Definition: Stuttering is defined as a
disorder of language fluency. This is characterised by
excessive amounts of dysfluencies in general and these dysfluencies
are also excessive in their durations. The
stutterers in addition may also demonstrate associated motor
behaviors while they speak. These motor behaviors
Stuttering and its
T. Balasubramanian M.S. D.L.O.
1. Excessive muscular effort while speaking
3. Hand and feet movements
classification of dysfluencies:
1. Part word
repetitions: Classic example being (ta-ta-ta- time). The
patient while saying the word time will keep saying ta ta ta before
articulating the full word time.
2. Whole word repetition:
Example (I - I - I ). The patient when saying the word I will
keep on repeating the word I atleast three or four times before
3. Phrase repetition: Example (why are you-why are
you-why are you).
4. Sound prolongations: Example
(sssssoup). The patient speaks the word soup as
indicated. There is prolongation of the sound S.
Interjections of sounds syllables or
Sound interjection: "um ... um I had a problem
Whole word interjection:
"I had well problem this
Phrase interjection: " I had a you know problem this morning"
pauses: A silent duration within speech is considered
" I am going
to the (Pause) store.
words: A silent pause within words: "It was won(pause)derful".
How to diagnose
Even normal speakers can manifest the various forms
of dysfluencies listed above in varying degrees. No one
is probably 100% fluent all the time. Pauses of varying
durations are also fairly common in normal individuals. To
distinguish a stutterer from a non stutterer the following
three issues are considered:
1. The frequency of
2. Type of dysfluencies
3. Duration of
Frequency of dysfluencies: A normal
speaker may be dysfluent depending upon the speaking situation,
the topic being discussed, and other factors like the response of
listners. It has been estimated that on an average a
stutterer stutters on about 10% of spoken words. Hence a
frequency of 10% dysfluency is considered abnormal. This is
the minimum percentage of dysfluency necessary to diagnose a
Listener's judgement of stutterer:
When ordinary people are asked to listen to speech samples and
requested to assess for stuttering they are known to pick up 5% of
dysfluencies easily. They even classify this group as
stutterers. Some speech pathologists hence would go for
the figure of 5% dysfluency as an indicator for stuttering. It
is always better to err on the side of caution, and 10% dysfluencies
in language may be used to diagnose stutterer.
dysfluencies: This is again one important aspect in the
assessment of stutterer. Eventhough all types of dysfluencies
are seen in normal individuals, some types are rare in
them. They are part word repetitions, speech sound
prolongations and word or phrase repetition. If these types of
dysfluencies are present in an individual then they must be labelled
as a stutterer.
Duration of dysfluencies: Most
speech pathologists diagnose stuttering if the duration of
dysfluency lasts for more than a second.
associated motor behavior:
of motor behaviors associated with stuttering are seen in the facial
muscles. Most adult stutterers tend to blink their eyes and
wrinkle their noses and forehead while speaking. Some of
the stutterers have trembling lips. They even have a tendency
to keep their mouth open even when they are not
associated with speech is also significant. Most stutterers
report tightness in their throat, jaws, stomach muscles while
speaking in a dysfluent way. Sometimes the whole body may
become tense. They may also manifest certain abnormal
breathing behaviors. Normal speakers stop and breathe often
during their speech, a stutterer may keep talking even when the air
supply is exhausted. Some stutters may stop
speaking and inhale air inappropriately.
Circumlocution: In lay terms it is known as beating
around the bush. This is a common statergy used by a stutterer
to mask stuttering. They tend to beat around the bush till the
listner says the word they have been avoiding. This is also
known as avoidance behavior.
Almost all the stutter
experience painful emotions associated with stuttering. These
emotional responses get stronger as the individual grows
older. The presence of consistent stuttering on certain
words and in certain speaking situations can create
apprehension and anxiety about speaking the word and about the
speaking situation. Most adult stutters can predict a certain
amount of their suttering even before
1% of general population are stutterers. It may be found
in all walks of life, and in different individuals be it a mentally
retarded or a mentally gifted individual. Males out number
females by a ratio 4:1. Girls recover from stuttering better
Genetic hypothesis: Since stuttering
tends to run in families has lent credence to this
hypothesis. It has also been demonstrated in concordant
monozygotic twins. Both heredity and environmental factors
play a role in the etiopathogenesis of stuttering.
Myths about stuttering:
Greek philosopher Aristotle
thought that a tongue too thick and sluggish caused stuttering in
Hippocrates father of modern medicine
attributed a dry tongue as the cause of stuttering.
Laryngeal dysfunction: It has been
postulated that the laryngeal muscles are too tense in
stutterers. These muscles were also found to be excessively
active. Opposing pairs of laryngeal muscles may be
simultaneously active. The vocal cords may vibrate in an
irregular manner. Laryngeal dysfunctions have been observed in
video laryngoscopy done on stutterers.
speech mechanism: Since brain controls the intricate mechanism
of speech, it has been postulated that stuttering could be due to
faulty functioning of brain. It has been demonstrated that
regardless of handedness, the left side of the brain is dominant for
speech. The right side of the brain is dominant for musical
and other non verbal activities. The left hemisphere of the
brain is slightly larger than its right counterpart because of the
importance and complexity of speech. If for some reason one of
the hemispheres is not dominant for language, then stuttering could
Diagnosogenic theory: This theory was
first propounded by Wendell Johnson. He explained stuttering
on the basis of environmental events. He even said that
stuttering is not in the mouth of the child but in the ears of the
Anticipatory struggle theory: This is a
modification of diagnosogenic theory. This was proposed by
Bloodstein. He suggested that stuttering is due to a belief in
a child that speech is a difficult task.
Theories based on
conditioning and learning: It has been observed that a
stutterer speaks some words fluently, in some speaking situations,
but speaks dysfluently on other words, in other speaking
situations. This behavior could be possible if one considers
stuttering to be a learned avoidance behavior.
Treatment of stuttering:
These methods include
psychoanalysis, psychotherapy and counselling. In
psychoanalysis the emphais is on unconsious sexual urges suppressed
by the individual. In psychotherapy the emphasis is on
emotional conflicts. The psychological methods of treating
stuttering are at the most indirect ways of managing the
situation. In order to successfully counsel these
patients the counseller should be a good listener.
He should listen to the problems of the patinet and counsel
Riper's procedure: He called this procedure fluent
stuttering. Riper beleived that normal fluency is not
possible in stutterers. He suggested the used of the term
fluent stuttering. He changed the form of stuttering in such a
way that it became less abnormal. He taught
stutterers to reduce the muscular tension and to speak without
associated bizarre facial expressions. He also taught
stutterers to repeat and prolong words in an easy and effortless
manner. This therapy ofcourse falls short of normal
Modified air flow technique: This method
concentrates the irregular breathing behaviors in stutterers.
The stutterer is taught to inhale sufficient air before
saying something. The air is also exhaled in a controlled
manner. These skills are meticulously taught in these patinets
by breathing exercises.
Gentle initiation of
sound: This procedure helps to reduce the chance of
stuttering. A stutterer is taught to start a word gently,
softly and in a relaxed manner. A stutterer is taught to slow
down the rate of speech. They are also taught to stretch
the syllables to prolong them. This prolongation reduces the
chance of stuttering. Ofcourse this type of speech
is monotonous and excessively slow.
auditory feed back: Electronic instruments can be used to slow
down the rate of speech in a stutterer. This device is known
as the vocal feedback device. It converts the movements of
vocal folds into vibrations that could be felt in the throat.
Through headphones the patient is able to hear his sound
with a fraction of a second delay. This in a way slows down
the rate of speech.
of a portable delayed feed back equipment.
contacts of articulators:
soft contacts of articulators makes speech more relaxed. Many
stutterers jam their tongue against the hard / soft palate.
Their lips may be closed too tightly. If these defects could
be rectified it will go a long way in reducing stuttering in
It is only a multi dimensional
approach management modality which will work satisfactorily in the
treatment of stuttering. It includes psychoanalysis,
counselling and speech
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