   #copyright

Stuttering

2007 Schools Wikipedia Selection. Related subjects: Linguistics

   Stuttering

   CAPTION: Stuttering
   Classifications and external resources

   ICD- 10 F98.5
   ICD- 9  307.0

   Stuttering, also known as stammering in the United Kingdom, is a speech
   disorder in which the flow of speech is disrupted by involuntary
   repetitions and prolongations of sounds, syllables, words or phrases;
   and involuntary silent pauses or blocks in which the stutterer is
   unable to produce sounds.

   The term stuttering is most commonly associated with involuntary sound
   repetition, but it also encompasses the abnormal hesitation or pausing
   before speech, referred to by stutterers as blocks, and the
   prolongation of certain sounds, usually vowels. Much of what
   constitutes "stuttering" cannot be observed by the listener; this
   includes such things as sound and word fears, situational fears,
   anxiety, tension, self-pity, stress, shame, and a feeling of "loss of
   control" during speech. The emotional state of the individual who
   stutters in response to the stuttering often constitutes the most
   difficult aspect of the disorder. The term "stuttering", as popularly
   used, covers a wide spectrum of severity: it may encompass individuals
   with barely perceptible impediments, for whom the disorder is largely
   cosmetic, as well as others with extremely severe symptoms, for whom
   the problem can effectively prevent most oral communication.

   Stuttering is generally not a problem with the physical production of
   speech sounds (see Voice disorders) or putting thoughts into words (see
   Dyslexia, Cluttering). Despite popular perceptions to the contrary,
   stuttering does not affect and has no bearing on intelligence. Apart
   from their speech impairment, people who stutter are generally normal.
   Anxiety, low confidence, nervousness, and stress therefore do not cause
   stuttering, although they are very often the result of living with a
   highly stigmatized disability.

   The disorder is also variable, which means that in certain situations,
   such as talking on the telephone, the stuttering might be more severe
   or less, depending on the anxiety level connected with that activity.
   In other situations, such as singing (as with country music star Mel
   Tillis or pop singer Gareth Gates) or speaking alone (or reading from a
   script, as with actor James Earl Jones), fluency improves. (It is
   thought that speech production in these situations, as opposed to
   normal spontaneous speech, may involve a different neurological
   function.) Some very mild stutterers, such as Bob Newhart, have used
   the disorder to their advantage, although more severe stutterers very
   often face serious hurdles in their social and professional lives.
   Although the exact etiology of stuttering is unknown, both genetics and
   neurophysiology are thought to contribute. Although there are many
   treatments and speech therapy techniques available that may help
   increase fluency in some stutterers, there is essentially no "cure" for
   the disorder at present.

Incidence and prevalence

   The prevalance of stuttering in preschool children is about 2.5%, that
   is, about 1 young child in 40 now stutters. The incidence is about 5%,
   or 1 in 20 children stutter at some point in childhood.^26

   About 1% of adults stutter. The figure found in a recent study was
   0.73%, or about one in 135 adults.^27 About 80% of adult stutterers are
   men and about 20% are women.^28

   Studies in years past claimed that some countries had higher or lower
   rates of stuttering, or that some cultures had no stutterers at all.
   These studies are generally discounted now, although there are likely
   more adult stutterers in countries with less speech therapy.
     * For more information, see Incidence and Prevalence

Other fluency disorders

   This article is about developmental stuttering, that is, stuttering
   that originates when a child is learning to speak and develops as the
   child matures into adulthood. Several other speech disorders resemble
   stuttering. See also:
     * Cluttering

     * Parkinson's speech

     * Essential tremor

     * Spasmodic dysphonia

     * Social anxiety

   Head injuries and strokes can cause repetitions, prolongations, and
   blocks. Rarer still are stutters induced by specific medications.
   Medications such as antidepressants, antihistamines, tranquilizers and
   selective serotonin reuptake inhibitors have been known to affect
   speech in this way. While these afflictions create stutter-like
   conditions they do not create a stutter in the traditional sense.
   However, these neurogenic stutterers lack the struggle behaviour and
   fears and anxieties of developmental stuttering. Developmental
   stutterers can fluently speak certain memorized phrases, such as the
   "Pledge of Allegiance." Neurogenic stutterers are disfluent on
   everything. Developmental stutterers can speak fluently in certain
   (typically low-stress) situations. Neurogenic stutterers are disfluent
   everywhere.

   Rarely, traumatic experiences caused an adult to begin stuttering.
   Psychogenic stuttering typically involves rapid, effortless repetitions
   of initial sounds, without struggle behaviour.
     * For more information, see Other Fluency Disorders

Causes

   No single, exclusive cause of stuttering is known. A variety of
   hypotheses and theories suggest multiple factors contributing to
   stuttering.

Genetics

   Stuttering has been correlated with certain genes^29; however, a
   genetic cause for stuttering has yet to be proven. Many studies have
   investigated stuttering in families, yet typically have yielded results
   that could be interpreted as either genetic or social environment
   ("nature" or "nurture").
     * For more information, see Genetics of Stuttering

Neurology of adult stuttering

   Brain scans of adult stutterers have found several neurological
   abnormalities:
     * During speech adult stutterers have more activity in their right
       hemispheres, which is associated with emotions, than in their left
       hemispheres, which is associated with speech. Non-stutterers have
       more left-hemisphere activity during speech. It is unknown whether
       this abnormal hemispheric dominance results from something wrong
       with stutterers' left-hemisphere speech areas, with
       right-hemisphere area unsuited for speech taking over speech tasks;
       or whether the unusual right-hemisphere activity is related to
       fears, anxieties, or other emotions stutterers associate with
       speech.
     * During speech, adult stutterers have central auditory processing
       underactivity. One study suggested that stutterers may have an
       inability to integrate auditory and somatic processing, i.e.,
       comparing how they hear their voices and how they feel their
       muscles moving.^36
     * A brain scan study examined the planum temporale (PT), an
       anatomical feature in the auditory temporal brain region. Typically
       people have a larger PT on the left side of their brains, and
       smaller PT the right side (leftward asymmetry). A brain scan study
       found that stutterers' right PT is larger than their left PT
       (rightward asymmetry).^37
     * Adult stutterers have overactivity in the left caudate nucleus
       speech motor control area. Because stuttering is primarily
       overtense, overstimulated respiration, vocal folds, and
       articulation (lips, jaw, and tongue) muscles, it should be no
       surprise that the brain area that controls these muscles is
       overactive.

   No brain scan studies have been done of stuttering children. It is
   unknown whether stuttering children have neurological abnormalities.

   Another prominent view is that stuttering is caused by neural
   synchronization problems in the brain. Recent research indicates that
   stuttering may be correlated with disrupted fibers between the speech
   area and language planning area, both in the left hemisphere of the
   brain. Such a disruption could potentially be due to early brain damage
   or to a genetic defect.

   The first brain imaging studies in stuttering were done on two subjects
   using SPECT scanning before and after the administration of
   haloperidol. The researchers found that the subjects with stuttering
   had less blood flow in the Broca's and Wernicke's area and associated
   this with dysfluency. They found that haloperidol not only reduced
   stuttering but reversed this functional abnormality. Numerous PET and
   functional MRI studies have presented data that is in agreement with
   this first study.

   Volumetric MRI studies have found that portions of the Broca's and
   Wernicke's areas are smaller in people who stutter and this corrolates
   well with the hypometabolism in these two brain regions. New forms of
   structural MRI have found that there is a disconnection in white matter
   fiber tracts in the left hemisphere and greater numbers of white matter
   fibre tracts in the right hemisphere.
     * For more information, see Neurology of Stuttering

Stress-related changes in stuttering

   In certain situations, such as talking on the telephone, stuttering
   might increase, or it might decrease, depending on the anxiety level
   connected with that activity.

   Under stress, people's voices change. They tense their
   speech-production muscles, increasing their vocal pitch. They try to
   talk faster. They repeat words or phrases. They add interjections, also
   known as "filler words", such as "uh." These are normal dysfluencies. A
   study found that under stress, non-stutterers went from 0% to 4%
   dysfluencies, for the simple task of saying colors. Stutterers went
   from 1% to 9%.^38

   Stuttering reduces stress 10%, as measured by systolic blood
   pressure.^39 But stuttering causes stress in listeners.^40 Stuttering
   appears to reduce stress temporarily, but then cause stress, creating a
   cyclical pattern in which the stutterer stutters on the first syllable
   of the first word, then says the rest of the word and several more
   words fluently, then stutters again, then says a few more words
   fluently, and so on.

   One study found that developmental stuttering and Tourette syndrome may
   be pathogenetically related.^41 Tics are exacerabated by stress, and
   when the affected person tries harder to control the undesired
   movement, the conditions can become more pronounced.
     * For more information, see Stress-Related Changes

Onset and development

                                                  Development of a stutter
                                                     Phase Description Age
                                                                         I
     * Disfluencies tend to be single syllable, whole word, or phrase
       repetitions, interjections, pauses, and revisions.
     * The child will not exhibit visible tension, frustration or anxiety
       when speaking disfluently.
     * Normal disfluency will occur when the child is learning to walk or
       refining motor skills.
     * There are periods (days or weeks) of fluency and disfluency
     * Changes in the child's environment can cause normal disfluency.

                                                                       2-6
                                                                        II
     * Disfluencies tend to be repetitions and sound prolongations
     * More than two disfluencies put together (e.g., "Lllllets g-g-go
       there") and periods of fluency and disfluency come and go in
       cycles.
     * The child demonstrates little awareness or concern about his/her
       disfluencies but may express frustration

                                                                       2-6
                                                                       III
     * Disfluency most commonly occurs at the beginning of words or
       phrases.
     * The child tends to be more disfluent when excited or upset
     * Repetitions are usually part-word as opposed to whole-word
     * The stuttering comes and goes in cycles, sometimes triggered by
       events and stressors
     * The child may show awareness that speech is difficult in addition
       to the frustration

                                                                       2-6
                                                                        IV
     * Types of disfluencies include repetitions, prolongations, and
       blocks.
     * Stuttering becomes chronic, without periods of fluency
     * Secondary behaviors appear (eye blinking, limb movements, lip
       movements, etc.)
     * Stuttering tends to increase when excited, upset or under some type
       of pressure.
     * Fear and avoidance of sounds, words, people, or speaking situations
       may develop.
     * The person may feel embarrassment or shame surrounding the
       stuttering

                                                                      6-13
                                                                         V
     * Speech is characterized by frequent and noticeable interruptions
     * The person may have poor eye contact and use various tricks to
       disguise the stuttering
     * Person anticipates stuttering, fears and avoids speaking
     * The person identifies him/herself as a stutterer and experiences
       frustration, embarrassment and/or shame.
     * The person may attempt to choose a lifestyle where speaking can
       often be avoided.

                                                                       14+
            Source: Onset and Development (2001). Retrieved March 20, 2005

   Stuttering is a developmental disorder. Children develop capabilities
   in a certain order, e.g., most children crawl before they walk. An
   unknown factor or combination of factors causes some children's speech
   to develop abnormally. As the child grows what appeared as a minor
   disfunction can develop into a major disability.

   The mean onset of stuttering is 30 months, or two and a half years
   old.^30 Stuttering rarely begins after age six.

   65% of preschoolers who stutter spontaneously recover, in their first
   two years of stuttering.^31 Only 18% of children who stutter five years
   recover spontaneously.^32 The peak age of recovery is 3.5 years old. By
   age six, a child is unlikely to recover without speech therapy.

   Among preschoolers, boys who stutter outnumber girls who stutter about
   two to one, or less.^33 But more girls recover fluent speech, and more
   boys don't.^34 By fifth grade the ratio is about four boys who stutter
   to one girl who stutters. This ratio remains into adulthood.^35

   Some pediatricians tell parents to "wait and see" if a child outgrows
   stuttering on his own. That advice is wrong. Children who stutter
   should be treated by a speech-language pathologist as soon as possible.

   All children experience normal dysfluencies as they learn to talk,
   which they will outgrow. A current issue is whether stuttering develops
   progressively from normal childhood dysfluencies, or whether stuttering
   is something entirely different. Many parents are unsure whether their
   child's dysfluencies are normal, or whether he or she is beginning to
   stutter. The Stuttering Foundation of America has written and video
   materials to help parents differentiate normal dysfluencies from
   beginning stuttering. Or parents can consult a speech-language
   pathologist.

   To find a speech-language pathologist for your child, start by calling
   your school. American schools provide free speech therapy to children
   as young as three years old.

   As speech and language are difficult and complex skills to learn,
   almost all children have some difficulty in developing these skills.
   This results in normal disfluencies that tend to be single-syllable,
   whole-word or phrase repetitions, interjections, brief pauses, or
   revisions. In the early years, a child will not usually exhibit visible
   tension, frustration or anxiety when speaking disfluently and most will
   be unaware of the interruptions in their speech. With young stutterers,
   their disfluency tends to be episodic, and periods of stuttering are
   followed by periods of relative fluency. This pattern remains through
   all stages of a stutter's development, but as the stutter develops, the
   disfluencies tend to develop more into repetitions and sound
   prolongations, often combined together (e.g., "Lllllets g-g-go there").

   Usually by the age of 6, a stutter is exacerbated when the child is
   excited, upset or under some type of pressure. Also around this age, a
   child will start to become aware of problems in his or her speech.
   After this age, stuttering includes repetitions, prolongations, and
   blocks. It also becomes more and more chronic, with longer periods of
   disfluency. Secondary motor behaviors (eye blinking, lip movements,
   etc.) may be used during moments of stuttering or frustration. Also,
   fear and avoidance of sounds, words, people, or speaking situations
   usually begin at this time, along with feelings of embarrassment and
   shame. By age 14 , the stutter is usually classified as an "Advanced
   stutter," characterized by frequent and noticeable interruptions, with
   poor eye contact and the use of various tricks to disguise the
   stuttering. Along with a mature stutter come advanced feelings of fear
   and increasingly frequent avoidance of unfavorable speaking situations.
   Around this time many become fully aware of their disorder and begin to
   identify themselves as "stutterers." With this may come deeper
   frustration, embarrassment and shame.

   It is important to note that stuttering does not affect intelligence
   and that stutterers are sometimes wrongly perceived as being less
   intelligent than non-stutterers. This is mainly due to the fact that
   stutterers often resort to a practice called word substitution, where
   words that are difficult for a stutterer to speak are replaced with
   less-suitable words that are easier to pronounce. This often leads to
   awkward sentences which give an impression of feeble mindedness.
   Stuttering is a communicative disorder that affects speech; it is not a
   language disorder—although a person's use of language is often affected
   or limited by a stutter. ^1 ^2
     * For more information, see Development of Childhood Stuttering

Characteristics

Core and secondary stuttering behaviors

   Core stuttering behaviors include disordered breathing, phonation
   (vocal fold vibration), and articulation (lips, jaw, and tongue).
   Typically these muscles are overtensed, making speech difficult or
   impossible.

   Secondary stuttering behaviors are unrelated to speech production. Such
   behaviors include physical movements such as eye-blinking or head
   jerks; avoidance of feared words, such as substitution of another word;
   interjected "starter" sounds and words, such as "um," "ah," "you
   know,"; and vocal abnormalities to prevent stuttering, such as speaking
   in a rapid monotone, or affecting an accent.

   Much of what constitutes "stuttering" cannot be observed by the
   listener; this includes such things as sound and word fears,
   situational fears, anxiety, tension, shame, and a feeling of "loss of
   control" during speech. The emotional state of the individual who
   stutters in response to the stuttering often constitutes the most
   difficult aspect of the disorder.
     * For more information, see Core Behaviors

Fluency

   Speech fluency consist of three variables: continuity, rate, and ease
   of speaking. Continuity refers to speech that flows without hesitation
   or stoppage. Rate refers the speed in which the words are spoken. For
   English-speaking adults, the mean overall speaking rate is 170 words
   per minute (w/m), substantially quicker than the approximately 120 w/m
   that stutterers produce.^1 Ease of speaking refers to the amount of
   effort being expended to produce speech. Fluent speakers put very
   little muscular or physical effort into the act of speaking, while
   stutterers exert a relatively large amount of muscular effort to
   produce the same speech. In addition to the physical effort involved in
   producing speech, the mental effort is usually much greater in
   stutterers than non-stutterers. ^1

   Disfluency in speech, including repetitions and prolongations, is
   normal for all speakers, but stuttering is distinct from normal
   disfluency in that it occurs with greater frequency and severity—the
   disfluencies occur much more often and tend to last longer with more
   strain. The types of disfluencies are also markedly different: normal
   disfluencies tend to be a repetition of whole words or the interjection
   of syllables like "um" and "er," while stuttering tends to be
   repetition and prolongation of sounds and syllables. The various
   behaviors that can disrupt the smooth flow of speech include
   repetition, prolongations, and pauses: ^4
     * Repetition occurs when a unit of speech, such as a phrase, word, or
       syllable, is superfluously repeated. (Examples of repetition for a
       phrase would be, "I want.. I want.. to go.. I want to go to the
       store," or, "I want to go to the - I want to go to the store." A
       word repetition would often resemble, "I want to-to-to go to the
       store," and a syllable or sound repetition being, "I wa-wa-want to
       go to the store," or, "I w-w-want to g-go to the store.")
       Repetition occurs in the speech of both stutterers and
       non-stutterers, but non-stutterers are less likely to repeat
       shorter units of speech, mainly repeating phrases and sometimes
       words but rarely syllables. Non-stutterers will also, in the
       majority of cases, repeat the unit once or twice as opposed to the
       6 or so times common from stutterers.

     * Prolongations are one of the least typical behaviour exhibited by
       stutterers. Prolongations normally happen with child stutterers and
       with the sounds /θ/, /ʃ/, /v/, and any other fricative consonant or
       vowel. With stutterers, prolonging a sound sometimes leads to a
       pitch and volume increase.

     * Pauses are also a common source of disfluency in both stutterers
       and non-stutterers. Most pauses can be divided into two categories:
       filled pauses and unfilled pauses.
          + Unfilled pauses are extraneous portions of silence in the
            ongoing stream of speech. These pauses differ from the pauses
            that punctuate normal speech, where they reflect common
            sentence structure or are used to add a particular rhythm or
            cadence to speech. Unfilled pauses by stutterers are usually
            unintentional and may cause the larynx to close, restricting
            the flow of air necessary for speech. Stutterers refer to this
            as "blocking". (See Blocking.)
          + Filled pauses are interjections typical in normal speech like
            "um", "uh", "er", and so on. In speech these serve as a kind
            of place-holder—a way a speaker lets listeners know that he or
            she still has the floor and is not finished speaking. In
            addition to being used as a way of preempting interruption,
            they are also used by stutterers as a way of easing into
            fluency or deflecting embarrassment when they cannot speak
            fluently.

Avoidance behaviour

   When stuttering, stutterers will often use nonsense syllables or
   less-appropriate (but easier to say) words to ease into the flow of
   speech. Stutterers also may use various personal tricks to overcome
   stuttering or blocks at the beginning of a sentence, after which their
   fluency can resume. Finger-tapping or head-scratching are two common
   examples of tricks, which are usually idiosyncratic and may look
   unusual to the listener. In addition to word substitution or the use of
   filled pauses, stutterers may also use starter devices to help them
   ease into fluency. A common practice is the timing of words with a
   rhythmic movement or other event. For instance, stutterers might snap
   their fingers as a starter device at the beginning of speech. These
   devices usually do work, but only for a short amount of time. Often a
   person who stutters will do something at some point to avoid, postpone,
   or disguise a stutter and, by coincidence, will not stutter. The
   stutterer then makes a cause-effect connection between that new
   behavior and the release of the stuttering, and the behaviour becomes a
   habit. ^4

   As stutterers often resort to word substitution in order to avoid
   stuttering, some develop an entire vocabulary of easy-to-pronounce
   words in order to maintain fluent speech—sometimes so well that no one,
   not even their spouses or friends, know that they have a stutter.
   Stutterers who successfully use this method are called "covert
   stutterers" or "closet stutterers". While they do not actually stutter
   in speech they nevertheless suffer greatly from their speech disorder.
   The extra effort it takes to scan ahead for feared words or sounds is
   stressful, and the replacement word is usually not as adequate a choice
   as the stutterer originally intended. Famously, some stutterers
   drastically limit their options when dealing with employees at given
   establishments; only eating cheeseburgers at fast-food restaurants,
   ordering toppings they do not like on pizzas, or getting a style of
   haircut they do not want as a by-product of their inability to
   pronounce certain words. Some stutterers have even changed their own
   given name because it contains a difficult-to-pronounce sound and
   frequently leads to embarrassing situations.

   Although this action may appear unusual or unreasoned to a fluent
   speaker, to a stutterer they come as second nature: due to the
   embarrassment and fear associated with speaking, many stutterers will
   wish to hide their stutter from listeners. This is the prime reason for
   avoidance.

Severity

   When the behaviors of a stutter are infrequent, brief, and are not
   accompanied by substantial avoidance behaviour, the stutter is usually
   classified as a mild or a non-chronic stutter. Non-chronic stuttering
   is often called "situational stuttering" because the afflicted person
   generally has difficulty speaking only in isolated situations—usually
   during public speaking or other stressful activities—and outside of
   these situations the person generally does not stutter. When the
   behaviors are frequent, long in duration, or when there are visible
   signs of struggle and avoidance behaviour, the stutter is classified as
   a severe or chronic stutter. Unlike mild or situational stuttering,
   chronic stuttering is present in most situations, but can be either
   exacerbated or eased depending on different conditions (see Positive
   conditions). Severe stutters often, but not always, are accompanied by
   strong feelings and emotions in reaction to the problem such as
   anxiety, shame, fear, self-hatred, etc. This is usually less present in
   mild stutterers and serves as another criteria by which to define
   stutters as mild or severe. Another way of discerning between the two
   severities is by percentage of disfluency per 100 words. When a speaker
   experiences disfluencies at a rate around 10%, they usually have a mild
   stutter, while 15% or more is usually indicative of a severe stutter.^2
   In addition to the disfluency, many people who stutter display
   secondary motor behaviors. Observers often notice muscles tensing up,
   facial and neck tics, excessive eye blinking, and lip and tongue
   tremors. In extreme cases entire body movements may accompany
   stuttering. Most common with stutterers is the inability to maintain
   eye contact with the listener, which in many cultures may hamper the
   growth of personal or professional relationships.

   It is worth noting that the severity of a stutter is not constant and
   that stutterers often go through weeks or months of substantially
   increased or decreased fluency. Stutterers universally report having
   "good days" and "bad days" and report dramatically increased or
   decreased fluency in specific situations. Below is an overview of the
   circumstances that harm and help the fluency of most stutterers:

Positive conditions

   Subtle changes in mood or attitude often greatly increase or decrease
   fluency, with many stutterers developing tricks or methods to achieve
   temporary fluency. Stutterers commonly report dramatically increased
   fluency when singing, whispering or starting speech from a whisper,
   speaking extremely slowly, speaking in chorus, speaking without hearing
   their own voice (e.g., speaking over loud music), speaking with a
   metronome or other rhythm, speaking with an artificial accent or voice,
   speaking in a foreign dialect, or when speaking while hearing their own
   voice with a minuscule delay or pitch change. (See Treatments.)
   Stutterers also display increased fluency when speaking to
   nonjudgmental listeners, such as pets, children, or speech
   pathologists. It is perhaps most interesting to note that most
   stutterers experience extraordinary levels of fluency when talking to
   themselves. A rare few even experience increased fluency when they
   exclusively "have the floor" ( public speaking or teaching), when they
   are intoxicated, or when they are explicitly trying to stutter. There
   is no universally accepted explanation for these phenomena.
   Unfortunately, non-stutterers often interpret such instances of fluency
   as evidence that a stutterer can in fact speak "normally", which may
   partly explain the popular belief that stuttering is a transient
   nervous condition. Nevertheless, the appearance of fluency in certain
   situations in no way indicates that a stutterer can consciously produce
   similar fluency at other times, or that the disorder is any less
   "real".

Negative conditions

   All speech is more difficult when under pressure. Commonly, social
   pressures, like speaking to a group, speaking to strangers, speaking on
   the telephone, or speaking to authority figures, will irritate and make
   worse a stutter. Also, time pressure often exacerbates a stutter.
   Pressure to speak quickly when answering or conversing is usually very
   difficult for a stutterer, particularly on the telephone where
   stutterers do not have body language to aid themselves. This usually
   leaves dead silence in the place of nonverbal communication, which will
   indicate to the listener that the stutterer is not there or the line
   has been disconnected. Other time pressures will also worsen a stutter,
   such as saying one's own name, which must be done without hesitation to
   avoid the appearance that one does not know his or her own name,
   repeating something just said, or speaking when somebody is waiting for
   a response. Getting hot or sweaty, heart pounding, and butterflies in
   the stomach are natural - the body responds to strong emotions. The
   problem is they tend to make things worse by making one even more
   self-conscious. By 16 years of age, a person who stammers will have had
   a great deal of experience of stammering and, for many, these
   experiences have been quite negative. The ever-present threat of being
   teased, bullied or not accepted takes a tremendous toll on the
   stutterer's everyday life. A person dealing with this may often feel
   like he or she has limited opportunities and options since today
   speaking out in public is almost a necessity, especially when one wants
   to be successful in one's career.

Adult stuttering treatments

   A wide variety of stuttering treatments are available. No single
   treatment is effective for every stutterer. This suggests that
   stuttering doesn't have a single cause, but rather is the result of
   several interacting factors. If so, then combining several stuttering
   treatments may be more effective than relying on a single treatment.
   Many speech-language pathologists favour such an integrated approach to
   stuttering, and tailor therapy to each individuals' needs.

Fluency shaping therapy

   Fluency shaping therapy trains stutterers to speak fluently by relaxing
   their breathing, vocal folds, and articulation (lips, jaw, and tongue).

   Stutterers are usually trained to breathe with their diaphragms, gently
   increase vocal fold tension at the beginning of words (gentle onsets),
   slow their speaking rate by stretching vowels, and reduce articulatory
   pressure. The result is slow, monotonic, but fluent speech. This
   abnormal-sounding speech is used only in the speech clinic. After the
   stutterer masters these target speech behaviors, speaking rate and
   prosody (emotional intonation) are increased, until the stutterer
   sounds normal. This normal-sounding, fluent speech is then transferred
   to daily life outside the speech clinic.

   A study followed 42 stutterers through the three-week fluency shaping
   program. The program also included psychological treatment to reduce
   fears and avoidances, discussing stuttering openly, and changing social
   habits to increase speaking. The therapy program reduced stuttering
   from about 15-20% stuttered syllables to 1-2% stuttered syllables. 12
   to 24 months after therapy, about 70% of the stutterers had
   satisfactory fluency. About 5% were marginally successful. About 25%
   had unsatisfactory fluency.^19
     * For more information, see Fluency Shaping

Stuttering modification therapy

   The goal of stuttering modification therapy is not to eliminate
   stuttering. Instead, the goals are to modify one's moments of
   stuttering, so that their stuttering is less severe; and reduce their
   fear of stuttering, while eliminating avoidance behaviors associated
   with this fear. Unlike fluency shaping therapy, stuttering modification
   therapy assumes that adult stutterers will never be able to speak
   fluently, so the goal is to be an effective communicator despite
   stuttering.

   Stuttering modification therapy has four stages:
     * In the first stage, called identification, the stutterer and
       clinician identify the core behaviors, secondary behaviors, and
       feelings and attitudes that characterize your stuttering.
     * In the second stage, called desensitization, the stutterer tells
       people that he is a stutterer, freezes core behaviors, and
       intentionally stutters ("voluntary stuttering").
     * In the third stage, called modification, the stutterer learns "easy
       stuttering." This is done by "cancellations" (stopping in a
       dysfluency, pausing a few moments, and saying the word again);
       "pull-outs," or pulling out of a dysfluency into fluent speech; and
       "preparatory sets," or looking ahead for words you're going to
       stutter on, and using "easy stuttering" on those words.
     * In the fourth stage, called stabilization, the stutterer prepares
       practice assignments, makes preparatory sets and pull-outs
       automatic, and changes his self-concept from being a person who
       stutters to being a person who speaks fluently most of the time but
       who occasionally stutters mildly.

   Only one long-term efficacy study of a stuttering modification therapy
   program has been published in a peer-reviewed journal. This study
   concluded that the program "appears to be ineffective in producing
   durable improvements in stuttering behaviors."^20

   For more information, see Stuttering Modification Therapy

Anti-stuttering medications

   Several dopamine antagonist medications reduced stuttering in
   double-blind, placebo-controlled studies, including Haloperidol
   (Haldol), risperidone (Risperdal),^12 and olanzapine (Zyprexa).^13
   These medications generally reduce stuttering 33-50%. Haldol is rarely,
   if ever, used by stutterers due to severe side effects. Risperdal and
   Zyprexa have fewer side effects. None of these drugs are FDA-approved
   for stuttering.

   Clinical trials are underway for what could be the first FDA-approved
   anti-stuttering medications. Pagoclone is a gamma amino butyric acid
   (GABA) selective receptor modulator. Dopamine and GABA are both
   neurotransmitters.^14

   Other medications can increase stuttering, or even cause a person to
   start stuttering. Such medications include dopamine agonists such as
   Ritalin and selective serotonin reuptake inhibitors (SSRI) such as
   Prozac and Zoloft.
     * For more information, see Anti-Stuttering Medications

Anti-stuttering devices

   Changing how a stutterer hears his voice usually improves his fluency.
   This altered auditory feedback effect appears to be related to the
   central auditory processing disorder seen in adult stutterers' brain
   scans; however, more research is needed in this area.

   The altered auditory feedback effect can be produced by speaking in
   chorus with another person, or hearing one's voice echo in a well.
   However, this effect is now usually produced with electronic devices.
   The three most common types of altered auditory feedback are:
     * Delayed auditory feedback (DAF), which delays the user's voice to
       his ear a fraction of a second.
     * Frequency-shifted auditory feedback (FAF), which changes the pitch
       of the user's voice in his ear.
     * Masking auditory feedback (MAF), which produces a synthesized sine
       wave in the user's ear at the frequency at which the user's vocal
       folds are vibrating.

   DAF and FAF immediately reduce stuttering about 70-80%, at normal
   speaking rates, without training or therapy, and with normal-sounding
   speech.^15 No study has measured the effects of MAF, but MAF has an
   advantage over DAF and FAF in that it can pull users out of silent
   blocks.

   Several long-term studies found excellent results when DAF devices were
   combined with fluency shaping therapy.^16 Two studies investigated
   long-term effects of anti-stuttering devices without therapy. In the
   first study, nine adult stutterers used DAF devices thirty minutes per
   day, for three months.^17

                          Image:SchoolDAF-small.jpg

   The immediate result was 70% reduction in stuttered words. Three months
   later there was no statistically significant "wearing off" of
   effectiveness when using the devices. When not using the devices the
   subjects stuttered 55% less. In other words, the subjects developed
   carryover fluency the rest of the day, when they weren't using the
   devices, training the subjects to no longer need the devices.

   In a second study, nine stutterers used a DAF/FAF device about seven
   hours per day. Their fluency was measured after four months and after
   twelve months.^18

                         Image:SpeechEasy-small.jpg

   The second device reduced stuttered syllables about 80%, when the
   device was used. This effect was maintained over the twelve months,
   with no statistically significant "wearing off" of effectiveness. But
   no carryover effect was seen. In other words, when the subjects removed
   the device they went right back to stuttering.

   About ten American states provide DAF/FAF anti-stuttering telephone
   devices free to qualified stutterers.^42
     * For more information, see Anti-Stuttering Devices

Childhood stuttering treatments

Stuttering therapies for pre-school children

   In the past, stuttering children received indirect therapy, which
   changed the parents' speech behaviors. Such indirect therapy has been
   proven ineffective. For example, popular websites^21 ^22 advise that
   parents should "speak slowly and in a relaxed manner"; make positive
   statements such as praise, and refrain from negative statements such as
   criticism; "pause before responding to your child's questions or
   comments," etc. Yet more than a dozen studies^23 found that such
   parental behaviour had no effect on children's stuttering—or the effect
   was the opposite of what the parents intended! For example, when
   parents spoke slower, their children spoke faster and their stuttering
   increased.^24

   Speech-language pathologists now recommend direct therapy with young
   children. The target speech behaviors are similar to fluency shaping
   therapy, but various toys and games are used. For example, a turtle
   hand puppet may be used to train the slow speech with stretched
   syllables goal. When the child speaks slowly, the turtle slowly walks
   along. But when the child talks too fast, the turtle retreats into his
   shell.
     * For more information, see Pre-School Stuttering Treatments

Stuttering therapies for school-age children

   A study of 98 children, 9 to 14 years old, compared three types of
   stuttering therapy.^25 One year after therapy, the percentage of
   children with disfluency rates under 2% were:
    1. 48% of the children who were treated by a speech-language
       pathologist.
    2. 63% of the children whose parents were trained by a speech-language
       pathologist to do speech therapy at home (but the children weren't
       treated by the speech-language pathologists).
    3. 71% of the children who were treated by a computer-based
       anti-stuttering program, with minimal interaction from
       speech-language pathologists.

   The results for children with disfluency rates under 1% were even more
   striking:
    1. 10% of the children from the clinician-based program.
    2. 37% of the children from the "parent-based" program.
    3. 44% of the children from the computer-based program.

   In other words, the computers were most effective, the parents next
   most effective, and the speech-language pathologists were least
   effective. At the 1% disfluency level, the computers and the parents
   were about four times more effective than the speech-language
   pathologists.

   Parents should realize that school speech-language pathologists are
   trained to treat a wide variety of speech and language disorders. Many
   don't have training or experience with stuttering, and few specialize
   in stuttering. Many school districts are underfunded and school
   speech-language pathologists have caseloads of 40 or more children,
   seeing each child for perhaps twenty minutes twice a week, or even
   doing group therapy with several children who have different
   communication disorders. Parents whose child's speech isn't improving
   may want to consider additional treatments beyond their school's
   speech-language pathologist:
     * Seeing a board-certified Fluency Specialist.
     * Asking the school speech-language pathologist to train the parents
       to do therapy at home, increasing therapy time to perhaps twenty
       minutes twice a day, every day.
     * Buying (or asking the state to provide) a computer-based or
       electronic speech therapy device, that the school speech-language
       pathologist can train the parent to do therapy with the child at
       home.

     * For more information, see School-Age Stuttering Treatments

Stuttering therapies for teenagers

   One strategy for treating teenagers who stutter is to include peers in
   therapy. This is usually the teenager's best friend. This can improve
   the stuttering teenager's motivation in therapy, and also the friend
   can give reminders outside of therapy for the stuttering teenager to
   use his speech target behaviors.

   Another strategy is to encourage a stuttering teenager to develop a
   passion for an activity requiring speech. This could be getting
   involved in the school's drama club, or doing a science project about
   stuttering.
     * For more information, see Teenage Stuttering Treatments

Stuttering and society

   For centuries stuttering has often featured prominently in both popular
   culture and in society at large. Because of the unusual-sounding speech
   that is produced, as well as the behaviors and attitudes that accompany
   a stutter, stuttering has frequently been a subject of scientific
   interest, curiosity, discrimination, and ridicule. Stuttering was, and
   essentially still is, a riddle with a long history of interest and
   speculation into its causes and cures. Stutterers can be traced back
   centuries to the likes of Demosthenes, Aesop, and Aristotle—some
   interpret a passage of the Bible to indicate Moses also to have been a
   stutterer.^5 Misinformation and superstition have influenced society's
   perceptions of the causes and remedies of a stutter, as well as the
   intelligence and perceived disposition of people afflicted with the
   disorder.
   The well-known author of Alice in Wonderland, Lewis Carroll hoped to
   become a priest but was not allowed to because of his stuttering. In
   response, he wrote a poem which mentions stuttering:Learn well your
   grammar / And never stammer / Write well and neatly / And sing soft
   sweetly / Drink tea, not coffee; Never eat toffy / Eat bread with
   butter / Once more don't stutter. (Excerpt from Rules & Regulations)
   Carroll's well-known stuttering trait is subliminally referenced in
   Alice, which features a Dodo bird in one scene. As Martin Gardner
   pointed out in The Annotated Alice, the bird is drawn to vaguely
   resemble Carroll, and Carroll often tended to say his own real last
   name "Do-Do-Dodgson". (See Dodo (Alice's Adventures in Wonderland)).
   Enlarge
   The well-known author of Alice in Wonderland, Lewis Carroll hoped to
   become a priest but was not allowed to because of his stuttering. In
   response, he wrote a poem which mentions stuttering:
   Learn well your grammar / And never stammer / Write well and neatly /
   And sing soft sweetly / Drink tea, not coffee; Never eat toffy / Eat
   bread with butter / Once more don't stutter.
   (Excerpt from Rules & Regulations) Carroll's well-known stuttering
   trait is subliminally referenced in Alice, which features a Dodo bird
   in one scene. As Martin Gardner pointed out in The Annotated Alice, the
   bird is drawn to vaguely resemble Carroll, and Carroll often tended to
   say his own real last name "Do-Do-Dodgson". (See Dodo (Alice's
   Adventures in Wonderland)).

   Partly due to a perceived lack of intelligence because of his stutter,
   the man who became the Roman Emperor Claudius was initially shunned
   from the public eye and excluded from public office. This exclusion
   from public life suited his inclination towards the academic and gave
   him time for study. His infirmity is also thought to have saved him
   from the fate of many other Roman nobles during the purges of Tiberius
   and Caligula. By studying history, Claudius became very knowledgeable
   about governmental institutions, which later aided him as an emperor.
   Isaac Newton, the famous English scientist who developed the law of
   gravity, also had a stutter. Other famous Englishmen who stammered were
   King George VI and Prime Minister Winston Churchill, who led the UK
   through World War II. Although George VI went through years of speech
   therapy for his stammer, Churchill thought that his own very mild
   stutter added an interesting element to his voice: "Sometimes a slight
   and not unpleasing stammer or impediment has been of some assistance in
   securing the attention of the audience…"^10
     * For more information, see Famous People Who Stutter

Ancient views of stuttering

   For centuries "cures" such as speaking with a pebble in the mouth (as
   per the legendary orator Demosthenes), consistently drinking water from
   a snail shell for the rest of one's life, "hitting a stutterer in the
   face when the weather is cloudy", strengthening the tongue as a muscle,
   and various herbal remedies were often used^6 ; clearly to little
   effect.

   Similarly, in the past people have subscribed to various theories about
   the causes of stuttering which today one might consider odd. Proposed
   causes of stuttering have included tickling an infant too much, eating
   improperly during breastfeeding, allowing an infant to look in the
   mirror, cutting a child's hair before the child spoke his or her first
   words, having too small a tongue, or the "work of the devil."^3

   Roman physicians attributed stuttering to an imbalance of the four
   bodily humors: yellow bile, blood, black bile, and phlegm. Humoral
   manipulation continued to be a dominant treatment for stuttering until
   the eighteenth century. Italian pathologist Giovanni Morgagni
   attributed stuttering to deviations in the hyoid bone, a conclusion he
   came to via autopsy. Later in the century, surgical intervention, via
   resection of a triangular wedge from the posterior tongue to prevent
   spasms of the tongue, was also tried.
   Notker Balbulus, from a medieval manuscript
   Enlarge
   Notker Balbulus, from a medieval manuscript

   Blessed Notker of St. Gall (ca. 840—912), called Balbulus (“The
   Stutterer”) and described by his biographer as being "delicate of body
   but not of mind, stuttering of tongue but not of intellect, pushing
   boldly forward in things Divine," was invoked against stammering.

Stuttering in the movies

   In more recent times, movies such as A Fish Called Wanda (1988) and A
   Family Thing (1996) have dealt with contemporary reactions to and
   portrayals of stuttering. In A Fish Called Wanda, a lead character,
   played by Michael Palin, has a severe stutter and low self-esteem. His
   character—who is socially awkward, nervous, an animal lover, and
   reclusive—portrays a prevalent stereotypical image of stutterers. The
   three other characters in the movie generally make up the spectrum of
   reactions to stuttering: Jamie Lee Curtis's character is sympathetic
   and sees past it, John Cleese's character is polite but indifferent,
   and Kevin Kline's is malicious and sadistic. Upon release the film
   caused controversy among some stutterers who disliked the film for its
   portrayal of Palin's character as a pushover amid the bullying his
   character receives, and received favour from others who valued the film
   for showing the difficulties stutterers commonly face. Palin, whose
   father was a stutterer, stated that in playing the role he intended to
   show how difficult and painful stuttering can be. He also donated to
   various stuttering-related causes and later founded the Michael Palin
   Centre for Stammering Children in London.

   The 1983 movie The Right Stuff referenced the real-life stuttering
   problem of John Glenn's wife Annie, and how it rendered her fearful and
   unwilling to do a news conference during his initial space flight. As
   he reported in his autobiography, John Glenn: A Memoir, and as shown
   on-screen in The Right Stuff, her stuttering was never a problem
   between the two of them, he "just thought of it as something Annie
   did". But she grew frustrated with it, and some years later put herself
   through intense speech therapy and was largely successful in masking
   the outward symptoms of stuttering. A proud moment for the both of them
   was the first public speech she gave on her experiences as a stutterer.

   Though a stutterer might seem to be an unlikely radio star, Howard
   Stern hired a mild stutterer sight unseen ("He stutters? Hire him.") to
   conduct celebrity interviews. Known on the Stern show as Stuttering
   John, John Melendez worked for Stern for 15 years before taking a
   position as the announcer on The Tonight Show. Howard Stern also has a
   collection of frequent guests, many of whom have speech impediments of
   some type; while their afflictions are exploited for comedic purposes,
   members of "The Wack Pack" are well-loved by Howard Stern and his fans.

   The Spanish actor Javivi is a stutterer which has often led him to
   comic roles.

Discrimination against stutterers

   In addition to personal feelings of shame or anxiety, outside
   discrimination is still a significant problem for stutterers. The vast
   majority of stutterers experience or have experienced bullying,
   harassment, or ridicule to some degree during their school years ^11.
   It can be especially difficult for stutterers to form romantic
   relationships, both because stutterers may avoid social exposure and
   because non-stutterers may find the disorder unattractive. The stigma
   of stuttering carries over into the workplace, often resulting in
   severe employment discrimination against stutterers. Consequently,
   stuttering has been legally classified as a disability in many parts of
   the world, affording stutterers the same protection from wrongful
   discrimination as for people with other disabilities. The UK Disability
   Discrimination Act 1995 and the Americans with Disabilities Act of 1990
   both expressly protect stutterers from wrongful dismissal or
   discrimination.

   Along with disability legislation, many stutterer rights groups have
   formed to address these issues. One interesting example is the Turkish
   Association of Disabled Persons, which successfully appealed to the
   major Turkish telephone company Telsim, resulting in reduced rates for
   people with stutters or other speech disabilities because of the
   additional time it takes them to converse on the telephone. Also, the
   U.S. Congress passed a resolution in May 1988 designating the second
   week of May as Stuttering Awareness Week, while International
   Stuttering Awareness Day, or ISAD, is held internationally on October
   22. In September 2005, ISAD was recognised and supported by over 30
   Members of the European Parliament (MEPS) at a reception given by the
   European League of Stuttering Associations.

   Even though public awareness of stuttering has improved markedly over
   the years, misconceptions are still very common, usually reinforced by
   inaccurate media portrayals of stuttering and by various folk myths. A
   2002 study focusing on college-age students and conducted by University
   of Minnesota Duluth found that a large majority viewed the cause of
   stuttering as either nervousness or low self-confidence, and many
   recommended simply "slowing down" as the best course of action for
   recovery.^7 While these misconceptions are damaging and may actually
   worsen the symptoms of stuttering, groups and organizations are making
   significant progress towards a greater public awareness.

Stuttering support groups

   Many stutterers find joining a support group to be of great value.
   Perhaps the worst part of stuttering is thinking that you're the only
   person with this disability. When you feel frustrated or depressed, you
   have no idea what to do. Talking to individuals who've been in the same
   situation will help you see that you have choices.

   Hearing other people's experiences improves your perspective. Your
   setbacks don't seem so bad. Sharing positive experiences makes everyone
   in the group feel good.

   Some groups are led by a speech-language pathologist, at a speech
   clinic. These groups may focus on practicing speech therapy.

   Other groups are self-help, i.e., are run by stutterers. These are
   usually more about support than therapy. One meeting might have a guest
   speakers, such as a successful attorney who stutters. Another meeting
   might have a discussion topics, such as strategies for making telephone
   calls. Another meeting might have a game to play. Some stuttering
   support groups focus on public speaking.

   There are even annual conventions for stutterers, with hundreds of
   people attending workshops and events.
     * For more information, see Support Groups

Stuttering in music

   " K-K-K-Katy" was published in 1918 by Geoffrey O'Hara and became a
   huge hit in wartime America, referred to as "The Sensational Stammering
   Song Success Sung by the Soldiers and Sailors". Anyone who had either a
   stutter or a lisp was covered. The song uses stuttered lyrics in every
   line of the chorus, and refers to the stuttering of a stereotypically
   bashful suitor.

   A stylized form of stuttering has frequently appeared in popular music
   over the past few decades. Buddy Holly was a notable user of this
   technique in many of his songs, as well as supplementing the stutters
   with other verbal 'tics' and 'hiccups'. In some songs from the 1960s
   and 1970s the vocalist would rapidly repeat the first syllable of a
   word. An early example is The Who's 1965 song " My Generation", in
   which Roger Daltrey sings the line "Just talkin' 'bout my
   G-g-g-generation". In that particular case, the song's stuttering style
   provides a framework leading up to the sly lyric, "Why don't you just
   fu.. fu.. fade away!" Another example was the affected stuttering by
   the Bachman-Turner Overdrive in their 1974 hit song "You Ain't Seen
   Nothin' Yet". By the early 1980s producers were creating the same
   effect synthetically using tape editing and sampling of lyrics. Paul
   Hardcastle's 1985 song "19" features it throughout in both the spoken
   word and vocal segments. Remixes of songs very frequently employed the
   effect. Starting in the 1990s stuttering effects fell out of popular
   use in music.

   In 1995, stutterer Scatman John turned his problem into his asset and
   wrote the hit song " Scatman". Stuttering assisted him to scat sing and
   create incredible sounds. The lyrics are inspirational and directed at
   stutterers:

          Everybody stutters one way or the other so check out my message
          to you
          As a matter of fact, don't let nothin' hold you back
          If the Scatman can do it, so can you.

   In 2001, " Stutter" by American R&B singer Joe featuring Mystikal, held
   the number-one spot for four weeks on the Billboard Hot 100.

   Placebo used a stammering man's voice on their song "Swallow" featured
   on their 1996 debut album, Placebo.

   Retrieved from " http://en.wikipedia.org/wiki/Stuttering"
   This reference article is mainly selected from the English Wikipedia
   with only minor checks and changes (see www.wikipedia.org for details
   of authors and sources) and is available under the GNU Free
   Documentation License. See also our Disclaimer.
