Stuttering:Frequently Asked Questions

STUTTERING SCIENCE

  • Does stuttering have a physical or psychological cause?
  • How common is stuttering in children? What percentage of adults stutter? Do more men than women stutter?
  • Is there a genetic basis for stuttering? Does stuttering run in families?
  • Do stutterers have neurological abnormalities? What have brain scan studies found?
  • Do stutterers' beliefs and attitudes affect their speech? Should stutterers change how they think about themselves?
  • How does stress affect stuttering? Does distraction work?
  • Why can stutterers talk fluently in some situations? What are these situations?
  • Are there other speech disorders similar to stuttering?
  • CHILDHOOD STUTTERING THERAPY

  • "My child is having trouble talking. Is he stuttering, or is it just normal childhood dissiliences?"
  • Should parents take a child to a speech pathologist right away, or wait and see if the child outgrows stuttering?
  • How is childhood stuttering treated?
  • What's the most effective treatment for school-age stuttering?
  • "My teenager has had stuttering therapy since kindergarten. He's fluent in the speech pathologist's office, but stutters elsewhere. He's not making progress and wants to discontinue therapy. He's withdrawing from his peers. What can we do?"
  • ADULT STUTTERING THERAPY

  • What are the traditional therapies for adult stuttering?
  • Are there computers or other electronic devices to help stutterers?
  • RESOURCES FOR STUTTERING

  • Are there any celebrities who stutter? How did they overcome stuttering?
  • How does stuttering affect employment? Should stutterers talk about their speech in job interviews?
  • What should listeners do when they talk to a stutterer?
  • STUTTERING SCIENCE

    Does stuttering have a physical or psychological cause?

    There's nothing wrong with stutterers' tongues or vocal folds or breathing. Stutterers are not more nervous, don't have worse self-esteem, and are not "schizo," as some movies have portrayed stutterers.

    Stuttering is a developmental disorder. Some experts believe that stuttering develops from the normal mistakes all children make when learning to talk ("normal disfluencies"). While most children can pick themselves up after a stumble, some children get into a vicious cycle of trying harder to talk, tensing their speech-production muscles too much, and getting more stuck.

    Other experts have found that severe stuttering can develop almost overnight in young children. They believe that stuttering may not develop gradually from normal disfluencies. Genes have been found associated with stuttering, so these experts believe that a genetic defect causes something in the child's brain to trigger stuttering.

    Although the origin of stuttering is not clear, everyone agrees that childhood stuttering can develop into a severe physical and psychological disability. Adults who stutter can have physical symptoms, including:

  • Breathing abnormalities during stuttering, especially upper chest tension.
  • Laryngeal blocks, which cut off airflow during stuttering.
  • Articulation problems, including tension in the lips, jaw and tongue, and prolonged or repeated sounds.
  • Secondary or "escape" behaviors, such as head jerks, eye blinking, or facial grimaces.
  • Neurological abnormalities visible via brain scans.
  • Adult stuttering psychological symptoms can include:

  • Avoidance of feared sounds, words, and speaking situations. For example, the stutterer may avoid making telephone calls.
  • How common is stuttering in children? What percentage of adults stutter? Do more men than women stutter?

    Between 5% and 15% of children stutter at some point in childhood. As children get older, the prevalence drops to about 1% in junior high school and high school, and to about 0.1% for adults.

    Of two- and three-year-olds, equal numbers of boys and girls stutter. The sex ratio becomes 3:1 by the first grade and 5:1 by the fifth grade, the same ratio as adults. 80% of adult stutterers are men.

    Is there a genetic basis for stuttering? Does stuttering run in families?

    The three genes that control levels of the neurotransmitter dopamine have been found to correlate with stuttering. These genes also correlate with Tourette's Syndrome, attention deficit hyperactive disorder (ADHD), and obsessive-compulsive disorder. These disorders appear to be caused by abnormally high levels of dopamine, in different parts of the brain. Research has not been done to determine whether all stutterers have these genes, or whether only some stutterers have these genes.

    If you stutter, you are about three times more likely to have a close relative who stutters. Stuttering runs in some families. However, studies of the families of stutterers have failed to find simple Mendelian types of inheritance, such as sex-linked, autosomal dominant, or recessive.

    Do stutterers have neurological abnormalities? What have brain scan studies found?

    Brain scan studies have found no differences in stutterer's brains when they are not talking, and when they are talking fluently. But during stuttering, changes are seen in stutterers' brain activity. Left-brain areas (where speech and language are produced) that should be active during speech become inactive, while right-brain areas that should be inactive during speech become active.

    Brain scans have found abnormally low activity during stuttering in the central auditory processing area, and in the area that integrates auditory and somatic (body) sensation. Stuttering seems to be related to an inability to integrate what the stutterer hears with the muscle movements he feels.

    Stuttering appears to be caused by excessive amounts of the neurotransmitter dopamine in the left caudate nucleus. This is the area that translates speech into muscle movements.

    We have no conscious awareness of central auditory processing and the left caudate nucleus. This explains why stuttering therapies that rely on consciously controlling your speech (and speech therapists that tell you to "try harder") are at best only temporarily effective. New stuttering therapies use drugs and computers to alter the brain areas that can't be consciously controlled.

    Do stutterers' beliefs and attitudes affect their speech? Should stutterers change how they think about themselves?

    A series of studies found that stutterers can predict with 98% accuracy the words they will stutter on in a written passage. Stutterers can accurately anticipate their stuttering.

    However, placebo studies found that stutterers' speech is not changed when they are given a pill and told that the pill will improve their speech. The belief that you will or will not stutter has no effect on your speech. The anticipation of stuttering does not cause stuttering.

    Some stutterers say that they stopped stuttering, temporarily or even permanently, when they adopted a new attitude about their speech. However, no study has ever proven these anecdotal reports.

    Stutterers should improve their awareness of their stuttering, be open about their stuttering, and try to talk more instead of avoiding speaking situations. These are all a part of overcoming stuttering. But few stutterers will experience improved speech solely from this they should also work on their physical speech production skills.

    Belief Anticipation, Distraction, Stress, and Placebos Psychological Self-Therapy

    How does stress affect stuttering? Does distraction work?

    Some types of stress increase stuttering. Some types of stress decrease stuttering. Other types of stress have no effect on stuttering.

    Physiological stress, such as elevated heart rate or blood pressure, has no effect on stuttering. No study has found that sleep deprivation, the flu, etc., increases stuttering.

    Emotional stress often reduces stuttering. Many stutterers report being "so scared" that they "couldn't stutter." There is a neurochemical explanation, based on the interaction of adrenaline and dopamine.

    Time pressure, cognitive stress (e.g., trying to talk to someone who is watching television), and speech-related fear and anxiety (such as fear of public speaking) increase stuttering.

    Several studies have found that distractions do not reduce stuttering.

    Belief Anticipation, Distraction, Stress, and Placebos

    Why can stutterers talk fluently in some situations? What are these situations?

    Stuttering usually occurs on the initial sound or syllable of a word, in the first word of a sentence, on accented syllables, and on "content" words. "Content" words carry the meaning of a sentence, which is why when listeners guess what a stutterer is trying to say, they often guess wrong.

    Stuttering increases when saying one's name, speaking on the telephone, speaking to an authority figure, or speaking to an audience.

    Stuttering decreases when saying a phrase repeatedly, speaking in chorus with another person, when speaking alone or to animals, when singing, using a lower pitch, using a different accent, using electronic anti-stuttering devices, and when crawling on all fours!

    Some stutterers can read fluently, while others can't. Some stutterers are fluent when they try to stutter, others stutter more.

    Stutterers report having "good days" and "bad days", possibly due to changing dopamine levels in their brains due to diet and other factors.

    Some of these effects are psychologically-conditioned, such as speaking to authority figures. Other effects are physiological, such as lowering vocal pitch, or speaking in chorus with another person.

    Conditions That Increase or Decrease Stuttering

    Are there other disorders similar to stuttering?

    Cluttering

    Cluttering is defined as "...a disturbance of fluency involving an abnormally rapid rate and erratic rhythm of speech that impedes intelligibility. Faulty phrasing patterns are usually present so that there are bursts of speech consisting of groups of words that are not related to the grammatical structure of the sentence. The affected person is usually unaware of any communication impairment."

    Cluttering usually includes effortless repetitions, usually single syllables, short words, and phrases (stutterers only repeat initial sounds).

    Cluttering may also be characterized by poor concentration and short attention span; perceptual weakness; and poorly organized thinking, or speaking before clarifying thoughts.

    Clutterer: "I want to go to the st...uh...place where you buy...market st-st-store and I don't have muh-muh ti-ti-time money."

    Stutterer: "I want to go to the sssssssssstore and I don't have muh-muh- muh-muh-money."

    Neurogenic Stuttering

    Strokes and head injuries can cause stuttering-like symptoms in adults. Neurogenic stuttering has repetitions, prolongations, and blocks. Neurogenic stutterers lack the facial grimaces, eye blinking, and fears and anxieties of developmental stuttering.

    Psychogenic Stuttering

    Adult psychogenic stuttering begins suddenly after an event causing extreme psychological stress. It's characterized by repetition of initial or stressed syllables, lack of conditions inducing fluency, an indifferent attitude toward the disorder, and maintenance of normal eye contact. Psychogenic stuttering is rare.

    Spastic Dysphonia

    Spastic dysphonia is a repeated blockage of the larynx only. The onset is in middle age, and the disorder affects an equal number of men and women.

    Tourette's Syndrome

    Tourette's is like stuttering with your hands and feet. Touretters compulsively touch objects, and some have verbal symptoms such as barking or saying obscenities. Like stuttering, these behaviors are situational, but trying to not do the behaviors makes the behavior stronger.

    Social Phobia

    People with social phobia experience anxiety and panic when going to parties, meeting strangers, or even in minor social situations such as talking to a store clerk.

    CHILDHOOD STUTTERING THERAPY

    "My child is having trouble talking. Is he stuttering, or is it just normal childhood disfluencies?"

    Danger signs include struggling to get words out, with an increase in vocal pitch, blocked airflow, or tongue protrusion. The child may show frustration at being unable to talk, and secondary behaviors such as eye blinking, nodding, or facial grimacing. Fear of talking or avoiding certain words or sounds is a danger sign.

    Other danger signs include multiple repetitions, or part word repetitions. For example, "That my-my ball" is a normal disfluency. But "The-the-the-that's my ball," is stuttering. Note the part-word repetition, the multiple repetitions, and the substitution of the "schwa" or neutral vowel in "the", instead of using the vowel in "that."

    Should parents take a child to a speech pathologist right away, or wait and see if the child outgrows stuttering?

    If a child has stuttering symptoms, he or she should see a speech pathologist right away. Many parents report that their pre-school children outgrew stuttering without therapy, but some researchers now believe that these children had normal childhood disfluencies, not stuttering. They suspect that few, if any, children outgrow stuttering without therapy.

    After the age of 4, the likelihood of outgrowing stuttering drops significantly. Children's stuttering becomes worse the longer they wait before treatment. Early intervention can head off a lifelong disability.

    How is childhood stuttering treated?

    There are two ways of doing stuttering therapy with pre-school children: changing the parents' behavior, or changing the child's speech.

    Indirect therapy changes the parents' behavior. Parents may be instructed not to talk too fast or use advanced vocabulary; be a good listener, such as not interrupting your child, or putting down what you're doing when the child wants to talk; reducing stress on the child, such as sticking to a predictable daily routine; and/or refrain from criticizing the child's speech, or correcting, helping, or reacting negatively to the child's speech.

    But research shows that changing parents' behavior has little effect on children's stuttering. It can't hurt, but don't rely on this exclusively. Instead, speech pathologists increasingly advocate direct therapy.

    Direct therapy begins by teaching the child to speak fluently. These skills include "easy speech" (also called "turtle talk") and stretching vowels. Therapy progresses from sounds to words and sentences, from a slow speaking rate to a normal speaking rate, and from the low-stress speech clinic to real-life conversations. If a child exhibits negative feelings or frustration in response to stuttering, the speech pathologist directly addresses these problems. For example, the speech pathologist may model the child's struggle behavior, and then discuss with the child whether the struggle behavior makes it easier or harder to talk.

    What's the most effective treatment for school-age stuttering?

    A study divided 98 children, 9 to 14 years old, into four groups:

        1. The first group was treated by speech pathologists in a speech clinic.

        2. In the second group, the parents were trained to administer the stuttering therapy to their        children, but the children did not see a speech pathologist.

        3. In the third group, the children used speech biofeedback computers designed for treating        stuttering. They were not treated by speech pathologists, and their parents weren't involved.

        4. The control group received no therapy.

    All children were fluent at the end of their therapy. One year after the therapy programs ended:

        1. 48% of the children treated by speech pathologists were fluent.

        2. 63% of the children treated by their parents were fluent.

        3. 71% of the children treated by computers were fluent.

        4. The control group's speech didn't improve.

    Too often children who stutter see to their school's speech pathologist once or twice a week, with no therapy outside the speech room, and no training for the parents. Even worse is group therapy where a stuttering child is treated with children who have articulation disorders (more common than stuttering) or are mentally-retarded (the stuttering child gets a message that he too is mentally-retarded).

    Too many school speech pathologists have caseloads of 40 children or more, with little time for each child and even less time for in-service training.

    Parents should ask their child's speech pathologist for therapy that can be done at home each day. Parents can also discuss with the speech pathologist whether a stuttering therapy computer would help.

    "My teenager has had stuttering therapy since kindergarten. He's fluent in the speech pathologist's office, but stutters elsewhere. He's not making progress and wants to discontinue therapy. He's withdrawing from his peers. What can we do?"

    Teenagers are adults, in terms of stuttering. Instead of relying on your school's speech pathologist, the teenager may be better off going to a university or other speech clinic. He could leave home for a stuttering therapy summer camp.

    The teenager may want to join a teen stuttering support group, including the ones on the Internet.

    The teenage years can be the worst for a stutterer, affecting the development of social skills such as dating. But teenagers are also able to develop focus, drive, and passion that adults may never again experience. Parents should help their stuttering teenager to find a fluency-enhancing activity that he or she feels passionate about. Examples include singing, acting, debating, or a foreign language.

    Teenagers should also be encouraged to do school projects about stuttering. These can include science experiments, interviewing a successful adult who stutters, or writing a history paper about stuttering.

    ADULT STUTTERING THERAPY

    What are the traditional therapies for adult stuttering?

    There are two traditional therapies for adult stutterers.

    The first is "stuttering modification therapy." This focuses on reducing fears and anxieties about talking. The stutterer also learns to stop, relax, and move forward with his speech. He still stutters, but it's "easy stuttering," and becomes less important in his life. This can be done with a self-therapy book or with a speech pathologist.

    The other therapy is called "fluency shaping." This trains fluent speech motor skills, in other words, the physical skills of fluent speech. It usually begins with extremely slow fluent speech, and then gradually increases the speaking rate until the speech sounds normal. This is usually done in a speech clinic

    Are there computers or other electronic devices to help stutterers?.

    The most popular electronic anti-stuttering devices provide delayed auditory feedback (DAF) or frequency-shifting auditory feedback (FAF). The stutterer hears his voice in headphones delayed slightly or shifted in pitch. DAF and FAF reduce stuttering on average 75-85% without training, mental effort, or slow or abnormal-sounding speech.

    DAF can be adjusted to make the stutterer to talk slower. This can almost 100% eliminate stuttering, but requires training and can produce abnormal-sounding speech.

    Brain scan research has found that these DAF and FAF correct the abnormal cerebal activity associated with stuttering. A variety of these devices are available, including miniature wearable devices and anti-stuttering telephones.

    Several computer systems are available for stuttering therapy. These train improved breathing, vocal fold control, and other aspects of fluent speech production. Some of these devices are for use only in speech clinics, but others can be used by stutterers for home practice.

    RESOURCES FOR STUTTERING

    Are there any celebrities who stutter? How did they overcome stuttering?

    There are dozens of famous people who stutter. In almost every case, the way the person overcame stuttering became the basis of his or her success later in life. Each would probably look back and see stuttering as a gift, not as a disability. For example:

    Carly Simon grew up in an emotionally-charged family, and developed severe stuttering and obsessive-compulsive behaviors. She was unable to express her emotions through speech, but she was able to sing fluently, so she developed her singing and songwriting. Her songs connect with listeners on an emotional level that few singer/songwriters have achieved.

    James Earl Jones stuttered so severely that he was "virtually mute" until high school. He then discovered that he could read Shakespeare aloud alone in the fields of his family farm. He developed his acting skills along with his fluency. Jones is now the most in-demand voice in Hollywood.

    Winston Churchill was the greatest orator in the British Parliament, but only if he prepared and practiced his remarks in advance. He studied issues weeks in advance, preparing responses to every possible objection. This extra effort made Churchill more knowledgeable than other leaders.

    For more information see

    Famous People Who Stutter

    Does stuttering affect employment? Should stutterers talk about their speech in job interviews?

    One study surveyed employers, and found that they would hire a deaf person or a person with cerebral palsy before they hired a stutterer. They discriminated against stutterers because they thought that stuttering was strange and they didn't understand it.

    Another study found that stutterers on average earn $7200 a year less than matched non-stutterers. But this study found that the stutterers had refused promotions, because they were afraid of making presentations or talking to customers.

    Stutterers should talk about their speech with their employers and in job interviews. This will make the interviewer feel more at ease. The stutterer should explain what he is doing to improve his speaking skills, such as therapy practice. He should give examples of having excellent communication skills, such as participation in Toastmasters.

    The Americans with Disabilities Act prohibits discrimination against stutterers, as well as other individuals with disabilities.

    What should listeners do when they talk to a stutterer?

    Don't finish their sentences. Don't tell them to "take a deep breath" or "think before you speak." Don't interrupt. Let the stutterer finish what he is saying. Interrupting or finishing his sentence will make his stuttering worse on the next sentence. Don't walk away or do something else. Keep your speech slow and relaxed, maintain eye contact. After he finishes talking, repeat back what he said so that he knows you understood him.

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