Speech-Language Pathology: Stuttering

According to Singular's Pocket Dictionary of Speech-Language Pathology “stuttering is an articulatory or phonatory problem that typically presents in childhood and is characterized by anxiety about the efficacy of spoken communication, along with forced, involuntary hesitation, duplication, and protraction of sounds and syllables.” Stuttering can be witnessed in the rate, pitch, inflection, and even facial expressions of a speaker. The cause of this problem is not set in stone, which leads to countless theories as to why people stutter. Along with numerous theories as to why people have this disorder, there are also limitless treatment methods that can be used to help a speaker with a stuttering problem. Stuttering has been a controversial
topic among professionals for hundreds of years, and we are still learning what works and what does not work for this curious disorder. The etiology of stuttering is not certain to this day. Many professionals are torn between the psychological and neurological theories as to why people stutter. There are many theories which explain stuttering as a psychosomatic problem that can be dealt with by using psychotherapy. The “Repressed Need” hypothesis explains that stuttering is a neurotic symptom which is fixed in the unconscious. The repressed need is said to come from a longing for either oral or anal gratification. The stutterer is able to satisfy their anal erotic needs by the “holding back of words that may represent a hostile expulsion and retention of feces.” This theory is closely related to Freud’s Oral and Anal stages. Some theorists believe that stuttering is caused by the “Anticipatory struggle”. The anticipatory struggle hypothesis explains that p63 “stutterers interfere in some manner with the way they are talking because of their belief in the difficulty of speech.” The stutterer is so frightened of making a mistake during speech they in turn avoid, brake, or interject their words and sentences. Stuttering is thought to be a variant disorder, meaning it can affect a person in certain situations that bring them great anxiety or fear. Using a phone and speaking in front of a group of people are examples of this . Although many signs point to a psychological explanation for stuttering, genetic and neurological problems have also been tied to stuttering. Early theorists, like the Roman physicians believed stuttering was related to an imbalance of the “four humors”, and humoral balance treatments were used to treat stuttering until the late eighteenth century. A more modern explanation of a neurological problem that causes stuttering would be the “cerebral dominance theory”, that explains conflict between the two hemispheres of the brain is the cause of stuttering. Stuttering has many different types of specified dysfluencies.
Although there are hesitations and interruptions found in all speakers, the disfluency found in stutterers seems to be more severe. There are several forms of dysfluencies when dealing with stuttering including interjections, repetitions, and revisions. A stutterer can encompass one or many dysfluencies ranging from minor incidents to very extreme episodes of stuttering. Interjections occur frequently in both fluent speakers and dysfluent speakers. An interjection occurs with the speaker uses “uh” or “er” while speaking. Repetitions also are common for stutterers. Repetitions can occur in part of the word ,” wh wh what” in the entire word, “what what what” and in phrases, “ what do what do what do you want?” Revisions during sentences such as,”I was, I am going” also happen often, along with broken words; I was t---alking, and prolonged sounds like the “wa” sound in what are also usual in
stuttering. Like other speech disorders, stuttering mainly occurs in children who show no evidence of having any other type of disorder. Stuttering comes in many shapes and forms and can be slight to extremely severe, making the all characteristics of this disorder always subject to change. Stutterers encompass hesitation, interruption, revisions, broken words, and prolonged sounds in their speech making it hard for people to follow. While most of the characteristics of a stutterer are only apparent when listening to them speak, there are also many secondary characteristics a stutterer may have. The secondary characteristics vary from person to person, however most of them occur in the face or hand motions. Visible characteristics include tension in the face, which can be seen when the speaker is talking and their face seems to turn sour and flushed. Stutterers also may frown, jerk their head, move their eyes erratically, or wrinkle their foreheads during a speech interruption. Stutterers show secondary characteristics in their hand movements and gestures as well. When stutterers feel tension which is usually caused by frustration of speech, they sometimes react by waving their arms and hands. This can sometimes help the stutterer to get out a word, phrase or sound they are trying to express. Vocal abnormalities are also present in some stutterers, including abnormal inflections in tone, and sharp pitch level shifts. A person can begin to stutter at any time, however most cases are recorded at a young age; most frequently between the ages of two through six.
An estimated fifteen million individuals world wide, including three million Americans stutter. A child can be diagnosed from eighteen months, when words starts to progress into more fluent speech. The median age of onset according to a study done by Daley (1955); which included fifty young stutterers recorded that the median age of onset was 3.87. Occurrence becomes less frequent with age, and seems to be tied to the development of language. Although there are millions of stutterers in the United States most of them will “recover” by adulthood. According to Andrews and Harris’s (1964) research that included 1,000 stutterers; 79% of children will stop stuttering by the age of sixteen. Boys are three times more likely to develop a stutter then a girl would according to the 3-1 ratio concluded by “US Nationwide, 1-12” Hull el at
(1976). Assessing a stuttering disorder can be done in many ways including, recognizing the frequency of the specified disfluency type, calculating the mean duration of stuttering, speech rate, and articulation of the person’s speech. When measuring the frequency of the stutter, the speech pathologist can try to account the percentage of moments of stuttered words or syllables. This is a popular way of diagnosing a stutter, since it is easily reportable. Speech pathologists can use electronic counters to measure the number of syllables stuttered during a speech session. A speech pathologist can also evaluate a patient by checking their speech rate. Checking a speech rate is done by the examination of abnormalities in the respiration, like disordered breathing, and phonation, such as breath holding. A professional can also make assumptions on a patient by listening to how long a stuttering block lasts for. An average duration of a stuttering block is one second, and in some severe cases of stuttering a block can last for an entire minute. When dealing with the treatment of a speech disorder like stuttering, the patient has many options, which may or may not work for them. Since stuttering usually begins at a young age, behavior therapy has been a popular method of treatment that may halt the progression of stuttering in children. In behavior therapy for early stutterers, the clinician can recommend the child to speak slower and smoother by teaching them a relaxed pattern of speech. Modeling and mimicking are excellent ways to help a child with a stutter to over come their impediment. Psychotherapy is another modern way of treatment among professionals. Psychoanalytical therapy can help the stutterer to over come their anxieties of speech, and give them the confidence that they lack. Speech therapists play a role in the treatment of stuttering by helping the patient modify their speech patterns. It seems that most stutters are able to talk in song, so the speech pathologist can teach the patient to speak rhythmically. Helping a person speak rhythmically can be taught by using hand and finger movements to assist the stutterer “move along” their fluency. While this is an effective treatment for stuttering, some patients might relapse and their learned hand movements become useless and the learned tendency can then become an abnormal secondary characteristic. Although the effectiveness of therapy is unclear, the patient has the option of many treatments, and eventually a stutterer may find something that will work for them or as in many cases, the person might recover spontaneously. Stuttering is classified as a speech disorder, however there is much more to this disorder that meets the eye. Researchers are still trying to pinpoint the exact cause of stuttering but one thing they can all agree on is that the emotional pain a person with a stutter lives with can affect them for the rest of their lives, even after the disorder subsides. Aside from the anxiety, shame, and fear that go along with this speech problem, many people go ahead to live seemingly normal lives. Through out history there have been countless successful individuals who stutter, ranging from Winston Churchill to James Earl Jones which goes to show that while stuttering can be difficult to overcome it does not deter a person from reaching their fullest potential.