Stuttering in both children and adults is among the most elusive, and somewhat mysterious speech problems that speech pathologists confront on an almost daily basis. What we know about stuttering is that it is an ancient problem. There are biblical references to Moses having been a stutterer. We also know that stuttering occurs in individuals cross culturally, making it a universal problem. The incidence of stuttering in preschool children is about 5%. The prevalence of stuttering however for this same group is approximately 2 1/2%, suggesting that half of all preschool children develop out of their stuttering at some point during the preschool years. By adulthood, this figure is further narrowed to 1%. Furthermore, stuttering is four times more likely to persist in boys than in girls. Although the rate of spontaneous remission is high, let’s explore why 1% of individuals persist in their stuttering?
First let us define what we mean by stuttering. Stuttering is characterized by its core features, which are repetitions of sounds and syllables and prolongations of sounds. We all have some of these dysfluencies in our speech, but when the repetitions are three of more iterations and the prolongation last for three or more seconds, they then constitute stuttering dysfluencies. When such dysfluencies occur on 10% or more of words spoken, our diagnosis is further confirmed. As children age and continue to stutter, their chances of “developing out” of stuttering decreases drastically. So why is this, why does this relatively small subgroup within the population persist in their stuttering?
To date, we think stuttering is caused by a multitude of factors. Research tells us that stuttering tends to run in families, suggesting that there is a genetic predisposition for stuttering, or a weakness for fluent speech. We also know that certain lifestyle factors such as: communicative pressure, setting unrealistic high standards, and an extremely fast paced lifestyle can all contribute to the maintenance of stuttering. As well a person’s own temperament, and particularly how sensitive they may be to their speech dysfluencies can be an important maintaining factor. These facts are of great prognostic importance. Speech pathologists have all heard parents say “I thought he would just grow out of it.” Not so at all when it is a male, with a history of stuttering somewhere in the family, who has a hectic lifestyle, with high standards of achievement, a sensitive temperament, and lots of competition to communicate at home. Indeed, just a few of these factors can prevent spontaneous recovery.
While most speech problems tend to improve over time, stuttering is unique in that it tends to worsen very quickly, here’s how. Stuttering is at least a two dimensional problem. It is both the behavior of stuttering itself (the prolongations and repetitions discussed earlier), and a psycho-emotional dimension. Society tends to penalize those who stutter, which creates fear of speaking and anxiety while speaking. These emotions almost always precipitate the stuttering behavior. We have all experienced such emotions (often referred to as stage fright) when speaking for the first time to a large audience. Such fear and anxiety will break down fluency in both normally fluent speakers, as well as those who stutter. Because of the penalty associated with stuttering, the natural reaction is to try to hide the stuttering. This may involve substituting easy words for feared words while speaking, or completely altering what one was about to say, and at a more extreme level simple refusing to speak. We must ask ourselves, if we were having a spasm somewhere in our bodies would we want others to see it, or to hear it happening to us? We would seek to hide it as well! As time advances, the psych-emotional dimension of fear, anxiety, and avoidance behaviors develop and stuttering becomes more severe and pervasive in the person’s life. Importantly stuttering, fear, anxiety, and avoidance behaviors become associated with specific people, speaking situations, and the physical environment in a classical conditioning paradigm. This happens in much the same way as when we hear a song from the past and conjure up memories of where we were, who we were with, and what was happening in our lives at that time. The spread of stuttering across people, situations, and physical environments accounts for the worsening of this problem over time. The individual who stutters often feels as though they are seized by stuttering in the moment of trying to speak. They feel as though this is something that happens to them, not something that they do as a result of the way they are trying to speak. From their perspective, there seems to be no explanation for it! What makes it even more difficult to live with, is the inconsistency of the disorder. One can be fluent on a given day or in a particular situation, and extremely dysfluent the very next day in that same situation. What a complex and insidious problem stuttering is!
As with most problems, early detection and treatment are or paramount importance. In order for treatment to be effective, both the behavior of stuttering as well as the psych-emotional dimension of stuttering, must be diagnosed and treated in therapy. If you or a loved one are caught in the throes of stuttering, seek out a competent and caring professional who can provide the necessary program for remediation.
Dr. Albert Oratio is the director, founder and principal Speech-Language Pathologist at Monmouth Center for Communication Disorders in Red Bank, N.J. His credentials include both licensure in the state of New Jersey, and the Certificate of Clinical Competence from the American Speech-Language-Hearing Association (ASHA). For more information or to schedule an appointment call us at 732.298.4769.
This article appears in the May 2019 issue of Natural Awakenings Magazine Monmouth Ocean edition. Click here to subscribe, thanks :)