In the movie, The King's Speech, the son of King George (mother of Queen Elizabeth) is unable to speak without a significant stutter. It results in his inability to function with the respect and admiration of those with whom he is required to engage in conversation. In fact, he is ridiculed, mocked and often disregarded as individuals consider him weak minded due to the impediment. Individuals who suffer from speech disorders such as stammering and stuttering are clearly misunderstood so let's review what stuttering is, the signs and symptoms of stuttering, diagnosis, and what can be done to reduce or eliminate it from one's speech patterns.
What is Stuttering? (Also known as stammering):
Stuttering is a speech impediment which often results when there are too many disruptions in the production of speech sounds. For instance, I'm sure you've heard individuals who, when speaking, utilize an overabundance of "uh's, um's and oh's". These are referred to as disfluencies (specifically interjections) in speech production and are quite common – even by individuals who aren't considered to have a speech production disorder. The problem exists when there are too many disfluencies present impeding an individual's ability to communicate effectively.
Stuttering usually becomes noticeable during childhood and will often last throughout one's lifetime. Parents aren't usually aware of speech production difficulties until their children begin speaking in sentences of more than a few words at a time. Stuttering will often invade many activities in a person's life, whether it is when talking on the telephone, in front of large groups or perhaps when in an environment that brings with it some level of discomfort or stress to the individual. In some cases, it is an issue across the board meaning that they struggle with communication at home, school, work and / or social situations.
As a result, many of these individuals will limit their participation in basic activities to avoid having to communicate with others. Why? They are often embarrassed or fear the reactions of others with whom they are attempting to communicate. Some stutterers may attempt to camouflage their speech difficulties by stopping mid-way in a sentence and pretending to have forgotten their train of thought; others will rearrange the words in a sentence in order to get the words out perhaps in an unusual order while others may decline speaking at all. Either way, it is truly a tragedy for those who have disengaged themselves from others in order to eliminate the need for communication.
Here are a few statistics that go along with stuttering:
– Stuttering will often appear between the ages of 2-1 / 2 and 4 years of age. Although infrequent, stuttering can develop during elementary school.
– Stuttering is more common in males than females and in fact, it is estimated that boys are three to four times more likely to stutter.
– Approximately 75% of preschoolers who may develop a stutter will also stop.
Signs and Symptoms of Stuttering:
As outlined below, stuttering or stammering is a disruption of speech making it often difficult for others to follow the pattern of speech and the information being relayed. But there is more to stuttering than one might realize. Stuttered speech also includes increased repetition of words or parts of words, such as when an individual may state, "I, I, I, I, I want a ccc-cookie" or as in prolongations of speech sounds such as in the example cccc -ookie.
Finally, you may notice part-word repetition which would be something like "Wh-Wh-Wh-What time is it?"
Individuals that stutter may seem to be out-of-breath and incredibly tense when attempting to communicate with others. There are many reasons for these mannerisms and understanding them will help us be more compassionate toward the individual. Some stutterers will actually appear to get the words "stuck" on their tongues without being able to utter a sound. This is described by many stutterers as the words being blocked in their throat. They know "what" they want to say, it just won't come out without some form of delay in their speech pattern.
Often, an interjection may be used to help "produce" the sound (s) that the individual is attempting to make and will frequently is in the form of an "um", "like" or some other word or sound used to allow the speech to flow freely. Again, everyone struggles to get the words out from time to time, stutterers find it difficult ALL of the time.
Diagnosing a Stutter:
It is not always to identify all of the signs and symptoms of a stutter. The repetitive sounds, prolongations of speech and interjections are easily observed by those listening to the individual who struggles to get the words out but there are unobserved difficulties as well. As a result, consulting with a certified speech-language pathologist (SLP) is the best course of action to take.
During the evaluation, the SLP will observe and note the following:
– The number and type of speech disruptions / disfluencies a person produces within a specified period of time and in various situations too.
– How the individual reacts to and copes with the disfluencies produced.
– Speech Rate.
– Language Skills.
– Severity of the symptoms identified and how it impacts their daily lives.
Information will also be obtained regarding particular circumstances or factors that may lead to or result in the stuttering becoming worse, for instance, teasing, mocking, or perhaps being tired, etc … Additionally, the SLP will want a history of the disfluencies including the age when the symptoms were first discovered, the current age of the patient and information about family members who may exhibit stuttering as well.
After all of the information is assessed, reviewed and analyzed, the SLP will be able to determine whether a fluency disorder exists and the extent to which it has affected the individual's ability to communicate with others and participate in life's daily activities.
Although the diagnosis is pretty consistent between adults and children, there are additional factors that will be considered when diagnosing young children. First and foremost the SLP will want to evaluate to determine whether there is a likelihood that the stuttering will continue throughout the child's lifetime or whether it is likely that it may subside with time. The evaluation will include multiple tests, observations and interviews that will be used to determine the risk of continued stuttering.
Included in these additional tests will be:
– Family history – did the father, grandmother or mother of the child struggle with stuttering as a child, adult, etc …
– Timeline – when did the stuttering begin and how long has it occurred to date; 1 – 3 months; 4 – 6 months; 6 months or more.
– Other speech and / or language disorders;
– Anxiety / Fear as expressed by the child or his / her family regarding stuttering.
Unfortunately, there is no isolated factor or single-predicator that will determine or help a SLP identify the likelihood of the child's stuttering continuance. The combination of all of the information obtained will help to determine the best treatment and course of action to be taken at this point in time to help reduce eliminate or provide successful intervention (s) for the child and / or adult.
Treatments for Calming a Stutter:
Treating a stutter focuses more behavioral triggers than medical reasons as there isn't a medicine that will reduce or eliminate a stutter. Treatment will focus on skills and techniques to help the individual manage their disorder and improve their ability to communicate orally. For example, the SLP may teach the individual to control his / her breathing. Calming breaths will help the individual through providing a sense of relaxation by reducing anxiety often exhibited when speaking. They will also learn how to monitor and control the speed at which they speak. By slowing speech rates and patterns they will often be able to speak with less disfluency in their sentences. Additionally, they will be instructed and observed as they learn to put together a fewer words which enable them to produce smoother flow of the words they are attempting to elicit. Treatment will take time and patience. It may be necessary for the individual to seek treatment on a daily, weekly or monthly basis and follow-up will be critical for continued successes.
It is important to realize that people who stutter are already critically aware of their inability to express themselves to others without feelings of tension or anxiousness. But did you know that there are things that individuals who are listening to people that stutter will often do which makes them more painfully aware than ever of their problem? For instance, completing sentences or filling in the blanks results in the speech becoming more disfluent as they become aware of one's impatience for them to complete their statement; interrupting their train of thought is also something to be avoided as it is difficult enough for them to complete a sentence when they're able to focus on what they want to say. Individuals who stutter want to be treated like anyone else – with the same level of respect and consideration. Please allow them the time to generate what they desire to communicate and then listen patiently. Avoid making statements such as, "take a deep breath", "calm down" or "take your time" as this too makes it more difficult for them to focus and concentrate as it results in more frustration and anxiety often resulting in their inability to complete their statement without more stuttering.
Individuals who stutter will develop their own strategies along with those learned from SLP's to enable themselves to communicate at a level that they feel more comfortable and confident in doing. It is helpful, should you find yourself needing to communicate regularly with an individual who struggles with stuttering, to simply ask the individual how they would like you (the listener) to respond when communicating. Letting the individual know that you are interested in "WHAT" they have to say and not "HOW" they say it will certainly reduce their level of anxiety, tension and awkwardness. For example, "I notice that you stutter." "I don't want you to feel uncomfortable when interacting with me so please tell me how you'd like me to respond when and / if you stutter." This statement should be made in a non-condescending manner providing the individual the confidence and sincerity necessary to engage in a conversation with you given that he / she will stumble upon certain words.
Although the exact cause of stuttering is unknown, studies suggest that an individual's genetics may play a significant role. It may perhaps be the individual inherited traits that have resulted in a stutter due to an impairment of one being able to produce sentences fluently in part due to an inability to control various muscle movements required. Whatever the essential reason, it is something that makes communication difficult for many stricken with the disorder. With this in mind, recognizing how we can help vs. How we hurt is something that each of us can do to reduce the frustration, embarrassment and anxiety that goes hand-in-hand with speech production issues.
I encourage you, if you've not already, to watch the movie, The King's Speech. It is truly a touching movie and allows viewers to recognize the emotional, social and interpersonal difficulties experienced by individuals who suffer with stuttering / stammering. Although a movie, it provides an excellent depiction of stuttering and how individuals have suffered for many years.
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