Stammering, Stuttering

What Is Stammering, Stuttering? What Causes Stammering, Stuttering?

Stammering and stuttering have the same meaning - it is a speech disorder in which the person repeats or prolongs words, syllables or phrases. The person with a stutter (or stammer) may also stop during speech and make no sound for certain syllables. People who stutter often find that stress and fatigue make it harder for them to talk flowingly, as well as situations in which they become self-conscious about speaking, such as public speaking or teaching. Most people who stutter find that their problem eases if they are relaxed.

According to Medilexicon's medical dictionary, to stammer is "To hesitate in speech, halt, repeat, and mispronounce, by reason of embarrassment, agitation, unfamiliarity with the topic, or as yet unidentified physiologic causes. To mispronounce or transpose certain consonants in speech."

We all have the capacity to stutter if pushed far enough. This may happen during a very stressful interrogation in a police station, talking to emergency services on the telephone, or trying to respond to a particularly agile and aggressive lawyer while on the witness stand in court. 

Stuttering is common when children are learning to speak. However, the majority of kids grow out of this stage of initial stuttering. For some, however, the problem persists and requires some kind of professional help, such as speech therapy. It is important that parents do not add to a child's stress by drawing too much attention to the problem when they are trying to communicate verbally. The calmer a child feels the less acute the symptoms tend to become.

What are the signs and symptoms of stuttering?

• Problems starting a word, phrase or sentence
• Hesitation before certain sounds have to be uttered
• Repeating a sound, word or syllable
• Certain speech sounds may be prolonged
• Speech may come out in spurts
• Words with certain sounds are substituted for others (circumlocution)
• Rapid blinking (when trying to talk)
• Trembling lips (when trying to talk)
• Foot may tap (when trying to talk)
• Trembling jaw (when trying to talk)
• Face and/or upper body tighten up (when trying to talk)
• Some may appear out of breath when talking
• Interjection, such as "uhm" used more frequently before attempting to utter certain sounds

What causes stuttering?

Experts are not completely sure. We do know that somebody with a stutter is much more likely to have a close family member who also has one, compared to other people. The following factors may also trigger/cause stuttering:

• Developmental stuttering - as children learn to speak they often stutter, especially early on when their speech and language skills are not developed enough to race along at the same speed as what they want to say. The majority of children experience fewer and fewer symptoms as this developmental stage progresses until they can speak flowingly.
• b>Neurogenic stuttering - when the signals between the brain and speech nerves and muscles are not working properly. This may affect children, but may also affect adults after a stroke or some brain injury. In rare cases neurogenic stuttering results in lesions (abnormal tissue) in the motor speech area of the brain.
• Psychological factors - it used to be believed that the main reasons for long-term stuttering were psychological. Fortunately, this is not the case anymore. Psychological factors may make stuttering worse for people who stutter, such as stress, embarrassment, etc., but they are not generally seen as underlying long-term factors. In other words, anxiety, low self-esteem, nervousness, and stress therefore do not cause stuttering per se. Rather, they are the result of living with a stigmatized speech problem which can sometimes make symptoms worse.

What are the risk factors?

• Family history - approximately half of all children who have a stutter that persists beyond the developmental stage of language have a close family member who stutters. If a young child has a stutter and also a close family member who stutters, his/her chances of that stutter continuing are much greater.
• Age when stutter starts - a child who starts stuttering before 3.5 years of age is less likely to be stuttering later on in life. The earlier the stuttering starts the less likely it is to continue long-term.
• Time since stuttering started - about three-quarters of all young children who stutter will stop doing so with one or two years without speech therapy. The longer the stuttering continues the more likely it is that the problem will become long-term without professional help (and even with professional help).
• Sex of the person - long-term stuttering is four times more common among boys than girls. Experts believe there may be neurological reasons for this, while others blame the way family members react to little boys' stuttering compared to little girls' stuttering. However, nobody is really sure what the reason is.

When to seek professional help

Experts say that parents should consider visiting their GP (general practitioner, primary care physician) when:

• The child's stuttering has persisted for over six months
• When the stuttering occurs more frequently
• When it is accompanied with tightness of the facial and upper body muscles
• When it interferes with the child's schoolwork
• When it causes emotional difficulties, such as fear of places or situations
• When it persists after the child is 5 years old

How is stuttering diagnosed?

Some aspects of stuttering are obvious to everyone, while others are not. To have a comprehensive and reliable diagnosis the patient should be examined by a well-qualified Speech-Language Pathologist (SLP).
The SLP will note how many speech disfluencies the person produces in various situations, as well as the types of disfluencies. How the person copes with disfluencies will also be assessed, how the person reacts to such factors as teasing, which can exacerbate their problems. The SLP may perform some other assessments, such as speech rate and language skills - this will depend on the patient's age and history. The SLP will analyze all the data and determine whether there is a fluency disorder. If there is one, the SLP will determine to what extent the disorder affects the patient's ability to function and take part in daily activities.

It is vital to try to predict whether a young child's stutter will become long-term. This can be fairly accurately done with the help of a series of tests, observations and interviews. Predicting whether an older child or an adult is likely to have continued stuttering over the long-term is less important because most likely the problem has been around long enough for the person to seek help. Assessments for older children and adults are aimed at gauging the severity of the disorder, and what impact it has on the person's ability to communicate and function appropriately in daily activities.

What is the treatment for stuttering?

A good evaluation (diagnosis) is vital as this determines what the best treatment might be.

Treatments for people who stutter tend to be aimed at teaching the person skills, strategies, and behaviors that help oral communication. This may include:

• Fluency shaping therapy
  
  
  • Controlling monitoring speech rate - this may involve practicing smooth, fluent speech at very slow speed, using short sentences and phrases. The person is taught to stretch vowels and consonants, while trying to secure continuous airflow. With practice the person gradually utters smooth speech at higher speed, and with longer sentences and phrases. Patients have higher long-term success rates if the sessions with the SLP are followed up regularly - this helps prevent relapses.
  • Breathing control - as the patient practices prolonged speech he/she also learns how to regulate breathing. Added to this is operant conditioning (controlling breathing, as well as phonation, and articulation (lips, jaw and tongue).
• Stuttering modification therapy
  
  The aim here is to modify the stuttering so that it is easier and requires less of an effort, rather than eliminating it. This therapy works on the principle that if anxiety exacerbates stuttering, using easier stuttering with less avoidance and fear will alleviate the stuttering. Charles Van Riper developed Block Modification Therapy in 1973; it includes four stages:
• Stage 1 (Identification) - the therapist and the patient identify the core behaviors, secondary behaviors, and feelings and attitudes that accompany the stuttering.
• Stage 2 (Desensitization) - the patient freezes stuttering behavior in an attempt to reduce fear and anxiety - this involves confronting difficult sounds, words and situations (rather than avoiding them), and stuttering intentionally (voluntary stuttering).
• Stage 3 (Modification) - the patient learns easy stuttering. He/she learns how to apply: a) 'cancellations' - stopping a dysfluency, pausing for a moment, and then repeating the word, b) 'pull-outs'- pulling out of a dysfluency into fluent speech, c) and 'preparatory sets' - anticipating words that cause stuttering and using 'easy stuttering' on those words.
• Stage 4 (Stabilization) - the patient prepares practice assignments, makes preparatory sets and pull-outs automatic, and changes the way he/she sees himself/herself from being a stutterer to being a person who speaks fluently most of the time, but stutters mildly occasionally.
• Electronic fluency devices
  
  Some patients have responded well to this type of treatment, while others have not. The patients hear their voice differently. Altered auditory feedback effect can be done by speaking in unison with another person (as groups of people do when they are praying or singing), and blocking out the stutterer's voice while talking - this is called masking. Some ear-pieces can echo the speaker's voice so that they feel they are talking in unison with someone else. Most stutterers can sing flowingly without stuttering - it seems that talking in unison with someone else often has the same effect as singing on a stutterer.

How to behave when you are talking with somebody who stutters

People who are not used to talking to somebody with a stutter may be unsure about how to respond. This can make the listener to look away whenever the stutterer stutters, or try to help out by completing his/her missing words or phrases - or simply to try to avoid people who stutter altogether.

It is important to remember that a person who stutters is interested in communicating just like everybody else, and would like to be treated just like any other person. Focus should be on the theme of the speaker, the information he/she is conveying, rather than how it is coming across.

A stutterer is only too aware of what his/her speech is like and that it can take longer to utter phrases. In fact, this awareness can sometimes make the stuttering worse. The stress of knowing that it takes longer to say something may make the stutterer try to speed up, which often makes things worse. It is important that the listener gives out a feeling (vibes) of patience, calm and peace. An impatient listener, or a listener who seems impatient, may make it harder for a stutterer to speak. Attempting to fill in the gaps (saying the missing words) is often an attempt to help out, but can come over to the stutterer as impatience.

Telling the stutterer to relax, or to take a deep breath, may have helpful intentions, but could stress the stutterer more (it may help some, though). Stuttering is not simple to overcome, and cannot usually be easily sorted out with a few deep breaths.

If you are really not sure how to behave, and you are talking to a person who stutters and nobody else is around, it may be helpful to ask them what would be the most best way to respond to his/her stuttering.

Put simply - focus on the content of the speaker's message, not how it is being delivered. Emit a sensation (vibes) of matter-of-fact patience, calm and peace.