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Stuttering

(Stammering; Disfluent Speech)

Definition

Stuttering is a speech disorder in which the flow of speech is interrupted by:
  • Repetition or prolongation of sounds, words, or syllables
  • An inability to begin a word
In an attempt to speak, the person who is stuttering may:
  • Frequently blink the eyes
  • Have abnormal facial or upper body movements

Causes

The cause of stuttering is not completely understood. Some experts have suggested that stuttering may occur when:
  • A child's ability to speak does not match his verbal demands
  • There are psychological factors in a child’s life such as mental illness, extreme stress
  • Problems occur in the connections between muscles, nerves, and areas of the brain that control speech
  • There are problems in the part of the brain that controls the timing of speech muscle activation
Muscles and Nerves Involved in Speech
Tongue Innervation
Copyright © Nucleus Medical Media, Inc.

Risk Factors

Factors that may increase your chance of developing stuttering include:
  • Family history of stuttering
  • Sex: male
  • Age: between 2-6 years of age

Symptoms

Symptoms may include:
  • Repetition of sounds, syllables, words, or phrases
  • Prolongation of sounds within words
  • Between-word pauses and lack of sound
  • Spurting speech
  • Accompanying behaviors, such as:
    • Blinking
    • Facial ticks
    • Lip tremors
    • Tense muscles of the mouth, jaw, or neck
  • Worsening symptoms when speaking in public
  • Improvement in symptoms when speaking in private

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Diagnosis may be based on:
  • Stuttering history
  • Circumstances under which stuttering occurs
  • Speech and language capabilities
  • Evaluation of hearing and motor skills, including a pediatric and neurological examination
  • Further testing and treatment by a speech language pathologist who specializes in communication disorders

Treatment

Treatment can improve stuttering. The main goal is to get and maintain a feeling of control over speech fluency. The doctor or speech therapist can:
  • Evaluate the stuttering pattern
  • Assess what strategies may work best
Treatment may include:
  • Behavioral therapy—This focuses on behavior modifications that can be made to improve fluency.
  • Speech therapy—A primary goal of this type of therapy is to slow the rate of speech.
There is little evidence to support the use of drugs to improve speech fluency.

Prevention

There are no guidelines to prevent stuttering. However, early recognition and treatment may minimize or prevent a life-long problem.

RESOURCES

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

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

CANADIAN RESOURCES

Canadian Stuttering Association http://www.stutter.ca

Institute for Stuttering Treatment and Research http://www.istar.ualberta.ca

References

Bothe AK, Davidow JH, et al. Stuttering treatment research 1970-2005:I. Systematic review incorporating trial quality assessment of behavioral, cognitive, and related approaches. Am J Speech Lang Pathol. 2006;15:321-352

Gordon N. Stuttering: incidence and causes. Dev Med Child Neurol. 2002;44:278-281.

Stuttering. American Speech-Language-Hearing Association website. Available at: http://www.asha.org/public/speech/disorders/stuttering/. Accessed May 20, 2013.

Stuttering. National Institute on Deafness and Other Communication Disorders website. Available at: http://www.nidcd.nih.gov/health/voice/pages/stutter.aspx. Updated March 2010. Accessed May 20, 2013.

Perkins WH. Anomalous anatomy of speech-language areas in adults with persistent developmental stuttering. Neurology. 2002;58:332-333

Prasse JE, Kiakano GE. Stuttering: an overview. American Family Physician. 2008;7:1271-1276.

Sommer M, Koch MA, et al. Disconnection of speech-relevant brain areas in persistent developmental stuttering. Lancet. 2002;360:380-383.

What is stuttering? The National Stuttering Association website. Available at: http://www.westutter.org/what-is-stuttering/stuttering-info/. Accessed May 20, 2013.

Yairi E, Ambrose NG. Early childhood stuttering: persistency and recovery rates. J Speech Lang Hear Res. 1999;42:1097-1112.

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