Stuttering
What is developmental stuttering?
Developmental stuttering is a communication disorder that affects the fluency of speech. It begins during childhood and, in some cases, persists throughout adulthood. The disorder is characterized by disruptions in the production of speech sounds. Speech-language pathologists refer to these disruptions as “disfluencies.” Disfluencies are not necessarily problematic; however, they can impede communication when a speaker produces too many of them or does not resolve them promptly.
Stuttered speech often includes repetitions of words or parts of words, as well as prolongations of speech sounds. The frequency of these disfluencies among persons who stutter tends to be much greater than it is for the general population. Some speakers who stutter exhibit excessive physical tension in the speech musculature or appear to be “out of breath” when talking. At times, the forward flow of speech may become completely stopped or blocked. Interjections such as “um” or “like” can be symptomatic of the disorder, as well, particularly when accompanied by repeated (“u- um- um”) or prolonged (“uuuum”) speech sounds or when they are used intentionally to delay the initiation of a word the speaker expects to “get stuck on.”
Examples of speech patterns produced by an adult who stutters:
- “W- W- W- Where are you going?” (Part-word repetition: The speaker is having difficulty moving from the “w” in “where” to the remaining sounds in the word. On the fourth attempt, he successfully completes the word.)
- “SSSSave me a seat.” (Sound prolongation: The speaker is having difficulty moving from the “s” in “save” to the remaining sounds in the word. He continues to say the “s” sound until he is able to complete the word.)
- “I’ll meet you – um um you know like – around six o’clock.” (A series of interjections: The speaker reports that he expects to have difficulty smoothly joining the word “you” with the word “around.” In response to the anticipated difficulty, he produces several interjections until he is able to say the word “around” smoothly.)
When does developmental stuttering begin? How does it change it over time?
The symptoms of developmental stuttering usually appear between the ages of 2 ½ and 4 years of age. Onset during the elementary school years is less common, but many such cases have been documented. Among elementary-school-aged children, it is estimated that boys are three to four times more likely to stutter than girls are. Preschoolers may show little or no awareness of their speech difficulties, particularly during the early stages of the problem. Throughout the school years and beyond, however, most speakers who stutter become increasingly aware of their speech difficulties and how others react when they do not speak fluently.
The developmental course of stuttering varies considerably across individuals. Some children show marked difficulty with speech fluency within days or weeks of onset. Others show a gradual increase in fluency difficulties over months or years. The severity of children’s stuttering can fluctuate greatly from day to day and week to week. With some children, the symptoms may appear to resolve for several weeks, only to re-emerge for no apparent reason. For adolescents and adults who stutter, the symptoms of stuttering tend to be more stable than they are during early childhood. Nonetheless, speech fluency may be significantly better or worse than usual during specific activities for these individuals.
Recent research suggests that about 75% of preschoolers who begin to stutter will eventually stop. Most children who “recover” from stuttering do so within months of the time their stuttering started. Nonetheless, there are documented instances of recovery among speakers who have stuttered for many years. The developmental processes associated with recovery are unclear, and it presently is not possible to say with certainty whether or not the stuttering symptoms for any particular child will persist into adulthood. Generally, it is thought that boys are at greater risk than girls for chronic stuttering. Recent research suggests that children who have other relatives who stutter are at greater risk for chronic stuttering than children who have no family history of stuttering.
What does a fluency assessment include?
During an evaluation, a speech-language pathologist may note the number and types of speech disfluencies a speaker produces in various situations, as well as the ways in which the speaker reacts to and copes with speech disfluencies. The speech-language pathologist may also gather information about environmental factors (e.g., teasing) that aggravate the problem. A variety of other assessments (e.g., speech rate, language skills) may be completed, as well, depending upon the speaker’s age and history. Information about the speaker is then analyzed to determine whether a fluency disorder exists, and if so, the extent to which it affects the ability to perform and participate in daily activities. With young children, the speech-language pathologist may use information from the assessment to estimate the extent to which the child is at risk for chronic stuttering.
For older children and adults, the question of whether stuttering is likely to continue is somewhat less central, because the stuttering has continued at least long enough for it to become a problem in the speaker’s daily life. For these individuals, an evaluation consists of tests, observations, and interviews that are designed to assess the overall severity of the disorder, as well as the degree of impact the disorder has on the speaker’s ability to communicate and participate appropriately in daily activities. Information from the evaluation is then used to develop a specific treatment program – one that is designed to help the individual speak more fluently, communicate more effectively, and participate more fully in life activities.
Can stuttering be treated?
Most treatment programs for people who stutter are “behavioral,” in that they are designed to teach the speaker specific skills or behaviors that lead to improved oral communication. Many speech-language pathologists teach speakers to control and/or monitor the rate at which they speak. In addition, speakers may learn to initiate words in a slightly slower and less physically tense manner, and regulate or monitor aspects of breathing. Speakers often begin by learning to produce smooth, fluent speech at rates that are slower than typical speech, using short phrases and sentences. Over time, speakers learn to produce smooth speech movements at progressively faster rates, in progressively longer sentences, and in progressively more challenging situations until speech sounds both fluent and natural. “Follow-up” or “maintenance” sessions are often necessary after completion of formal speech therapy to prevent relapse.
In addition to the strategies described above, speech-language pathologists may also work to help people who stutter lessen the impact or severity of disfluency when it occurs. The goal here is not so much to eliminate disruptions in fluency – which many speakers find difficult to do – but to minimize their impact upon communication when they do occur. Speakers may be taught to identify the ways in which they currently react to or cope with breaks in speech fluency, and then learn alternate responses that are more compatible with fluent speech and effective communication. For instance, a speaker who routinely produces long, physically tense disfluencies would learn to modify these disfluencies so they become fleeting, relatively effortless breaks in speech. As speakers become increasingly competent at managing stuttering during therapy sessions, they gradually practice their newly learned skills in real-life situations.
A speech-language pathologist may recommend a “wait and see” approach for children who have been stuttering for only a few months and who, otherwise, appear to be unconcerned and at low risk for persistent stuttering. If treatment is recommended for preschoolers, the approaches taken usually are somewhat different from those used with older children and adults. Parents may learn to provide youngsters with feedback about their speech fluency, praising the fluent speech (“That was very smooth!”), and occasionally highlighting instances of disfluent speech (“That sounded a little bumpy.”). Parents also may learn to model alternate ways to produce disfluent words.
Where can I find more information?
Additional information about stuttering, its treatment, and how to respond to people who stutter can be found in brochures from the Stuttering Foundation of America (www.StutteringHelp.org) and the National Stuttering Association (www.WeStutter.org). For general information about communication disorders, see the American Speech-Language-Hearing Association (www.asha.org).