What is stuttering?
Stuttering is a disorder of speech motor planning that affects the fluency of speech. The exact cause known for stuttering is unknown but research evidence suggests a genetic link. Excitement or anxiety may increase/exacerbate stuttering behaviors but do not cause it. Stuttering varies in severity (mild to severe) across individuals and is three times more likely to occur in boys than girls. There is a strong family history association with stuttering – 60% of people who stutter have a family history of it.
Stuttering usually begins in the first 2-3 years of life and onset may be gradual or sudden. Onset typically occurs as children are starting to put words together into short sentences, between the ages of 2 to 5 years. A recent study that followed a group of Australian infants found that by 36 months of age 8.5% of them had begun to stutter, and the figure is 12.2% by 48 months. Some children recover from stuttering naturally, although the exact rate of recovery and the average time taken to recovery is not known. It is important to begin treatment of stuttering some time within 12 months of onset, and it is known that some children will have recovered without treatment by then. At present it is not possible to say whether an individual child will recover naturally or will require treatment.
Symptoms of stuttering
Stuttering may present as the following:
- Repetitions – sounds (b-b-body); syllables (bo-bo-body); words (body-body-body); phrases (his body-his body-his body)
- Prolongations of sounds (ssssssnake)
- Blocks – uncontrolled stops/ being unable to get the word out
- Hesitations – inappropriate silent intervals
- Interjections – meaningless word insertions (um-um-snake; er-er-body)
Body and facial movements may accompany these stuttering behaviours e.g. poor eye contact, excessive blinking, jaw tremors, face grimacing and others.
Diagnosis of stuttering
Stuttering is different from normal speech/language development in children. Normal dysfluencies are part of a child’s language and speech development. As children are learning to talk, process language and express themselves more elaborately, they will have dysfluencies in speech. However, stuttering presents with higher number of dysfluencies, units of repetitions and word insertions, and different types of dysfluencies compared to normal dysfluencies. These can only be diagnosed by a trained and certified speech-language therapist.
An evaluation consists of a series of tests, observations, and interviews designed to estimate the child’s risk for continuing to stutter. During an evaluation, an speech therapist will note the number and types of speech disfluencies a person produces in various situations. She will also assess the ways in which the person reacts to and copes with disfluencies. The speech therapist may also gather information about factors such as teasing that may make the problem worse. A variety of other assessments (e.g., speech rate, language skills) may be completed as well, depending upon the person’s age and history. Information about the person is then analyzed to determine whether a fluency disorder exists. If so, the extent to which it affects the ability to perform and participate in daily activities is determined.
Treatment for stuttering
Speech-language therapists work in collaboration with families to reduce the severity of stuttering to minimal levels as stuttering does not have a complete cure. Treatment programs for stuttering are usually “behavioral.” Parent involvement is necessary as they are trained by the speech-language therapist to provide intervention at home. Early intervention has shown to be most effective before the age of 7. Programs aimed at reducing stuttering in young children are the Lidcombe program, Syllable-timed speech, Extended Length Utterance and the Camperdown program.