Stuttering: Types, Symptoms, Causes, Diagnosis And Treatment

In order to deliver the right information, one must be able to speak clearly and fluently. When a person has trouble speaking in a fluid, or flowing way, for example, he/she may say the whole word or parts of the word more than once, or pause awkwardly between words - it is termed as stuttering.

A speech disorder, it is also called as stammering or diffluent speech. Stuttering usually develops between the age of 2 and 6 years old ^[1] .

Many children go through normal periods of dysfluency lasting for around 6 months and as the child's development progresses, the stuttering will stop. Dysfluencies lasting longer than this may need intervention. Stuttering can even be seen during adolescence or adulthood ^[2] .

Types Of Stuttering

The speech disorder is classified into three different types and they are as follows ^[3] :

Developmental

Neurogenic

Psychogenic

Symptoms Of Stuttering

Stuttering is characterised by repeated words, sounds, or syllables, halting speech production and uneven rate of speech ^[4] .

Other signs that indicate the speech disorder are as follows:

• Frustration when attempting to communicate
• Refusal to speak
• Hesitation or pausing before starting to speak
  Using extra sounds or words into sentences, such as 'uh' or 'mm'
• Facial tics
• Lip tremors
• Excessive blinking of eyes
• Tension in the face and upper body
• Repetition of words or phrases
• Head jerks
• Clenching fists

Causes Of Stuttering

There is no specific cause for the speech disorder. However, the probable causes are as follows ^[5] :

• Family history of stuttering
• Development during childhood
• Neurophysiology
• Family dynamics
• Being in contact with another stutter
• Abnormalities in speech motor control

Apart from the aforementioned, neurogenic stuttering can be caused by brain injuries and severe emotional trauma can cause psychogenic stuttering ^[6] .

Diagnosis Of Stuttering

If your child or someone you know stutters, you should get help from a Speech-Language Pathologist (SLP), as early as possible. Because, it is important to intervene children or adults with stuttering at the earliest, as it not only affects the way a person speaks but also nurtures feelings like fear, shame, avoidance, isolation anxiety, guilt etc. Hence early intervention has faster progress and helps to reduce its negative consequences ^[7] .

There is no requirement for invasive testing.

Treatment For Stuttering

Not everyone who stutters will require treatment because developmental stuttering usually resolves with time. The medical and emotional care provided for individuals with stuttering is as follows ^{[8] [9]} :

• Speech therapy: It can help interruptions in speech and improve one's self-confidence. Therapy focuses on controlling speech patterns by monitoring the rate of speech, breath support, and laryngeal tension.

• Electronic devices: Various electronic devices are available to enhance fluency.

• Parent-child interaction: Parental involvement in practising techniques at home is a critical step in improving the child's stuttering.

• Cognitive behavioural therapy: This type of psychotherapy can help you learn to identify and change ways of thinking that might make stuttering worse. This therapy is also beneficial for managing the related stress, anxiety and self-esteem problems ^[10] .

Do's And Dont's For Parents & Caregivers

• Don't finish their sentences: As a parent or teacher or even a listener you might be tempted to finish their sentences to help them but this does more harm than good.
• Don't look distressed or avoid eye contact: You need to let the person know by your manner that you are paying attention and listening to what they say rather how they say it.
• Don't say, relax, or slowdown: Such simple advice can be demeaning to them.
• Don't speak deliberately too slow or too fast: Talking naturally promotes good communication model.
• Provide an opportunity to talk: You need to allow them to speak without distractions from family members, classmates or friends.
• Be patient: Give them enough time to talk e.g.: give the person time to answer a question before you ask the second one.
• Be aware of their difficulties: Persons with stuttering may have factors that aggravate their difficulty e.g.: telephonic conversation, time pressure, unfamiliar listeners, fatigue or stress.
• Repeat or rephrase: You can repeat or rephrase what the person says that you have understood it.

With inputs from Rekha D, Speech-Language Pathologist