Stuttering may seem simple enough. People who stutter cannot get words out properly. They repeat or prolong sounds or syllables, sometimes appearing to physically struggle to speak.
But the problem is much more complex than that, involving factors as disparate as genetics, emotion, brain activity, motor control and language, said Jane Fraser, president of the Stuttering Foundation of America.
"There are so many factors involved in saying one word, it is the most complex thing we do," Fraser said. "There's nothing we do as humans more complex than speaking."
Stuttering took center stage recently with the popularity and critical success of "The King's Speech," which was awarded the "best picture" Oscar at this year's Academy Awards. The movie has brought new attention to the problem of stuttering, which affects millions.
Children and stuttering
Experts' understanding of stuttering has evolved considerably from days past, when most people thought the problem was all in the stutterers' heads.
"In light of 'The King's Speech,' certainly in the '30s and '40s, I think people thought in general stuttering was a psychological problem," Fraser said. "If you had enough willpower, you could just get on top of it. My father and his brother both stuttered, and both were punished for stuttering. People thought they could spank it out of you, and in his and his brother's case, it just made it worse."
Doctors have since identified four factors that can influence a person's chance of developing a stutter, according to the Stuttering Foundation:
Genetics: about three of every five people who stutter have a family member with the same problem.
Child development: children with early speech or language problems, or some other form of developmental delay, are more likely to stutter.
Neurophysiology: researchers have found that people who stutter process speech and language differently than people without a stutter.
Family dynamics: pressure to succeed and a fast-paced lifestyle can prompt stuttering in some people.
"Stutterers are more vulnerable to a breakdown in the system that includes everything from thinking the thought to translating the thought into actual speaking," Fraser said.
Speech therapy for stutterers
Therapies for stuttering also have advanced as understanding of the disorder has grown, said Fraser and Tommie L. Robinson Jr., immediate past president of the American Speech-Language-Hearing Association and a therapist at the Children's National Medical Center in Washington, D.C.
Today, people who stutter receive speech therapy as well as therapy that attempts to get to the psychological or neurophysiological issues that make them more apt to struggle with their speech, Fraser and Robinson said.
Because of this, it is crucial that a stutterer develop a healthy relationship with his or her therapist, one that goes far beyond teaching techniques to get around a blocked word or sound, Robinson said.
"They've got to be able to talk about what they're feeling, what's going on inside," he said.
Therefore, psychotherapeutic techniques such as cognitive behavioral therapy are valued just as highly as speech therapy tactics that teach stutterers to speak more slowly and use tricks to get past blocked sounds or syllables, Fraser said.
Early intervention is also important, Robinson said. The most common form of stuttering develops in early childhood, when a child is learning how to translate thoughts into words, according to the NIH. Developmental stuttering occurs when a child's speech and language abilities can't keep pace with verbal demands placed on the child.
"If we intervene with people early, we can teach parents to slow their speech and minimize the pressure placed on their kids," Robinson said. "That is the best thing."
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