Stuttering

By:    Published: August 13, 2014

Chronic stuttering can be a debilitating and deeply stressful condition, undermining a person’s ability to do the very thing that makes us human.

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Chronic stuttering can be a debilitating and deeply stressful condition, undermining a person’s ability to do the very thing that makes us human – communicate.

According to Craig Coleman, assistant professor at Marshall University and director of the Virtual Stuttering Center, “95 percent of cases of stuttering will start by age 4 or earlier,” attacking people at their youngest and most vulnerable. What can seem like the normal disfluency of developing speech can, unchecked, create patterns of altered verbal behavior that last a lifetime.

“The child’s more likely to get frustrated, more likely to shorten their sentences and then you change the whole way they talk,” says Coleman. “You don’t want that to start happening.”

Fortunately, stuttering is a condition that can be diagnosed and treated, if you know what to watch out for, and what to do when you see it.

 

What is Stuttering?

“Everybody has normal disfluency in their speech, which is some interruption in the forward flow of speech,” explains Coleman.

Such disfluencies include starting a sentence then restarting to say it a different way, using word-finding tactics such as “like” and “um”; and even repeating whole phrases.  These irregularities are entirely normal and happen to us all, at every age, but they are particularly prevalent in young children as they “go through transient periods of disfluency as their language skills develop,” says Coleman. “Those tend to resolve within six months. But if it’s been more than six months, that raises a red flag.”

In addition to a prolonged duration of occurrence, Coleman said telltale signs that a disfluency is more than just a hitch include physical tension and negative reactions. A person who stutters might tighten up around the face, head, neck, abdomen or chest when “stuck” on a word. They might also display repetitive physical behaviors such as blinking, nodding or hand-tapping as they struggle through a word. And as they do so, they will often show extreme frustration, shame or other emotions indicating the stutter is causing them distress.

“A person having normal disfluency doesn’t feel bad about having it,” says Coleman. “It just happens.”

While it is possible for stuttering to manifest later in life, Coleman said such cases are generally the result of a brain trauma or stroke, or in rare cases, a side effect of an underlying psychological disorder.

“Stuttering in and of itself is not a psychological or emotional disorder,” he says. “People who stutter really have no more psychological or emotional disorders than people who don’t stutter.”

On the contrary, Coleman said that research shows stuttering appears to be largely neurophysiological. “The brains of people who stutter just work a little differently during speech … using a few more areas of their brain than the person who speaks fluently,” he explains. “So there is a little bit of dis-coordination there.”

This is why stuttering tends to appear very early in life, revealing itself as children’s brains begin building the neurological pathways of speech.

 

Risk Factors

If you suspect your child has a stutter, Coleman recommends seeking confirmation with a speech-language pathologist right away. When diagnosing your child, the speech-language pathologist will consider the following risk factors:

  • Family History and Genetics
    “The No. 1 risk factor you would look for in a young child is family history,” says Colman. “Stuttering has a strong genetic component, so if a child comes in and they’re having some stuttering-like disfluencies and they have a family history of stuttering — that’s going to be a red flag right away.”
     
  • Gender
    “If you look at the ratios of males to females who stutter at the preschool level, it tends to run about 2 to 1 males to females. When you get up to school age, adolescent and through adulthood, it jumps to 4 to 1. So what that tells you is a lot more girls are recovering than boys. Being a boy is a lot higher risk,” says Coleman.
     
  • Speech Sound Disorders/Language Disorders
    While most children have some difficulty early on formulating words and pronouncing speech properly, children who have speech or language disorders may be at a higher risk to develop stuttering. In addition, some children who stutter may appear to have decreased language skills, but this may be avoidance related to stuttering. Children can learn very early that using longer, more complex sentences may lead to more stuttering, so they may use shorter sentences, with less complex vocabulary.
     
  • Reactions
    For Coleman, negative reactions are a vital concern, even in children he diagnoses that have “none of those other risk factors. … [If] it’s bothering them or bothering the family, that’s enough for me to say there should at least be some formal therapy done.”

 

​Treatment 

Treatment for stuttering “depends so much on the child,” says Coleman. “You may have one child who is completely okay and well-adjusted with their stuttering and all they need is a couple techniques, a toolbox. … Another child could come with so many negative reactions that you have to start with getting them to be more comfortable with stuttering.  This might begin by working on education with the child and family and really setting the theme that stuttering is ok.”

Basic techniques for alleviating stuttering include teaching a child to slow down their rate of speech and implement what are known as “easy” or “gentle onsets,” sensing when a stutter is approaching, letting it come, and working through it in as relaxed a manner as possible.

For more advanced cases, Coleman might teach a child to embrace their stuttering, advertising it, not fighting it and possibly even stuttering on purpose to become as comfortable with it as possible. The tactics are different for every case, and also hinge largely on age level.

For ages 2 to 5, Coleman says you can actually “eliminate stuttering in a lot of cases if you get to it early enough. Young children’s brain function is much more malleable to change. … A 3-year-old can still be developing different pathways and change the pathways their brain uses for various tasks.”

But for ages 6, 7, 8 and beyond, “your goal shifts because you’re not going to eliminate it for those children. Stuttering is something that’s always going to be with them, so your goal is always going to be management at that point,” Coleman says. “The analogy I use is that it’s something like asthma, allergies, diabetes at that age. You don’t cure any of those things but if you do the right things you can successfully manage them to the point where it doesn’t have to have a negative impact on your life.”

Because stuttering is genetic and neurophysiological, there is no cure for it.

Next Steps

For Patients

  • Reduce Time Pressure
    “We try to work with parents at the beginning of therapy to educate them on things they can do from an environmental standpoint to put less pressure on the child,” explains Coleman. He does this to take away a lot of the speaking demand and let the child speak at their own pace. “[It’s important to] really to create an environment that’s more conducive to fluency.”
     
  • Empower
    People who stutter can be empowered by spending time with other people who stutter, which makes them feel less alone and builds confidence.

    In his own practice, Coleman often uses technology to let several of his patients talk to each other simultaneously over the Internet. For adults, he recommends checking out the National Stuttering Association, which has chapters in most major cities offering regular weekly meetings with other folks who stutter.

    What people who stutter need most is “to have someone who understands stuttering and for someone to be an advocate for them and to be okay with the fact that’s just who they are,” says Coleman.

For Family Caregivers

Find the Right Speech-Language Pathologist

When seeking out a speech-language pathologist for your child, you should look for one with a background in stuttering. “Just because someone is a speech-language pathologist doesn’t mean they have a lot of experience in stuttering. It’s very important for parents to know what experience somebody has in that area,” explains Coleman.

 

Communication, Communication, Communication

It can be delicate broaching the topic of stuttering with your child, if only because they may not yet even be able to fully grasp what it means.

“The term ‘stuttering’ is a bit too abstract for a 3- or 4-year-old, but I do talk about it with them. I use the term ‘bumpy speech’ because they understand what ‘bumpy’ means, they understand what ‘speech’ means,” says Coleman.

The goal in communication, Coleman explained, is to put the child at ease and let them know that it’s okay to have bumpy speech sometimes. Saying something as simple as “We still want to her what you have to say,” can make a big difference.

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  • Craig Coleman, MA, CCC-SLP, BCS-F, is an assistant professor at Marshall University and director of the Virtual Stuttering Center. He is an associate coordinator for ASHA Special Interest Group 4: Fluency and Fluency Disorders.
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