Communication is a fundamental aspect of human interaction, shaping our relationships, careers, and personal growth. For people who stutter (PWS), communication can be more challenging than those who do not stutter. While stuttering impacts millions of people world-wide, it remains widely misunderstood.
In this comprehensive guide, we shed light into the field of stuttering, exploring the causes and range of speech therapy options available. Whether you are a PWS or a concerned loved one, this blog aims to provide much needed clarity on the topic.
The Difference between Stuttering and Stammering
There is no difference between stuttering and stammering. Oftentimes the term stuttering is used by American English speakers while the term stammering is used by British English speakers.
What is Stuttering?
Stuttering is a complex disorder and involves much more than what listeners hear. There are six major components of stuttering:
Overt speech characteristics: interruptions in the normal flow of speech that occur when the individual is breathing, making sounds, or forming words. Speakers may hear these interruptions in the form of:
Repetitions (repeated syllables, sounds or words, for example: “f-five”)
Prolongations (drawing out a sound, for example: “mmmmmy name”)
Blocks (difficulty with getting a sound out, for example: “th—at”)
Physical manifestations: tense body movements, especially in the head or neck. This tension does not need to be present for a diagnosis of stuttering, but may appear as an individual attempts to get through a stuttering event.
Physiological activity: Stuttered speech is associated with changes in the blood flow, skin reactions, brainwave activities and other physiological changes. While most of this cannot be observed by a listener, it has been documented by technology.
Emotional Aspect: Strong emotional reactions about speaking are often associated with stuttering. These emotions can include sadness, frustration, and fear. Sometimes these feelings can mask disfluent speech through avoidance of speaking situations.
Cognitive factors: selection, planning, preparation, and executing speech can in effect present as an “overload” to the individual which may cause disfluent speech.
Social dynamics: The purpose of speech is to communicate with others. Most speakers watch for signs that their listeners hear, think, and respond to what was said to them. The speaker’s communicational intent can be disturbed if the listener pays more attention to the stutter or becomes judgemental. This can cause the emotional features discussed earlier and can have a devastating impact on the speaker.
The Causes of Stuttering
The exact cause of stuttering remains unknown; nevertheless, ongoing research in the field persists in illuminating this complex disorder and offering hope for effective treatment and management.
Below are some potential factors influencing stuttering:
Genetics: Evidence indicates that genetics play a role in stuttering. A person who stutters (PWS) is more likely to have at least one relative who stutters. However, the severity of the stutter does not transfer.
Gender: Males with relatives who stutter are at a higher risk of stuttering compared to females with relatives who stutter. Additionally, males are twice as likely as females to exhibit stuttering initially, with a greater risk of sustaining stuttering over time.
Developmental factors: Stuttering is most commonly diagnosed between the ages of 2 and 5, with a significant decline in incidence after age early childhood. While many children outgrow stuttering, some may continue to stutter into adolescence and adulthood. Factors such as language development, motor skills, and overall speech fluency during critical periods of development may influence the persistence of stuttering.
Neurological factors: Differences in brain structure and function exist in individuals who stutter, particularly concerning speech production, motor control, and language processing. Consistent research findings indicate abnormalities in the left hemisphere white matter, including reduced volume, organization, and myelin coverings of fibers, as well as right hemisphere hyperactivity and indications of reduced gray matter in subcortical centers.
Cognitive impairments: Stuttering is more prevalent in people with intellectual disabilities or impairments.
Language Processing: Some researchers suggest that difficulties in language processing may contribute to stuttering. It is noteworthy that stuttering often emerges in early childhood when language skills are developing.
Psychological Factors: Psychological factors such as anxiety, stress, self-esteem, and social pressures can influence stuttering. While they often do not cause stuttering, these factors can impact the severity of stuttering and avoidance behaviors.
Different Types of Stuttering
There are three different types of stuttering which include:
Developmental Stuttering, also known as childhood-onset stuttering, is the most common type of stuttering and typically emerges in early childhood
Neurogenic Stuttering results from damage or injury to the brain
Psychogenic Stuttering is uncommon and results from extreme trauma or stress
How stuttering is diagnosed
Stuttering is typically diagnosed by a speech-language pathologist (SLP) through a comprehensive evaluation process. Here's an overview of how stuttering is diagnosed:
Gathering Information:
Case History: The initial step involves gathering an organized record of all relevant information concerning your disorder, which might be useful in treatment and related counseling. This includes a detailed account of factors ranging from the initial onset and development to the current status of stuttering.
Family History: Understanding your family history of stuttering can inform the likelihood of the persistence of stuttering and provide other valuable information.
Medical History: Any medical or neurological conditions will be explored to rule out potential contributing factors.
Assessing your Speech
Speech Sample Context: An SLP may collect a speech sample to analyze disfluencies and types of disfluencies. Sometimes, 2-3 different speech samples are taken due to the variability in disfluencies. These samples may include spontaneous speech, such as conversation, oral reading, group discussion, or phone calls.
Formal Assessment: The SLP may use standardized assessment tools and measures to evaluate the individual's speech fluency and identify specific characteristics of stuttering, such as repetitions, prolongations, and blocks. These assessments may include tasks such as reading aloud, conversational speech, and spontaneous speech samples.
Speech Analysis: The SLP may analyze the individual's speech patterns and fluency disruptions to determine the frequency, duration, and severity of stuttering events. They may also assess associated features such as secondary behaviors (e.g., facial grimaces, head movements) and emotional reactions to stuttering.
Assessing Beyond Speech
Attitude Rating Scale: This step involves obtaining information regarding your perception of yourself, attitudes and feelings about communication, and emotions about stuttering. This information helps inform therapy.
Specific Goals for the Client: You will work together with an SLP to set personal stuttering treatment goals for your therapy. Goals may include reducing disfluencies, improving communication confidence, or managing particular speaking situations.
Distinguishing between Stuttering and other Speech Disorders
Distinguishing stuttering from other speech disorders can be challenging, but there are several key factors that Speech-Language Pathologists (SLPs) consider during the evaluation process:
Speech Disfluencies: Stuttering is characterized by specific types of disfluencies including repetitions of sounds, syllables, or words, prolongations, blocks, or prolongations. Speech disorders that consist of disfluencies often involve different types of disfluencies.
Age of onset and developmental history: Stuttering often begins in early childhood between the ages of 2 and 5 years of age. Developmental milestones and progression of stuttering symptoms over time may provide useful information regarding stuttering and other disorders.
Consistency and context: Stuttering varies in severity and frequency depending on many factors such as stress, excitement, fatigue, or specific speaking situation. Other speech disorders are often consistent in terms of severity and frequency.
Secondary characteristics and behaviors: Stuttering often involves secondary behaviors such as head movements, tension, or eye blinking, tension in the speech muscles. This helps in differentiating stuttering from other disorders.
Overall, a comprehensive evaluation by a qualified speech-language pathologist, incorporating observations of speech patterns, developmental history, associated features, and impact on communication, is necessary to accurately distinguish stuttering from other speech disorders and determine appropriate intervention strategies.
Stuttering Treatment Options
Some techniques Speech-Language Pathologists use to treat stuttering disorders include:
Stuttering Modification Therapy: Rather than attempting to eliminate the stuttering, this approach aims to assist individuals to become more comfortable with their speech and reduce the negative impact of stuttering in their life.
Imagine you're driving a car and you hit a bump in the road. Instead of panicking or trying to avoid bumps altogether, you learn how to navigate them smoothly and confidently. Similarly, stuttering modification therapy teaches individuals how to navigate stuttering moments with ease and confidence.
Fluency Shaping Therapy: This therapy is designed to improve the fluency of speech by empowering individuals who stuttering to develop new habits and strategies for speaking that promote fluency.
Imagine a child first learning to ride a bike. At first, it might feel wobbly or uncertain, but with practice and guidance, they gradually develop smoother, mor coordinated movements. Fluency shaping teaches individuals who stutter a new way of speaking that is smoother and more fluent.
Avoidance Reduction Therapy: This therapy aims to reduce the avoidance an individual may experience because of stuttering. During therapy, a client may be asked to discuss different scenarios he avoids and then therapy aims to tackle these scenarios.
Oftentimes these stuttering therapy approaches are combined and altered to meet the individual needs of clients.
How Speak with Stephanie Implements Stuttering Therapy
Speak with Stephanie LLC is a distinguished speech therapy company specializing in delivering high-quality, in-home speech therapy services to individuals residing in Skokie, Evanston, Wilmette, Lincolnwood, and surrounding areas of Illinois. Additionally, our commitment extends to providing teletherapy services throughout Illinois, New York, and New Jersey.
Our comprehensive range of offerings includes consultations, screenings, evaluations, and individualized speech therapy tailored specifically for children and adults presenting with stuttering disorders. At Speak with Stephanie, we adopt a holistic approach with each client, fostering collaborative efforts to formulate goals that address their unique needs.
Families or individuals seeking treatment for stuttering disorders benefit significantly from engaging with Speak with Stephanie. Our therapy is designed for utmost convenience, and we are affiliated with Blue Cross Blue Shield PPO and Cigna plans.
During stuttering therapy,
I work with preschoolers and their parents to identify and modify situations that may cause stress on the child's speech and language system. Additionally, I work directly with the child to improve their speech fluency.
I work holistically with school-aged children, teenagers, and adults. This includes education about stuttering and creating an awareness of the individual's stuttering pattern. Techniques to manage stuttering are then taught and practiced in role-playing scenarios to reduce fear and avoidance and generalize skills into everyday life.
Emphasis is placed on addressing thoughts and feelings as they have a direct impact on both the individual and their speech. Principles of Avoidance Reduction Therapy (ART) and Cognitive Behavioral Therapy (CBT) are incorporated to promote successful outcomes.
Specifically, Speak with Stephanie excels in the following areas related to stuttering treatment:
Individualized Treatment Plans: Our commitment to personalized care means that we approach each client holistically, rejecting the notion of a one-size-fits-all treatment model.
Evidence-Based Treatment Approaches: Our methodology is rooted in evidence-based treatment approaches, ensuring that our interventions are supported by research.
Regular Feedback: We prioritize open communication by providing regular, insightful feedback to families, fostering a collaborative and transparent therapeutic process.
Collaboration with Families and Teachers: We actively collaborate with everyone involved in the child's well-being, including families, teachers, and related service providers.
Frequently Asked Questions
What causes stuttering?
We don’t know the precise cause of stuttering, but we know genetics, gender, cognitive impairments, language processing, developmental, neurological, and psychological factors may play a role in stuttering.
Is stuttering genetic?
Yes, some stuttering can be genetic.
Can stuttering be cured?
Spontaneous recovery of stuttering is common in early childhood. However, stuttering that continues past childhood often has no cure. Speech therapy can help individuals manage their stuttering more effectively and improve their overall speech fluency.
At what age does stuttering typically start?
Stuttering often begins early in childhood, at about 2 years of age through 5. It can also start later in life.
How common is stuttering?
According to the Stuttering Foundation of America, over 3 million individuals in the United States stutter and over 80 million people worldwide stutter.
What are common treatments for stuttering?
Fluency Shaping, avoidance reduction, stuttering modification, or a mixture of the combination are common treatments for stuttering.
Are there support groups for people who stutter?
Your local National Stuttering Association (NSA) often have stuttering support groups. They can be found here.
Are there any medications for stuttering?
Dopamine blockers have confirmed efficacy for reducing stuttering, but this medication is, as of now, not approved to treat stuttering.
What should family members or friends of someone who stutters do to help?
Listen. Allow your family member or friend to speak, say what they want to say without judgement, and let them tell you what they need.
About the author:
Stephanie Jeret is a Speech-Language Pathologist and the owner of Speak with Stephanie LLC. She obtained her Bachelor's and Master's degree from the City University of New York. She has practiced speech therapy in a number of settings including outpatient rehabilitation, telepractice, skilled nursing facilities, schools, and a private practice. She specializes in the evaluation, diagnosis, and treatment of a variety of communication disorders including articulation disorders, receptive/expressive language disorders, and fluency disorders. Information is available by emailing her at stephanie@speakwithstephanie.com or by visiting www.speakwithstephanie.com.