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.
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.
Stuttering involves irregular and interrupted speech patterns.
Characteristics of typical speech patterns include:
- Repetitions of sounds, syllables, or short words. These may occur as:
- False starts: "c-c-cold."
- One-syllable words: "I-I hear you."
- Entire words that have more than one syllable: "Giraffes-giraffes are tall!"
- Phrases: "I want-I want to go too."
- With word interruptions (interjections): "How do I—um—get up there?"
- Within a word (broken words): "I am hun ... [pause] ... gry."
- With lips together or mouth open but no words are produced.
- Word substitutions (circumlocution) to avoid trying to say difficult words.
- Complete changes of words or thoughts: "I found my—Do you want to eat?"
- Drawn-out words (prolongations), usually at the beginning of sentences: "M-m-m-m-m-mommy, you have ice cream".
You may notice that your child stutters more when excited, anxious, overwhelmed, or tired. For example, talking to someone who does not appear interested or asking or answering questions may trigger or increase stuttering. Also, stuttering often gets worse when a child tries to explain something complex.
Stuttering may also occur with repetitive gestures or unusual mannerisms, such as exaggerated blinking or tension around the mouth. This is more likely to occur when stuttering is severe or getting worse. These symptoms often mean that the speaker is aware of and embarrassed by his or her stuttering.
Types of stuttering
Stuttering can be categorized into three main types according to when it begins, its typical pattern, and whether it resolves on its own.
- Normal disfluency is stuttering that occurs during early childhood, when speech is rapidly developing, but resolves without treatment before puberty. This type of stuttering may appear sporadically and gradually decrease until it no longer occurs. The irregular speech may be infrequent, and the child usually does not notice or is not bothered by it.
- Developmental stuttering generally requires treatment to improve. Speech problems most often first appear around age 5 during the critical stages of language development but can occur any time between about 2 and 7 years of age. Symptoms can range from mild to severe.
- Mild developmental stuttering and normal disfluency can be hard to tell apart. In general, mild stuttering causes more frequent symptoms. It may also recur after a temporary improvement or get worse. Children with mild developmental stuttering may feel frustrated and bothered by their speech problem.
- Severe developmental stuttering affects almost every sentence of speech in all situations. Children usually become frustrated, upset, and embarrassed by their stuttering and often cover their mouths with their hands while attempting to speak. They also may develop mannerisms such as nodding the head or closing, blinking, or frequently moving the eyes in an exaggerated way. Severe stuttering most often affects older children, but it can occur in very young children as well. Speech therapy and other forms of treatment are needed to improve severe stuttering.
- Acquired stuttering may result from an injury or condition that damages the brain, such as a stroke or Alzheimer's disease. Less often, stuttering begins after experiencing an emotional trauma. Typically, a person with acquired stuttering repeats or draws out sounds, syllables, or word patterns. The speaker maintains normal eye contact, does not seem anxious or bothered by his or her speech problems, and doesn't have unusual mannerisms, such as grimacing or eye-blinking.
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.
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.