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Health and Disease

What causes stuttering, how it is treated and how it may affect people

Background

Stuttering, also known as speech dysfluency, is a condition that involves involuntary verbal expressions. Often stuttering is characterised by repetitions of words, letters or sounds, however, it may also be prolongations of the latter. In other instances speech dysfluency is demonstrated through tension in one’s speech while pronouncing words. A person who stutters may also use circumlocutions, which is substituting a problematic word with one that is easier to pronounce. While symptoms present themselves verbally, symptoms may also present themselves physically which is comprised of involuntary physical expressions such as eye blinking, jaw jerking and jerking movements in general. (Prasse & Kikano, 2008)

There are two different types of stuttering. The first one is developmental stuttering, which is a result of children that are developing their communication skills rapidly. The second is stuttering that manifests itself later in life due to fx head injuries, strokes or progressive neurological conditions. However, the second type of stuttering may be caused by emotional or psychological trauma, medicine or specific drugs. (NHS, 2019)

Causes of stuttering

Why stuttering occurs is not completely clear but there are contributing factors involved. For developmental stuttering this includes both developmental and inhertied factors. Usually, children develop their speech through speech and langauge with the correct rhythm and pronunciation. For this to happen it is required that the child gets sufficient practice in doing so, so that the neural pathways are constructed, and thus, function properly. If this is not the case, the child may incorporate behaviors such as repetitions and blockings, which specifically may present itself when the child wants to say something, feels pressured or when the child is excited. After a while these behaviors should disappear as the brain grows. 

Furthermore, the stuttering may also be of genetical concern as people with speech dysfluencies can potentially have inherited it from their parents and for some only their risk of developing speech dysfluency is increased genetically. (NHS, 2019)

However, research suggests that stuttering may be due to the central nervous system failing to develop stable, basic motor programs and muscle synergies  (Smith & Weber, 2017)

Treatment

There are a variety of different treatment options but generally, a speech therapist will be involved in order to construct an appropriate plan for treating the stutter. The treatment can be comprised of developing strategies that prevent dysfluency and improve communication overall. Another form of treatment would be exploring fear and anxiety related to the stutter and processing these feelings. Additionally, it may be beneficial to adjust the child’s environment in such a way that it is easier for the child to feel relaxed and confident about their speaking abilities. Statistically, boys are more likely to stutter than girls are and genetically there are 2 out of 3 people who stutter that have family members who also have a history of stuttering. (NHS, 2019)

Treatment plans mainly depend on the person’s age and circumstances. These treatment plans are divided into indirect therapy, direct therapy, psychological therapies, and feedback devices.

Indirect therapy builds on focusing less on the speech of the child but rather on how the parents talk with their child and changing the environment at home. Indirect therapy usually recommends the parents to speak in a slow and calm way to their child, avoiding interrupting the child as well as criticizing it. The parent(s) could also optimize the environment in a way that makes it comfortable too. Although, it may also be helpful to identify the things that assist the child in improving speech fluency and focusing on amplifying these things. The parent(s) should also make family members take turns in conversations.

This type of therapy is suitable in the case of the child being older than 5 and hasn’t been stuttering for any more than several months, while also getting worse at communicating.

Direct therapy is different for younger and older children. 

For younger children, the Lidcombe Program is prevalent in behavioral therapy for stuttering in children. It is a program that is made for the parent(s) that is supervised by a speech therapist. The fundamentals of the program rely on regular feedback that is not harmful but constructive and sympathetic. 

For older children (late-onset stuttering) it is more challenging to treat. This is due to the fact that with time the child will acquire various problems associated with stuttering such as being anxious about and afraid of speaking because of the potential to stutter at any time. In addition, this may cause embarrassment and thus, the child will associate stuttering with it. For this reason, the direct therapy for older children pays attention to the social, psychological, and emotional perspectives in regard to stuttering.

In most cases with children old enough to attend school, direct therapy is used to better communication abilities and make the child process its feelings that are linked to stuttering while also aiding increased fluency and understanding of speech dysfluency. Moreover, direct therapy assists in being open about stuttering experiences as well as in gaining self-confidence and more positive attitudes toward stuttering.

However, direct and indirect therapy are not the only solutions as psychological therapy and feedback devices exist.

Psychological therapy is not a direct treatment, although, this type of therapy is meant to combat unfavorable feelings connected to stuttering. It consists of several subtypes of psychological therapy such as solution-focused brief therapy, personal construct therapy, neurolinguistic programming, and cognitive behavioral therapy.

Feedback devices are auditory-based electronic devices that modify the way a child hear their own voice. These feedback devices can have different features like delayed auditory feedback, frequency-shifted auditory feedback, and combined delayed and frequency-shifted auditory feedback.

The following general guidelines for speaking to someone who stutters should be followed with respect to lowering the demands and the risk of overwhelming the child. The children have to be given time in order to process and think about everything being said and their own responses. (NHS, 2018b)

Effects of stuttering

As a result of stuttering as a person, they may make ways of trying to disguise their stutter. For this reason, they may adopt behaviors that make them hide from social interactions, differ in the way they speak, being fearful, frustrated, shameful, or embarrassed of their stutter. In addition to this, they may also try to get past saying specific words that are hard for them to pronounce without stuttering.

All of this may contribute to being self-conscious in certain situations, such as when they have to speak to an authoritative person like a teacher, reading a text in class, answering in front of the class, or having a conversation over the phone. (NHS, 2018a)

Conclusion

In conclusion, it is clear that stuttering is caused by various things in terms of both developmental stuttering and late-onset stuttering. Stuttering is mostly caused by social pressure that has been put on a child in developmental stuttering. However, it is different for late-onset stuttering as its causes are incredibly situational and generally get caused by accidents. Sometimes stuttering happens because of being inherited from parents.

The treatments for stuttering are also shockingly situational as it depends on what type of stuttering it is as well as the roots the stuttering stems from. Although, if the stuttering is not treated the affected individual may avoid certain social situations and therefore limiting their fx academic potential.

References:

NHS. (2018a, October 3). Stammering – How it can affect you. National Health Service. https://www.nhs.uk/conditions/stammering/symptoms/

NHS. (2018b, October 3). Stammering – Treatment. National Health Service. https://www.nhs.uk/conditions/stammering/treatment/

NHS. (2019). Overview – Stammering. NHS. https://www.nhs.uk/conditions/stammering/

Prasse, J. E., & Kikano, G. E. (2008). Stuttering: an overview. American Family Physician, 77(9), 1271–1276. https://pubmed.ncbi.nlm.nih.gov/18540491/

Smith, A., & Weber, C. (2017). How Stuttering Develops: The Multifactorial Dynamic Pathways Theory. Journal of Speech, Language, and Hearing Research, 60(9), 2483–2505. https://doi.org/10.1044/2017_jslhr-s-16-0343

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