• 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
    • Psychological factors in a child’s life (eg, mental illness, extreme stress)
    • Problems occur in the connections between muscles, nerves, and areas of the brain that control speech
    • Problems in the part of the brain that controls the timing of speech muscle activation
    Muscles and Nerves Involved in Speech
    Tongue Innervation
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    Risk Factors

    These factors increase your chance of developing stuttering. Tell your doctor if you have any of these risk factors:
    • Family history of stuttering (There is increasing evidence to support a genetic link in 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. She will also do a physical exam. 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 (someone 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. Recovery rate is about 80%, more in girls than in boys. The doctor or speech therapist can:
    • Evaluate the stuttering pattern
    • Assess what strategies may work best
    Treatment may include:
    • Drug therapy—There is little evidence to support the use of drugs to improve speech fluency.
    • 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.

    Prevention

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

    RESOURCES

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

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

    CANADIAN RESOURCES

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

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

    References

    American Speech-Language-Hearing Association website. Available at: http://www.asha.org/ .

    Bothe AK, Davidow JH, Bramlett RE, 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. National Institute on Deafness and Other Communication Disorders website. Available at: http://www.nidcd.nih.gov/ .

    The National Stuttering Association website. Available at: http://www.nsastutter.org .

    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, Paulus W, et al. Disconnection of speech-relevant brain areas in persistent developmental stuttering. Lancet. 2002;360:380-383.

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

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