medical information

Stuttering | Description | Prevention | Causes and symptoms | Treatment

Definition

Stuttering is a speech disorder in which there is a disruption in the normal flow of speech (disfluency). Disfluencies include repetitions of a sound, syllable, or word; silent blocks (drawing out a sound silently); and prolongations (drawing out a voiced sound). Certain behaviors such as eye blinks, facial twitches, or body movements may also accompany stuttering. Stuttering may become worse under stressful situations (such as speaking in front of a group) but may improve when speaking, reading aloud, or singing while alone.

Description

It is estimated that approximately three million Americans are affected by some form of stuttering. The disorder most often affects children between the ages of two and five, usually resolving before puberty. Boys are three times as likely to be stutterers than girls. Less than 1% of adults in the United States suffer from stuttering.

Developmental stuttering (DS) most often occurs in children during the age at which they are developing their language and speech. The onset of DS is gradual, typically occurring before the age of 12. Persistent developmental stuttering (PDS) is defined as stuttering that does not resolve spontaneously or with treatment over time.

Acquired stuttering (AS) occurs in individuals who have been previously fluent. There is no gradual onset of disordered speech in persons with AS; disfluency occurs rather abruptly. AS may be neurogenic or psychogenic. Neurogenic stuttering is caused by problems in the signaling between the brain and the various muscles and nerves used in generating speech. This may occur after a stroke or damage to the brain. Psychogenic stuttering tends to occur after a trauma or period of extreme stress, or in individuals suffering from mental illness.

Causes and symptoms

Although the exact cause of stuttering is not known, there are three leading theories that propose how stuttering develops. The learning theory proposes that stuttering is a learned behavior and that most children are occasionally disfluent (i.e. speaking rapidly, searching for the right words, etc.) when at the age at which speech and language develop. If a child is criticized or punished for this, he or she may develop anxiety about the disfluencies, causing increased stuttering and increased anxiety.

The second theory suggests that stuttering is a psychological problem—that stuttering is an underlying problem that can be treated with psychotherapy. The third theory proposes that the cause of stuttering is organic, that neurological differences exist between the brains of those who stutter and those who do not.

There is also some indication that genetic factors are involved in the development of stuttering and subsequent recovery, as shown by various studies done on families and twins. It is not known to what degree stuttering is dependent on genetic factors, on environmental factors, or on both.

Symptoms

A certain measure of disfluency is expected in small children as they learn to speak a language. Some symptoms of normal disfluency are the following:

· less than 10 disfluencies per 100 spoken words

· whole-word repetitions ("She-she-she")

· part-word repetitions ("M-milk")

· phrase repetition ("I don't want-I don't want to go")

· interjections ("Um," "ah," "uh")

The child would also not normally appear visibly tense or anxious while communicating.

There are some basic characteristics that differentiate stuttering from normal childhood disfluencies. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) describes those characteristics as follows:

· sound and syllable repetitions

· sound prolongations

· interjections

· broken words (for example, pauses within a word)

· audible or silent blocking (filled or unfilled pauses in speech)

· circumlocutions (word substitutions to avoid problematic words)

· words produced with an excess of physical tension

· monosyllabic whole-word repetitions ("I-I-I-I see him").

The DSM-IV also indicates that such disfluency "interferes with academic or occupational achievement or with social communication."

Diagnosis

A diagnosis of stuttering typically includes a complete medical history, a physical examination, a complete history of the speech disorder, and an evaluation of speech and language by a speech-language pathologist. An important function of the speech evaluation is to distinguish between normal disfluency and stuttering.

Treatment

Treatment for stuttering varies according to the patient's age and type and severity of stuttering. Speech therapy is a popular method of treatment that involves learning new speech techniques (such as speaking syllable-by-syllable) and modifying current ways of speaking (such as reducing the rate of speech). It may also include psychological counseling as a way of boosting self-esteem and reducing the tendency of avoiding fearful situations such as speaking in front of a group.

Studies have looked into the potential of treating stuttering with medications. Haloperidol has been the most widely studied antistuttering medication and the only drug to show improvement in fluency. The side effects of haloperidol, however, are not well-tolerated and so the drug is often discontinued.

Prognosis

Nearly 80% of children with DS will recover by puberty, spontaneously or with treatment. One study looking at the recovery rate for stutterers ages nine to 14 who had undergone speech therapy noted that over 70% remained nonstutterers for one year after treatment. Five years after treatment, that rate remained approximately the same. The recovery rate among adult stutterers is not as high, in part because of extensive social phobias and depression.

Health care team roles

Common health care professionals involved in the care of an individual with a stuttering problem include:

· speech-language pathologists

· pediatricians and primary care physicians

· psychiatrists or psychologists

· neurologists

KEY TERMS

Disfluency— An interruption in the normal flow of speech.

Prevention

There is no cure for stuttering, but parents can do a number of things to help their child recover from DS, thereby preventing a life-long stutter. These include:

· speaking slowly and fluently in front of the child, but avoiding criticizing or punishing his or her rate of speech or disfluencies

· questioning the child less and commenting on his or her activities more

· refraining from having the child speak in front of large groups

· listening carefully to what the child has to say

· resisting from completing the child's words or sentences

Resources

PERIODICALS

Costa, Daniel and Robert Kroll. "Stuttering: An Update for Physicians." Canadian Medical Association Journal 162 (27 June 2000): 1849-55.

Lawrence, Michael, and David M. Barclay. "Stuttering: A Brief Review." American Family Physician57 (1 May 1998): 2175-80.

ORGANIZATIONS

American Speech-Language-Hearing Association (ASHA). 10801 Rockville Pike, Rockville, MD 20852. (888) 321-ASHA. 〈http://www.asha.org〉.

National Institute on Deafness and Other Communication Disorders (NIDCD) Information Clearinghouse. 1 Communication Ave., Bethesda, MD 20892-3456. (800) 241-1044.〈http://www.nidcd.nih.gov〉.

National Stuttering Association. 5100 E. La Palma, Suite 208, Anaheim Hills, CA 92807. (800) 364-1677. 〈http://www.nsastutter.org〉.

Stuttering Foundation of America. 3100 Walnut Grove Rd., Suite 603, PO Box 11749, Memphis TN 38111-0749. (800) 992-9392. 〈http://www.stuttersfa.org〉.

OTHER

"Diagnostic Criteria for 307.0 Stuttering." Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Psychiatric Association, 1994. 6 July 2001. 8 August 2001〈http://www.behavenet.com/capsules/disorders/stutter.htm.

"Stuttering." National Institute on Deafness and Other Communication Disorders. 25 June 2001. 8 August 2001 〈http://www.nidcd.nih.gov/health/pubs_vsl/stutter.htm〉.