 Fluent
speech is smooth, forward-moving, unhesitant and effortless
speech. A "dysfluency" is any break in fluent speech.
Everyone has dysfluencies from time to time. "Stuttering" is
speech that has more dysfluencies than is considered
average.
Everyone has dysfluencies in their speech. The
average person will have between 7-10% of their speech dysfluent.
These dysfluencies are usually word or phrase repetitions,
fillers (um, ah) or interjections. When a speaker experiences
dysfluencies at a rate greater than 10% they may be stuttering.
Stuttering is often accompanied by tension and anxiety. The
types of dysfluencies in stuttering may also be different. Sound
or syllable repetitions, silent "blocks", and prolongations
(unnatural stretching out of a sound) and facial grimaces or
tics can be present.
There are many different kinds of dysfluencies.
Dysfluencies heard in the speech of normal speakers include
fillers (um, ah), hesitations, whole word and phrase
repetitions, and revisions. Dysfluencies that are more
characteristic of stuttering include sound or syllable
repetition, prolongations (unnatural stretching out of sounds),
and blocks (sound gets stuck and can't come out). Stuttering can
be differentiated from normal dysfluencies by the type,
frequency and duration of dysfluency. A percentage of dysfluency
can be determined by counting the number of dysfluencies in a
100 words. The average speaker has upto 7% dysfluencies of the
types described above. They are usually rapid and don't slow
speech down. Stuttering occurs at frequencies of 10% and up and
can last from a half second up to 30 seconds, and is accompanied
by tension.
Many children go through a period of normal
nonfluency between the ages of 2 and 5 years. The frequency of
dysfluency can be 10%, sometimes greater. The dysfluencies are
usually whole word or phrase repetitions and interjections. The
word is repeated just once or twice and is repeated easily. The
child does not demonstrate any tension in their speech and is
often unaware of their difficulty. It has been suggested that
the cause of this nonfluency may be a combination of increases
in language development, development of speech motor control,
environmental stresses that can occur in typical busy families.
Some children "outgrow" these dysfluencies, others do not.
There have been many theories about the cause
of stuttering and many misconceptions exist. Currently, it is
believed that a number factors play a role in the development
and maintenance of stuttering. These factors can be grouped and
classified as constitutional, environmental and communication
factors. There is some evidence that stuttering is genetic; it
does run in some families. There is also evidence that
stuttering is due to a disorder in the timing of movements of
speech muscles, a defect in auditory feedback, and a lack of
cerebral dominance for language functions. Researchers in San
Diego reported results of a study using positron emission
tomography scanning (PET scan) that supports all three of the
above causes. In normal, right-handed individuals, language
functions are localized to the left side of the brain. PET
scanning allows one to look at brain activation during different
activities. Stutterers showed a shift in brain activation from
the left to the right side of the brain, suggesting that they
process language differently. This right-side activation
occurred when stutterers were stuttering and speaking fluently.
There are many myths about stuttering. Here
are some facts:
Stuttering occurs more often in males than
females, about 3:1.
The incidence of stuttering is reported to be between 5-10%.
Stuttering is not a symptom of emotional or mental problems.
Stuttering may be a source of stress and cause emotional
difficulties.
Stutterers are not less intelligent than normal speakers; they
are of normal intelligence.
Stuttering is not learned by imitating others who stutter.
There are as many different treatment
approaches as there are theories about the cause of stuttering.
Therapy is different depending on the age of the stutterer.
There is no "cure" for stuttering. Stuttering can be prevented
in preschoolers and young borderline stutterers through
environmental manipulation and parent counselling. Advanced
stutters learn skills and strategies to manage their stuttering.
Environmental manipulation involves
identifying variables in the child's environment that are
increasing dysfluencies and then reducing or eliminating them.
Some variables include: competition for talking time, listener
loss, interruptions, pressure to speak or perform, too much or
too little structure, sibling rivalry, fast-paced, busy
environment, high level of excitement.
Treatment approaches generally fall into 2
different camps: "speak more fluently" or "stutter more easily".
An integration of these 2 approaches is ideal for many
individuals. The "speak more fluently" approach focuses on
learning "targets" or fluency-enhancing skills (e.g., easy
onsets, light contacts, blending). The "stutter more easily"
approach helps the stutter to reduce tension and modify his/her
stuttering so that it doesn't interfere with his/her ability to
communicate.
Most intensive fluency programs will help a
stutter to feel more confident and to speak more fluently.
Unfortunately, the gains made in therapy are not always
maintained when therapy is finished. The stutterer must be
motivated and dedicated to continue to practise their techniques
as often as they need to in order to maintain their fluency.
When speaking with an individual who stutters
it is helpful to focus on what they say rather than how.
Modifying your own speaking rate to one that is slightly slower
and inserting pauses into your speech sets the pace. Be relaxed
and attentive. Don't look away if they get stuck; on the other
hand don't stare at them intently. Don't interrupt or finish
their sentences. Advice such as "slow down", "relax", "take a
breath" is NOT helpful. It often increases tension and thus
stuttering.
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