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Stuttering FAQ v.4.02


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Archive-name: support/stuttering
Posting-Frequency: monthly
Last-modified: 2006/7/15
Version: 4.02
URL: http://www.casafuturatech.com/Book/faq.html

See reader questions & answers on this topic! - Help others by sharing your knowledge
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/).


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