Stuttering – Causes, Signs and Symptoms

Stuttering

Also called: Stammering

Summary

Stuttering is a communication disorder that causes interruptions in a person’s ability to form the words and sentences necessary to verbally communicate with other people. More than 3 million Americans stutter, according to the Stuttering Foundation. 

It is normal for children to stutter between the ages of 2 and 5, and in most cases the condition resolves on its own over time. However, other people have stuttering problems that persist or worsen as they get older. In many cases, stuttering remains a lifelong problem. Without proper therapy, stuttering can significantly impair people’s ability to communicate and impact their quality of life.

Numerous factors are believed to contribute to stuttering, including genetics, developmental delays and other speech and language problems. Stuttering is much more likely to affect males than females.

Symptoms associated with stuttering include hesitation when speaking, repetition of words and stumbling when forming verbal thoughts and sentences. Unusual body movements and facial tics may also affect the person during speech. Parents who notice a persistent stuttering problem are often urged to bring the fact to a physician’s attention before the child’s third birthday.

Children who are believed to have a stuttering problem often are referred to a speech-language pathologist for further evaluation. The speech-language pathologist will observe the patient’s speech and look for patterns of dysfluencies that occur. Various assessments will also be performed to try to pinpoint the nature of the patient’s disorder.

There is no cure for stuttering. However, patients who undergo speech therapy can learn techniques that can help them overcome their difficulty and to speak normally and fluently. In addition, parents can play a significant role in helping their child to overcome a stuttering problem by offering support and encouragement.

Recently, tiny devices have been developed that fit behind a patient’s ear and provide audio (such as a playback of the patient’s own voice or “white noise”) that has been shown to help some patients who stutter to speak with more fluently. Research continues into how these devices work and how they may be improved.

About stuttering

Stuttering is a disorder that causes a person to hesitate when speaking, repeat words or sounds, or experience abnormal stoppages of no sound when forming verbal thoughts and sentences. It is a form of dysfluency, which is an interruption in a person’s speech flow.

During normal speech, a person forms a thought that is then coded by the brain into language. The brain then sends signals to the muscles that control speech so that they move in a fashion that produces certain words. The mouth, face, neck, tongue and throat muscles all work in tandem to deliver the words that people hear.

A person who stutters experiences a breakdown in this flow of speech that is known as dysfluency. This happens to everyone occasionally. However, a person who stutters regularly experiences dysfluency that interferes with the ability to communicate.

For most people, stuttering begins in childhood. It is normal for children to stutter between the ages of 2 and 5 years, with the first signs of this obstacle to speech typically appearing between 18 months and 24 months. Children generally stutter when learning new ways to use language, and their stuttering may come and go with each new level of language achievement. This normal, temporary stuttering is sometimes referred to as developmental dysfluency or pseudostuttering. Parents should remain patient with their child during this stage of development, which usually lasts for weeks or months.

After that time, the child will likely progress to more natural speech patterns as basic conversation skills and the ability to coordinate muscles used to talk progress. Once children enter school and begin conversing regularly, stuttering problems tend to drop sharply.

However, in some cases stuttering remains or even worsens as a child grows older. About 20 percent of children develop a stuttering problem that is significant enough to cause parental concern, according to the Stuttering Foundation. Some people only stutter under certain circumstances (such as when speaking before a large group) whereas others may find that stuttering hinders most of their attempts to communicate. About 1 percent of adults stutter, according to the National Institutes of Health.

Certain situations – especially conditions of great stress or embarrassment – can trigger episodes of stuttering.

Research also indicates that children who stutter experience greater difficulty controlling their attention, behavior and emotions than those who do not.

Risk factors and causes for stuttering

Numerous factors are believed to contribute to stuttering, although it is not completely understood what causes this disorder. Genetics play a role, as 60 percent of people who stutter have a family member who also stutters, according to the Stuttering Foundation. Some degree of temporary stuttering is normal during child development. This developmental stuttering occurs as children attempt to master more complex rules of grammar. It generally goes away once the child begins attending school. Developmental delays and other speech and language problems do contribute to more problematic, chronic stuttering, as well.

It also appears that people with long-term stuttering problems process language in an area of the brain that differs from the normal language-processing area of nonstutterers. Finally, people who stutter have difficulty connecting messages from the brain to the muscles and body parts that are used for speaking. Certain brain injuries (e.g., head trauma, stroke) can also cause stuttering problems in people who previously did not stutter.

Stuttering tends to affect males more often than females, with boys up to four times more likely than girls to stutter during elementary-school years, according to the the Stuttering Foundation.

It was once believed that stuttering resulted primarily from emotional disorders. However, it is now known that this disorder is not generally caused by emotional or psychological problems.

Those who stutter are no more likely to be diagnosed with such conditions than others in the general population. When they do occur, certain emotional problems may be due to stuttering (e.g., avoiding situations where stuttering is likely). However, a small number of patients may develop stuttering problems as a result of a mental illness (e.g., social phobia) or following traumatic events.

Signs and symptoms of stuttering

There are several distinct symptoms that may indicate that a person has a stuttering disorder. Symptoms associated with stuttering may fluctuate from day to day or week to week.

Patients who stutter may repeat or extend syllables, words or phrases. It is common to repeat the first part of a word many times (e.g., “W-w-what’s going on?”), to hold a sound for a long period of time (e.g., “That’s a ba-a-a-a-d idea”), or to repeatedly use interjections such as “um” or “like.” The pitch of the voice may rise during these repetitions. Patients may experience halting speech and difficulty forming certain sounds. In addition, they may experience “blocks” where no airflow or voice is present for several seconds despite positioning the mouth as though to speak. Stuttering that includes blocks and more than two repetitions (e.g., “W-w-w-w-what’s going on?”) is more serious than stuttering that does not include these elements. However, this may still be regarded as mild.

Although these symptoms are often the result of a normal phase of development, parents should be concerned if their child stutters frequently (e.g., more than 10 percent of their speech), has stuttering that grows progressively worse, or stutters in association with unusual body movements, facial tics or tension.

Other signs of problem stuttering include:

  • Excessive repetition of whole words and phrases
  • Increased facial tension (particularly around the mouth) and tics during speech
  • Growing tendency to prolong words
  • Speech that appears increasingly strained or full of effort
  • Speech that becomes louder or rises in pitch
  • Tendency of the child to avoid situations that require talking

Children who stutter may be embarrassed about or ashamed of their disorder and may develop self-esteem issues. This may be exacerbated by teasing at the hands of friends and classmates. Patients who are embarrassed by their condition often compensate by speaking less and less.

People who stutter frequently find that their stuttering disappears while singing, or when they are alone and talk to themselves. Stuttering that persists into adolescence or adulthood is typically more stable than it was during childhood.

Diagnosis methods for stuttering

Parents who notice a persistent stuttering problem are often urged to bring the fact to a physician’s attention before the child’s third birthday. If a child is still stuttering by age 5, medical attention is even more strongly recommended. If a stuttering problem appears to be evident, the child may be referred to a speech-language pathologist who will further test the child’s speaking ability.

The speech-language pathologist will first obtain a detailed history of the condition (e.g., when it was first noticed, the circumstances under which it occurs), followed by a complete evaluation of speech and language abilities. This includes observing  the patient’s speech and looking for patterns of dysfluencies. Speech rate and language skills tests may also be performed, and details about environmental factors that affect the patient’s stuttering (e.g., how teasing or speaking in public influence speech patterns) will be noted.

In some cases, an audiologist (a specialist in hearing problems) may be consulted to test the child’s hearing, as children who cannot hear well may have increased difficulty hearing themselves and pronouncing words correctly.

In children younger than 5, it can be difficult to decide whether or not the child is likely to outgrow stuttering over time or whether the child needs treatment. Factors that may indicate a likely need for treatment include a family history of stuttering, stuttering symptoms that have lasted for at least six months and the presence of other speech or language disorders. Patients older than age 5 who stutter significantly are usually considered to be candidates for treatment.

In cases in which stuttering occurs following a head injury, or appears in advanced ages, it is necessary for a physician to perform a complete physical examination and compile a thorough medical history. Further tests (e.g. brain imaging) may be necessary to diagnose probable neurological problems such as stroke.

Treatment and prevention for stuttering

In most cases, stuttering is a temporary problem that resolves on its own and requires no treatment. About 75 percent of children who stutter as preschoolers will eventually stop doing so, according to the American Speech-Language-Hearing Association. However, other cases of stuttering are more persistent and may last a lifetime. Such persistent stuttering is more common in males. There is no cure for stuttering. However, patients can learn techniques that can help them overcome their difficulty and to speak normally and fluently.

Patients may undergo speech therapy, in which they learn new language skills that enable them to speak more clearly and naturally. This therapy may include breathing techniques, relaxation techniques that help the patient relax key muscles during speech and voice exercises. Patients are encouraged to monitor and control their rate of speech by speaking short phrases or sentences very slowly, then gradually building up to greater speeds.

Speakers who have difficulties controlling dysfluencies in their speech are taught techniques that help them to break down and incorporate these dysfluencies into their speech patterns. This helps create speech patterns that are more seamless and natural sounding.

By following the therapist’s suggestions and practicing at home, patients can master new ways of producing sounds that form words. At first, using these techniques often feels awkward to patients, especially when transferred to real-world situations. However, over time many patients become more comfortable and confident in using these aids. Children with severe stuttering difficulties show improvement when they reduce the tendency to stutter tensely or to avoid certain words altogether and instead begin to display more episodes of repetitions or prolongations of sound. These healthier, less severe symptoms of stuttering need to be recognized as progress in the patient’s treatment plan.

Parents can also help their child overcome a stuttering problem by offering support and encouragement. This is often most effective when parents establish time alone with their children without distractions. Children are often embarrassed by their stuttering problem, so it is important that parents try to provide a calm atmosphere for the child. Children should be allowed to speak freely without having to worry about the precision of their words. Telling a stuttering child to “slow down,” “start over” or to speak in smaller sentences will only increase the child’s self-consciousness. It also helps to avoid asking too many questions. It may be easier on a child who stutters to speak freely instead of answering direct questions.

Parents are also encouraged to resist the urge to finish a child’s sentences. Patience on the part of the parent is crucial to helping build the child’s confidence. Parents are urged to retain eye contact when their child is speaking and not look away or show other signs of disappointment or embarrassment. Parents who slow down their own speech offer a model for their child to slow down and improve fluency. This speech model needs to be smooth with plenty of pauses, but should not sound abnormal.

Children should also be allowed to avoid speaking in moments when they are particularly uncomfortable. Parents are urged to talk to the child’s teachers and request that the child not be placed in speaking situations that may be difficult. Once children have begun to make progress in speech therapy, they may be more equipped to tackle speaking challenges.  Finally, self-help and support groups are available to offer patients the support they need to cope with their condition and the encouragement that can help them adhere to their treatment plan. In some cases, reducing a patient’s fear and anxiety of speaking is as important or more important than learning how to properly form sounds. The encouragement received from support groups and family members can reduce these anxieties and make overall treatment easier.

Ongoing research regarding stuttering

Recent studies have indicated that people who stutter are often able to speak more fluently if they hear their own voices played back to them at a slight delay or a lower or higher pitch. “White noise” played into a patient’s ear also seems to help encourage fluency in some patients.

As a result, tiny devices have been developed that fit behind a patient’s ear and perform these functions. It appears that these devices help some patients, but are less effective in others. Research continues into how these devices work and how they may be improved.

Questions for your doctor regarding stuttering

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients and family members may wish to ask the doctor the following stuttering-related questions:

  1. What are the signs and symptoms that may indicate a stuttering problem?
  2. How will I know whether my child’s stuttering is normal or a problem needing attention?
  3. What are the factors that might be causing my child/me to stutter? 
  4. How will you diagnose whether my child/I have a stuttering problem?
  5. What are my child’s/my treatment options?
  6. How long will it take for my child’s/my condition to improve?
  7. What are some potential signs of improvement?
  8. How can I track my child’s progress following treatment?
  9. How can I encourage my child to keep talking and practicing therapy techniques?
  10. What should I avoid that might discourage my child or make his/her condition worse?
  11. What issues should I discuss with my child’s daycare or school staff?
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