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The latest version of this FAQ is at http://www.casafuturatech.com/Book/faq.html WHAT IS STUTTERING? What are the core and secondary symptoms of stuttering? What other speech disorders are sometimes confused with stuttering? What causes stuttering? Is stuttering a physical or psychological disorder? What is the incidence and prevalence of stuttering? How does stuttering develop in childhood? Do stutterers have neurological abnormalities? Does stress affect stuttering? TREATING STUTTERING How is adult stuttering treated? What is fluency shaping therapy? What is stuttering modification therapy? How do anti-stuttering devices work? What anti-stuttering medications are available? How is childhood stuttering treated? What treatments are available for pre-school stutterers? What treatments are available for school-age children? What treatments are available for teenagers? LIVING WITH STUTTERING Why should I join a stuttering support group? How should I say about stuttering in a job interview? Are there any famous people who stutter? ---- WHAT IS STUTTERING? Stuttering 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. Stuttering is known as "stammering" in the United Kingdom, and is sometimes misspelled "studdering." -- WHAT ARE THE CORE AND SECONDARY SYMPTOMS OF STUTTERING? 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 http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/Core_Behav iors -- WHAT OTHER SPEECH DISORDERS ARE SOMETIMES CONFUSED WITH STUTTERING? 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, including: - Cluttering, which is characterized by too-rapid speaking rate, unclear articulation, and disordered language. See http://en.wikipedia.org/wiki/Cluttering - Parkinson's disease is associated with repetitions, unclear articulation, and low volume. See http://en.wikibooks.org/wiki/Speech-Language_Pathology/Parkinson%27s - Spasmodic dysphonia is characterized by too tense or too relaxed vocal folds during speech, and typically affects middle-aged women. See http://en.wikipedia.org/wiki/Spasmodic_dysphonia - Head injuries and strokes can cause repetitions, prolongations, and blocks. However, these neurogenic stutterers lack the struggle behavior 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 cause an adult to begin stuttering. Psychogenic stuttering typically involves rapid, effortless repetitions of initial sounds, without struggle behavior. For more information, see http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/Other_Flue ncy_Disorders ---- WHAT CAUSES STUTTERING? IS STUTTERING A PHYSICAL OR PSYCHOLOCAL DISORDER? Stuttering is not a physical disorder. There is nothing with stutterers' tongues or jaw or vocal folds. Stuttering is not a psychological disorder. While stuttering can cause speech-related fears and anxieties in adults and older children, stutterers are, on average, psychologically normal. Anxiety, low confidence, nervousness, and stress do not cause stuttering. Stuttering a developmental disorder. Children develeop capabilities in a certain order, e.g., most children crawl before thay 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. Theories proposed since the 1930s that stuttering was caused by parental behavior, such as parents reacting negatively to children's normal dysfluencies, have been disproven. Stuttering has been correlated with certain genes; 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"). Brain scans of adult stutterers show several neurological abnormalities, but it is unknown whether these neurological abnormalities are present before a child talks, and cause stuttering; or whether stuttering causes children's brain to develop abnormally. For more information, see http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/Developmen t_of_Childhood_Stuttering ---- WHAT IS THE INCIDENCE AND PREVALENCE OF STUTTERING? The prevalance of preschool children stuttering is about 2.5%, that is, about 1 in 40 young children now stutter. The incidence is about 5%, or 1 in 20 children stutter at some point in childhood. About 1% of adults stutter. 0.73%, or about one in 135 adults, was the figure found in a recent study. 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 http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/Incidence_ and_Prevalence ---- HOW DOES STUTTERING DEVELOP IN CHILDHOOD? The mean onset of stuttering is 30 months, or two and a half years old. Stuttering rarely begins after age six. 65% of preschoolers who stutter spontaneously recover, in their first two years of stuttering. Only 18% of children who stutter five years recover spontaneously. 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. But more girls recover fluent speech, and more boys don't. By fifth grade the ratio is about four boys who stutter to one girl who stutters. This ratio remains into adulthood. 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. For more information, see http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/Developmen t_of_Childhood_Stuttering ---- DO STUTTERERS HAVE NEUROLOGICAL ABNORMALITIES? 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, then 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. What this means is unknown. 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. - 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). - 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 done of stuttering children. It is unknown whether stuttering children have neurological abnormalities. For more information, see http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/Neurology_ of_Stuttering ---- DOES STRESS AFFECT 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, 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%. Stuttering reduces stress 10%, as measured by systolic blood pressure. But stuttering causes stress in listeners. 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. Stuttering has been correlated with three genes that control the neurotransmitter dopamine. The study also correlated these genes to ADHD, Tourette's syndrome, obsessive compulsive disorder (OCD), and tics. All five disorders are exacerabated by stress, and when the affected person tries harder to control the undesirable behavior, the behavior becomes stronger and more difficult to control. For more information, see http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/Stress-Rel ated_Changes ---- HOW IS ADULT STUTTERING TREATED? A wide variety of stuttering treatments are available. No single treatment is effective for every stutterer. Because stuttering appears to be caused by several factors most stutterers need more than one treatment to substantially improve their speech. Because individual stutterers appear to have more of one factor and less of other factors, some clinicians tailor therapies to the individual stutterer. -- WHAT IS FLUENCY SHAPING THERAPY? Fluency shaping therapy trains stutterers to speak fluently with relaxed 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 transfered to daily life outside the speech clinic. A study followed 42 stutterers through the three-week fluency shaping program. The program 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. For more information, see http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/Fluency_Sh aping -- WHAT IS STUTTERING MODIFICATION THERAPY? The goal of stuttering modification therapy is not to eliminate stuttering. Instead, the goals are to modify your moments of stuttering, so that your stuttering is less severe; and reduce your 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." For more information, see http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/Stuttering _Modification -- HOW DO ANTI-STUTTERING DEVICES WORK? Changing how a stutterer hears his voice usually improves his fluency. Speculatively, such "altered auditory feedback" corrects the auditory processing underactivity seen in adult stutterers' brain scans. 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 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. 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. Two studies investigated long-term effects of anti-stuttering devices without therapy. The first study had nine adult stutterers used DAF devices thirty minutes per day, for three months. 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. In the 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. The DAF/FAF 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. Why one anti-stuttering device produced carryover fluency, reducing the users' need for the device, when another anti-stuttering device produced no carryover, is not yet known. For more information, see http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/Anti-Stutt ering_Devices -- WHAT ANTI-STUTTERING MEDICATIONS ARE AVAILABLE? Some dopamine antagonist medications reduce stuttering. Such medication include haloperidol (Haldol), risperidone (Risperdal), and olanzapine (Zyprexa). These medications generally reduce stuttering 33-50%. Some stutterers experience severe side effects on some medications; other stutterers experience few side effects. 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 http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/Anti-Stutt ering_Medications ---- HOW IS CHILDHOOD STUTTERING TREATED? WHAT TREATMENTS ARE AVAILABLE FOR PRE-SCHOOL STUTTERERS? In the past, stuttering children received "indirect therapy," which changed the parents' speech behaviors. Such changed included the parents speaking slower, or not interrupting their child. Such indirect therapy has been proven ineffective. 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 http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/Childhood_ Stuttering/Pre-School_Stuttering -- WHAT TREATMENTS ARE AVAILABLE FOR SCHOOL-AGE CHILDREN? A study of 98 children, 9 to 14 years old, compared three types of stuttering therapy. One year after the three therapy programs, the percentage of children with disfluency rates under 2% were: - 48% of the children who were treated by a speech-language pathologist. - 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). - 71% of the children who were treated by a computer-based anti-stuttering program, with minimal interaction from speech-language pathologists. The computers were most effective, the parents next most effective, and the speech-language pathologists were least effective in the long term. Parents of school-age children perhaps should not assume that the therapy their children receives in school is sufficient. Parents may want to consider asking their child's speech-language pathologist to train the parents to do therapy at home. Or the parents may want to ask their child's speech-language pathologist to recommend a computer-based or electronic stuttering therapy device for the child to practice with at home. Parents may also want to consider paying for treatment with a board-certified Fluency Specialist. School speech-language pathologists are trained in a wide variety of communication disorders, with few specializing in stuttering. Of the more than 100,000 speech-language pathologists in the United States, fewer than 500 are board certified Fluency Specialists. For more information, see http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/School-Age _Stuttering -- WHAT TREATMENTS ARE AVAILABLE 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 http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/Teenage_St uttering ---- LIVING WITH STUTTERING WHY SHOULD I JOIN A STUTTERING SUPPORT GROUP? 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 http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/Support_Gr oups -- HOW SHOULD I SAY ABOUT STUTTERING IN A JOB INTERVIEW? "Excellent communication skills" is the #1 qualification employers look for. Tell potential employers that although your stutter, you are an excellent communicator. Give concrete examples: - If you're in a speech therapy program, discuss your progress and the techniques or strategies you use. - If you learned nonavoidance skills in speech therapy, explain that although you stutter, you've overcome your fears of talking to strangers. - "I can say a phrase fluently if I say it a lot. In my last job, I pretty much said the same things to customers all day, and my speech was fine." This should be acceptable for retail jobs. - If you use an electronic anti-stuttering device, show it to the interviewer and explain how it works. If the job requires making presentations, say that you can't say as much as non-stutterers so you prepare your remarks in advance and get right to the main points, unlike people who ramble on for half an hour. Membership in Toastmasters proves that you have excellent communication skills. Toastmasters gives out lots of prizes, so mention if you won a blue ribbon for one of your speeches. Communication is a two-way street. Say that you may not speak as well as other people, but you listen more carefully. Demonstrate that by not interrupting the interviewer, and by rephrasing and repeating back his questions. Ask the interviewer whether listening or speaking is more important in the job -- they'll always say that listening is more important. For more information, see http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/How_to_Han dle_Job_Interviews -- ARE THERE ANY FAMOUS PEOPLE WHO STUTTER? In 1957 (1932- ) began working as a singer for Minnie Pearl, Nashville's great country comedienne. Pearl encouraged Tillis to talk on stage, but he refused, afraid that he'd be laughed at because he stuttered. Pearl replied, "Let 'em laugh. Goodness gracious, laughs are hard to get and I'm sure that they're laughing with you and not against you, Melvin." Little by little, Tillis increased his speaking on-stage. He developed humorous routines about his stuttering. Then "word began to circulate around Nashville about this young singer from Florida who could write songs and sing, but stuttered like hell when he tried to talk. The next thing I knew I was being asked to be on every major television show in America." Tillis' career took off. In 1976, Tillis was named Country Music Entertainer of the Year. -- James Earl Jones (1931- ) was "virtually mute" as a child. With the help of his high school English teacher, Jones overcame stuttering by reading Shakespeare "aloud in the fields to myself," and then reading to audiences, and then acting. Jones went on the be a great Shakespearen actor, but better known as the voice of Darth Vader in "Star Wars." He portrayed a stutterer in the movie "A Family Thing" (1995). -- Bob Love (1942- ) was a three-time NBA All-Star and led the Chicago Bulls in scoring for seven consecutive seasons. Reporters rarely interviewed him. "I would score 45 points, go into the locker room, and all the reporters would come down," Love recalls. "Everybody would pass me by." Love retired in 1977. Because of his stuttering he went from one dead-end job to another. The low point was in 1985, at the age of 42, when a restaurant hired Love as a $4.45/hour busboy. Love had tried speech therapy twice before without success. He tried again. After a year of stuttering therapy, Love began public speaking. As a boy, he had a dream of standing on a podium, speaking to thousands of people. Love gave motivational speeches to churches, high school students, and other groups. He's now director of community relations and spokesman for the Bulls. "It's hard to believe I make a living speaking. It's a dream come true. I held onto my dreams, and I tell kids they have to hold on to theirs." For more information, see http://en.wikibooks.org/wiki/Speech-Language_Pathology/Stuttering/Famous_Peo ple_Who_Stutter ---- This document is provided as is without any express or implied warranties. While every effort has been taken to ensure the accuracy of the information contained in this article, the author and contributors assume no responsibility for errors or omissions, or for damages resulting from the use of the information contained herein. The Stuttering FAQ is part of the Stuttering Science & Therapy Website (http://www.casafuturatech.com/).