Stuttering: Myth vs. Fact

Stuttering specialist Catherine Montgomery had a blind patient who stuttered. Someone once asked him which was more difficult to deal with in life — blindness or stuttering.

“The man thought for a moment,” Montgomery recalls. “Then he replied, ‘Stuttering — because unlike my blindness, people don’t understand that stuttering is beyond my control.’”

“Interesting, isn’t it?” she says. “You’d never think of saying to a blind person, ‘Slow down and you’ll be able see,’ or ‘If you just tried a little harder you could see.’ But most of us think if a stutterer just relaxed and tried a little harder, he could speak fluently. That’s not the case,” says Montgomery, M.S., CCC-SLP, executive director and founder of The American Institute for Stuttering in New York City, N.Y.

Stuttering is a chronic dysfluency or break in fluent speech. It’s characterized by sound, syllable, word or phrase repetitions; hesitations, fillers (um, ah) and revisions in word choices. It can also include unnatural stretching out of sounds and blocks in which a sound gets stuck and just won’t come out. Stuttering may be accompanied by muscle tension, facial tics and grimaces.

No one really knows for sure exactly what causes it, but researchers believe there’s a neurological basis with a strong genetic component. Currently, the medical community categorizes stuttering as a psychiatric disorder — just like they do schizophrenia and bipolar disorder.

“There are probably multiple factors that can cause stuttering,” says Gerald Maguire, M.D., assistant clinical professor and director of residency training in the department of psychiatry at the University of California at Irvine. “There is a strong genetic component — stuttering does run in families. But it may be a combination of genetics, something neurological and something environmental. Since about 99 percent of all stutterers develop the disorder in childhood — usually before age 9 or 10 — it indicates that something occurs in the developing brain.”

“The idea that stuttering is a brain disorder in the same category as schizophrenia and bipolar disorder is very controversial,” says Maguire, a stutterer. In fact, there has been a push to recategorize stuttering as something other than psychiatric. “Some feel it attaches a stigma to a disorder that’s already very misunderstood by most,” Maguire said.

Among the things researchers do know about stuttering is that it’s not caused by emotional or psychological problems. It’s not a sign of low intelligence. The average stutterer’s IQ is 14 points higher than the national average. And it’s not a nervous disorder or a condition caused by stress. “If stress caused stuttering, we’d all be stutterers,” says Montgomery. Stuttering can, however, be made worse by anxiety or stress. And anxiety and stress can be a product of stuttering.

Two Layers to Stuttering

Stuttering really has two layers, says Montgomery.

“There’s the neurological-genetic-environmental layer and then there’s the part that goes on inside your head layer, the conditioned or learned response,” Montgomery said. “For example, on the first day of preschool, Mommy takes little Michael by the hand to meet his teacher. Smiling, the teacher asks Michael, ‘What’s your name?’ And even though he’s never stuttered before, he says, ‘M-M-Michael.’ And he sees a response — maybe the teacher stops smiling for a minute or Mommy tightens her grip on his hand. Consciously or unconsciously, he may think, ‘I have trouble saying my name.’

“So the next time someone asks his name, he has a memory flash of that first time he had trouble saying his name, which sets up a fight or flight response and he stutters over his name,” says Montgomery.

The pattern can continue without intervention. Studies show by age 7 children begin to develop attitudes and feelings about their speech difficulties, and by age 12 speech patterns are set — which makes it difficult to overcome stuttering.

“Lots of kids go through stuttering as a period in their development — and that’s OK for most kids,” says Scott Yaruss, Ph.D., an assistant professor at the University of Pittsburgh, clinical research consultant at Children’s Hospital of Pittsburgh and co-director of the Stuttering Center of Western Pennsylvania.

In fact, researchers say one in four American preschoolers stutter at some point. Only one in 30 in older children, however, actually develop real stuttering problems, according to the U.S. Department of Health and Human Services.

“Most get better — but some get worse,” Yaruss adds. “The problem is, at this time it’s difficult to tell who is stuttering normally in their development and who is at risk for problems. For years, the advice was to do nothing. Ignore it and it’ll probably go away. That’s not true anymore. Today, the best advice is to have your child evaluated by a speech language pathologist who specializes in stuttering.”

Speech language pathologists who are certified by the American Speech-Hearing-Language Association (that’s the equivalent of the American Medical Association for speech pathologists) have the letters CCC-SLP after their name. They mean “Certificate of Clinical Competence — Speech Language Pathologist.”

Most experts agree your child should be evaluated if he begins to demonstrate a physical awareness of his stuttering. Does he become frustrated, distressed or anxious? Does she become tense or tighten her muscles when she has trouble getting the words out?

The second signal is family history. “Not every child of a stutterer will become a stutterer,” says Yaruss. “But since stuttering runs in families, there’s no reason to wait.”

Children don’t learn to stutter from a parent, researchers say. But they may learn the frustration that comes with stuttering from the parent.

Treatment usually varies according to the age of the stutterer, says Yaruss. And different therapies work for different children. A speech language pathologist who specializes in stuttering can match your child with the right therapy.

To treat a very young child, the speech pathologist usually works with the family to help stack the deck in the child’s favor to be as fluent as possible. This may include encouraging parents to create a calm setting for conversation, ensuring that only one person talks at a time and making sure the child doesn’t feel rushed to speak. “As the child approaches age 7, we begin to work more with the child and less with the family,” he says. “We encourage the child to speak more slowly and help shape the child’s speech with specific therapies.”

In adults, the approach may include a three-pronged approach of cognitive-behavioral therapy (to help weaken the connection between stuttering and your reaction to it, and to help change your thinking patterns about what makes you feel badly about stuttering), speech therapy and medication.

At UC Irvine, Maguire is currently conducting clinical trials in adults on a new generation of drugs used to treat schizophrenia and Tourette’s Syndrome. These drugs — risperidone (Risperdal) and olanzapine (Zyprexa) — are dopamine blockers. Dopamine is a neurotransmitter chemical that sends messages from one cell to the next.

Research indicates that stutterers may have dopamine levels that are too high in one area of the brain. The drugs are designed to block the impulses that encourage stuttering. Maguire, who is also a participant in the trials, says the outcomes have been very positive.

But for now, Maguire says, the best bet in beating stuttering is early intervention. “The earlier the therapy occurs, the better the results in resolving stuttering,” he says.

Yaruss agrees. “The key is to catch the disfluency before it becomes ingrained and the child begins to believe ‘I’m not good at talking.’ But it’s also important to know this: A person who stutters can still do anything in the world that a non-stutterer can,” he adds.

Fast Facts about Stuttering

  • Stuttering affects more than 3 million Americans.
  • The exact cause of stuttering is still unknown, but researchers believe it is neurologically based with a strong genetic component.
  • One in 30 American children stutters. About 75 percent of them will outgrow it.
  • Males are four times more likely to stutter than females.
  • The average IQ of people who stutter is 14 points higher than the national average.
  • Early intervention is critical. Research shows the likelihood of total recovery significantly diminishes as the child grows older.
  • Parents should contact a specialist in stuttering treatment if their child shows signs of stuttering as early as age two.

Sources: The U.S. Department of Health and Human Services, The National Stuttering Association and The American Institute for Stuttering.

More Information, Please . . .

In addition to valuable nuts-and-bolts information, many organizations offer resources like referrals to speech language pathologists who specialize in stuttering, and support groups for stutterers and parents of stutterers. Want to learn more? Consider the following Web sites: