Written by
Ms. Shruthi Sathyan, MASLP
Speech Language Pathologist
How we speak and interact with others is mostly determined by the fluency in our speech. Fluency refers to the extent to which we can speak accurately and smoothly in a particular language that can be easily understood by others. But sometimes, that can be interrupted and broken with “umm”, or “ahh”, as we think about what we need to talk about next. This is what we call disfluencies.
Children learn to speak as they try to imitate an adult’s speech. But it’s not necessary that we understand what they say completely. That is known as normal non-fluency, when the child is less fluent during his/her development. Sometimes this might continue in their mature speech and affect their communication skills, making it difficult for them to convey their thoughts. This is when we say that “the child might be stuttering!”.
What are the core behaviours of stuttering?
People who stutter may have more disfluencies and disfluencies of various types. The most basic features of stuttering are:
- Repetitions– repeat parts of words
- Prolongations- stretch a sound out for an extended period of time
- Blocks- struggle to get a word out.
Does stuttering have any secondary features?
A normally disfluent child generally has no secondary behaviours because he/she has not developed any reactions to his disfluencies, such as escape or avoidance behaviours.
But those who stutter usually stop talking abruptly in between the conversation, knowing that they might stutter on the next word or sound. This kind of reaction begins as a struggle but soon turns into behaviour that is difficult to manage later. Such reactions are:
Escape behaviours: These occur when they are stuttering and attempt to terminate the stutter and finish the word with eye blinks, head nods, and interjections of extra sounds, such as “uh”.
Avoidance behaviours: Here, the stutterer often shows behaviours he has used previously to escape from moments of stuttering or may try something different such as changing the word he was planning to say (substitutions or circumlocutions). In the beginning, it may prevent stuttering, but soon it becomes a strong habit that is resistant to change.
How does an individual with stuttering feel?
In the beginning, a child’s positive feelings of excitement and negative feelings of fear may result in repetitive stutters that he hardly notices. Then, as he stutters more frequently, he may become frustrated or ashamed because he can’t say what he wants to say. These feelings make speaking harder as frustration and shame increase their effort and tension, which eventually makes them hold back speech.
Feelings include not only frustration and shame but also fear of stuttering again, guilt about not being able to help himself, and hostility toward listeners as well.
What are the common symptoms of stuttering?
People who stammer know what they want to say but struggle to say it. Difficulties in speech are usually seen as:
Starting a word, phrase, or sentence seems to be difficult.
Prolongs sound within a word.
Outbreaks of a sound, syllable, or word.
Short periods of silence for particular syllables or words, or pauses within a word (broken word).
Adds extra words, such as “um,” if complexity is expected while moving to the next word.
Excessive facial tension, tightness, or movement to produce a word.
Express nervousness while talking.
Restricts themselves from conversations.
What Causes Stuttering?
One cannot pinpoint the cause of stuttering. Even though there is no single cause of stuttering, there are a few risk factors that could be considered as red flags.
Language skills: For young children, stammering is a usual step in learning to speak. Stuttering occurs when a child’s speech and language abilities are insufficient to keep up with what they want to say.
Age of occurrence: Children who start stuttering at age 3½ or later are more likely to continue stuttering.
Severity: Adults stutter when chronic stuttering persists into adulthood.
Relapse: Recurrence of stuttering is often seen when the person confronts emotional triggers. So the person who has successfully reduced his/her stuttering restarts to stutter again in such situations.
Genetic: Stuttering tends to run in families. Children are more likely to have stuttering if their parents or grandparents had the same issue in life.
Gender: As the researcher’s state, boys are more likely than girls to stutter persistently.
What are the difficulties a stutterer commonly faces?
Persons with stuttering face a lot of difficulties in everyday communication. Be it in social gatherings or job interviews, there is always a fear of stuttering in them. Some of the difficulties are:
- Becoming nervous to speak.
- Difficulty in talking over the phone.
- Unable to deliver a speech in front of a large crowd.
- Avoiding situations that necessarily involve communication.
- Being teased as well as bullied.
- Self-esteem issues.
- Loss of social, academic, or occupational participation and success.
What are the types of stuttering?
There are so many classifications of stuttering done by many researchers on the basis of age of onset, severity, cause etc. Here are the most common ways of classification of the types of stuttering.
Developmental stuttering
Normal disfluency occurs throughout childhood and adulthood. It may sometimes begin earlier than 18 months of age and eventually peak between ages 2 and 3.5 years. It slowly diminishes thereafter, but sometimes it might persist into childhood, exhibiting the core behaviours of stuttering.
Neurogenic stuttering
It is caused by neurological disease or damage, typically acquired after childhood. It may be due to stroke, head trauma, tumour, disease processes such as Parkinson’s, or drug toxicity.
Psychogenic stuttering
It is usually a late-onset disorder, typically beginning after a prolonged period of stress or after a traumatic event. Unlike malingering or faking, this type of stuttering is not conscious, volitional behaviour by the client, but it is involuntary.
What are the treatments for stuttering?
Major goals of stuttering therapy include improving speech fluency to develop effective communication and increase participation in school, work and social activities. While there is no universal cure for stuttering, treatment can be extremely helpful. Young children quite often overcome stuttering completely, even without treatment. But older children and adults may continue to stutter, but with the right treatment and support, they can improve their speech quality.
Speech therapy: Visit a speech therapist immediately. Speech therapy helps to slow down the speech and create awareness when you stutter. It aims at reducing the occurrence of dysfluencies by using various techniques that are taught to the individual to be used every time they stutter. One such common strategy used is prolonging the sounds in a word while you know you might stutter.
Assistive devices: Metronome is used to keep the pace of stuttered speech. Delayed auditory feedback is provided, which helps improve the rate of speech.
Cognitive behavioural therapy: It helps reduce stress, anxiety or self-esteem problems related to stuttering.
How can a Speech-Language Pathologist help you conquer stuttering?
Speech Language Pathologists are the primary therapist who can help develop a healthy attitude about speaking and reduce the severity and frequency of stuttering moments.
According to the individual’s need, specific intervention strategies will be taught by the speech therapist. For instance, tailored approaches will vary according to the age at which stuttering occurred and the severity of stuttering, in consideration of the situations in which they stutter, such as talking over the phone, to strangers or even while they talk with their close ones. Treatment usually focuses on developing a smooth way of speaking and helping to reduce tension and anxiety that ease stuttering.
For children, various analogies such as ‘Lilly pad analogy’ is used to teach the differences between smooth and bumpy speech. While for adults, strategies focus on reducing the rate of speech using ‘Finger tapping’ and easing the flow of speech by ‘Prolonged speech techniques’.
So as early as possible, consult a speech-language pathologist for better care and improved quality of life.
Tips for speaking with children who stutter:
As parents of children with stuttering, it is very common to get anxious and tense about your child’s speech. Many parents make sure that their child does not suffer and tries to complete sentences for him. That is not helpful at all. Below are a few tips that parents can incorporate into their everyday conversations with their children:
- Listen attentively to the child while they speak.
- Give the child time to speak, and let them complete without saying them for him or her.
- Praise your child for the correct way of speaking instead of being negative about their stuttering moments.
- Encourage the child to talk about their favourites more.
- Take turns talking during a conversation.
- Don’t focus on the child’s stuttering, instead, focus on their communication.
- Educate your child’s teachers and help them provide a school environment that is accepting and safe from bullying.
References:
Guitar, B. (2013), Stuttering: An integrated approach to its nature and treatment. Lippincott Williams & Wilkins. (4th edition, chapter-7)
Ward.D (2008), “Stuttering and Cluttering Frameworks for understanding and treatment” Hove; Psychology Press (chapter- 1)
Manning W.H (2009); “Clinical Decision Making in Fluency Disorders” (3rd edition); New York; Delmar Cengage Learning (chapter-2)
https://www.mayoclinic.org/diseases-conditions/stuttering/symptoms-causes/syc-20353572
https://www.asha.org/public/speech/disorders/stuttering/
FAQ
Talk slower and give them enough time to respond. Prepare him to speak in public situations. If stuttering persists for more than 6 months, refer to a speech-language pathologist.
Stuttering can be caused due to head injury when there is damage to the language centres of the brain. However, sometimes there are no structural or neurological components that cause a stutter. It can be caused due to the negative emotional experience that follows after an incident. Post-traumatic stress can also induce stuttering in various cases.
There is no single remedy common for all. Consult a speech-language pathologist without delay to understand the individual’s specific needs and improve speech quality effectively. For the listeners, be patient and listen to the person while he/she is speaking. Let them take their own time to respond. Persons with stuttering can help themselves by relaxing and using slow and smooth talking while conversing with others.
Speak to the child slowly, and wait for their response. Do not give negative feedback when they stutter, instead, paraphrase their statement in a simpler form and ask them to repeat it. If stuttering persists, consult a speech-language pathologist as soon as possible.
Stuttering can occur at any age due to various causes. It commonly occurs when the child’s speech and language skills are less than what is demanded by their parents or outside environment. It occurs more around the age of 2 years to 5 years. While in adults, it occurs most commonly due to head trauma, stroke or even as a part of mental illness at any age.
If stuttering affects the daily functions of your life and reduces the quality of your life, it can be termed as a disability. Disability is when impairments are “substantially” limiting their independence in life.
Anxiety is never the root cause of stuttering, but it can worsen the stuttering moments. As the fear of speaking increases, the person tends to become more anxious and nervous about stuttering
Children with autism spectrum disorders tend to have stuttering-like features, for example, revisions, interjections or even repetitions. High-functioning autism is found to have more stammering than the others in the spectrum.
