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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 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.
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 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.
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, 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.
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 additional information?
American
Speech-Language-Hearing Association
10801 Rockville Pike
Rockville, MD 20852
Voice/TTY: (301) 987-5700
Voice: (800) 638-8255
Fax: (301) 571-0457
Internet: www.asha.org
National Council
on Stuttering
Counseling Center
1200 W. Harrison Street, Suite 2010
MIC 333
Chicago, IL 60607-7110
Voice: (312) 996-3132
E-mail: cdugan@uic.edu
National Stuttering
Project
5100 East La Palma Avenue
Suite 208
Anaheim Hills, CA 92807
Voice: (800) 364-1677
Fax: (714) 693-7554
Internet: www.nspstutter.org
Stuttering
Foundation of America
P.O. Box 11749
3100 Walnut Grove Road #603
Memphis, TN 38111
Voice: (800) 992-9392
E-mail: stuttersfa@aol.com
Internet: www.stuttersfa.org
Stuttering
Resource Foundation
123 Oxford Rd.
New Rochelle, NY 10804
Voice: (800) 232-4773
August 1997
NIH Pub. No. 97-4232
For more information,
contact the health.htm#contact">NIDCD Information
Clearinghouse.
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