Stuttering, also called stammering, is a speech disorder where an individual repeats or prolongs words, syllables, or phrases.
A person with a stutter (or stammer) may also stop during speech and make no sound for certain syllables. In this article, we explain the causes of stuttering, how it is diagnosed, and available treatments.
We all have the capacity, it may happen during a stressful job interview, talking to emergency services on the telephone, or during a presentation to a large crowd.
Stuttering is common when children are learning to speak and is an estimated five times more common in boys than girls. However, the majority of children grow out it. The speech disorder affects less than 1 percent of all adults.
For some, however, the problem persists and requires some kind of professional help, such as speech therapy.
A person who stutters often repeats words or parts of words, and tends to prolong certain speech sounds. They may also find it harder to start some words. Some may become tense when they start to speak, they may blink rapidly, and their lips or jaw may tremble as they try to communicate verbally.
According to the American Speech-Language-Hearing Association, some individuals who stutter appear extremely tense or out of breath when they talk. Their speech may be completely “blocked” (stopped).
“Blocked” is when their mouths are in the right position to say the word, but virtually no sound comes out. This may last several seconds. Sometimes, the desired word is uttered, or interjections are used in order to delay the initiation of a word the speaker knows causes problems. Examples of interjections include such words as “um,” “like,” “I mean,” “well,” or “umm.”
Common signs and symptoms associated with stuttering:
- Problems starting a word, phrase, or sentence.
- Hesitation before certain sounds have to be uttered.
- Repeating a sound, word, or syllable.
- Certain speech sounds may be prolonged.
- Speech may come out in spurts.
- Words with certain sounds are substituted for others (circumlocution).
Also, when talking there may be:
- rapid blinking
- trembling lips
- foot tapping
- a trembling jaw
- the face and/or upper body tightens
Some aspects of stuttering are obvious to everyone, while others are not. To have a comprehensive and reliable diagnosis, the patient should be examined by a speech-language pathologist (SLP).
The SLP will note the types of problem the individual has when speaking, and how often problems occur. How the person copes with the stutter is also assessed.
The SLP may perform some other assessments, such as speech rate and language skills – this will depend on the patient’s age and history. The SLP will analyze all the data and determine whether there is a fluency disorder. If there is one, the SLP will determine to what extent the disorder affects the patient’s ability to function and take part in daily activities.
It is vital to try to predict whether a young child’s stutter will become long-term. This can be fairly accurately done with the help of a series of tests, observations, and interviews.
Assessments for older children and adults are aimed at gauging the severity of the disorder, and what impact it has on the person’s ability to communicate and function appropriately in daily activities.
Experts are not completely sure what causes stuttering. We do know that somebody with a stutter is much more likely to have a close family member who also has one, compared with other people. The following factors may also trigger/cause stuttering:
As children learn to speak, they often stutter, especially early on when their speech and language skills are not well developed. The majority of children experience fewer and fewer symptoms as this developmental stage progresses until they can speak flowingly.
This is when the signals between the brain and speech nerves and muscles are not working properly. This may affect children, and can also affect adults after a stroke or some brain injury. The following may cause neurogenic stuttering:
- head trauma
- ischemic attacks – temporary block of blood flow to the brain
- degenerative diseases, such as Parkinson’s
It used to be believed that the main reasons for long-term stuttering were psychological. Fortunately, this is no longer the case.
However, psychological factors may make stuttering worse for people who already stutter.
In other words, anxiety, low self-esteem, nervousness, and stress do not cause stuttering; rather, they are the result of living with a stigmatized speech problem, which can sometimes make symptoms worse.
Family history – many children who have a stutter that persists beyond the developmental stage of language have a close family member who stutters. If a young child has a stutter and also a close family member who stutters, their chances of that speech disorder continuing are
Age when stutter starts – a child who starts stuttering before 3.5 years of age is less likely to stutter later in life. The earlier the stuttering starts, the less likely it is to continue long-term.
Time since stuttering started – about three-quarters of all young children who stutter will stop doing so within 1 or 2 years without speech therapy.
The longer the stuttering continues, the more likely it is that the problem will become long-term without professional help (and even with professional help).
Sex – long-term stuttering is four times more common among boys than girls. Experts believe there may be neurological reasons for this, while others blame the way family members react to little boys’ stuttering compared with little girls’ stuttering. However, nobody is really sure what the reason is.
Experts say that parents should consider visiting their doctor when:
- The child’s stuttering has persisted for over 6 months.
- When the stuttering occurs more frequently.
- When it is accompanied with tightness of the facial and upper body muscles.
- When it interferes with the child’s schoolwork.
- When it causes emotional difficulties, such as fear of places or situations.
- When it persists after the child is 5.
The Stuttering Foundation of America advises parents whose child has been stuttering for a few weeks not to be alarmed and to wait-and-see. The Foundation emphasizes that waiting a couple of months does not seem to affect how well the child might respond to treatment later on.
A good evaluation (diagnosis) is vital, as this determines what the best treatment might be. Treatments for people who stutter tend to be aimed at teaching the person skills, strategies, and behaviors that help oral communication. This may include:
Fluency shaping therapy
Controlling monitoring speech rate – this might involve practicing smooth, fluent speech at very slow speed, using short sentences and phrases. The person is taught to stretch vowels and consonants. With practice, the person can speak at higher speed, and with longer sentences and phrases.
Breathing control – as the patient practices prolonged speech, they also learn how to regulate breathing.
Stuttering modification therapy
The aim here is to modify the stuttering so that it is easier and requires less effort, rather than eliminating it. This therapy works on the principle that if anxiety makes stuttering worse, reducing the effort needed will alleviate the stuttering.
Electronic fluency devices
Some patients respond well to this type of treatment, but others do not. This uses the so-called altered auditory feedback effect. An earpiece echoes the speaker’s voice so that they feel they are talking in unison with someone else. In some people, this can relieve the stutter.
People who are not used to talking to somebody with a stutter might be unsure about how to respond.
Sometimes, the listener will look away whenever the stutterer stutters, or try and help by completing their missing words or phrases – or simply to try to avoid people who stutter altogether.
It is important to remember that a person who stutters is interested in communicating just like everybody else. Focus should be on the theme of the speaker and the information they are trying to get across, rather than how it sounds.
A stutterer is very aware of what their speech is like; they know only too well that they can take longer to utter phrases. In fact, this awareness sometimes makes the stuttering worse.
It is important that the listener gives out a feeling of patience, calm, and peace. An impatient listener, or a listener who seems impatient, may make it harder for a stutterer to speak. Attempting to fill in the gaps (saying the missing words, for instance) is often an attempt to help, but it can be perceived by the stutterer as impatience.
Telling the stutterer to relax, or to take a deep breath, may have helpful intentions, but could stress them out even more (it may help some, though). Stuttering is not simple to overcome, and cannot usually be easily sorted out with a few deep breaths.
If you are really not sure how to behave, and you are talking to a person who stutters and nobody else is around, it might be helpful to ask them what would be the best way to respond.