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Stuttering or Stammering
ICD 307.0


Article by:
Sarah Morales, BS
Children's Speech Care Center

Stuttering (abnormal dysfluency) is a complex disorder. Wendell Johnson, the prominent researcher of this disorder in the 1950s, believed that the cause of stuttering was overly critical parents. Modern research and theory, however, indicate that Johnson’s theory is in error. Speech-language pathologists now believe that childhood stuttering is caused by an interaction of neurological (within the brain), environmental (within the child’s environment), and developmental (within the child’s overall development) factors. The neurological factors are most likely genetic (inherited). Parents, classroom teachers, and speech-language pathologists can influence environmental and developmental factors. Neurogenic stuttering (stuttering due to brain damage) can result from a traumatic head injury; this type is more common in elderly persons (i.e. due to a stroke).

Early childhood stuttering (usually beginning between the ages of 2 and 6 years) typically involves repetitions of parts of words, for example syllables, as in “bah-bah-bah-bah-baby.” More severe behaviors may also be present, including prolongations of sounds (i.e. “wwwwhy are you doing that?”) and blocks (the mouth is open or preparing for speech and gets “frozen”, with no sound coming out). According to Yairi (1997), a prominent researcher in stuttering, even young children near the onset of stuttering may exhibit severe stuttering that includes tension. Others may show what speech-language pathologists call easy repetitions (repetitions free of tension). Some children may react with shame or frustration, while others may be oblivious to their stuttering. Upon starting school, teasing may be a factor that further promotes shame and frustration. However, Yairi’s studies have found high rates of spontaneous recovery (recovery without any treatment)—around 75% in general.

Parents are in a key position to manipulate the child’s environment to help their child recover. Time pressure is difficult for children who stutter. Examples of this pressure include: a rapid-paced lifestyle, wherein family members speak rapidly or interrupt each other; rapid-fire questions addressed to the child; reduced time in turn taking in conversation, etc. Other pressures in communicating include demand speech (i.e. parental requests for speech performance/recitation, translation for family members who don’t speak English, parents’ demands for a verbal explanation which may be emotionally and/or linguistically difficult for the child, etc.). Reducing time pressure, increasing time for turn taking in conversation, reducing demands upon the child to speak, and decreasing the rate of speech addressed to the child are helpful ways to manipulate the child’s environment.

Developmental factors are also important to consider. Often children who stutter have unusually precocious language development; perhaps they attempt to use big words or long sentences, and their speech motor system (system that generates action of speech muscles within the brain) cannot keep up. Others have language delays (language skills that lag behind those of peers) and the demands on the brain for appropriate language formulation and speech production compete with resulting dysfluency (e.g., a demands-capacity model of the brain for speech/language). Some children who stutter have phonological disorders (mispronunciations of speech sounds), another possible indicator of a problematic speech motor system.

It is important to remember that a certain amount of dysfluency is normal in the child who is developing the complex system for speech and language. Stuttering that involves whole word or phrase repetitions (depending on amount) and/or hesitations and revisions may be considered typical dysfluency. A determination of stuttering is based on such information as the type, amount, and severity of the dysfluencies, the amount of struggle and tension during speech, and the length of time a child has been dysfluent.

Stuttering can best be diagnosed by a speech-language pathologist. Early intervention (treating the disorder at the first sign of symptoms) is very important. Stuttering becomes increasingly difficult to treat over time. Many severe adult stutterers, however, do find therapy beneficial and can maintain these benefits over time.

For more information, view the following links:
www.nsastutter.org (the National Stuttering Association)
www.asha.org (American Speech-Language Hearing Association)
www.mankato.msus.edu/dept/comdis/kuster/stutter.html
www.speech-language-therapy.com

 
 
 
 

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