Stuttering Can Be Stopped
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Stuttering Can Be Stopped

What do James Earl Jones, William Buckley, and John Stossel have in common? They all depend on speaking to do their jobs. And they all stutter.

Fifty-five million people around the world stutter, and most are men. Stuttering is four times more common among men than women, a phenomenon that is not totally understood. Indeed, researchers have not determined the exact cause of stuttering. One thing is certain: stuttering is embarrassing and frustrating for many men, and it can control their lives.

"Many men who stutter choose professions in which they don't have to talk or talk little," says Barry Guitar, PhD, therapist and chairman of the department of communication sciences at the University of Vermont. "They're less likely to seek better jobs or a raise in rank because they are often accompanied by more speaking opportunities." Stuttering also hinders men's willingness to socialize.

What Is Stuttering?

Stuttering is commonly described as a condition in which the flow of speech is broken by abnormal stoppages, repetitions, or prolongation of sounds and syllables. Stuttering, while not the worst of handicaps, certainly can be one of the most frustrating. Unlike other disabilities, stuttering has the mystifying and maddening habit of coming and going. Even if you stutter badly, chances are that you will be perfectly fluent when singing, talking in unison with other people, and in certain speaking situations.

While many psychological theories have been advanced to explain stuttering, there is increasing evidence that at least some stuttering is due to failed coordination signals between areas of the brain that control the movements of speech. These findings suggest that stuttering is a neurological problem, not primarily a psychological one. Recent studies using drugs that modify several neurotransmitter systems in the brain suggest that stuttering may be influenced by the dopamine system. Other studies using functional brain imaging have shown solid evidence for impaired coordination among brain centers. Imaging studies have also increasingly been used to assess the effectiveness of treatments for stuttering.

Why in Men More Than Women?

According to Peter Ramig, PhD, professor of speech pathology at the University of Colorado and a therapist, "Male children tend to be more delayed in speech and language than females of the same age. Thus males are at a deficit when it comes to speech and language development."

Dr. Guitar explains that the speech and language centers in male brains are localized in the left hemisphere. In women, they are distributed in both hemispheres, which gives them more flexibility. Speech and language abilities of those who stutter shift partly to the right hemisphere. "If the studies can be generalized," says Dr. Guitar, "it follows that it's not a big deal for women because they have the cellular structure to handle speech and language in the right hemisphere, but men have less capacity."

More Than Heredity

While stuttering has long been acknowledged as a familial disorder, the actual nature of a genetic component remains unclear to scientists. According to Professor Ehud Yairi at the University of Illinois at Urbana-Champaign, "It appears that 40% of children who stutter have someone in their immediate family with a history of stuttering and 70 percent have an immediate or extended family relative with a stuttering history."

Research supports the theory that stuttering is inherited, but as Dr. Ramig explains, "No doubt that because of what we experience as people who stutter—being different, feeling different, having lower self-esteem—those experiences lead to emotional psychological byproducts. You start to fear speaking situations, saying your name, making phone calls. When you're fearful, your muscles tighten. Muscular tension increases stuttering and makes it worse."

Along with the vocal difficulties, those who stutter often nod, squeeze their fists, and blink their eyes in an attempt to force the words out. These gestures make those who stutter more self-conscious.

Men Seeking Therapy

Dr. Ramig explains that "It's not unusual to see men who stutter who are discouraged . . . who think they can't change. But it's very rare for me to see a person who stutters who can't make a change if he gets the right therapy or support group."

"Many of us who stutter are no longer handicapped by it," says Dr. Ramig. "It is triggered sometimes, but even then it is minimal compared to what it used to be."

"The worst enemy of stuttering is the person who stutters," says Dr. Ramig. "People want to push and force past it. Pushing and forcing makes stuttering worse." Rather than use force, some men use humor. As a young man, actor Bruce Willis reportedly used humor to help him get through embarrassing times.

Many men seek treatment when they reach a turning point in their lives, such as:

  • Going off to college where stuttering may hold them back socially and academically
  • Seeking career advancement, which often involves increased communication skills
  • Graduating from college and facing the job market and interviews
  • Being denied, or suspecting that they were denied, a promotion because they stutter

Some men seek help when they start a family because they are afraid their child might learn to stutter from them. This is an unfounded fear. "We do not believe people who stutter learn it from someone else who stutters," says Dr. Ramig.

Types of Therapy

Two therapeutic approaches are used by Dr. Ramig to treat people who stutter. Combinations of these approaches may also be employed.

  • Fluency Shaping , which teaches people not to stutter, "is not as realistic as we'd like to think," says Dr. Ramig. "People who stutter already have a vast array of tricks—that actually make stuttering worse over time." Fluency shaping attempts to get people to slow down and change their breathing. "For individuals who are more chronic, fluency shaping doesn't work," says Dr. Ramig.
  • Modification Therapy , helps people learn to confront their fears about stuttering rather than avoid them. This approach allows them to stutter in an easier, forward flowing fashion. "Through confronting stuttering you confront your fears," explains Dr. Ramig. "As you confront your fears you become less fearful. The reward is much more fluency later on."

There are, however multiple therapies which have been proposed for stuttering, and many of these have been subjected to clinical trials. In a recent meta analysis of multiple clinical trials on stuttering, Bothe and colleagues from the University of Georgia concluded that effective treatments differ for children and adults. “Response-contingent” treatments have the most proven effectiveness in children. In this type of treatment, children are taught to stop speaking immediately when a signal (such as a red light) indicates that they have begun to stutter.

Proven effective treatments for adults include techniques of “prolonged speech” (similar to Dr. Ramig’s fluency shaping). Studies show that teaching adults to speak slowly can lead to reduced stuttering without compromising fluency. As stuttering reduces, speech velocity can be increased. Other techniques with a reasonably strong evidence base include self-management and response-contingent treatments (as used with children).

Medication, so far has not been shown to have sufficient effectiveness to justify side-effects and risks. However, increasing understanding of stuttering may lead to the development of safe and effective drug treatments. Olanzapine, for example, has been shown in some trials to relieve stuttering more effectively than does placebo.

Getting Help

Men should seek a therapist who specializes in stuttering, says Dr. Ramig. "Get a therapist who has a good understanding of both behavior modification and fluency shaping. Most of us in stuttering therapy use the combined approach because there are merits from each." Support groups can also provide invaluable help.

Dr. Guitar believes it is critical to be open about your stuttering. "It's hard, but if you can be open it really helps," he says. "It's best to tell a prospective employer that you stutter."

Choosing the Right Words

The National Stuttering Program notes that while it has "no objection to the word 'stuttering,'" it considers the word "stutterer" to be inaccurate, preferring instead "person who stutters." After all, "stuttering is something we do; it is not something we are."

RESOURCES:

National Stuttering Association
http://www.nsastutter.org

Stuttering Foundation of America
http://www.stuttersfa.org

Successful Stuttering Management Program (SSMP)
http://www.ssmpmanual.com

References:

Boberg E, Kully D. Long-term results of an intensive treatment program for adults and adolescents who stutter. J Speech Hear Res . 1994;5:1050-1059.

Jones M, Onslow M, Harrison E, Packman A. Treating stuttering in young children: predicting treatment time in the Lidcombe Program. J Speech Lang Hear Res . 2000;6:1440-1450.

Lawrence M, Barclay DM 3rd. Stuttering: a brief review. Am Fam Physician . 1998; 9:2175-2178.

Sommer M, Koch MA, Paulus W, Weiller C, Buchel C. Disconnection of speech-relevant brain areas in persistent developmental stuttering. Lancet 2002; 9330:380-383.

Bothe AK, Davidow JH, Bramlett RE, Ingham RJ. Stuttering treatment research 1970-2005: Systematic review incorporating trial quality assessment of behavioral, cognitive, and related approaches. Am J Speech Lang Pathol. 2006;15(4):321-341.

Stager SV, Calis K, Grothe D, Bloch M, Berensen NM, Smith PJ, Braun A. Treatment with medications affecting dopaminergic and serotonergic mechanisms: effects on fluency and anxiety in persons who stutter. J Fluency Disord. 2005;30(4):319-335.



Last reviewed January 2007 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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