whom the disorder is largely cosmetic, as well as others with extremely severe symptoms, for whom the problem can effectively prevent most oral communication.

Stuttering is generally not a problem with the physical production of speech sounds or putting thoughts into words. Despite popular perceptions to the contrary, stuttering does not affect and has no bearing on intelligence. Apart from their speech impediment, people who stutter may well be 'normal' in the clinical sense of the term. Anxiety, low self-esteem, nervousness, and stress therefore do not cause stuttering per se, although they are very often the result of living with a highly stigmatized disability and, in turn, exacerbate the problem.

The disorder is also variable, which means that in certain situations, such as talking on the telephone, the stuttering might be more severe or less, depending on the anxiety level connected with that activity. Although the exact etiology of stuttering is unknown, both genetics and neurophysiology are thought to contribute. Although there are many treatments and speech therapy techniques available that may help increase fluency in some stutterers, there is essentially no "cure" for the disorder at present.

Classification

Developmental stuttering is stuttering that originates when a child is learning to speak and develops as the child matures into adulthood. Other speech disorders with symptoms resembling stuttering are cluttering, Parkinson's speech, essential tremor, spasmodic dysphonia and social anxiety.

Characteristics

Primary behaviors

Primary stuttering behaviors are the overt, observable signs of speech fluency breakdown, including repeating sounds, syllables, words or phrases, silent blocks and prolongation of sounds. These differ in from the normal disfluencies found in all speakers in that stuttering disfluencies may last longer, occur more frequently, and are produced with more effort and strain. Stuttering disfluencies also vary in quality: normal disfluencies tend to be a repetition of words, phrases or parts of phrases, while stuttering is characterized by prolongations, blocks and part-word repetitions.

• Repetition occurs when a unit of speech, such as a sound, syllable, word, or phrase is repeated and are typical in children who are beginning to stutter. For example, "st-st-st-story".
• Prolongations are the unnatural lengthening of continuant sounds, for example,"mmmmmmmmmilk". Prolongations are also common in children beginning to stutter.
• Blocks are inappropriate cessation of sound and air, often associated with freezing of the movement of the tongue, lips and/or vocal folds. Blocks often develop later, and can be associated with muscle tension and effort.

Secondary behaviors

Secondary stuttering behaviors are unrelated to speech production and are learned behaviors which become linked to the primary behaviors.

Secondary behaviors include escape behaviors, in which a stutterer attempts to terminate a moment of stuttering. Examples might be physical movements such as sudden loss of eye contact, eye-blinking, head jerks, hand tapping, interjected "starter" sounds and words, such as "um," "ah," "you know". In many cases, these devices work at first, and are therefore reinforced, becoming a habit that is subsequently difficult to break. Other situations, such as public speaking and speaking on the telephone are often greatly feared by stutterers, and increased stuttering is reported.

Feelings and attitudes

Stuttering may have a significant negative cognitive and affective impact on the stutterer. In a famous analogy, Joseph Sheehan, a prominent researcher in the field, compared stuttering to an iceberg, with the overt aspects of stuttering above the waterline, and the larger mass of negative emotions invisible below the surface. Feelings of embarrassment, shame, frustration, fear, anger guilt are frequent in stutterers, and may actually increase tension and effort, leading to increased stuttering. With time, continued exposure to difficult speaking experiences may crystallize into a negative self-concept and self-image. A stutterer may project his or her attitudes onto others, believing that they think he is nervous or stupid. Such negative feelings and attitudes may need to be a major focus of a treatment program. The mean onset of stuttering is 30 months. Most young children are unaware of the interruptions in their speech. Though the rate of early recovery is very high, With time secondary stuttering including escape behaviours such eye blinking, lip movements, etc. may be used, as well as fear and avoidance of sounds, words, people, or speaking situations. Eventually, many become fully aware of their disorder and begin to identify themselves as "stutterers." With this may come deeper frustration, embarrassment and shame. Other, rarer, pattern of stuttering development have been described, including sudden onset with the child being unable to speak, despite attempts to do so. The child usually blocks silently of the first sound of a sentence, and shows high levels of awareness and frustration. Another variety also begins suddenly with frequent word and phrase repetition, and do not develop secondary stuttering behaviours.

Acquired

In rare cases, stuttering may be acquired in adulthood as the result of a neurological event such as a head injury, tumour, stroke or drug abuse/misuse. The stuttering has different characteristics from its developmental equivalent: it tends to be limited to part-word or sound repetitions, and is associated with a relative lack of anxiety and secondary stuttering behaviors. Techniques such as altered auditory feedback (see below) which may promote fluency in stutterers with the developmental condition, are not effective with the acquired type.

Psychogenic stuttering may also arise after a traumatic experience such as a bereavement, the breakup of a relationship or as the psychological reaction to physical trauma. Its symptoms tend to be homogeneous: the stuttering is of sudden onset and associated with a significant event, it is constant and uninfluenced by different speaking situations, and there is little awareness or concern shown by the speaker.

Causes of developmental stuttering

No single, exclusive cause of developmental stuttering is known. A variety of hypotheses and theories suggest multiple factors contributing to stuttering. Children who have first-degree relatives who stutter are three times as likely to develop a stutter. However, twin and adoption studies suggest that genetic factors interact with environmental factors for stuttering to occur, and forty to seventy percent of stutterers have no family history of the disorder. There is evidence that stuttering is more common in children who also have concomitant speech, language, learning or motor difficulties.

In some stutterers, congenital factors may play a role. These may include physical trauma at or around birth, including cerebral palsy, retardation, or stressful situations, such as the birth of a sibling, moving, or a sudden growth in linguistic ability.

Auditory processing deficits have also been proposed as a cause of stuttering. Stuttering is less prevalent in deaf and hard of hearing individuals, and stuttering may be improved when auditory feedback is altered, such as masking, delayed auditory feedback (DAF), or frequency altered feedback. Brain scans of adult stutterers have found increased activation of the right hemisphere, which is associated with emotions, than in the left hemisphere, which is associated with speech. In addition reduced activation in the left auditory cortex has been observed.

Treatment

Fluency shaping therapy

Fluency shaping therapy, also known as "speak more fluently" or "prolonged speech", trains stutterers to speak fluently by controlling their breathing, phonation, and articulation (lips, jaw, and tongue). It is based on operant conditioning techniques.

Stutterers are trained to reduce their speaking rate by stretching vowels and consonants, and using other fluency techniques such as continuous airflow and soft speech contacts. The result is very slow, monotonic, but fluent speech used only in the speech clinic. After the stutterer masters these fluency skills, the speaking rate and intonation are increased gradually. This more normal-sounding, fluent speech is then transferred to daily life outside the speech clinic, though lack of speech naturalness at the end of treatment remains a frequent criticism. Fluency shaping approaches are often taught in intensive group therapy programs, which may take two to three weeks to complete, but more recently the Camperdown program, using a much shorter schedule, has been shown to be effective.

Stuttering modification therapy

The goal of stuttering modification therapy is not to eliminate stuttering but to modify it so that stuttering is easier and less effortful. The rationale is that since fear and anxiety causes increased stuttering, using easier stuttering and with less fear and avoidance, stuttering will decrease. The most widely known approach was published by Charles Van Riper in 1973 and is also known as block modification therapy.

As proposed by Van Riper, stuttering modification therapy has four overlapping stages:

• In the first stage, called identification, the stutterer and clinician identify the core behaviors, secondary behaviors, and feelings and attitudes that characterize the stuttering.
• In the second stage, called desensitization, the stutterer works to reduce fear and anxiety by freezing stuttering behaviors, confronting difficult sounds, words and situations, and intentionally stuttering ("voluntary stuttering").
• In the third stage, called modification, the stutterer learns "easy stuttering." This is done by "cancellations" (stopping in a dysfluency, pausing a few moments, and saying the word again); "pull-outs," or pulling out of a dysfluency into fluent speech; and "preparatory sets," or looking ahead for words one may stutter on, and using "easy stuttering" on those words.
• In the fourth stage, called stabilization, the stutterer prepares practice assignments, makes preparatory sets and pull-outs automatic, and changes their self-concept from being a person who stutters to being a person who speaks fluently most of the time but who occasionally stutters mildly.

Electronic fluency devices

seealso Electronic fluency devices Altered auditory feedback, so that stutterers hears their voice differently, has been used for over 50 years in the treatment of stuttering. Altered auditory feedback effect can be produced by speaking in chorus with another person, by providing blocking out the stutterer's voice while talking (masking), by delaying the stutterer's voice slightly (delayed auditory feedback) and/or by altering the frequency of the feedback (frequency altered feedback). Studies of these techniques have had mixed results, with some stutterers showing substantial reductions in stuttering, while others improved only slightly or not at all.

Anti-stuttering medications

The effectiveness of pharmacological agents, such as anti-convulsants, anti-depressants, antipsychotic and antihypertensive medications, and dopamine antagonists in the treatment of stuttering has been evaluated in studies involving both adults and children. A comprehensive review of pharmacological treatments of stuttering in 2006 concluded that few of the drug trials were methodologically sound. showed a reduction in stuttering to less than 5%. In addition, potentially serious side effects of pharmacological treatments were noted. and about 74% recover by their early teens. In particular, girls seem to recover well. For others, early intervention is effective in helping the child achieve normal fluency.

Once stuttering has become established, and the child has developed secondary behaviors, the prognosis is more guarded, However, with treatment young children may be left with little evidence of stuttering. and overall males are affected two to five times more often than females. Most stuttering begins in early childhood and according studies suggest 2.5% of children under the age of 5 stutter. due to higher recovery rates in girls. the overall prevalence of stuttering is generally considered to be approximately 1%.

History and cultural aspects

For centuries stuttering has featured prominently in society at large. Because of the unusual-sounding speech that is produced, as well as the behaviors and attitudes that accompany a stutter, stuttering has been a subject of scientific interest, curiosity, discrimination, and ridicule. Stuttering was, and essentially still is, a riddle with a long history of interest and speculation into its causes and cures. Stutterers can be traced back centuries to the likes of Demosthenes, who tried to control his disfluency by speaking with pebbles in his mouth. The Talmud interprets Bible passages to indicate Moses was also a stutterer, and that placing a burning coal in his mouth had caused him to be "slow and hesitant of speech" (Exodus 4, v.10) Partly due to a perceived lack of intelligence because of his stutter, the man who became the Roman Emperor Claudius was initially shunned from the public eye and excluded from public office.. However, those who knew Churchill and commented on his stutter believed that it was or had been a significant problem for him. His secretary Phyllis Moir in her 1941 book 'I was Winston Churchill's Private Secretary' commented that 'Winston Churchill was born and grew up with a stutter'. Moir writes also about one incident 'It’s s s simply s s splendid” he stuttered, as he always did when excited.’ Louis J. Alber. who helped to arrange a lecture tour of the United States wrote in Volume 55 of the The American Mercury (1942) ‘Churchill struggled to express his feelings but his stutter caught him in the throat and his face turned purple' and ‘Born with a stutter and a lisp, both caused in large measure by a defect in his palate, Churchill was at first seriously hampered in his public speaking. It is characteristic of the man’s perseverance that, despite his staggering handicap, he made himself one of the greatest orators of our time.’ (More on Churchill at http://www.stutterers.org)

For centuries "cures" such as consistently drinking water from a snail shell for the rest of one's life, "hitting a stutterer in the face when the weather is cloudy", strengthening the tongue as a muscle, and various herbal remedies were used. Similarly, in the past people have subscribed to theories about the causes of stuttering which today are considered odd. Proposed causes of stuttering have included tickling an infant too much, eating improperly during breastfeeding, allowing an infant to look in the mirror, cutting a child's hair before the child spoke his or her first words, having too small a tongue, or the "work of the devil."

Jazz and Euro Dance musician Scatman John wrote the song "Scatman (Ski-Ba-Bop-Ba-Dop-Bop)" to help children who stutter overcome adversity. Born John Paul Larkin, Scatman spoke with a stutter himself, and won the American Speech-Language-Hearing Association's Annie Glenn Award for outstanding service to the stuttering community.

See also

• Developmental dysfluency
• List of stutterers
• The Monster Study
• Dyslexia
• Speech processing
• Basal ganglia

Notes

References

• Stuttering: An Integrated Approach to Its Nature and Treatment
• Stuttering
• Stuttering and Cluttering: Frameworks for understanding treatment

Further reading

• Alm, Per A. (2005). On the Causal Mechanisms of Stuttering. Doctoral dissertation, Dept. of Clinical Neuroscience, Lund University, Sweden.
• Stammering : its nature, history, causes and cures
• Stuttering
• If Your Child Stutters: A Guide for Parents

External links

• International Stuttering Association
• European League of Stuttering Associations
• The Stuttering Foundation of America
• Indian Stuttering Association
• Italian Stuttering Association
• (Organizations)

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