Finding Voice

Stuttering, Stammering and Speech Defects

Albert Frederick Arthur George was a miserable young man. Born into British nobility in 1895, he spent much of his youth as the understudy to the future King of England, his elder brother, Edward. That understudy job had one serious demand that drove the young Albert to tears in his younger days — the demand of public speech. Albert was a brave solider in his country’s armed forces, but he shunned the public eye and more importantly, he dreaded needing to speak in large gatherings. He would tense up, his mouth would rebel and words would not exit with any kind of rhythm, let alone rhyme. The young prince had a stutter for which he had been chastised his entire life. His father used to yell and rage against him to “Just get it out!” The young prince had a speech disorder, a stutter or a stammer as it is frequently called. It took years of therapy, but he eventually led his subjects, as King (Edward had some issues) into the Second World War. On the first evening of the Last Great War he addressed his empire with a speech that would live in history, it’s sentences and cadence perfectly delivered.

There is hope when dealing with stuttering and stammering. There are treatments and there are even cures. But the issue is complicated by the fact that there are many different causes and hence, many different ways of dealing with the issue.

Let’s start by trying to understand the basics of what a speech impediment is and then work from there.  A speech disorder is a type of communication disorder where 'normal' speech is disrupted. Stammering and Stuttering, which are actually two words for the same thing, can be defined as the repetition or prolongation of words, syllables or phrases. The person with a stutter (or stammer) may also stop during speech and make no sound for certain syllables.

At their most basic, speech disorders are associated with stress. They cause stress and they are worsened by it as well, forming a feedback loop which eventually causes the patient great anxiety, especially when the subject is young and trying to communicate with their peers or parents. Children with speech impediments usually do less well in school, NOT because of any mental deficiency or challenge, but simply because they fear being heard.

Signs and Symptoms

A more clinical description of the issue can be put this way— the patient will often repeat words or parts of words, and prolong certain syllables. They will have difficulty starting off some words, others they will need to repeat multiple times. Blinking rapidly and other facial tics often accompany the speech issue. At times of extreme tension, the patient may get so anxious that they try to form words but no sounds come at all and the patient is known to be “Blocked”.

This can 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 “uumm".

Causes and Risks

Perhaps because of modern medicine’s lack of understanding of the brain, there is no authority which can say for sure WHY this class of disorders exists. Progress has been made in understanding the areas of the brain which control and coordinate speech movements of the lips, tongue and throat and how they link up with the centers of the brain that actually “think” of what needs to be said. But for now, the best that can be said is that you are more likely to develop a speech impediment if there is someone else in the family who also has a speech disorder.

The following factors may also trigger/cause stuttering:

• Developmental stuttering - A little bit of stuttering or stammering is completely normal in young children when they first begin to develop their vocabulary. When a child wishes to express something faster than their developing speech pathways can process, they will stumble and stutter. This kind of impediment disappears with age.
• Neurogenic stuttering - This is where the disorder has an organic cause. Traumatic brain injury, strokes and even certain infections are known to upset the signaling in the speech pathways of the brain and cause stuttering.
• Psychological factors - At one time, the causes of all speech disorders was pinned on psychological or psychiatric issues. Now we have a much wider experience with the issue and know that this is not the case. Psychological factors WILL make stuttering worse for patients and cause that feedback loop I mentioned. But stress itself is not generally seen as an underlying long-term factor.

What are the risk factors for stuttering?

1. Family history - 50% of children who have a speech disorders that lasts beyond childhood will have a close family member who stutters as well.
2. Age when impediment starts - The earlier it starts, the less likely it is to persist in adulthood. The age 3 and a half seems important, any disorder that starts before that almost never persists.
3. Time since stuttering started - about three-quarters of all young children who stutter will stop doing so within one or two years without speech therapy.
4. 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).
5. Gender of the patient - No one is sure why, but boys seem to be almost 4 times more likely to have a speech disorder than girls. The reasons may be neurological, or there could be sociological issues as to how different children are treated when they do stutter.

Diagnosis

To have a truly thorough diagnosis and understand all aspects of the problem, it is best to take someone you suspect of a speech disorder to a well-qualified Speech and Language Pathologist (SP).

The SP will observe how many speech issues the person has in various situations. How the person copes with issues will also be assessed. They also try to understand how the person reacts to such factors as social stigma and anxiety, which can exacerbate the patient’s problems.

The SP may want to do other assessments as well, such as speech rate and language skills.

It is vital to try to predict whether a young child's stutter will become long-term. Predicting whether an older child or an adult is likely to have continued stuttering over the long-term is less important because most likely the problem has been around long enough for the person to seek help.

Assessments for older children and adults are aimed at figuring out the severity of the problem, and what impact it has on the patient’s ability to communicate and function in society.

Treatment

Treatments tend to be aimed at teaching the person skills that help oral communication. This may include:

Fluency shaping: Where the patient is made to practice very slow speech with short sentences and slowly ramp them up. Breathing control is also a big part of the training.

Stuttering modification therapy

The idea here is to modify the stuttering so that it causes less anxiety and less of an effort, rather than eliminating it. Charles Van Riper developed Block Modification Therapy in 1973; it includes four stages:

Stage 1 (Identification) - the therapist and the patient identify the core behaviors, secondary behaviors, and feelings and attitudes that accompany the stuttering.

Stage 2 (Desensitization) - the patient freezes stuttering behavior in an attempt to reduce fear and anxiety - this involves confronting difficult sounds, words and situations (rather than avoiding them), and stuttering intentionally (voluntary stuttering).

Stage 3 (Modification) - the patient learns easy stuttering. He/she learns how to apply: a) 'cancellations' - stopping a speech disorder, pausing for a moment, and then repeating the word, b) 'pull-outs'- pulling out of a problem phrase into fluent speech, c) and 'preparatory sets' - anticipating words that cause stuttering and using 'easy stuttering' on those words.

Stage 4 (Stabilization) - the patient prepares practice assignments, makes preparatory sets and pull-outs automatic, and changes the way he/she sees himself/herself from being a stutterer to being a person who speaks fluently most of the time, but stutters mildly occasionally.

Electronic fluency devices

The patients hear their own voice differently. Altered auditory feedback effect can be done by speaking in unison with another person (as groups of people do when they are praying or singing), and blocking out the stutterer's voice while talking - this is called masking.

Some ear-pieces can echo the patient’s voice so that they feel they are talking in unison with someone else.

Most stutterers can sing flowingly without stuttering - it seems that talking in unison with someone else often has the same effect as singing on a stutterer.